Bill > AB574

This bill aims to improve access to physical therapy by restricting prior authorization requirements for health care service plans and health insurance policies. Starting January 1, 2027, health plans and insurers will be prohibited from requiring prior authorization for the first 12 physical therapy treatment visits for a new medical condition. For recurring conditions, prior authorization may be imposed only if the patient seeks care within 180 days of their last physical therapy intervention. The bill requires physical therapy providers to verify patient coverage, disclose cost-sharing details, and obtain separate written consent for potential out-of-pocket costs. Providers must also provide a written cost estimate in the patient's primary language if it is a Medi-Cal threshold language. The legislation does not apply to Medi-Cal managed care plans and is motivated by concerns that existing authorization practices create barriers to timely and necessary physical therapy treatments. The bill recognizes that overly restrictive prior authorization processes can interfere with patients receiving appropriate care and potentially lead to poor health outcomes by limiting the number of recommended therapy visits.

Budget and Finance, Health and Social Services

https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202520260AB574