Prior authorization: physical therapy.

Assembly Member Mark González's physical therapy access measure eliminates prior authorization requirements for initial treatment visits under California health plans and insurance policies beginning January 2027. The legislation prohibits insurers from requiring pre-approval for the first 12 physical therapy visits when treating new conditions, while maintaining authorization protocols for recurring conditions if care is sought within 180 days of previous treatment.

Physical therapy providers must verify coverage and disclose cost-sharing details to patients before beginning treatment, including maximum out-of-pocket expenses if coverage is denied. For potentially uncovered services, providers must obtain separate written consent with cost estimates in the patient's primary language if it meets Medi-Cal threshold language criteria. Providers must also inform patients if they are not in-network for the patient's health plan.

The requirements apply to health care service plans regulated by the Department of Managed Health Care and health insurance policies overseen by the Department of Insurance, with an exemption for Medi-Cal managed care plans. The provisions take effect for plans and policies issued, amended, or renewed after January 1, 2027, allowing time for implementation of the new authorization protocols and disclosure requirements.