SB 480 — limiting certain prior authorization requirements for physical therapy, occupational therapy, and similar rehabilitative services.

SB 480-FN - AS INTRODUCEDAMENDED BY THE SENATE 03/05/2026 0838s SESSION 26-2040 05/09 SENATE BILL 480-FN AN ACT limiting certain prior authorization requirements for physical therapy, occupational therapy, and similar rehabilitative services.

Health and Human Services ───────────────────────────────────────────────────────────────── AMENDED ANALYSIS ThisThe bill prohibits health carriers from requiring prior authorization for the first 12 visits of physical or occupational therapy,therapy orvisit similarin services,any for each new episode of care, definedand asmandates aapproval newof conditionat orleast one8 notmedically treatednecessary intreatments after the pastinitial 60evaluation days.before further review.

However,This claimsbill canalso stillpreserves beinsurers’ deniedability ifto thedeny treatmentclaims wasdeemed not medically necessary.

SB 480-FN - AS INTRODUCEDAMENDED BY THE SENATE 03/05/2026 0838s 26-2040 05/09 STATE OF NEW HAMPSHIRE In the Year of Our Lord Two Thousand Twenty-Six AN ACT limiting certain prior authorization requirements for physical therapy, occupational therapy, and similar rehabilitative services.

Prior Authorization for RehabilitativePhysical orTherapy Habilitativeand Services;Occupational Therapy;

420-J:6-f Prior Authorization for RehabilitativePhysical orTherapy Habilitativeand Services;Occupational Therapy;

   I.

A health carrier shall not require prior authorization for rehabilitativephysical ortherapy habilitativeand services,occupational including,therapy, butas notdefined limitedin to,RSA physical328-A:2, therapyXI services and occupationalRSA therapy326-C:1, services,IV, respectively, for the first 12visit visits 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.

  II.

This section doesshall 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.

This act shall take effect 60January days1, after2027. its passage.

LBA 26-2040 11/6/253/19/26 SB 480-FN- FISCAL NOTE AS INTRODUCEDAMENDED BY THE SENATE (AMENDMENT # 2025-0838s) AN ACT limiting certain prior authorization requirements for physical therapy, occupational therapy, and similar rehabilitative services.

Estimated State Impact FY 2026 FY 2027 FY 2028 FY 2029 Indeterminable Indeterminable Indeterminable Revenue $0 Increase Increase Increase (notRevenue provided$0 by$250,000 (notto provided$250,000 (notto provided$250,000 byto agency)$1,250,000 by$1,250,000 agency)$1,250,000 agency) Revenue Fund(s) General Fund Expenditures* $0 $0 $0 $0 Funding Source(s) None Appropriations* $0 $0 $0 $0 Funding Source(s) None *Expenditure = Cost of bill *Appropriation = Authorized funding to cover cost of bill Estimated Political Subdivision Impact FY 2026 FY 2027 FY 2028 FY 2029 County Revenue $0 $0 $0 $0 County Expenditures $0 Indeterminable Indeterminable Indeterminable Local Revenue $0 $0 $0 $0 Local Expenditures $0 Indeterminable Indeterminable Indeterminable METHODOLOGY:

This bill amends RSA 420-J to prohibit health carriers from requiring prior authorization for the first 12visit visits of physical therapy,therapy and occupational therapy,therapy orfor similareach rehabilitativenew orepisode habilitativeof servicescare forand eachrequires newapproval episode of care.at least 8 medically necessary treatments following the initial evaluation before additional review.

The Insurance Department states thisprior billauthorization willis havea ancommonly indeterminableused impactcost-containment onmechanism statein Generalhealth Fundinsurance. revenues.

The Department notesindicates that limiting prior authorization isrequirements afor widelythese usedservices cost-controlmay measureincrease inthe bothfrequency publicof claims and privatetotal healthclaims insurancecosts plans.for physical and occupational therapy services.

EliminatingIncreased priorclaims authorizationcosts formay theresult firstin 12higher visitsinsurance ofpremiums, thesewhich serviceswould may lead to an increase inInsurance thePremium totalTax numberrevenue ofdeposited claimsinto andthe overallGeneral costsFund. for this category of treatment.

TheseThe increasedDepartment costsestimates could,the increase in turn,state leadrevenue to higherbe insuranceindeterminable premiumsbut andlikely abetween corresponding$250,000 increaseand in$1,250,000 Insuranceannually. Premium Tax revenue to the state.

The Department states the magnitude of this impact cannot be estimated without detailed claims data and analysis of utilization patterns.