CA AB1468

Requires health care service plans and health insurers implementing automated prior authorization systems to use evidence-based clinical guidelines and make algorithms available for download on provider websites.

Mandates that a licensed physician or qualified health care professional must personally review and make final decisions on authorization denials or modifications, rather than simply ratifying automated responses.

Prohibits prior authorization requirements for the first 12 treatment visits in a new episode of care for chiropractic services, physical therapy, occupational therapy, acupuncture and traditional medicine, speech language pathology, and auditory therapies for contracts and policies issued, amended, or renewed on or after January 1, 2022.

Defines "new episode of care" as treatment for a new or recurring condition when the patient has not been treated by the provider within the previous 90 days and is not currently undergoing active treatment.

Allows health plans and insurers to still require referrals or prescriptions for the specified services.