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.

Furthermore, the bill introduces new definitions and requirements for health benefit plans and self-insured health plans. It defines "urgent health care service" and outlines that prior authorization cannot be required for services incidental to covered surgical services deemed medically necessary by a healthcare provider. The bill also mandates that utilization review organizations provide medical evidence-based policy information to healthcare providers upon request and prohibits the use of claims data for developing coverage algorithms. Overall, the bill 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)