Section 26-55-113 - Prior Authorization for Rehabilitative or Habilitative Services

26-55-113. Prior authorization for rehabilitative or habilitative services. (a) A health insurer or contracted utilization review entity shall not require prior authorization for rehabilitative or habilitative services including, but not limited to, physical therapy services or occupational therapy services for the first twelve (12) visits for each new episode of care. For purposes of this subsection, 'new episode of care' means treatment for a new condition or treatment for a recurring condition that an enrollee has not been treated within the previous ninety (90) days. (b) This section does not limit the right of a health insurer or contracted utilization review entity to deny a claim when an appropriate prospective or retrospective review concludes that the health care services were not medically necessary.