Senate panel weighs bill to limit prior authorization for early physical and occupational therapy visits

Concord — Testimony at the Senate Health and Human Services Committee centered on SB480, a bill proposed by Senator Sue Prentiss that would prohibit insurers from requiring prior authorization for the first 12 visits of a new physical-therapy or occupational-therapy episode.

Prentiss told the committee the change seeks to reduce administrative delays that interrupt timely care and rehabilitation, particularly in a state facing workforce constraints. “Under this bill, insurers may not require authorization for the first 12 visits of each new episode,” she said, explaining her intent to protect early access while preserving insurers’ ability to deny services found not medically necessary after review.

Michelle Heaton, director of life and health at the New Hampshire Insurance Department, cautioned that prior authorization serves safety and cost-control purposes and that removing initial prior authorization could leave patients exposed to later denials. She summarized recent statutory reforms (SB561) that require electronic prior-author- ization turnaround times (14 days, 72 hours for urgent cases) and noted that if a carrier fails to act within the statutory period the prior authorization is deemed approved.

Physical therapists and occupational therapists gave detailed examples of clinical disruption. Mark Mayhew, a PT with 35 years of experience, said repeated authorizations and reevaluations consume provider time and delay recovery; he cited national utilization data that “85 to 90 percent of all physical therapy episodes are completed within 12 visits.” Colleagues described local survey data showing high rates of delayed starts, abandoned care and worsened outcomes tied to authorization delays.

Insurers (Anthem, Cigna, Harvard Pilgrim, AHIP) urged caution. Sabrina Dunlap of Anthem said many carriers already operate dynamic, digital utilization-management systems that return immediate tailored approvals and argued a blanket 12-visit rule effectively mandates coverage and would need to be priced into premiums. Paula Rogers of AHIP and other payer representatives encouraged continued stakeholder negotiations and technical fixes rather than broad legislative mandates.

Committee members asked sponsors to continue working with carriers, the insurance department and providers to find a middle ground; the testimony indicated commitments to follow-up meetings and to circulate pending rule changes. No committee vote on SB480 was recorded in the transcript.