RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES --, PHYSICAL THERAPY COPAY
Summary
H7429 would require most individual and group health insurance plans issued, delivered, or renewed in Rhode Island on or after January 1, 2027, to treat physical therapy cost-sharing the same as primary care physician or osteopath visits. Specifically, insurers could not charge a copayment, coinsurance, or office-visit deductible for services provided by a licensed physical therapist that is higher than the amount charged for comparable primary care or osteopathic services. The bill applies this rule across the state’s major insurance chapters, including accident and sickness policies, nonprofit hospital service corporations, nonprofit medical service corporations, and health maintenance organizations.
The bill also requires insurers to clearly disclose the availability of physical therapy coverage and any related limitations, conditions, or exclusions. It takes effect upon passage, but the new parity requirement would apply only to plans delivered, issued for delivery, or renewed on or after January 1, 2027.
Impact
If enacted, H7429 would amend four separate insurance statutes in Title 27 to create a uniform cost-sharing standard for physical therapy services. It would not mandate coverage where none exists, but it would cap patient out-of-pocket charges for covered physical therapy at the same level as primary care or osteopathic visits, affecting insurers, health plans, and insured consumers statewide. The bill would likely make physical therapy more affordable and could increase utilization of rehabilitative care.
Sentiment
Based on the bill text and the absence of recorded committee testimony or votes, the available record suggests a generally supportive policy approach focused on improving access to physical therapy and reducing cost barriers for patients. The sponsor list indicates broad House support at introduction, but there is no documented floor or committee debate in the provided materials to show formal opposition or amendment activity.
Contention
The main policy issue likely to arise is the cost impact on insurers and whether parity with primary care cost-sharing is appropriate for physical therapy services. Supporters would likely emphasize improved access, earlier treatment, and reduced financial barriers for patients needing rehabilitation. Potential critics could argue that the mandate may increase premiums or limit insurer flexibility in designing benefit structures. No specific objections, amendments, or opposing stakeholders are identified in the provided record.
Limits copays, coinsurance or office deductibles for services of a physical therapist to the amount authorized for the services of a primary care physician or osteopath on or after January 1, 2026.
Limits copays, coinsurance or office deductibles for services of a physical therapist to the amount authorized for the services of a primary care physician or osteopath on or after January 1, 2026.
Requires individual and group health insurance policies that provide pregnancy-related benefits to cover medically necessary expenses for diagnosis and treatment of infertility and standard fertility-preservation services.