CaliforniaPrior authorization: physical therapy.
What it does
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law sets forth specified prior authorization limitations for health care service plans and health insurers.
More detail
This bill would prohibit a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2027, that provides coverage for physical therapy from imposing prior authorization for the initial 12 physical therapy treatment visits for a new condition. The bill would authorize prior authorization for physical therapy for a recurring condition, as specified. The bill would require a physical therapy provider to verify an enrollee's or an insured's coverage and disclose their share of the cost of care, as specified. The bill would require a physical therapy provider to obtain separate written consent for costs that may not be covered by the enrollee's or insured's plan contract or policy, that includes a written estimate of the cost of care for which the enrollee or insured is responsible if coverage is denied or otherwise not applicable. With respect to health care service plans, the bill would specify that its provisions do not apply to Medi-Cal managed care plan contracts. Because a willful violation of this provision by a health care service plan would be a crime, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
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Where it stands
- Introduced
- Passed Assembly
- Passed Senate
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Jan 22Consideration of Governor's veto stricken from file.Latest
- 2025
- Oct 6Consideration of Governor's veto pending.
- Oct 6Vetoed by Governor Gavin Newsom.Major
- Sep 9Enrolled and presented to the Governor at 3 p.m.To Governor
- Sep 3Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 76. Noes 1. Page 2859.).Major
- Vote recorded AB 574 Mark González Concurrence in Senate Amendments. Result: pass.Lower
- Sep 2In Assembly. Concurrence in Senate amendments pending.
- Vote recorded 3rd Reading AB574 Mark González et al. By Wiener. Result: pass.Upper
- Sep 2Read third time. Passed. Ordered to the Assembly. (Ayes 39. Noes 0. Page 2388.).Passed Senate
- Jul 1Read second time. Ordered to third reading.Minor
- Jun 30From committee: Be ordered to second reading pursuant to Senate Rule 28.8.Minor
- Jun 16Read second time and amended. Re-referred to Com. on APPR.Major
- Jun 13From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 7. Noes 0.) (June 11).Major
- Jun 11
- Vote recorded Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations]. Result: pass.Upper
- May 21Referred to Com. on HEALTH.Minor
- May 13In Senate. Read first time. To Com. on RLS. for assignment.Minor
- May 12Read third time. Passed. Ordered to the Senate. (Ayes 73. Noes 1. Page 1511.)Passed Assembly
- Vote recorded AB 574 Mark González Assembly Third Reading. Result: pass.Lower
- May 1Read second time. Ordered to third reading.Minor
- Apr 30From committee: Do pass. (Ayes 14. Noes 0.) (April 30).Minor
- Vote recorded Do pass. Result: pass.Lower
- Apr 23From committee: Do pass and re-refer to Com. on APPR. (Ayes 16. Noes 0.) (April 22). Re-referred to Com. on APPR.Minor
- Apr 22
- Vote recorded Do pass and be re-referred to the Committee on [Appropriations]. Result: pass.Lower
- Mar 11Re-referred to Com. on HEALTH.Minor
- Mar 10From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended.Major
- Mar 10Referred to Com. on HEALTH.Minor
- Feb 13From printer. May be heard in committee March 15.
- Feb 12Read first time. To print.Introduced