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1 Statement of Findings. The general court hereby finds that:
I. Pregnancy, childbirth, gynecologic conditions, pelvic surgeries, menopause, and aging commonly cause pelvic-floor dysfunction.
II. Conservative pelvic-floor physical therapy (PFPT) and supervised pelvic-floor muscle training (PFMT) are evidence-based first-line treatments that improve symptoms, quality of life, and often reduce need for surgeries related to pelvic-floor dysfunction.
III. Leading clinical guidelines and recent systematic reviews recommend supervised PFMT programs of approximately 8-12 weeks as a first-line care for stress or mixed urinary incontinence and support PFPT for fecal incontinence, pelvic organ prolapse conservative management, pelvic pain and sexual pain disorders.
IV. Coverage expansion for such treatment would promote prevention and speedy recovery, reduces downstream costs, and improves maternal mental health.
2 New Chapter; Pelvic Health Insurance Coverage. Amend RSA by inserting after chapter 420-Q the following new chapter:
CHAPTER 420-R
PELVIC HEALTH INSURANCE COVERAGE
420-R:1 Definitions. In this chapter:
I. "Pelvic floor physical therapy" means assessment and treatment by a licensed physical therapist or other licensed clinician with pelvic-health training addressing pelvic floor muscle function, bladder/bowel training, manual therapy, biofeedback, therapeutic exercise, education and behavioral interventions.
II. "Covered diagnoses" means urinary incontinence, fecal incontinence, pelvic organ prolapse, diastasis recti, pelvic girdle pain, dyspareunia, pelvic pain, vulvodynia, rehab after cesarean or vaginal birth, and peri or menopausal pelvic dysfunction.
III. "Prehabilitation" means targeted pelvic floor physical therapy prior to pelvic surgery to optimize functional status and reduce postoperative morbidity.
420-R:2 Baseline Coverage.
I. Notwithstanding any other provision of law to the contrary, all health insurance plans in this state shall include pelvic-floor physical therapy (PFPT) as a covered rehabilitative benefit. No plan subject to this chapter shall categorically exclude coverage for PFPT.
II. Initial evaluations shall be covered without prior authorization when ordered by an authorized provider.
III. Notwithstanding any other provision of law to the contrary, insurers shall allow direct access to pelvic-health physical therapy in compliance with this chapter.
IV. Co-pays and deductibles for services under this chapter shall be no less favorable than those for other physical therapy services.
420-R:3 Diagnosis-Specific Coverage. Insurers shall provide coverage for the following:
I. Initial assessments and supervised pelvic-floor physical therapy (PFPT) programs for the following diagnoses:
(a) Stress urinary incontinence (SUI), urgency urinary incontinence (UUI), and mixed urinary incontinence (MUI);
(b) Fecal incontinence;
(c) Pelvic organ prolapse (POP);
(d) Diastasis recti abdominis (DRA) and abdominal separation-related dysfunction;
(e) Pelvic girdle pain;
(f) Dyspareunia, pelvic pain syndromes, and vulvodynia;
(g) Rehabilitation after cesarean or vaginal birth, including perineal tear repair follow-ups; and
(h) Pelvic-floor dysfunction related to menopause.
II. One initial comprehensive evaluation.
III. Twelve weeks of supervised PFPT:
IV. For postpartum patients with perineal tears, immediate postpartum PFPT visits.
V. Therapeutic exercises, biofeedback, vaginal or rectal manual therapy, myofascial release, neuromuscular retraining, bladder or bowel retraining, behavior modification, education, pelvic girdle stabilization, and scar mobilization after cesarean or perineal repair.
VI. Telehealth or group sessions for diagnoses or services under paragraphs I-V where appropriate.
VII. An extension for services offered under paragraphs I-VI for up to 12 months where medically necessary. For chronic or recurrent conditions, coverage may be extended where clinicians request authorization for an additional 12 months of coverage, provided that authorization is resubmitted every 3 months.
420-R:4 Prehabilitation and Post-Surgical Rehabilitation Coverage.
I. For patients scheduled for pelvic reconstructive surgery, continence surgery, major gynecologic surgery, or colorectal/anal sphincter repair, insurers shall cover no more than 6 preoperative pelvic-floor physical therapy (PFPT) sessions, to be delivered within 4 to 12 weeks before surgery, that are focused on education about pelvic-floor optimization, toileting strategies, pre-op strengthening, and functional training.
