An act relating to health insurance and Medicaid coverage for physical therapy services

2025-2026 Regular Session Introduced by Mari Cordes and 1 co-sponsor

Requires private health plans and Medicaid in Vermont to cover physical therapy services.

Read first time and referred to the Committee on Health Care

Summary of Bill H. 271 (2025-2026) – Vermont

Purpose and intent

H. 271 proposes health insurance and Medicaid coverage for physical therapy services. The bill aims to ensure that individuals have access to medically necessary physical therapy by requiring coverage under private health insurance plans and the state Medicaid program.

Key provisions and changes

Coverage Mandate for Physical Therapy Services: Requires health insurance plans (private/commercial) to cover physical therapy services. The specifics—such as whether coverage must include certain settings (outpatient, in-home) or frequency limits—are not detailed in the provided summary, but the bill centers on ensuring access to therapeutic services.

Medicaid Coverage: Directs Medicaid to cover physical therapy services as part of its benefits package, aligning Medicaid with standards of care for physical therapy.

Scope of Services: Focuses on physical therapy, including evaluation, treatment, and modalities ordinarily provided by licensed physical therapists. It may address reasonable and medically necessary treatment plans.

Provider and Beneficiary Protections: Likely includes provisions to ensure timely access to therapy, appropriate billing practices, and avoidance of discrimination or arbitrary denial of services, though specific consumer protections are not enumerated in the provided information.

Cost and Administrative Provisions: May include administrative rules to implement coverage, such as credentialing, reimbursement rates, and oversight mechanisms. The exact financial impact and rate structure are not stated here.

Who would be affected

Individuals with Private Health Insurance: Patients who require physical therapy would gain mandated coverage, reducing out-of-pocket costs and access barriers.

Medicaid Enrollees: Beneficiaries eligible for Medicaid would receive coverage for physical therapy services.

Licensed Physical Therapists and Providers: Practitioners would interact with mandated coverage criteria, billing practices, and reimbursement processes under both private plans and Medicaid.

Insurers and MCOs: Private insurers and any managed care organizations administering Medicaid would need to align policies with the new coverage requirements and update claims processing accordingly.

Procedural and timeline aspects

Committee Assignment: Read first time and referred to the House Committee on Health Care on February 19, 2025.

Sponsors: Co-sponsors include Emilie Krasnow and Mari Cordes.

Next Steps: The bill would undergo committee review, potential amendments, and floor consideration. If advanced, it would proceed through Vermont’s legislative process toward passage and potential gubernatorial action.

Notes

The description provided does not include specific language on exemptions, cost estimates, reimbursement rates, duration of therapy, or caps. For a complete understanding, one would need the bill text to verify definitions (e.g., “medically necessary,” allowable modalities, and limits) and to assess potential fiscal impact and implementation timelines.