Health plans would cover pelvic floor therapy for listed conditions

Health plans would cover pelvic floor therapy for listed conditions. Listed conditions include bladder or bowel leakage, pelvic organ prolapse, pelvic pain, recovery after childbirth, and pelvic changes related to menopause. An initial evaluation would not need prior approval when an authorized provider orders it. Patients could directly access pelvic health therapy, and their copays and deductibles could be no less favorable than those for other physical therapy. Covered therapy would be provided by licensed physical therapists with documented pelvic health skills. The proposed coverage would begin July 1, 2027.

Insurers would cover therapy before and after certain surgeries. Before surgery, this would apply to patients scheduled for pelvic reconstructive, continence, major gynecologic, or colorectal or anal sphincter surgery. Afterward, it would apply to patients who have any pelvic surgery. Before surgery, coverage would be limited to six sessions. After surgery, coverage would include up to 12 sessions in the first 12 weeks, with up to 24 more sessions in a 12-month period if medically necessary. The proposed coverage would begin July 1, 2027.

Insurers would report treatment data to state agencies, and the Insurance Department would publish a yearly report. Insurers would report therapy use, diagnoses, sessions, outcomes when available, surgery rates, and time to a first appointment to the Insurance Department and the Department of Health and Human Services. The Insurance Department could also adopt rules about provider credentials and educating providers. These provisions would begin July 1, 2027. The report would be due by October 1 each year.