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1 New Section; Managed Care Law; Prior Authorization for Physical Therapy and Occupational Therapy; When Required. Amend RSA 420-J by inserting after section 6-e the following new section:
420-J:6-f Prior Authorization for Physical Therapy and Occupational Therapy; When Required.
I. A health carrier shall not require prior authorization for physical therapy and occupational therapy, as defined in RSA 328-A:2, XI and RSA 326-C:1, IV, respectively, for the first visit of each new episode of care. Health carriers may require prior authorization following the covered person's first visit. Each health carrier shall provide prior authorization for physical therapy and occupational therapy, if medically necessary based on the evaluation of the patient at the initial visit, for not less than 8 treatments before requiring additional review for medical necessity, unless otherwise specified in the plan sponsor's contract with the health carrier. For purposes of this section, "new episode of care" means treatment for a new condition or treatment for a recurring condition for which an enrollee has not been treated within the previous 60 days.
II. This section shall not limit the right of a health carrier to deny a claim when an appropriate prospective or retrospective review concludes that the health care services or treatment rendered were not medically necessary.
2 Effective Date. This act shall take effect January 1, 2027.
Text to be added highlighted in green.
1 New Section; Managed Care Law; Prior Authorization for Physical Therapy and Occupational Therapy; When Required. Amend RSA 420-J by inserting after section 6-e the following new section:
420-J:6-f Prior Authorization for Physical Therapy and Occupational Therapy; When Required.
I. A health carrier shall not require prior authorization for physical therapy and occupational therapy, as defined in RSA 328-A:2, XI and RSA 326-C:1, IV, respectively, for the first visit of each new episode of care. Health carriers may require prior authorization following the covered person's first visit. Each health carrier shall provide prior authorization for physical therapy and occupational therapy, if medically necessary based on the evaluation of the patient at the initial visit, for not less than 8 treatments before requiring additional review for medical necessity, unless otherwise specified in the plan sponsor's contract with the health carrier. For purposes of this section, "new episode of care" means treatment for a new condition or treatment for a recurring condition for which an enrollee has not been treated within the previous 60 days.
II. This section shall not limit the right of a health carrier to deny a claim when an appropriate prospective or retrospective review concludes that the health care services or treatment rendered were not medically necessary.
2 Effective Date. This act shall take effect January 1, 2027.