II. After any pelvic surgery, insurers shall cover post-op PFPT packages, initial post-op evaluation, and no more than 12 sessions in the first 12 weeks for education regarding complex or prolonged post-op surgery recovery, with an additional 24 sessions in a 12-month period if deemed medically necessary.
III. Insurers shall encourage bundled payment programs where prehabilitation, surgery, and post-op rehabilitation are coordinated to incentivize better outcomes and fewer readmissions.
420-R:5 Credentialing; Cost; and Reporting.
I. Covered pelvic-floor physical therapy (PFPT) services shall be provided by licensed physical therapists with documented competency in pelvic health.
II. No blanket bans on internal vaginal/rectal assessments shall be allowed under this chapter.
III. Prior authorization shall only be required after an initial covered package and shall be conducted within 7 business days for non-urgent authorizations and within one business day for urgent authorizations.
IV. Telehealth and group supervised pelvic floor muscle training classes shall be treated by in the same manner as in-person classes, when clinically appropriate.
V. Insurers shall deliver group sessions, tele-rehab, and early intervention models under this chapter in a cost-effective manner.
VI. Notwithstanding any other provision of law to the contrary, insurers shall report annually to insurance department and the department of health and human services data on:
(a) The number of PFPT-related episodes authorized;
(b) The number of PFPT-related diagnoses,
(c) The average number PFPT sessions used;
(d) Patient outcome measures, where available;
(e) Surgical rates for PFPT-related diagnoses; and
(f) The time between a PFPT-related diagnoses referral and a first appointment.
420-R:6 Annual Report. The insurance department shall prepare and publish on or before October 1 of each year an annual report evaluating access, utilization, disparities, cost offsets, and such other PFPT-related matters as the insurance department shall determine.
420-R:7 Rulemaking. The insurance department may adopt rules, pursuant to RSA 541-A, relative to in-network provider credentialing and educating providers about this chapter.
3 Effective Date. This act shall take effect July 1, 2027.
Text to be added highlighted in green.
1 Statement of Findings. The general court hereby finds that:
I. Pregnancy, childbirth, gynecologic conditions, pelvic surgeries, menopause, and aging commonly cause pelvic-floor dysfunction.
II. Conservative pelvic-floor physical therapy (PFPT) and supervised pelvic-floor muscle training (PFMT) are evidence-based first-line treatments that improve symptoms, quality of life, and often reduce need for surgeries related to pelvic-floor dysfunction.
III. Leading clinical guidelines and recent systematic reviews recommend supervised PFMT programs of approximately 8-12 weeks as a first-line care for stress or mixed urinary incontinence and support PFPT for fecal incontinence, pelvic organ prolapse conservative management, pelvic pain and sexual pain disorders.
IV. Coverage expansion for such treatment would promote prevention and speedy recovery, reduces downstream costs, and improves maternal mental health.
2 New Chapter; Pelvic Health Insurance Coverage. Amend RSA by inserting after chapter 420-Q the following new chapter:
CHAPTER 420-R
PELVIC HEALTH INSURANCE COVERAGE
420-R:1 Definitions. In this chapter:
I. "Pelvic floor physical therapy" means assessment and treatment by a licensed physical therapist or other licensed clinician with pelvic-health training addressing pelvic floor muscle function, bladder/bowel training, manual therapy, biofeedback, therapeutic exercise, education and behavioral interventions.
II. "Covered diagnoses" means urinary incontinence, fecal incontinence, pelvic organ prolapse, diastasis recti, pelvic girdle pain, dyspareunia, pelvic pain, vulvodynia, rehab after cesarean or vaginal birth, and peri or menopausal pelvic dysfunction.
III. "Prehabilitation" means targeted pelvic floor physical therapy prior to pelvic surgery to optimize functional status and reduce postoperative morbidity.
420-R:2 Baseline Coverage.
I. Notwithstanding any other provision of law to the contrary, all health insurance plans in this state shall include pelvic-floor physical therapy (PFPT) as a covered rehabilitative benefit. No plan subject to this chapter shall categorically exclude coverage for PFPT.
