(a) (1) On and after January 1, 2026, a health benefit plan that is offered, issued, renewed, delivered, or extended in this state shall provide coverage to an enrollee for medically necessary treatment related to or as a result of an acquired brain injury.(2) As required under subdivision (a)(1) of this section, medically necessary treatment shall include without limitation:(A) Cognitive rehabilitation therapy;(B) Cognitive communication therapy;(C) Community reintegration services;(D) Functional rehabilitation therapy;(E) Neurocognitive therapy and rehabilitation;(F) Home and community-based treatment;(G) Inpatient services;(H) Neurobehavioral therapy, neurocognitive therapy, and neuropsychological testing;(I) Neurofeedback therapy;(J) Outpatient and day treatment services; and(K) Post-acute care residential treatment services.
(1) On and after January 1, 2026, a health benefit plan that is offered, issued, renewed, delivered, or extended in this state shall provide coverage to an enrollee for medically necessary treatment related to or as a result of an acquired brain injury.
(2) As required under subdivision (a)(1) of this section, medically necessary treatment shall include without limitation:(A) Cognitive rehabilitation therapy;(B) Cognitive communication therapy;(C) Community reintegration services;(D) Functional rehabilitation therapy;(E) Neurocognitive therapy and rehabilitation;(F) Home and community-based treatment;(G) Inpatient services;(H) Neurobehavioral therapy, neurocognitive therapy, and neuropsychological testing;(I) Neurofeedback therapy;(J) Outpatient and day treatment services; and(K) Post-acute care residential treatment services.
(A) Cognitive rehabilitation therapy;
(B) Cognitive communication therapy;
(C) Community reintegration services;
(D) Functional rehabilitation therapy;
(E) Neurocognitive therapy and rehabilitation;
(F) Home and community-based treatment;
(G) Inpatient services;
(H) Neurobehavioral therapy, neurocognitive therapy, and neuropsychological testing;
(I) Neurofeedback therapy;
(J) Outpatient and day treatment services; and
(K) Post-acute care residential treatment services.
(b) The coverage for medically necessary treatment for an acquired brain injury under subdivision (a)(1) of this section:(1) (A) Is not subject to a lifetime limitation or an unreasonable annual limitation of the number of days or sessions of medically necessary treatment services.(B) A limitation on rehabilitation services in an inpatient rehabilitation facility shall be:(i) Separate from and shall not be included in any limitation of post-acute care rehabilitation services; and(ii) Stated separately by the healthcare insurer;(2) Is not subject to a greater deductible, coinsurance, copayment, or out-of-pocket limits than any other benefit provided by a healthcare insurer under a health benefit plan; and(3) Does not diminish or limit benefits otherwise allowable under a health benefit plan.
(1) (A) Is not subject to a lifetime limitation or an unreasonable annual limitation of the number of days or sessions of medically necessary treatment services.(B) A limitation on rehabilitation services in an inpatient rehabilitation facility shall be:(i) Separate from and shall not be included in any limitation of post-acute care rehabilitation services; and(ii) Stated separately by the healthcare insurer;
(A) Is not subject to a lifetime limitation or an unreasonable annual limitation of the number of days or sessions of medically necessary treatment services.
(B) A limitation on rehabilitation services in an inpatient rehabilitation facility shall be:(i) Separate from and shall not be included in any limitation of post-acute care rehabilitation services; and(ii) Stated separately by the healthcare insurer;
(i) Separate from and shall not be included in any limitation of post-acute care rehabilitation services; and
(ii) Stated separately by the healthcare insurer;
(2) Is not subject to a greater deductible, coinsurance, copayment, or out-of-pocket limits than any other benefit provided by a healthcare insurer under a health benefit plan; and
(3) Does not diminish or limit benefits otherwise allowable under a health benefit plan.
(c) For medically necessary treatment covered under this section, only a clinical peer reviewer may preauthorize coverage or conduct utilization review.
(d) The Insurance Commissioner shall promulgate rules to create a process to permit an expedited appeal of an adverse determination by the healthcare insurer for medically necessary treatment covered under this section.
(e) An individual practitioner and treatment facility shall be qualified to provide acute care and post-acute care rehabilitation services to an enrollee with an acquired brain injury through possession of the appropriate licenses, accreditation, training, and experience deemed customary and routine in the appropriate trade practice.