BILL ANALYSIS
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THIRD READING
Bill No: AB 933
Author: Fong (D)
Amended: 8/17/10 in Senate
Vote: 21
SENATE LAB. & INDUS. RELATIONS COMMITTEE : 4-1, 6/23/10
AYES: DeSaulnier, Ducheny, Leno, Yee
NOES: Hollingsworth
NO VOTE RECORDED: Wyland
SENATE APPROPRIATIONS COMMITTEE : 7-4, 8/12/10
AYES: Kehoe, Alquist, Corbett, Leno, Price, Wolk, Yee
NOES: Ashburn, Emmerson, Walters, Wyland
ASSEMBLY FLOOR : 49-30, 5/21/09 - See last page for vote
SUBJECT : Workers compensation: medical treatment
SOURCE : American Federation of State, County and
Municipal Employees, AFL-CIO
Union of American Physicians and Dentists
California Society of Industrial Medicine and
California Society of Physical Medicine and
Rehabilitation
DIGEST : This bill modifies workers compensation
requirements pertaining to licensed physicians who conduct
utilization review and requirements for approval of a
medical provider network.
CONTINUED
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ANALYSIS : Existing law establishes a workers'
compensation system, administered by the Administrative
Director (AD) of the Division of Workers' Compensation
(DWC), to compensate an employee for injuries that arise
out of, or in the course of, employment. Employers are
required to secure the payment of workers' compensation for
injuries incurred by their employees.
Existing law requires every employer to secure the payment
of workers' compensation either by being insured against
liability by one or more insurers duly authorized to write
compensation insurance in this state or by securing a
certificate of consent to self-insure from the Director of
Industrial Relations. Existing law requires an insurer,
with certain exceptions, to discuss all elements of a
workers' compensation claim file that affect the employer's
premium with the employer, and to supply copies of the
documents that affect the premium at the employer's expense
during reasonable business hours.
Existing law requires every employer to establish a medical
treatment utilization review (UR) process to determine
whether or not to approve medical treatment recommended by
a physician which must be based on the medical treatment
guidelines. Under existing law:
1. Every employer must establish a UR process, in
compliance with specified requirements, either directly
or through its insurer or an entity with which the
employer or insurer contracts for these services.
2. No person other than a licensed physician who is
competent to evaluate the specific clinical issues
involved in the medical treatment services (and where
these services are within the scope of the physician's
practice) requested by the physician may modify, delay,
or deny requests for authorization of medical treatment
for reasons of medical necessity to cure and relieve.
Existing law authorizes an employer or insurer to establish
or modify a medical provider network (MPN) for the
provision of medical treatment to injured employees, and to
submit a medical provider network plan to the
administrative director for approval. An MPN is an entity
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or group health care providers set up to treat workers
injured on the job. Under state regulations, each MPN must
include a mix of doctors specializing in work-related
injuries and doctors with expertise in general areas of
medicine. MPNs are required to meet access to care
standards for common occupational injuries and work-related
illnesses. The MPN program became effective January 1,
2005 and employees can be covered by an MPN once a plan has
been approved by the DWC administrative director.
This bill modifies workers' compensation requirements
pertaining to licensed physicians who conduct utilization
review and requirements for approval of a medical provider
network.
This bill requires physicians performing utilization
reviews in the workers' compensation process to be licensed
in California. This bill also modifies the definition of a
psychologist, for workers' compensation purposes, to
include only psychologists licensed in California.
Prior Legislation
AB 2969 (Lieber) of 2007-08 Session, this bill would have
prohibited utilization reviews by physicians not licensed
in California in order to ensure compliance with California
workers' compensation law. This bill was vetoed by the
Governor. In his veto message the Governor stated that,
"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."
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
SUPPORT : (Verified 8/17/10) (unable to reverify)
American Federation of State, County and Municipal
Employees, AFL-CIO (source)
Union of American Physicians and Dentists (co-source)
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California Society of Industrial Medicine and Surgery
(co-source)
California Society of Physical Medicine and Rehabilitation
(co-source)
Association for Los Angeles Deputy Sheriffs
California Applicants' Attorneys Association
California Chiropractic Association
California Labor Federation
California Medical Association
California Nurses Association/National Nurses Organizing
Committee
California Orthopaedic Association
California School Employees Association
California State Employees Association
International Chiropractors Association of California
Los Angeles Police Protective League
Los Angeles Probation Officers Union, Local 685
Medical Board of California
Parthenia Medical Group, Inc.
Peace Officers Research Association of California
Riverside Sheriffs' Association
U.S. Healthworks
Western Occupational and Environmental Medical Association
OPPOSITION : (Verified 8/17/10) (unable to reverify)
Alpha Fund
Association of California Insurance Companies - ACIC
Association of California Water Agencies
California Association of Joint Powers Authorities
California Chamber of Commerce
California Coalition on Workers' Compensation
California Special Districts Association
California State Association of Counties
CSAC EXCESS Insurance Authority [a Joint Powers Authority].
Department of Industrial Relations
League of California Cities
Regional Council of Rural Counties
ARGUMENTS IN SUPPORT : According to proponents, an
out-of-state UR entity may understand the application of
the ACOEM guidelines, but it is not always familiar with
all the aspects of California workers' compensation system
that are necessary. Proponents argue that effective and
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fair utilization review rests upon a physician
knowledgeable of the laws and regulations that govern that
particular state's workers' compensation system.
Proponents maintain 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 proponents believe this bill will improve
the situation (although it should be noted that an East
Coast-based physician can hold a California license).
Proponents also believe that having reviewing physicians
regulated by the Medical Board 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.
ARGUMENTS IN OPPOSITION : According to opponents,
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. Opponents state that there is no specific
knowledge that is unique to California-licensed physicians,
and to limit utilization reviews to these physicians would
only have the effect of limiting the number of available
reviewing physicians, which would drive up the cost.
Additionally, with regard to the new requirements for
re-certification of a Medical Provider Network, opponents
argue that MPN certification filings are quite complex and
it is unreasonable to require a signature under penalty of
perjury because simple mistakes could lead to criminal
prosecution. Opponents note that these new requirements
will only increase the cost of administering an MPN without
offering any additional value to injured workers.
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ASSEMBLY FLOOR :
AYES: Ammiano, Arambula, Beall, Block, Blumenfield,
Brownley, Buchanan, Caballero, Charles Calderon, Carter,
Chesbro, Coto, Davis, De La Torre, De Leon, Eng, Evans,
Feuer, Fong, Fuentes, Furutani, Galgiani, Hall, Hayashi,
Hernandez, Hill, Huffman, Jones, Krekorian, Lieu, Bonnie
Lowenthal, Ma, Mendoza, Monning, Nava, John A. Perez, V.
Manuel Perez, Portantino, Price, Ruskin, Salas, Skinner,
Solorio, Swanson, Torlakson, Torres, Torrico, Yamada,
Bass
NOES: Adams, Anderson, Bill Berryhill, Tom Berryhill,
Blakeslee, Conway, Cook, DeVore, Duvall, Emmerson,
Fletcher, Fuller, Gaines, Garrick, Gilmore, Hagman,
Harkey, Huber, Jeffries, Knight, Logue, Miller, Nestande,
Niello, Nielsen, Silva, Smyth, Audra Strickland, Tran,
Villines
NO VOTE RECORDED: Saldana
PQ:do 8/17/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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