SB 914: Workers’ compensation: medical provider networks: independent medical reviews.
- Session Year: 2015-2016
- House: Senate
- Latest Version Date: 2016-07-22
Existing law establishes a workers compensation system, administered by the Administrative Director of the Division of Workers Compensation, to compensate an employee for injuries sustained in the course of his or her employment. Existing law authorizes an insurer, employer, or entity that provides physician network services to establish or modify a medical provider network for the provision of medical treatment to injured employees, and requires the administrative director to contract with individual physicians or an independent medical review organization to perform medical provider network independent medical reviews. Existing law provides that if a treatment or diagnostic service remains disputed after a 3rd physicians opinion, the injured employee may request a medical provider network independent medical review. Existing law requires the review to use standards established in statute or use the American College of Occupational and Environmental Medicines Occupational Medicine Practice Guidelines.
This bill would delete the authorization to use the American College of Occupational and Environmental Medicines Occupational Medicine Practice Guidelines as standards for those independent medical reviews. The bill would make additional technical, nonsubstantive changes.
Existing law establishes a workers compensation system, administered by the Administrative Director of the Division of Workers Compensation, to compensate an employee for injuries sustained in the course of his or her employment. Existing law authorizes an insurer, employer, or entity that provides physician network services to establish or modify a medical provider network for the provision of medical treatment to injured employees, and requires the administrative director to contract with individual physicians or an independent medical review organization to perform medical provider network independent medical reviews. Existing law provides that if a treatment or diagnostic service remains disputed after a 3rd physicians opinion, the injured employee may request a medical provider network independent medical review. Existing law requires the review to use standards established in statute or use the American College of Occupational and Environmental Medicines Occupational Medicine Practice Guidelines.
This bill would delete the authorization to use the American College of Occupational and Environmental Medicines Occupational Medicine Practice Guidelines as standards for those independent medical reviews. The bill would make additional technical, nonsubstantive changes.
Existing law establishes a workers compensation system, administered by the Administrative Director of the Division of Workers Compensation, to compensate an employee for injuries sustained in the course of his or her employment. Existing law authorizes an insurer, employer, or entity that provides physician network services to establish or modify a medical provider network for the provision of medical treatment to injured employees, and requires the administrative director to contract with individual physicians or an independent medical review organization to perform medical provider network independent medical reviews. Existing law provides that if a treatment or diagnostic service remains disputed after a 3rd physicians opinion, the injured employee may request a medical provider network independent medical review. Existing law requires the review to use standards established in statute or use the American College of Occupational and Environmental Medicines Occupational Medicine Practice Guidelines.
This bill would delete the authorization to use the American College of Occupational and Environmental Medicines Occupational Medicine Practice Guidelines as standards for those independent medical reviews. The bill would make additional technical, nonsubstantive changes.
(a)(1)The administrative director shall contract with individual physicians, as described in paragraph (2), or an independent medical review organization to perform medical provider network (MPN) independent medical reviews pursuant to this section.
(2)Only a physician licensed pursuant to Chapter 5 (commencing with Section 2000) of the Business and Professions Code may be an MPN independent medical reviewer.
(3)The administrative director shall ensure that an MPN independent medical reviewer or those within the review organization shall do all of the following:
(A)Be appropriately credentialed and privileged.
(B)Ensure that the reviews provided by the medical professionals are timely, clear, and credible, and that reviews are monitored for quality on an ongoing basis.
(C)Ensure that the method of selecting medical professionals for individual cases achieves a fair and impartial panel of medical professionals who are qualified to render recommendations regarding the clinical conditions consistent with the medical utilization schedule established pursuant to Section 5307.27.
(D)Ensure that confidentiality of medical records and the review materials, consistent with the requirements of this section and applicable state and federal law.
(E)Ensure the independence of the medical professionals retained to perform the reviews through conflict-of-interest policies and prohibitions, and ensure adequate screening for conflicts of interest.
(4)A medical professional selected by the administrative director or the independent medical review organization to review medical treatment decisions shall be a physician, as specified in paragraph (2) of subdivision (a), who meets the following minimum requirements:
(A)The medical professional shall be a clinician knowledgeable in the treatment of the employees medical condition, knowledgeable about the proposed treatment, and familiar with guidelines and protocols in the area of treatment under review.
(B)Notwithstanding any other law, the medical professional shall hold a nonrestricted license in any state of the United States, and for a physician, a current certification by a recognized American medical specialty board in the area or areas appropriate to the condition or treatment under review.
