HB 1646

This bill requires a health insurer or health maintenance organization that offers a health benefit plan in this state to provide coverage for medically necessary treatment related to or resulting from an acquired brain injury. " Medically necessary treatment "" includes, but is not limited to, c ognitive rehabilitation therapy, c ognitive communication therapy, n eurocognitive therapy and rehabilitation, n eurobehavioral therapy, n europhysiological testing, n europsychological testing, n eurofeedback therapy, v is ion therapy, f unctional rehabilitation therapy, c ommunity reintegration services, p ost-acute residential treatment services, i npatient services, o utpatient and day treatment services, and h ome and community-based treatment. LIMITATIONS This bill prohibits such c overage from including any lifetime limitation or unreasonable annual limitation of the number of days or sessions of treatment services. Any limitations on rehabilitation services in an inpatient rehabilitation facility must be separate from, and must not be included in, any limitations of post-acute rehabilitation. Additionally, a n insurer or health maintenance organization must separately state any limitations. Covered services must not be subject to a greater deductible, co insurance, copayment, or out-of-pocket limitation than another covered service provided under a health benefit plan by the health insurer or health maintenance organization. PREAUTHORIZATION – UTILIZATION REVIEW This bill requires, for services required to be covered by this bill, a health insurer or health maintenance organization to ensure that only a clinical peer reviewer conducts coverage preauthorization or utilization review. PRACTITIONER AND TREATMENT FACILITY QUALIFICATIONS In order to be eligible for reimbursement for services, this bill requires an individual practitioner or treatment facility to be qualified to provide acute care and post-acute care rehabilitation services to an individual with an acquired brain injury by possessing the appropriate license, registration, certification, or accreditation, training, and experience deemed customary and routine in the trade practice, in addition to meeting the requirements for licensure, registration, certification, or other pe rmitting required by the law of this state. RULEMAKING This bill requires the commissioner of commerce and insurance to promulgate rules to create a process to permit an expedited appeal of any adverse determination by a health insurer or health maintenance organization for services required to be covered under this bill. APPLICABILITY This bill applies to contracts for insurance entered into, amended, or renewed on or after January 1, 2027."