Senate Bill 373 aims to amend existing laws regarding prior authorization for various health care services, specifically physical therapy, occupational therapy, speech therapy, and chiropractic services. The bill prohibits health plans from requiring prior authorization for the first 12 visits of these therapies and for any nonpharmacologic management of chronic pain for the first 90 days of treatment, with a limit of twice per week per service. It also mandates that health plans must make decisions on reauthorization requests within three business days, and if they fail to do so, prior authorization is automatically granted. Additionally, the bill requires health plans to provide clear explanations for any denials of coverage and to ensure that copayment and coinsurance amounts for these services are equivalent to those for primary care services.

Furthermore, the bill introduces new definitions, such as "urgent health care service," and outlines the responsibilities of utilization review organizations. These organizations must provide licensed health care providers with relevant medical evidence-based policy information and cannot use claims data to develop coverage algorithms. The bill also expands the current prohibition on requiring prior authorization for emergency medical services to include any covered services incidental to surgical services deemed medically necessary by a healthcare provider. Overall, the legislation seeks to streamline access to essential therapies and improve transparency in health care coverage decisions.

Statutes affected:
Bill Text: 632.85(title), 632.85, 632.85(3)