(C)The medical professional shall have no history of disciplinary action or sanctions, including, but not limited to, loss of staff privileges or participation restrictions taken or pending by any hospital, government, or regulatory body.
(b)If, after the third physicians opinion, the treatment or diagnostic service remains disputed, the injured employee may request an MPN independent medical review regarding the disputed treatment or diagnostic service still in dispute after the third physicians opinion in accordance with Section 4616.3. The standard to be utilized for an MPN independent medical review is identical to that contained in the medical treatment utilization schedule established in Section 5307.27.
(c)An application for an MPN independent medical review shall be submitted to the administrative director on a one-page form provided by the administrative director entitled MPN Independent Medical Review Application. The form shall contain a signed release from the injured employee, or a person authorized pursuant to law to act on behalf of the injured employee, authorizing the release of medical and treatment information. The injured employee may provide any relevant material or documentation with the application. The administrative director or the independent medical review organization shall assign the MPN independent medical reviewer.
(d)Following receipt of the application for an MPN independent medical review, the employer or insurer shall provide the MPN independent medical reviewer, assigned pursuant to subdivision (c), with all information that was considered in relation to the disputed treatment or diagnostic service, including both of the following:
(1)A copy of all correspondence from, and received by, any treating physician who provided a treatment or diagnostic service to the injured employee in connection with the injury.
(2)A complete and legible copy of all medical records and other information used by the physicians in making a decision regarding the disputed treatment or diagnostic service.
(e)Upon receipt of information and documents related to the application for an MPN independent medical review, the MPN independent medical reviewer shall conduct a physical examination of the injured employee at the employees discretion. The MPN independent medical reviewer may order any diagnostic tests necessary to make his or her determination regarding medical treatment. Utilizing the medical treatment utilization schedule established pursuant to Section 5307.27, and taking into account any reports and information provided, the MPN independent medical reviewer shall determine whether the disputed health care service was consistent with Section 5307.27 based on the specific medical needs of the injured employee.
(f)The MPN independent medical reviewer shall issue a report to the administrative director, in writing, and in laypersons terms to the maximum extent practicable, containing his or her analysis and determination whether the disputed health care service was consistent with the medical treatment utilization schedule established pursuant to Section 5307.27, within 30 days of the examination of the injured employee, or within less time as prescribed by the administrative director. If the disputed health care service has not been provided and the MPN independent medical reviewer certifies in writing that an imminent and serious threat to the health of the injured employee may exist, including, but not limited to, serious pain, the potential loss of life, limb, or major bodily function, or the immediate and serious deterioration of the injured employee, the report shall be expedited and rendered within three days of the examination by the MPN independent medical reviewer. Subject to the approval of the administrative director, the deadlines for analyses and determinations involving both regular and expedited reviews may be extended by the administrative director for up to three days in extraordinary circumstances or for good cause.
(g)The MPN independent medical reviewers analysis shall cite the injured employees medical condition, the relevant documents in the record, and the relevant findings associated with the documents or any other information submitted to the MPN independent medical reviewer in order to support the determination.
(h)The administrative director shall immediately adopt the determination of the MPN independent medical reviewer, and shall promptly issue a written decision to the parties.
(i)If the determination of the MPN independent medical reviewer finds that the disputed treatment or diagnostic service is consistent with Section 5307.27, the injured employee may seek the disputed treatment or diagnostic service from a physician of his or her choice from within or outside the medical provider network. Treatment outside the medical provider network shall be provided consistent with Section 5307.27. The employer shall be liable for the cost of any approved medical treatment in accordance with Section 5307.1 or 5307.11.
(a)(1)The administrative director shall contract with individual physicians, as described in paragraph (2), or an independent medical review organization to perform medical provider network (MPN) independent medical reviews pursuant to this section.
(2)Only a physician licensed pursuant to Chapter 5 (commencing with Section 2000) of the Business and Professions Code may be an MPN independent medical reviewer.
(3)The administrative director shall ensure that an MPN independent medical reviewer or those within the review organization shall do all of the following:
(A)Be appropriately credentialed and privileged.
(B)Ensure that the reviews provided by the medical professionals are timely, clear, and credible, and that reviews are monitored for quality on an ongoing basis.
