New YorkPlan reviewers would consider more than measurable gains for rehab coverage
If enacted, health plan reviewers would have to consider whether skilled rehabilitation can maintain function or prevent decline, even when a patient shows no measurable improvement.
What it does
A plan reviewer would not be allowed to deny, reduce, or end coverage for medically necessary skilled rehabilitation solely because a person has not measurably improved. Reviewers would consider whether care may maintain function, ease symptoms, or help prevent decline or more intensive treatment.
Argument forPeople who cannot improve may still get skilled care that could ease pain, maintain function, or help prevent more intensive treatment.
Argument againstReviewers may need to assess other clinical reasons for ending care, which could make coverage decisions more involved when patients show no measurable gains.
More detail
A utilization review agent would not be allowed to deny, reduce, or end coverage solely because a person has not measurably improved. This would apply to people insured or enrolled in a health plan and to skilled rehabilitation provided by licensed health care professionals, such as physical, occupational, speech, pulmonary, or cardiac rehabilitation. The services must be medically necessary skilled rehabilitation. Coverage would not be required for services that are not otherwise medically necessary or do not require a licensed professional’s specialized knowledge, judgment, or skills. The bill would take effect immediately if enacted.
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Where it stands
- Introduced
- Passed 1st Chamber
- Passed 2nd Chamber
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Sep 2REFERRED TO INSURANCEIntroduced
Healthcare