On January 14, 2026, Massachusetts Governor Maura Healey announced that the Division of Insurance (DOI) will be promulgating updates to its regulations with the intent of streamlining prior authorization practices for health insurance claims. According to the Governor, the DOI regulations “will reduce unnecessary delays and cut administrative burdens to make it easier, cheaper and faster for people to get the medications and care they need,” including by elimination of prior authorization requirements for routine and essential services.
The forthcoming regulations are likely to be issued by the DOI in the coming weeks and are expected to include:
- Elimination of prior authorization requirements for routine and essential services, including for patients with diabetes related to any services, devices or drugs related to the chronic disease;
- A 24-hour response timeframe for urgent prior authorization requests;
- Continuity of care requirements for patients switching health plans, including honoring previously existing authorizations when a patient switches insurers;
- Initiatives to increase transparency and reduce provider burden when determining if a prior authorization is necessary.
The announcement also included the establishment of a Health Care Affordability Working Group, composed of industry stakeholders, which will focus on identifying drivers of health care costs and issuing proposals to make health care more affordable in the commonwealth. These DOI regulations are just one of the anticipated legislative and regulatory initiatives in Massachusetts to address health care costs as the “health care industry spent $1.3 billion on administrative costs related to prior authorizations in 2023,” according to the Governor, citing a Council for Affordable Quality Healthcare report.
The forthcoming DOI regulations will be important to health care providers that participate in commercial or state administered health plans in Massachusetts and may lead to changes in existing prior authorization processes, including requiring updates to existing provider participation agreements. We will issue an update when the DOI regulations are released.