(C)Ensure that the method of selecting medical professionals for individual cases achieves a fair and impartial panel of medical professionals who are qualified to render recommendations regarding the clinical conditions consistent with the medical utilization schedule established pursuant to Section 5307.27.
(D)Ensure that confidentiality of medical records and the review materials, consistent with the requirements of this section and applicable state and federal law.
(E)Ensure the independence of the medical professionals retained to perform the reviews through conflict-of-interest policies and prohibitions, and ensure adequate screening for conflicts of interest.
(4)A medical professional selected by the administrative director or the independent medical review organization to review medical treatment decisions shall be a physician, as specified in paragraph (2) of subdivision (a), who meets the following minimum requirements:
(A)The medical professional shall be a clinician knowledgeable in the treatment of the employees medical condition, knowledgeable about the proposed treatment, and familiar with guidelines and protocols in the area of treatment under review.
(B)Notwithstanding any other law, the medical professional shall hold a nonrestricted license in any state of the United States, and for a physician, a current certification by a recognized American medical specialty board in the area or areas appropriate to the condition or treatment under review.
(C)The medical professional shall have no history of disciplinary action or sanctions, including, but not limited to, loss of staff privileges or participation restrictions taken or pending by any hospital, government, or regulatory body.
(b)If, after the third physicians opinion, the treatment or diagnostic service remains disputed, the injured employee may request an MPN independent medical review regarding the disputed treatment or diagnostic service still in dispute after the third physicians opinion in accordance with Section 4616.3. The standard to be utilized for an MPN independent medical review is identical to that contained in the medical treatment utilization schedule established in Section 5307.27.
(c)An application for an MPN independent medical review shall be submitted to the administrative director on a one-page form provided by the administrative director entitled MPN Independent Medical Review Application. The form shall contain a signed release from the injured employee, or a person authorized pursuant to law to act on behalf of the injured employee, authorizing the release of medical and treatment information. The injured employee may provide any relevant material or documentation with the application. The administrative director or the independent medical review organization shall assign the MPN independent medical reviewer.
(d)Following receipt of the application for an MPN independent medical review, the employer or insurer shall provide the MPN independent medical reviewer, assigned pursuant to subdivision (c), with all information that was considered in relation to the disputed treatment or diagnostic service, including both of the following:
(1)A copy of all correspondence from, and received by, any treating physician who provided a treatment or diagnostic service to the injured employee in connection with the injury.
(2)A complete and legible copy of all medical records and other information used by the physicians in making a decision regarding the disputed treatment or diagnostic service.
(e)Upon receipt of information and documents related to the application for an MPN independent medical review, the MPN independent medical reviewer shall conduct a physical examination of the injured employee at the employees discretion. The MPN independent medical reviewer may order any diagnostic tests necessary to make his or her determination regarding medical treatment. Utilizing the medical treatment utilization schedule established pursuant to Section 5307.27, and taking into account any reports and information provided, the MPN independent medical reviewer shall determine whether the disputed health care service was consistent with Section 5307.27 based on the specific medical needs of the injured employee.
(f)The MPN independent medical reviewer shall issue a report to the administrative director, in writing, and in laypersons terms to the maximum extent practicable, containing his or her analysis and determination whether the disputed health care service was consistent with the medical treatment utilization schedule established pursuant to Section 5307.27, within 30 days of the examination of the injured employee, or within less time as prescribed by the administrative director. If the disputed health care service has not been provided and the MPN independent medical reviewer certifies in writing that an imminent and serious threat to the health of the injured employee may exist, including, but not limited to, serious pain, the potential loss of life, limb, or major bodily function, or the immediate and serious deterioration of the injured employee, the report shall be expedited and rendered within three days of the examination by the MPN independent medical reviewer. Subject to the approval of the administrative director, the deadlines for analyses and determinations involving both regular and expedited reviews may be extended by the administrative director for up to three days in extraordinary circumstances or for good cause.
(g)The MPN independent medical reviewers analysis shall cite the injured employees medical condition, the relevant documents in the record, and the relevant findings associated with the documents or any other information submitted to the MPN independent medical reviewer in order to support the determination.
(h)The administrative director shall immediately adopt the determination of the MPN independent medical reviewer, and shall promptly issue a written decision to the parties.
(i)If the determination of the MPN independent medical reviewer finds that the disputed treatment or diagnostic service is consistent with Section 5307.27, the injured employee may seek the disputed treatment or diagnostic service from a physician of his or her choice from within or outside the medical provider network. Treatment outside the medical provider network shall be provided consistent with Section 5307.27. The employer shall be liable for the cost of any approved medical treatment in accordance with Section 5307.1 or 5307.11.
