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Committee hears bill to limit prior authorization for rehabilitative care after PTs warn delays harm patients
Summary
H 7347 would prohibit insurers from requiring prior authorization for the first episode of rehabilitative care for up to 12 visits and require quick insurer responses. Physical therapists testified that prior authorization delays care, increases administrative overhead and contributes to clinician burnout.
Providence — Representative McGaw introduced H 7347, a bill designed to curb delays caused by insurer prior authorization for rehabilitative care. The bill would block insurers from requiring prior authorization for a new episode of care for up to 12 visits and would require insurers to respond to prior authorization requests within 24 hours when authorization is required.
Physical therapists and the American Physical Therapy Association’s Rhode Island leadership told the committee that prior authorization requirements divert clinical staff time to administrative tasks, delay treatment start dates and can worsen outcomes for patients with acute conditions such as low back pain. “Prior authorization requirements not only delay care, but they quietly erode patient access over time,” said Dr. Yvonne Swanson, APTA‑RI vice president.
Dan Macera, a regional director at a statewide PT provider, said his practice evaluated about 20,000 new patients last year and that prior authorization was required for roughly 8,000 of those cases, creating frequent disruptions to care continuity. Witnesses argued that early access to physical therapy can reduce downstream imaging, opioid use and more costly interventions.
Committee members noted a letter of opposition from the insurance trade group AHIP that argued prior authorization prevents low‑value or inappropriate services; PT witnesses responded that clinicians are trained to triage and that prior authorization often functions as an administrative hurdle rather than a clinical safeguard for appropriate PT care.
The Committee closed the hearing and left open the opportunity for amendments that would preserve necessary oversight while preventing delays in access. Sponsors and stakeholders are expected to negotiate technical language about triggers for the exemption and procedural safeguards for cases where utilization review is appropriate.
Next steps: Committee staff will circulate the AHIP letter and gather follow‑up language proposals from sponsors and PT stakeholders.
