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AB 574

Relating to: verifying a voter’s change of address and registration status and removing ineligible voters from the official voter registration list. (FE)

2025-2026 Regular Session Introduced by Elijah Behnke and 9 co-sponsors

AB 574 limits prior authorization for physical therapy: no prior auth for the first 12 visits for a new condition, with upfront coverage, cost-sharing disclosures.

Fiscal estimate received
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WeVote Research Nonpartisan
Bill Summary · AB 574

AB 574 (González) — Prior authorization: physical therapy

Status: Introduced Feb 12, 2025. Fiscal estimate received. (As of 06/10/2025, the bill was in Senate Health.)
Subject: Health & Safety Code / Insurance Code — limits on prior authorization for physical therapy; provider disclosure and consent requirements.

Purpose / Intent

The bill seeks to reduce administrative barriers and delays that patients face when accessing physical therapy by limiting the circumstances in which health plans and insurers may require prior authorization for physical therapy, and by increasing transparency about coverage and patient financial responsibility.

Key provisions

  • Effective timing: Applies to health care service plan contracts and health insurance policies issued, amended, or renewed on or after January 1, 2027.
  • Prior authorization limits:
    • For a new condition: plans and insurers may NOT require prior authorization for the initial 12 physical therapy treatment visits.
    • For a recurring condition: plans/insurers may require prior authorization if the individual seeks care within 180 days of their last physical therapy intervention for that same condition.
  • Provider verification and disclosure (pre-treatment):
    • Physical therapy providers must verify the enrollee’s/insured’s coverage.
    • Providers must disclose the enrollee’s/insured’s cost-sharing, including the maximum out‑of‑pocket the enrollee/insured may be charged per visit if the plan/insurer denies coverage.
    • Providers must disclose whether they are out‑of‑network for the enrollee/insured’s plan/policy.
  • Written consent and cost estimate:
    • For care that may not be covered, providers must obtain a separate written consent including a written estimate of the cost the enrollee/insured would owe if coverage is denied or not applicable.
    • The consent and estimate must be provided in the enrollee’s/insured’s language if it is a Medi‑Cal threshold language (per Section 128552).
  • Scope and exemptions:
    • The Health & Safety Code provision does not apply to Medi‑Cal managed care plans that contract with the State Department of Health Care Services.
    • Cross‑references note existing protections (does not exempt certain noncontracting providers from other statutory requirements).
  • Enforcement / penalties:
    • The bill references that a willful violation by a health care service plan may constitute a crime under the Knox‑Keene Act; the measure is characterized as creating a state‑mandated local program but declares no state reimbursement required under Article XIII B procedures.

Who is affected

  • Health care service plans regulated under Knox‑Keene and health insurers issuing policies in California (for applicable contracts/policies on/after 1/1/2027).
  • Physical therapy providers (additional verification, disclosure, and consent obligations).
  • Patients/enrollees/insureds (reduced likelihood of prior‑authorization delays for initial PT care; improved disclosure of potential out‑of‑pocket costs).
  • Regulators (Department of Managed Health Care, Department of Insurance) for enforcement/oversight.

Potential impacts / considerations

  • Expected to reduce administrative delays and improve timely access to early physical therapy for new conditions.
  • May increase initial utilization of physical therapy services and shift some cost/authorization burden onto plans/insurers.
  • Adds compliance tasks for providers (verification and documented informed consent/estimates).
  • The Medi‑Cal managed care exemption preserves existing state contract arrangements; implications for self‑insured ERISA plans are not addressed in the bill text and may be subject to federal preemption considerations.

Timeline / procedural notes

  • Introduced Feb 12, 2025. Provisions take effect for contracts/policies issued/renewed/amended on or after Jan 1, 2027.
  • As of the latest provided documents (June 10, 2025), the bill had been considered by Assembly committees and was in Senate Health.

Compiled from official sources — confirm details with the bill’s official record.

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