(a)(1)The administrative director shall contract with individual physicians, as described in paragraph (2), or an independent medical review organization to perform medical provider network (MPN) independent medical reviews pursuant to this section.
(2)Only physicians a physician licensed pursuant to Chapter 5 (commencing with Section 2000) of the Business and Professions Code may be an MPN independent medical reviewers. reviewer.
(3)The administrative director shall ensure that the an MPN independent medical reviewers reviewer or those within the review organization shall do all of the following:
(A)Be appropriately credentialed and privileged.
(B)Ensure that the reviews provided by the medical professionals are timely, clear, and credible, and that reviews are monitored for quality on an ongoing basis.
(C)Ensure that the method of selecting medical professionals for individual cases achieves a fair and impartial panel of medical professionals who are qualified to render recommendations regarding the clinical conditions consistent with the medical utilization schedule established pursuant to Section 5307.27.
(D)Ensure that confidentiality of medical records and the review materials, consistent with the requirements of this section and applicable state and federal law.
(E)Ensure the independence of the medical professionals retained to perform the reviews through conflict-of-interest policies and prohibitions, and ensure adequate screening for conflicts of interest.
(4)Medical professionals A medical professional selected by the administrative director or the independent medical review organization to review medical treatment decisions shall be physicians, a physician, as specified in paragraph (2) of subdivision (a), who meet meets the following minimum requirements:
(A)The medical professional shall be a clinician knowledgeable in the treatment of the employees medical condition, knowledgeable about the proposed treatment, and familiar with guidelines and protocols in the area of treatment under review.
(B)Notwithstanding any other law, the medical professional shall hold a nonrestricted license in any state of the United States, and for physicians, a physician, a current certification by a recognized American medical specialty board in the area or areas appropriate to the condition or treatment under review.
(C)The medical professional shall have no history of disciplinary action or sanctions, including, but not limited to, loss of staff privileges or participation restrictions taken or pending by any hospital, government, or regulatory body.
(b)If, after the third physicians opinion, the treatment or diagnostic service remains disputed, the injured employee may request an MPN independent medical review regarding the disputed treatment or diagnostic service still in dispute after the third physicians opinion in accordance with Section 4616.3. The standard to be utilized for an MPN independent medical review is identical to that contained in the medical treatment utilization schedule established in Section 5307.27, or the American College of Occupational and Environmental Medicines Occupational Medicine Practice Guidelines, as appropriate. 5307.27.
(c)Applications An application for an MPN independent medical review shall be submitted to the administrative director on a one-page form provided by the administrative director entitled MPN Independent Medical Review Application. The form shall contain a signed release from the injured employee, or a person authorized pursuant to law to act on behalf of the injured employee, authorizing the release of medical and treatment information. The injured employee may provide any relevant material or documentation with the application. The administrative director or the independent medical review organization shall assign the MPN independent medical reviewer.
(d)Following receipt of the application for an MPN independent medical review, the employer or insurer shall provide the MPN independent medical reviewer, assigned pursuant to subdivision (c), with all information that was considered in relation to the disputed treatment or diagnostic service, including both of the following:
(1)A copy of all correspondence from, and received by, any treating physician who provided a treatment or diagnostic service to the injured employee in connection with the injury.
(2)A complete and legible copy of all medical records and other information used by the physicians in making a decision regarding the disputed treatment or diagnostic service.
(e)Upon receipt of information and documents related to the application for an MPN independent medical review, the MPN independent medical reviewer shall conduct a physical examination of the injured employee at the employees discretion. The MPN independent medical reviewer may order any diagnostic tests necessary to make his or her determination regarding medical treatment. Utilizing the medical treatment utilization schedule established pursuant to Section 5307.27, or the American College of Occupational and Environmental Medicines Occupational Medicine Practice Guidelines, as appropriate, and taking into account any reports and information provided, the MPN independent medical reviewer shall determine whether the disputed health care service was consistent with Section 5307.27 or the American College of Occupational and Environmental Medicines Occupational Medicine Practice Guidelines based on the specific medical needs of the injured employee.
