Prior authorization: physical therapy.

Assembly Member Mark González's physical therapy access measure would eliminate prior authorization requirements for initial treatment visits under California health plans and insurance policies. Starting January 1, 2027, the legislation prohibits insurers from requiring prior authorization for the first 12 physical therapy visits in a new episode of care, defined as treatment for conditions not addressed by the provider within the previous 90 days.

The bill establishes new transparency requirements for physical therapy providers. Before beginning treatment, providers must verify coverage, disclose patient cost-sharing obligations, and obtain separate written consent for any services that may not be covered. These disclosures must include maximum out-of-pocket costs if coverage is denied and clearly indicate whether the provider participates in the patient's insurance network. For potentially uncovered services, providers must furnish written cost estimates in the patient's primary language if it meets Medi-Cal threshold language criteria.

While the measure applies broadly to health plans and insurers in California, it explicitly exempts Medi-Cal managed care plans. The bill's provisions would take effect for insurance contracts issued, amended or renewed after January 1, 2027. Under the Knox-Keene Act's existing enforcement framework, willful violations by health plans would constitute criminal offenses, creating a state-mandated local program for enforcement.