Thank you to the home health agencies that responded to HCA’s rapid survey last week on prior authorization requirements in Massachusetts. Your timely input is directly informing our advocacy efforts.

Responses reinforce a consistent theme: prior authorization processes vary widely across payer types. Agencies report significant differences in submission portals, documentation standards, approval timelines, and reauthorization frequency. In some cases, authorizations extend 30 days or longer; in others, requirements shift depending on the specific health plan.

More than half of respondents indicated that prior authorization requirements sometimes or frequently delay patient care, including weekend and holiday admissions. Agencies described conflicting guidance from plans, limited retroactive approvals, and denials issued after services have already begun—shifting financial risk to providers and, at times, creating disruptions in care continuity.

Importantly, agencies emphasized that the concern is not clinical oversight itself. Rather, it is the lack of standardization, transparency, and predictable decision-making that creates operational strain and potential access issues for patients who rely on timely home-based services.

These findings are shaping HCA’s ongoing engagement with state policymakers as we advocate for clearer, more consistent prior authorization requirements that protect patient access while reducing unnecessary administrative burden.

We appreciate members who responded on short notice. Your feedback strengthens our voice and ensures that real-world provider experience informs the policy conversation.