(f)The MPN independent medical reviewer shall issue a report to the administrative director, in writing, and in laypersons terms to the maximum extent practicable, containing his or her analysis and determination whether the disputed health care service was consistent with the medical treatment utilization schedule established pursuant to Section 5307.27, or the American College of Occupational and Environmental Medicines Occupational Medicine Practice Guidelines, as appropriate, within 30 days of the examination of the injured employee, or within less time as prescribed by the administrative director. If the disputed health care service has not been provided and the MPN independent medical reviewer certifies in writing that an imminent and serious threat to the health of the injured employee may exist, including, but not limited to, serious pain, the potential loss of life, limb, or major bodily function, or the immediate and serious deterioration of the injured employee, the report shall be expedited and rendered within three days of the examination by the MPN independent medical reviewer. Subject to the approval of the administrative director, the deadlines for analyses and determinations involving both regular and expedited reviews may be extended by the administrative director for up to three days in extraordinary circumstances or for good cause.
(g)The MPN independent medical reviewers analysis shall cite the injured employees medical condition, the relevant documents in the record, and the relevant findings associated with the documents or any other information submitted to the MPN independent medical reviewer in order to support the determination.
(h)The administrative director shall immediately adopt the determination of the MPN independent medical reviewer, and shall promptly issue a written decision to the parties.
(i)If the determination of the MPN independent medical reviewer finds that the disputed treatment or diagnostic service is consistent with Section 5307.27 or the American College of Occupational and Environmental Medicines Occupational Medicine Practice Guidelines, 5307.27, the injured employee may seek the disputed treatment or diagnostic service from a physician of his or her choice from within or outside the medical provider network. Treatment outside the medical provider network shall be provided consistent with Section 5307.27 or the American College of Occupational and Environmental Medicines Occupational Practice Guidelines. 5307.27. The employer shall be liable for the cost of any approved medical treatment in accordance with Section 5307.1 or 5307.11.
|
Date
|
Status
|
|---|---|
| Apr 11, 2016 | Read third time. Passed. (Ayes 36. Noes 0.) Ordered to the Assembly. |
| Jul 22, 2016 | Chaptered by Secretary of State. Chapter 84, Statutes of 2016. |
| Jul 22, 2016 | Approved by the Governor. |
| Jul 13, 2016 | Enrolled and presented to the Governor at 4 p.m. |
| Jun 30, 2016 | Read third time. Passed. (Ayes 79. Noes 0. Page 5598.) Ordered to the Senate. |
| Jun 30, 2016 | Read third time. Passed. Ordered to the Senate. |
| Jun 30, 2016 | In Senate. Ordered to engrossing and enrolling. |
| Jun 23, 2016 | Read second time. Ordered to consent calendar. |
| Jun 22, 2016 | From committee: Do pass. Ordered to consent calendar. (Ayes 13. Noes 0.) (June 22). |
| Apr 28, 2016 | Referred to Com. on INS. |
| Jan 26, 2016 | Introduced. Read first time. To Com. on RLS. for assignment. To print. |
| Apr 11, 2016 | Read third time. Passed. (Ayes 36. Noes 0. Page 3460.) Ordered to the Assembly. |
| Apr 11, 2016 | In Assembly. Read first time. Held at Desk. |
| Apr 7, 2016 | Read second time. Ordered to third reading. |
| Apr 6, 2016 | From committee: Do pass. (Ayes 4. Noes 0.) (April 6). |
| Apr 6, 2016 | From committee: Do pass. (Ayes 4. Noes 0. Page 3420.) (April 6). |
| Mar 18, 2016 | Set for hearing April 6. |
| Feb 4, 2016 | Referred to Com. on L. & I.R. |
| Jan 27, 2016 | From printer. May be acted upon on or after February 26. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Jun 30, 2016 | SB 914 Mendoza Consent Calendar Second Day Regular Session | Assembly Floor |
Passed |
|
| Jun 22, 2016 | Do pass. To Consent Calendar. | Assembly Standing Committee on Insurance |
Passed |
|
| Apr 11, 2016 | Senate 3rd Reading SB914 Mendoza | Senate Floor |
Passed |
|
| Apr 6, 2016 | Do pass | Senate Standing Committee on Labor and Industrial Relations |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| California Neurology Society | ** Support | Apr 11, 2016 |
| California Society Of Industrial Medicine And Surgery | ** Support | Apr 11, 2016 |
| California Society Of Physical Medicine And Rehabilitation | ** Support | Apr 11, 2016 |
Date of Hearing: June 22, 2016
ASSEMBLY COMMITTEE ON INSURANCE
Tom Daly, Chair
SBPCA Bill Id:SB 914
Author:(Mendoza) – As Introduced Ver:January 26, 2016
SENATE VOTE: 36-0
SUBJECT: Workers’ compensation: medical provider networks: independent medical reviews
SUMMARY: Repeals outdated references to certain medical treatment guidelines. Specifically, this bill deletes several references to the American College of Occupational and Environmental Medicine's (ACOEM) treatment guidelines from the Labor Code.
