Bill > S2561

This bill aims to reduce the burden of prior authorization, a process where health insurance companies must approve medical services before they are provided, for rehabilitative and habilitative services, which are treatments to help individuals regain or develop skills. Specifically, it prohibits requiring prior authorization for the first twelve visits of a new episode of care, defined as treatment for a condition not addressed by the provider in the past ninety days, and also exempts ninety days of physical medicine or rehabilitation services for patients diagnosed with chronic pain, which is defined as pain lasting over three months. Furthermore, insurers must respond to prior authorization requests within twenty-four hours, and delays or failures in their system will result in automatic approval; the bill also allows for retroactive authorization for medically necessary services if a determination of medical necessity can be made after the service is rendered, and provides appeal rights for denied requests, with these changes taking effect on January 1, 2027.

Health and Social Services

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