Prior authorization for coverage of physical therapy, occupational therapy, speech therapy, chiropractic services, and other services under health plans

What it would have done

Summary by the Legislative Reference Bureau, the Legislature's nonpartisan drafting office. It's their wording, not ours.

Generally, this bill requires and prohibits certain actions related to prior authorization of physical therapy, occupational therapy, speech therapy, chiropractic services, and other health care services by certain health plans. Under the bill, health plans are prohibited from requiring prior authorization for the first 12 physical therapy, occupational therapy, speech therapy, or chiropractic visits with no duration of care limitation or for any physical therapy, occupational therapy, or chiropractic care for the nonpharmacologic management of pain provided to individuals with chronic pain for the first 90 days of treatment, not to exceed a frequency of twice per week per service. Under the bill, “chronic pain” is defined to mean persistent or recurring pain lasting three months or longer. Further, the bill provides that every health plan, when requested to authorize coverage following completion of the initial 12 visits or subsequent to a request for reauthorization of coverage, shall issue a decision on reauthorization within three business days of receiving the request. If a health plan does not issue a decision on reauthorization within three business days of receiving the request, prior authorization is assumed to be granted for the service.

The bill requires health plans that provide coverage of physical therapy services, occupational therapy services, speech therapy services, or chiropractic services to reference the applicable policy and include an explanation to the service provider and to the covered individual for any denial of coverage for or reduction in covered services and to impose copayment and coinsurance amounts on covered individuals for provided services that are equivalent to copayment and coinsurance amounts imposed for primary care services under the plan whenever copayment or coinsurance is required.

Who's behind it

17 representatives are its authors⁠. 11 are Republicans and 6 are Democrats.

25 more lawmakers signed on in support⁠.