EXISTING LAW:
- Establishes a comprehensive system to provide benefits, including medical treatment, to employees who are injured or suffer conditions that arise out of or in the course of employment.
- Requires treatment to be evidence-based, as detailed in a Medical Treatment Utilization Schedule adopted and maintained by the Administrative Director (AD) of the Division of Workers’ Compensation (DWC).
- Required, subsequent to the 2004 workers’ compensation reforms, that the ACOEM guidelines be utilized when making medical treatment decisions, until such time as the AD adopted alternative guidelines.
- Continues to reference ACOEM despite the AD having adopted alternative guidelines.
FISCAL EFFECT: Undetermined; the bill is keyed non-fiscal by Legislative Counsel.
COMMENTS:
- Purpose. According to the author, the DWC has suggested that the Labor Code be cleaned up to reflect the fact that the references to ACOEM are no longer accurate, and could potentially be confusing. The bill is the author’s effort to accomplish this goal.
- Background. In 2004, the Legislature passed SB 899 (Poochigian), Chapter 34, Statutes of 2004, which was a major reform of the California workers’ compensation system. As a part of that reform, SB 899 required the DWC to create an evidence-based set of medical guidelines to ensure that injured workers were receiving consistent, appropriate treatment from physicians. In the intervening period, SB 899 required that physicians use the ACOEM guidelines, which are a set of widely-utilized evidence-based, peer reviewed medical guidelines that continue to be used in California’s workers’ compensation system and many other state workers’ compensation systems.
In 2009, the DWC promulgated the California-specific workers’ compensation system medical treatment guidelines known as the MTUS. The MTUS utilized many of the chapters that make up ACOEM, but also referenced additional guidelines or developed independent guidance on medical treatment. As such, while ACOEM is still used as a part of the MTUS, it no longer operates as a stand-alone guideline, and the references to it in the Labor Code can be confusing and cause practitioners to fail to refer to the MTUS.
REGISTERED SUPPORT / OPPOSITION:
Support
None received
Opposition
None received
Analysis Prepared by: Mark Rakich / INS. / (916) 319-2086
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB |
THIRD READING
Bill No: SB 914
:
SENATE LABOR & IND. REL. COMMITTEE: 4-0, 4/6/16
AYES: Mendoza, Stone, Leno, Mitchell
NO VOTE RECORDED: Jackson
DIGEST: This bill strikes an out-of-date reference to the American College of Occupational and Environmental Medicine’s Occupational Medicine’s Practice Guidelines in the California Labor Code.
Existing law:
- Establishes a workers’ compensation system that provides benefits to an employee who suffers from an injury or illness that arises out of and in the course of employment, irrespective of fault. This system requires all employers to secure payment of benefits by either securing the consent of the Department of Industrial Relations to self-insure or by securing insurance against liability from an insurance company duly authorized by the state.
- Provides that medical, surgical, chiropractic, acupuncture, and hospital treatment, including nursing, medicines, medical and surgical supplies, crutches, and apparatuses, including orthotic and prosthetic devices and services, that is reasonably required to cure or relieve the injured worker from the effects of his or her injury shall be provided by the employer. (Labor Code §4600)
- Provides that the Administrative Director must adopt, after public hearings, a medical treatment utilization schedule, that shall incorporate the evidence-based, peer-reviewed, nationally recognized standards of care and must address, at a minimum, the frequency, duration, intensity, and appropriateness of all treatment procedures and modalities commonly performed in workers’ compensation cases. (Labor Code §5307.27)
This bill:
- Strikes an out-of-date reference to the American College of Occupational and Environmental Medicine’s Occupational Medicine Practice Guidelines.
