BILL ANALYSIS
AB 933
Page 1
ASSEMBLY THIRD READING
AB 933 (Fong)
As Introduced February 26, 2009
Majority vote
INSURANCE 7-3
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|Ayes:|Coto, Charles Calderon, | | |
| |Carter, Feuer, Hayashi, | | |
| |Hill, Torres | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Garrick, Blakeslee, | | |
| |Niello | | |
| | | | |
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SUMMARY : Requires that a physician who is conducting
utilization review be licensed in California.
EXISTING LAW :
1)Provides for a comprehensive system of workers' compensation
benefits for workers injured on the job, including medical
benefits.
2)Requires medical treatment to be provided in most cases
consistent with the American College of Occupational and
Environmental Medicine (ACOEM) Guidelines.
3)Authorizes employers or insurers to conduct "utilization
review" of proposed medical treatment in order to determine
the appropriateness of that treatment and its compliance with
the applicable guidelines.
4)Specifies that "[n]o person other than a licensed physician
who is competent to evaluate the specific clinical issues
involved . . . may modify, delay or deny requests" for medical
treatment. By regulation, this has been interpreted to mean a
physician licensed in any state.
FISCAL EFFECT : Potentially increased costs to the state's
workers' compensation program. Potential cost increases if the
Medical Board of California (MBC) actually devotes resources to
AB 933
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investigating and disciplining California licensed physicians
who perform utilization review.
COMMENTS :
1)Purpose : Proponents of the bill believe that out-of-state
utilization review physicians are making inappropriate
decisions at least in part because there is no regulatory
structure to hold them accountable. The bill is intended to
ensure that there is a regulatory oversight body, MBC, that
can discipline a utilization physician in the event the
physician violates practice standards.
2)Support : Supporters offer several arguments in favor of the
bill. First, some argue that requiring a California license
will make it easier for the reviewing doctor and treating
doctor to communicate, thereby enhancing the chances of a
re-evaluation of any decision to deny or modify treatment
requests. Many treating physicians have complained about the
difficulty of communicating with reviewers three time zones
away, and supporters believe this bill will improve the
situation (although it should be noted that an East
Coast-based physician can hold a California license).
Supporters also believe that having reviewing physicians
regulated by the MBC will provide appropriate oversight and
quality control that is not available for non-California
licensed physicians. Supporters also point out that many
utilization review companies already employ only
California-licensed physicians, and assert that there is no
shortage of these physicians.
3)MBC authority and priorities : According to the MBC, a
decision to delay, modify or deny a medical treatment
constitutes the practice of medicine, and the MBC would have
jurisdiction over this act. However, the Business and
Professions Code (Section 2220.05) establishes an order of
priority for the use of the MBC resources, and the five listed
priorities do not include any language that would refer to
violations of professional standards in the conduct of
utilization review.
4)Do current regulations violate California statute ? Because
the MBC deems the performance of utilization review to be the
practice of medicine, and because the treatment at issue is to
AB 933
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be provided (in most cases) to a California resident, it can
be argued that by operation of the Medical Practice Act only a
California-licensed physician can lawfully perform the
utilization review function. The Administrative Director (AD)
of the Division of Workers' Compensation declined to adopt
this interpretation of the law when she adopted the
regulations to implement the utilization review statute.
5)Opposition : Opponents point out that utilization review was
one of the most important provisions for employers in the 2004
workers' compensation reform. They believe that this bill
undermines their ability to effectively conduct utilization
review, by causing delays and increasing costs. They argue
that the medical treatment issues are not unique to California
in law or practice, as the ACOEM Guidelines have been used in
many states for far longer than they have been used in
California. Thus, there is no reason to think that
non-California physicians are less able to review California
treatment, and some reason to expect out of state physicians
may be more experienced with the ACOEM Guidelines.
Opponents further argue that the requirement that the physician
be competent to evaluate the specific clinical issues involved
in the case is sufficient, and that there is no specific
knowledge that is unique to California-licensed physicians.
6)Prior legislation . AB 2969 (Lieber) of 2008 proposed the same
rule being proposed by this bill. AB 2969 was passed by the
Legislature, but vetoed by the Governor. The veto message
follows: "This bill would require a physician conducting
utilization review in the workers' compensation system to be
licensed in California. Such a requirement would be
inconsistent with how utilization review is conducted in other
areas of medicine in and not in line with best practices
nationwide. The proponents of this measure have not
demonstrated a need for this disparity in treatment."
Analysis Prepared by : Mark Rakich / INS. / (916) 319-2086
FN: 0000590