Bill > H843

This bill mandates that health insurance plans, including various types of policies and contracts offered by insurance companies, group hospital service corporations, and health maintenance organizations, must provide coverage for cognitive rehabilitation therapy and related services for individuals with acquired or traumatic brain injuries. This coverage is required for a range of treatments and services, including cognitive communication therapy, neurocognitive testing and treatment, neurofeedback therapy, and functional rehabilitation, as well as acute and post-acute care services like transition, community reintegration, residential, inpatient, outpatient day treatment, and other necessary post-acute care. The bill prohibits lifetime or unreasonable annual limitations on the number of days or sessions for acute and post-acute care, and requires that any limitations be separately stated. It also stipulates that payment limitations, deductibles, copayments, and coinsurance factors for this brain injury rehabilitation coverage should be the same as for other similar coverage under the plan. Furthermore, the bill requires health plans to cover reasonable expenses for periodic reevaluation of care for individuals with brain injuries who may become responsive to treatment later, and it outlines factors to consider when determining the reasonableness of these expenses. The bill also introduces requirements for training personnel involved in preauthorization and utilization review to ensure proper coverage, mandates annual written notification to insured individuals about these coverages, and specifies that utilization review determinations and appeals for coverage extensions must be responded to within three business days. Importantly, coverage cannot be denied solely because treatment is provided at a facility other than a hospital, as long as the facility is appropriate and licensed. Finally, the commissioner is tasked with preparing and publishing consumer information about recommended coverage for brain injuries.