California Assembly Bill AB931

California 2023-2024 Regular Session

• Introduced: 2/14/23
• Refer: 2/23/23
• Report Pass: 4/12/23
• Refer: 4/12/23
• Report Pass: 4/26/23
• Engrossed: 5/1/23
• Refer: 5/2/23
• Refer: 5/10/23
• Report Pass: 6/14/23
• Refer: 6/15/23
• Refer: 6/26/23
• Report Pass: 9/1/23
• Enrolled: 9/11/23
• Vetoed: 10/7/23

Caption

Prior authorization: physical therapy.

Impact

The bill introduces significant changes to the way physical therapy is accessed, enhancing transparency and potentially improving health outcomes for patients. By removing prior authorization for the initial visits, patients can begin treatment more quickly and without the added stress of navigating bureaucratic hurdles. Furthermore, the requirement for providers to disclose potential costs upfront means that patients can make informed decisions about their healthcare, knowing their financial responsibilities ahead of time. The provisions do not apply to Medi-Cal managed care plan contracts, which may limit the bill's impact on low-income patients who rely on Medi-Cal for their health coverage.

Summary

Assembly Bill 931, introduced by Assembly Member Irwin, addresses the prior authorization requirements for physical therapy services in California. Set to take effect on January 1, 2025, the bill mandates that health care service plans and health insurance policies cannot impose prior authorization for the first twelve treatment visits for a new episode of care in physical therapy. This legislative measure aims to streamline access to necessary physical therapy services, thus reducing delays in treatment that can arise from cumbersome authorization processes. It also requires physical therapy providers to verify coverage and disclose cost-sharing information before treatment begins.

Sentiment

The sentiment surrounding AB 931 appears to be positive among healthcare advocates and patients who have experienced difficulties in obtaining timely treatment due to prior authorization policies. Supporters argue that the bill will promote greater accessibility to physical therapy and mitigate the barriers that have previously compromised patient care. However, there might be some apprehension among insurance companies and health care service plans regarding the potential increase in treatment costs due to unregulated access to physical therapy services without prior approvals.

Contention

Notable points of contention may arise regarding the implications of removing prior authorization. Critics question whether this approach could lead to overutilization of services and increased costs for insurers and taxpayers in the long run. Moreover, the act imposes criminal penalties on healthcare service plans for willful violations, which could create operational challenges as insurers adapt to the new requirements. The bill's intent to simplify processes and enhance care will have to balance with maintaining oversight to prevent potential abuses of the system.