Plain English Breakdown
The official status indicates a veto; whether lawmakers overrode the veto is not confirmed in the provided text.
AB-574: Prior Authorization Rules for Physical Therapy
This vetoed bill would have stopped health plans from requiring approval before patients get their first 12 physical therapy visits for new conditions, while adding rules about cost disclosure.
What This Bill Does
- Prohibits prior authorization requirements for the initial 12 physical therapy treatment visits for a new condition on policies issued, amended, or renewed on or after January 1, 2027.
- Allows health plans to require prior authorization for recurring conditions as specified in the bill.
- Requires providers to verify patient coverage and disclose their share of the cost before care begins.
- Mandates that providers get separate written consent from patients if costs might not be covered, including a written estimate of those costs.
Who It Names or Affects
- Health care service plans regulated by the Department of Managed Health Care
- Health insurers regulated by the Department of Insurance
- Physical therapy providers in California
Terms To Know
- Prior authorization
- A rule requiring a patient to get approval from their insurance company before receiving medical treatment.
- New condition
- An injury or health issue that is not considered recurring under the bill's rules.
Limits and Unknowns
- The bill does not apply to Medi-Cal managed care plan contracts.
- The Governor vetoed this bill, so it did not become law unless lawmakers overrode the veto.
- Rules only apply to policies issued, amended, or renewed on or after January 1, 2027.