Limits prior authorization requirements for rehabilitative and habilitative services. Also prohibits prior authorization for the first twelve (12) visits of a new episode of care and for ninety (90) days following a chronic pain diagnosis.

Plain-English Summary

This bill would place new limits on when health insurance companies in Rhode Island can require "prior authorization" for certain medical services. Prior authorization is the process where a patient or their doctor must get approval from an insurance company before receiving treatment — a process that can delay care. Specifically, this bill targets rehabilitative services (like physical therapy after an injury or surgery) and habilitative services (therapy that helps people develop or maintain daily life skills, often used by people with disabilities or developmental conditions).

Under this bill, insurance companies would be prohibited from requiring prior authorization for the first 12 visits when a patient starts a new episode of care — meaning the first stretch of treatment for a new condition or injury. Additionally, insurers could not require prior authorization for 90 days after a patient is diagnosed with chronic pain, giving patients more immediate access to treatment during that critical early period.

This bill would most directly affect patients who need ongoing or repeated therapy, such as people recovering from injuries, surgeries, or strokes, as well as individuals living with disabilities or chronic pain conditions. It would also affect healthcare providers like physical therapists and occupational therapists, who often spend significant time navigating prior authorization requirements. Insurance companies would need to adjust their approval processes to comply with the new rules.

The bill has been introduced and referred to the Senate Health and Human Services Committee, meaning it is in the early stages of the legislative process and has not yet been voted on.