BILL ANALYSIS �
SB 146
Page 1
SENATE THIRD READING
SB 146 (Lara)
As Amended June 13, 2013
2/3 vote. Urgency
SENATE VOTE :32-0
INSURANCE 13-0
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|Ayes:|Perea, Hagman, Bonilla, | | |
| |Bradford, Ian Calderon, | | |
| |Cooley, Frazier, | | |
| |Beth Gaines, Gonzalez, | | |
| |Mitchell, Nestande, | | |
| |Olsen, Wieckowski | | |
| | | | |
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SUMMARY : Repeals the requirement that a copy of a prescription
is a necessary element of a claim for reimbursement for a
medication provided to an injured worker. Specifically, this
bill :
1)Provides that a copy of a prescription for pharmaceutical
services is not necessary unless required under a written
agreement between an employer, insurer, or third-party claims
administrator and a pharmacy.
2)Allows an employer, insurer, or third-party claims
administrator to request a copy of the prescription during a
review of any records of prescription drugs dispensed by a
pharmacy.
3)Provides that any entity that submitted a pharmacy bill for
payment on or after January 1, 2013, and was denied payment
for not including a copy of the prescription from the treating
physician, shall have until March 31, 2014, to resubmit those
bills for payment.
4)Declares the bill to be an urgency measure, to take effect
immediately.
EXISTING LAW :
SB 146
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1)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.
2)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.
3)Requires that any provider of medical services, including
pharmacies, must submit, as a condition required to obtain
payment for services or supplies provided, a request for
payment with an itemization of services provided and the
charge for each service, a copy of all reports showing the
services performed, the prescription or referral from the
primary treating physician if the services were performed by a
person other than the primary treating physician, and any
evidence of authorization for the services that may have been
received.
FISCAL EFFECT : Unknown. This bill is keyed non-fiscal by the
Legislative Counsel.
COMMENTS :
1)Purpose . According to the author, the workers' compensation
reform enacted last year (SB 863 (De Le�n), Chapter 363,
Statutes of 2012) contained a provision that is unnecessary,
burdensome, and incompatible with the Division of Workers'
Compensation's (DWC) electronic billing standard for pharmacy
billings - which does not support attachments that would be
necessary to comply with the literal requirements of the new
statute (i.e., providing an actual copy of a prescription that
was issued electronically or telephonically). In the
administrative process implementing SB 863, pharmacy interests
sought a remedy to this problem, but the DWC (correctly)
concluded that the problem is statutory, and legislation is
required. This bill is designed to narrowly resolve this
problem.
2)Urgency clause . Proponents have provided the Assembly
SB 146
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Insurance Committee with records indicating that legitimate
pharmacy bills have been denied based solely on the failure of
the biller to comply with the statutory requirement that is
virtually impossible to comply with.
3)Denied bills . The bill allows a grace period (until March 31,
2014) during which a biller may re-submit a bill that was
denied for failure to comply with the specific requirement
that the bill is changing. This provision is necessary
because SB 863 also added a requirement that services be
billed within a short time frame after the services were
rendered. The March 31 date was adopted, consistent with the
earlier 90-day grace period, to allow time for providers to be
educated about the change in the law, and still have
reasonable time frames within which to re-submit previously
denied bills.
4)Contractual agreements . While not likely to be a common
practice, the bill allows a pharmacy provider to agree by
contract to provide information not mandated by law, but
desired by a payor, as a condition of obtaining payment.
Analysis Prepared by : Mark Rakich / INS. / (916) 319-2086
FN: 0001146