II. Initial evaluations shall be covered without prior authorization when ordered by an authorized provider.
III. Notwithstanding any other provision of law to the contrary, insurers shall allow direct access to pelvic-health physical therapy in compliance with this chapter.
IV. Co-pays and deductibles for services under this chapter shall be no less favorable than those for other physical therapy services.
420-R:3 Diagnosis-Specific Coverage. Insurers shall provide coverage for the following:
I. Initial assessments and supervised pelvic-floor physical therapy (PFPT) programs for the following diagnoses:
(a) Stress urinary incontinence (SUI), urgency urinary incontinence (UUI), and mixed urinary incontinence (MUI);
(b) Fecal incontinence;
(c) Pelvic organ prolapse (POP);
(d) Diastasis recti abdominis (DRA) and abdominal separation-related dysfunction;
(e) Pelvic girdle pain;
(f) Dyspareunia, pelvic pain syndromes, and vulvodynia;
(g) Rehabilitation after cesarean or vaginal birth, including perineal tear repair follow-ups; and
(h) Pelvic-floor dysfunction related to menopause.
II. One initial comprehensive evaluation.
III. Twelve weeks of supervised PFPT:
IV. For postpartum patients with perineal tears, immediate postpartum PFPT visits.
V. Therapeutic exercises, biofeedback, vaginal or rectal manual therapy, myofascial release, neuromuscular retraining, bladder or bowel retraining, behavior modification, education, pelvic girdle stabilization, and scar mobilization after cesarean or perineal repair.
VI. Telehealth or group sessions for diagnoses or services under paragraphs I-V where appropriate.
VII. An extension for services offered under paragraphs I-VI for up to 12 months where medically necessary. For chronic or recurrent conditions, coverage may be extended where clinicians request authorization for an additional 12 months of coverage, provided that authorization is resubmitted every 3 months.
420-R:4 Prehabilitation and Post-Surgical Rehabilitation Coverage.
I. For patients scheduled for pelvic reconstructive surgery, continence surgery, major gynecologic surgery, or colorectal/anal sphincter repair, insurers shall cover no more than 6 preoperative pelvic-floor physical therapy (PFPT) sessions, to be delivered within 4 to 12 weeks before surgery, that are focused on education about pelvic-floor optimization, toileting strategies, pre-op strengthening, and functional training.
II. After any pelvic surgery, insurers shall cover post-op PFPT packages, initial post-op evaluation, and no more than 12 sessions in the first 12 weeks for education regarding complex or prolonged post-op surgery recovery, with an additional 24 sessions in a 12-month period if deemed medically necessary.
III. Insurers shall encourage bundled payment programs where prehabilitation, surgery, and post-op rehabilitation are coordinated to incentivize better outcomes and fewer readmissions.
420-R:5 Credentialing; Cost; and Reporting.
I. Covered pelvic-floor physical therapy (PFPT) services shall be provided by licensed physical therapists with documented competency in pelvic health.
II. No blanket bans on internal vaginal/rectal assessments shall be allowed under this chapter.
III. Prior authorization shall only be required after an initial covered package and shall be conducted within 7 business days for non-urgent authorizations and within one business day for urgent authorizations.
IV. Telehealth and group supervised pelvic floor muscle training classes shall be treated by in the same manner as in-person classes, when clinically appropriate.
V. Insurers shall deliver group sessions, tele-rehab, and early intervention models under this chapter in a cost-effective manner.
VI. Notwithstanding any other provision of law to the contrary, insurers shall report annually to insurance department and the department of health and human services data on:
(a) The number of PFPT-related episodes authorized;
(b) The number of PFPT-related diagnoses,
(c) The average number PFPT sessions used;
(d) Patient outcome measures, where available;
(e) Surgical rates for PFPT-related diagnoses; and
(f) The time between a PFPT-related diagnoses referral and a first appointment.
420-R:6 Annual Report. The insurance department shall prepare and publish on or before October 1 of each year an annual report evaluating access, utilization, disparities, cost offsets, and such other PFPT-related matters as the insurance department shall determine.
420-R:7 Rulemaking. The insurance department may adopt rules, pursuant to RSA 541-A, relative to in-network provider credentialing and educating providers about this chapter.
3 Effective Date. This act shall take effect July 1, 2027.