Purpose

Prohibits the denial of reimbursement for services rendered by physical therapists if the insurance carrier provides benefits for such services.

Background

Current state law prohibits denial of insurance contract benefits to chiropractors, psychologists, nurses, optometrists, psychiatrists, drug abuse services and alcoholism services if an insurance contract provides for or offers reimbursement for any service that is within the scope of the practitioner or service.

The strike everything amendment to S.B. 1229 includes licensed physical therapists to the list of practitioners and services that are ensured reimbursement by insurance carriers. The amendment requires insurers to allow self-referral to a physical therapist on an out-of-network basis. However, if a physician refers the insured, the insured may go to a physical therapist on an in-network basis.

Based on the concerns of the Department of Administration regarding the insured person’s ability to seek any physical therapist and the costs associated with such services and how the content of the striker amendment considers those concerns, there appears to be no fiscal impact to the cost of workers' compensation payouts or health insurance for state employees related to this bill.

Provisions

1. Enables an insured person to select a licensed physical therapist for services that are within the scope of a physical therapist, if the insurance carrier provides for or offers reimbursement for such services.

2. Authorizes an insurer to require prior authorization or any other form of utilization review as a condition of coverage of physical therapy services.

3. Authorizes an insurer, as a condition of coverage of physical therapy services, to impose coinsurance, copayments, deductibles, dollar caps and limitations on the number of visits, provider network restrictions or other cost containment measures.

4. Requires an insurer that offers a contract with in-network and out-of-network coverage of physical therapy services to allow self-referral to a physical therapist under the out-of-network coverage.

5. Permits an insurer to require the insured to be examined and diagnosed by a physician and obtain a physician referral prior to physical therapy services being provided on an in-network basis if the insurer provide a contract with in-network and out-of-network coverage of physical therapy services.

6. Provides for a general effective date, but applies only to contracts, policies and evidences of coverage issued or renewed from and after December 31, 2002.

SR/TM/jas