BILL ANALYSIS
AB 361
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ASSEMBLY THIRD READING
AB 361 (Lowenthal)
As Amended May 14, 2009
Majority vote
INSURANCE 10-0
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|Ayes:|Coto, Garrick, Blakeslee, | | |
| | | | |
| |Charles Calderon, Carter, | | |
| |Feuer, Hayashi, Nava, | | |
| |Niello, Torres | | |
|-----+--------------------------+-----+--------------------------|
| | | | |
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SUMMARY : Precludes an employer from refusing to pay for
workers' compensation medical treatment services if the employer
has approved those services prior to the time the medical
provider treated the claimant. Specifically, this bill :
1)Provides that, regardless of whether the employer has
established a medical provider network, an employer that
authorizes medical treatment cannot rescind or modify the
approval after the services are provided.
2)States that nothing in the above rules can be construed to
expand or alter the benefits available under, or the terms and
conditions of, any contract.
3)Specifies that the restriction on rescission or modification
does not impede medical provider network contracts, nor does
it impede an employer from transferring an employee into a
medical provider network.
EXISTING LAW :
1)Establishes a comprehensive system of workers' compensation
benefits for workers injured during employment, including
medical treatment benefits.
2)Prohibits, in the context of health insurance, a health plan
or insurer from rescinding or modifying an authorization for
medical services after the services are rendered.
AB 361
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FISCAL EFFECT : Undetermined
COMMENTS :
1)Purpose. The author introduced this bill at the request of
the California Chiropractic Association, which reports that
many of its members have experienced billing problems when
billing for services that had been previously approved by the
appropriate payor. While the problem in the market was raised
by chiropractors, the solution properly applies to any
workers' compensation medical treatment services that have
been properly pre-approved.
2)Related law. AB 1324 (De La Torre), Chapter 702, Statutes of
2007, established in the health insurance context the same
rule proposed here for the workers' compensation system. The
principles are the same: if the responsible party authorizes
a medical provider to treat a patient, then it is
inappropriate for that same party to decline to pay for the
treatment once it has been provided.
3)Employer concerns. Employers have expressed concerns to the
author and Assembly Insurance Committee staff that the bill
may have unintended consequences. The concern that was
expressed was that the language might unintentionally preclude
the employer from modifying or reversing its decision for
services not yet rendered. The author and the employer
community have agreed to have further discussions to refine
the language beyond the clarifying amendment that was adopted
in the Assembly Insurance Committee. The recent floor
amendments are a part of that process.
4)The recent floor amendments are intended to ensure that the
existing medical provider network arrangements are not
adversely impacted by the bill. However, these amendments are
not intended to allow the employer to use that fact that it
should have referred the employee to the medical provider
network if out of network services were actually performed
based on a prior approval.
Analysis Prepared by : Mark Rakich / INS. / (916) 319-2086
FN: 0000686
AB 361
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