Official Text and Analysis.

Prohibits a health carrier from requiring certain treatment visits to meet medical necessity standards, so long as the patient's treating provider determines the visit is medically necessary.

Reinstates the ability for a carrier to subject an initial evaluation and management visit and up to 6 treatment visits to quantitative treatment limits; and (2) Permits a patient's treating or referring provider, as opposed to chiropractor or other primary care provider, to determine medical necessity or appropriateness for purposes of receiving treatment visits.

Makes provisions relating to prior authorization applicable to a health carrier's contracting entity, in addition to the carrier itself. Expands the prohibition against prior authorization to include utilization management or review of any kind, including prior, concurrent, or postservice review. Clarifies that utilization management or review may not be required for six visits for each of the following: Chiropractic, physical therapy, occupational therapy, acupuncture, massage therapy, or speech and hearing therapy. Removes the requirement that the six visits be consecutive or for a new episode of care. Changes the definition of "new episode of care" by making it applicable to new conditions or diagnoses (instead of new or recurrent conditions) and lengthening the time period within which the enrollee may not have been treated for the new condition or diagnosis to within the plan year, instead of within the previous ninety days. Prohibits a health carrier or its contracting entity from retroactively denying care or refusing payment for the six visits. Inserts an intent section.

Makes provisions relating to prior authorization applicable to a health carrier's contracting entity, in addition to the carrier itself. Expands the prohibition against prior authorization to include utilization management or review of any kind, including prior, concurrent, or postservice review. Clarifies that utilization management or review may not be required for six visits in a new episode of care for each of the following: Chiropractic, physical therapy, occupational therapy, acupuncture, massage therapy, or speech and hearing therapy. Removes the requirement that the six visits be consecutive or for a new episode of care. Changes the definition of "new episode of care" by making it applicable to new conditions or diagnoses (instead of new or recurrent conditions) for which the enrollee has been treated by a provider of the same profession. Prohibits a health carrier or its contracting entity from retroactively denying care or refusing payment for the six visits. Inserts an intent section.