Maine Senate unanimously enacts Sen. Brenner bill to reduce insurance hurdles for accessing physical therapy

AUGUSTA – On Wednesday, the Maine Senate unanimously enacted a bill from Sen. Stacy Brenner, D-Scarborough. As amended, LD 1383, “An Act to Regulate Insurance Carrier Prior Authorization Requirements for Rehabilitative and Habilitative Services,” would limit when insurance companies can require prior authorization for rehabilitation and occupational therapy.

“I’m grateful for my colleague’s unanimous support for this bill,” said Sen. Brenner. “Rehabilitative therapy services can be a vital part of addressing a patient’s health needs. However, there are many hurdles all Mainers face when dealing with the complicated system of health insurance. This bill ensures that there is one less hurdle for those who need access to occupational and physical therapy.”

LD 1383 would prohibit health insurance carriers from requiring prior authorization for the first 12 visits of rehabilitation or habilitation services. As amended, the bill would require a health insurance carrier to provide clear, written policies and procedures on how to obtain prior authorization. This legislation does not limit carriers from denying claims when services or treatment rendered were not medically necessary.

In April 2022, the Office of the Inspector General (OIG) for the U.S. Department of Health and Human Services published a report on the use of prior authorization by Medicare Advantage Organizations (MAOs). OIG indicated that the use of prior authorization frequently caused delays in the beneficiary’s access to medically necessary services and denial of payments to providers for covered services that should have been paid.

LD 1383 now goes to the Governor’s desk, where she has 10 days to either sign it, veto it or allow it to become law without her signature.

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