- Makes additional minor and technical changes to existing law.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
California Neurology Society
California Society of Industrial Medicine and Surgery
California Society of Physical Medicine and Rehabilitation
None received
ARGUMENTS IN SUPPORT: The author notes that the Medical Treatment Utilization Schedule (MTUS) was created in 2009, and since that time has been the sole medical guideline for medical treatment in the California workers’ compensation system. Despite this, some out-of-date Labor Code sections continue to reference the predecessor American College of Occupational Medicine’s Medicine Practice Guidelines (ACOEM). SB 914 would strike these out-of-date references, ensuring that existing law accurately reflects the status of the MTUS as the sole medical guideline, reducing confusion and increasing the clarity of existing law.
4/8/16 14:09:28
**** END ****
SENATE COMMITTEE ON LABOR AND INDUSTRIAL RELATIONS
Senator Tony Mendoza, Chair
2015 - 2016 Regular
Bill No: SB 914 Hearing Date: April 6, 2016
Author: | Mendoza | ||
Version: | January 26, 2016 | ||
Urgency: | No | Fiscal: | No |
Consultant: | Gideon Baum | ||
Subject: Workers’ compensation: medical provider networks: independent medical reviews
KEY ISSUE
Should the Legislature strike an out-of-date reference to the American College of Occupational and Environmental Medicine’s Occupational Medicine’s Practice Guidelines in the California Labor Code?
ANALYSIS
Existing law establishes a workers’ compensation system that provides benefits to an employee who suffers from an injury or illness that arises out of and in the course of employment, irrespective of fault. This system requires all employers to secure payment of benefits by either securing the consent of the Department of Industrial Relations to self-insure or by securing insurance against liability from an insurance company duly authorized by the state.
Existing law provides that medical, surgical, chiropractic, acupuncture, and hospital treatment, including nursing, medicines, medical and surgical supplies, crutches, and apparatuses, including orthotic and prosthetic devices and services, that is reasonably required to cure or relieve the injured worker from the effects of his or her injury shall be provided by the employer.
(Labor Code §4600)
Existing law provides that the Administrative Director must adopt, after public hearings, a medical treatment utilization schedule (MTUS), that shall incorporate the evidence-based, peer-reviewed, nationally recognized standards of care and must address, at a minimum, the frequency, duration, intensity, and appropriateness of all treatment procedures and modalities commonly performed in workers’ compensation cases. (Labor Code §5307.27)
This bill strikes an out-of-date reference to the American College of Occupational and Environmental Medicine’s Occupational Medicine Practice Guidelines.
This bill also makes additional minor and technical changes to existing law.
COMMENTS
1. Need for this bill?
In 2004, the Legislature passed SB 899 (Poochigian), Chapter 34, Statutes of 2004, which was a holistic reform of the California workers’ compensation system. As a part of that reform, SB 899 required that the Division of Workers’ Compensation (DWC) create an evidence-based set of medical guidelines to ensure that injured workers were receiving consistent, appropriate treatment from physicians. In the intervening period, SB 899 required that physicians use the American College of Occupational Medicine’s Medicine Practice Guidelines (ACOEM), which are a set of widely-utilized evidence-based, peer reviewed medical guidelines that continue to be used in California’s workers’ compensation system and many other state workers’ compensation systems.
In 2009, the DWC promulgated the California-specific workers’ compensation system medical treatment guidelines. Known as the Medical Treatment Utilization Schedule (MTUS), the guidelines utilized many of the chapters that make up ACOEM, but also referenced additional guidelines or developed independent guidance on medical treatment. As such, while ACOEM is still used as a part of the MTUS, it is no longer referred to as a stand-alone guideline.
SB 914 would strike references to the use of ACOEM as a stand-alone medical guideline.
2. Proponent Arguments:
The author notes that the Medical Treatment Utilization Schedule (MTUS) was created in 2009, and since that time has been the sole medical guideline for medical treatment in the California workers’ compensation system. Despite this, some out-of-date Labor Code sections continue to reference the predecessor American College of Occupational Medicine’s Medicine Practice Guidelines (ACOEM). SB 914 would strike these out-of-date references, ensuring that existing law accurately reflects the status of the MTUS as the sole medical guideline, reducing confusion and increasing the clarity of existing law.
3. Prior Legislation:
SB 542 (Mendoza), Chapter 542, Statutes of 2015, also struck out-of-date references to the ACOEM Medical Practice Guidelines.
SUPPORT
None on file.
OPPOSITION
None on file.
-- END --
Discussed in Hearing
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Bill Author
Bill Co-Author(s):