CA AB931

Prohibits health care service plans and health insurers from requiring prior authorization for the initial 12 treatment visits for a new episode of care in physical therapy for contracts issued, amended, or renewed on or after January 1, 2025.

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

Requires physical therapy providers to verify coverage and disclose cost-sharing details prior to treatment, including maximum out-of-pocket expenses and whether the provider is in-network.

Mandates providers obtain separate written consent with a written cost estimate for any services that may not be covered by the patient's plan or policy, with documents provided in Medi-Cal threshold languages when applicable.

Exempts Medi-Cal managed care plans from these requirements and clarifies the bill does not affect noncontracting health professionals at contracting facilities.