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AB 574 would let patients start up to 12 physical‑therapy sessions without prior authorization, proponents say
Summary
The bill would require health plans to allow up to 12 initial medically necessary physical‑therapy visits without prior authorization (excluding Medi‑Cal managed care). Supporters said prior‑auth delays harm recovery and increase costs; insurers warned the change removes an important clinical‑review safeguard.
Assemblymember Gonzales presented AB 574, which would allow patients to begin up to 12 medically necessary physical‑therapy sessions without prior authorization from their health plans (the author said the bill does not apply to Medi‑Cal managed care plans). Gonzales described the bill as a response to delays created by prior authorization requirements and gave a personal account involving her mother’s post‑stroke care.
Dr. Oscar Gallardo, a doctor of physical therapy with the Los Angeles County Department of Health Services, said administrative interruptions often force patients to stop and restart therapy, which can cause permanent setbacks. “This stop start cycle is essentially damaging for patients with neurological conditions,” Gallardo testified, saying interruptions can lead to complications and readmissions.
Dr. Rick Katz, president of the California Physical Therapy Association, presented data and argued that early, uninterrupted physical therapy reduces downstream costs and improves outcomes. He said algorithms or insurer automated reviews often authorize fewer visits than clinician review; Katz cited analyses showing clinicians typically authorize 12 visits when consulted.
Opposition testimony came from insurance trade groups. Stephanie Watkins of the Association of California Life and Health Insurance Companies said prior authorization ensures services are medically necessary and adherent to evidence‑based guidelines and that AB 574 would undermine that process. Olga Shiloh of the California Association of Health Plans echoed concerns that prior authorization helps ensure safety, quality and affordability.
Committee action: The committee moved AB 574 as amended and referred it to Appropriations; roll calls recorded the item as advanced during the hearing. Members noted this measure intersects with broader efforts to reform prior authorization and that stakeholders continue talks on a broader, systemic approach.
Context: Supporters framed AB 574 as a targeted patient‑safety and access bill; opponents said the measure removes an insurer review that protects patients and controls costs. The author and stakeholders indicated they would continue negotiations as the bill moves through the process.
