Prior authorization: physical therapy.

Assembly Member Mark González's physical therapy access measure would eliminate prior authorization requirements for initial treatment visits while establishing new cost transparency protocols for providers. Under the proposal, health plans and insurers could not require prior authorization for a patient's first 12 physical therapy visits for new conditions starting in 2027, though authorization could still be required for recurring conditions treated within the previous 180 days.

The legislation creates new obligations for physical therapy providers to verify coverage and disclose potential costs before beginning treatment. Providers must obtain separate written consent for any services that may not be covered, including detailed cost estimates provided in the patient's preferred language if it is a Medi-Cal threshold language. The measure requires providers to encourage patients to contact their health plans directly for coverage details while maintaining all existing patient rights.

These provisions would apply to both health care service plans regulated by the Department of Managed Health Care and health insurance policies overseen by the Department of Insurance, though Medi-Cal managed care plans would be exempt. The bill maintains current requirements for non-contracted providers working at in-network facilities regarding billing practices and patient protections.