Prior authorization: physical therapy.
Vote required
Majority
Fiscal committee
No
Appropriation
No
Current location
Vetoed
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed Assembly
- Passed Senate
- To Governor
- Became Law
Overview
This bill aims to reduce barriers to physical therapy by limiting prior authorization requirements for the first 12 treatment visits for new conditions under health insurance policies and service plans. It requires providers to verify coverage and disclose potential costs to patients, and mandates separate written consent for any uncovered expenses. The bill applies to policies and plans issued on or after January 1, 2027, and excludes coverage for Medi-Cal managed care plans.
Key provisions
- Prohibits prior authorization for the initial 12 physical therapy visits for a new condition.
- Allows prior authorization for recurring conditions, with a 180-day limit from the last intervention.
- Requires providers to verify coverage and disclose cost-sharing to patients.
- Mandates separate written consent for costs not covered by the patient’s plan.
- Requires a written cost estimate to be included in the consent.
- Excludes Medi-Cal managed care plans from the bill’s provisions.
- Specifies that the bill creates a state-mandated local program.
- Requires disclosure if the provider is not in the patient’s network.
Who is affected
- Patients receiving physical therapy
- Physical therapy providers
- Health care service plans
- Health insurers
- Individuals covered by health insurance policies
Notable changes
Bill text
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Sponsors
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3 on record
Primary sponsor
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