California's Ban on Forfeited ABA Hours Is on Newsom's Desk Until September 30

AB 2233 would stop commercial health plans and insurers from using weekly caps that make unused authorized hours disappear. Medi-Cal plans are excluded. If the governor doesn't act by September 30, it becomes law anyway.

California's AB 2233 was presented to Governor Newsom on August 27. It amends the state's autism coverage mandate so that a health plan or insurer “shall not impose restrictions on the utilization of authorized treatment hours within the six-month authorization period, including weekly caps or limitations that result in the forfeiture of unused hours.” The Senate passed it 38-0 and the Assembly concurred 76-0.

The governor has until September 30. Under the state constitution, a bill he holds on September 1 that he doesn't return by September 30 “becomes a statute” without his signature. If enacted, it takes effect January 1, 2027.

The turn: it protects hours, but only documented ones

The bill doesn't make every authorized hour freely movable. Hours stay available “throughout the authorization period” only “if the use of the hours is reasonably consistent with the treatment plan and clinical guidelines, and is documented in the treatment plan and progress reports.” A make-up week that the plan and progress notes don't account for isn't covered by the new language.

It also leaves the existing section (g) untouched, so plans can still use case management, utilization review and prior authorization.

Who it reaches

  • Covered: health care service plans regulated under Knox-Keene (Health and Safety Code §1374.73) and health insurers (Insurance Code §10144.51).
  • Excluded: “A health care service plan contract in the Medi-Cal program,” and the insurance equivalent. Medi-Cal managed care is outside this bill.
  • Not reached by state law: self-funded employer plans, which state insurance mandates generally don't govern. Check each client's plan type.

The limits

This is still a bill. As of September 18 it had no chapter number and no veto message, and it wasn't on the governor's September 14 signing list. A veto ends it for this session. And the six-month period it refers to is the treatment-plan review cycle already in the mandate. It doesn't lengthen any plan's authorization.

What you must know or do

  • Billers: list your commercial clients whose authorizations carry a weekly hour cap, with the plan name and whether it's DMHC-regulated, CDI-regulated or self-funded. That's the population this bill would change.
  • Clinical directors: start documenting make-up sessions now. When a family cancels, the progress report should say which hours will be made up and why that fits the treatment plan. That's the documentation standard the bill writes in.
  • Owners: pull six months of cancellations for capped commercial clients and total the hours that expired unused. That's the revenue this bill puts back in play from January 1.
  • Check the governor's action after September 30 before changing any scheduling policy. The rule starts January 1, 2027, not on signature.