Bill > SB480

This bill prohibits health carriers, which are insurance companies that provide health coverage, from requiring prior authorization, which is an insurance company's approval before a service is provided, for the first visit of physical therapy, occupational therapy, or similar rehabilitative services for any new episode of care. A "new episode of care" is defined as treatment for a new condition or a condition that hasn't been treated in the last 60 days. After the initial evaluation, health carriers must approve at least 8 medically necessary treatments before requiring further review, unless the plan sponsor's contract states otherwise. However, this bill does not prevent insurers from denying claims if they determine, through a review, that the services provided were not medically necessary. This act is set to take effect on January 1, 2027.