BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 2780|
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THIRD READING
Bill No: AB 2780
Author: Solorio (D)
Amended: 8/19/10 in Senate
Vote: 27 - Urgency
PRIOR SENATE VOTES NOT RELEVANT
SENATE LABOR & INDUST. RELATIONS COMMITTEE : 6-0, 8/30/10
AYES: DeSaulnier, Wyland, Ducheny, Hollingsworth, Leno,
Yee
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : Not relevant
SUBJECT : Workers compensation: individually
identifiable
information
SOURCE : Author
DIGEST : This bill authorizes the Department of Health
Care Services to review individually identifiable
information relating to a Medi-Cal claim in order to
determine if this claim was actually a result of an 'on-the
job injury' that should have been paid by a workers'
compensation insurer rather than the Medi-Cal program.
ANALYSIS : Existing law establishes the Medi-Cal program,
administered by the Department of Health Care Services
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(DHCS), under which basic health care services are provided
to qualified low-income persons. Existing law provides
that when benefits are provided or will be provided to a
beneficiary under the Medi-Cal program because of an injury
for which another person or insurance carrier is liable,
the Director of DHCS may recover from that person or
carrier the reasonable value of benefits provided.
Existing law establishes a workers' compensation system,
administered by the Administrative Director of the Division
of Workers' Compensation (DWC), to compensate an employee
for injuries sustained in the course of his or her
employment. Existing law provides that a person or public
or private entity who is not a party to a claim for
workers' compensation benefits may not obtain individually
identifiable information, as defined, that is obtained or
maintained by the DWC of the Department of Industrial
Relations (DIR) on that claim, except as specified.
Existing law expresses the intent of the Legislature to
comply with federal law requiring that when a beneficiary
has other available health coverage or insurance, the
Medi-Cal Program shall be the payer of last resort.
(Section 14124.795 of the Welfare and Institutions Code)
Existing law requires DHCS to enter into contracts to
recover Medi-Cal costs that are payable as workers'
compensation claims, including matters on file with the
Workers' Compensation Appeals Board. (Section 14124.82 of
the Welfare and Institutions Code)
This bill authorizes DHCS to obtain and use individually
identifiable information from DIR for the purpose of
seeking recovery of Medi-Cal costs incurred by the state
for treatment provided to injured workers that should have
been incurred by employers and insurance carriers pursuant
to existing law governing workers' compensation claims.
Specifically, this bill:
1. Requires DIR to furnish individually identifiable
information to DHCS and allows DHCS to furnish the
information to its designated agent, provided that the
information is disclosed only for the purpose noted
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above.
2. Authorizes the Administrative Director of DWC to adopt
regulations solely for the purpose of governing access
by DHCS or its designated agents to individually
identifiable information.
3. Specifies that this authorization shall remain in effect
only until January 1, 2017, and as of that date is
repealed, unless a later enacted statue deletes or
extends that date.
Prior Legislation
AJR 42 (Solorio), Chapter 92, Statutes of 2010, requests
that the Congress and the President of the United States
enact the Medicare Secondary Payer Enhancement Act of 2010
which is designed to protect the Medicare Trust Fund and
ensure that Medicare pays only for medical expenses for
which it is responsible.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 8/30/10)
Health Management Systems
California Applicants Attorneys Association
CSAC Excess Insurance Authority
ARGUMENTS IN SUPPORT : According to the author, DHCS has
been able to recover millions for the State of California
by instituting a third party liability program which
recovers the cost of Medi-Cal claims that should have been
paid by private insurers or other government programs.
DHCS contracts with a private company, Health Management
Systems (HMS), to assist the department in these
recoveries. The author argues that, unfortunately, DHCS
currently does not have the ability to review workers'
compensation claims - unless they are being adjudicated -
to see if Medi-Cal claims should have been paid by a
workers' compensation insurer.
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The author states that typically when a Medi-Cal
beneficiary files a workers' compensation claim, Medi-Cal
has already paid for medical services associated with the
accident. The author argues that the only way for Medi-Cal
to recover funds that they should not have paid is to
access workers' compensation claims data to see if the
Medi-Cal patient was actually injured on the job. In
addition, proponents argue that currently, because only
denials are shared with third party liability programs,
only denied cases are worked. Proponents argue that having
access to the full DIR workers' compensation file,
including both accepted and denied claims, could save
millions.
According to the author, this bill authorizes DIR to share
workers' compensation claims data with DHCS and, thereby,
enhance the ability of DHCS to recover Medi-Cal costs that
should have been paid by a workers' compensation insurer.
PQ:mw 8/30/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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