Prior authorization: physical therapy.

The bill now covers health care service plans (Health and Safety Code) and health insurers (Insurance Code), not just hazardous waste facilities. It applies to contracts or policies issued, amended, or renewed on or after January 1, 2027.

The prior authorization prohibition does not apply to Medi-Cal managed care plan contracts with the State Department of Health Care Services.

Prohibits prior authorization for the initial 12 physical therapy treatment visits for a new episode of care. A 'new episode of care' is defined as treatment for a new or recurring condition where the patient has not been treated by that provider within the previous 90 days and is not currently undergoing active treatment.

Physical therapy providers must verify the patient's coverage before treatment, disclose cost sharing including maximum out-of-pocket per visit if coverage is denied, indicate whether they are in-network, and obtain separate written consent with a written cost estimate for any costs that may not be covered. Documents must be provided in the patient's spoken language if it is a Medi-Cal threshold language.

New legislative findings section identifies that computer-generated denials and visit limits below research-supported levels are interfering with timely care and creating confusion for patients about their coverage expectations.

Fiscal committee review changed from 'no' to 'yes' and state-mandated local program changed from 'no' to 'yes' because the bill creates a new crime (willful violation by a health care service plan).

The original hazardous waste change (fixing 'Any An application' to 'An application' in Section 25200.4) is retained but renumbered from Section 1 to Section 5.

The bill text was reformatted from a formal enrolled document (with page numbers, clerk/governor signature blocks, and chapter heading) into a web page layout that includes site navigation elements, bill status dates, and version history links. The underlying legislative language in all four sections is unchanged.

The entire hazardous waste provision (amendment to Section 25200.4 of the Health and Safety Code) was removed, which had required a nonsubstantive change to disclosure statement requirements for hazardous waste facility permits.

The bill's title and legislative digest were updated to remove all reference to hazardous waste, narrowing the bill to physical therapy prior authorization only.

A new exception was added in both the Health and Safety Code (Section 1367.26) and Insurance Code (Section 10123.75): for a recurring condition, plans and insurers may impose prior authorization if the individual seeks care within 180 days of their last physical therapy intervention for that condition.

Assembly Member Irwin and Senator Wiener were added as coauthors.

Fiscal committee designation changed from 'no' to 'yes' and state-mandated local program changed from 'no' to 'yes', reflecting the removal of the hazardous waste provision and its associated cost implications.