BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 146|
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UNFINISHED BUSINESS
Bill No: SB 146
Author: Lara (D)
Amended: 6/13/13
Vote: 27 - Urgency
SENATE LABOR & INDUSTRIAL RELATIONS COMMITTEE : 4-0, 3/13/13
AYES: Lieu, Wyland, Leno, Lara
NO VOTE RECORDED: Padilla
SENATE FLOOR : 32-0, 3/18/13
AYES: Anderson, Beall, Berryhill, Block, Cannella, Corbett,
Correa, De León, DeSaulnier, Emmerson, Evans, Fuller, Gaines,
Galgiani, Hernandez, Hill, Huff, Knight, Lara, Leno, Lieu,
Liu, Monning, Nielsen, Pavley, Roth, Steinberg, Walters, Wolk,
Wright, Wyland, Yee
NO VOTE RECORDED: Calderon, Hancock, Jackson, Padilla, Price,
Vacancy, Vacancy, Vacancy
ASSEMBLY FLOOR : 36-30, 6/27/13 (FAIL) - See last page for vote
ASSEMBLY FLOOR : 73-0, 7/1/13 - See last page for vote
SUBJECT : Workers compensation: medical treatment: billing
SOURCE : CompPharma
DIGEST : This bill (1) provides that a copy of a prescription
for pharmaceutical services is not necessary unless the provider
of services has entered into a written agreement, as specified,
that requires a copy of the prescription for a pharmacy service;
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(2) allows an employer, pharmacy benefits manager, 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; and, (3) provides that any entity
submitting a pharmacy bill for payment, on or after January 1,
2013, and 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.
Assembly Amendments (1) change the date from 90 days after
January 1, 2014 to March 31, 2014 to resubmit pharmacy bills for
payment that was denied for failure to comply with specific
requirements, (2) add an urgency clause, and (3) make technical
and clarifying changes.
ANALYSIS :
Existing law:
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. This system requires all employers to
secure payment of benefits by either securing the consent of
the Department of Industrial Relations to self-insure or by
securing insurance against liability from an insurance
company duly authorized by the state.
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/her injury shall be provided by the
employer.
3. Requires that any provider of medical services, including
pharmacies, must submit its 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
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received.
This bill:
1. Provides that a copy of a prescription for pharmaceutical
services is not necessary unless the provider of services has
entered into a written agreement, as specified, that requires
a copy of the prescription for a pharmacy service.
2. Allows an employer, pharmacy benefits manager, 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 submitting a pharmacy bill for
payment, on or after January 1, 2013, and 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.
Background
SB 863 (DeLeon, Chapter 363, Statutes of 2012) created several
new requirements for medical service providers when seeking
reimbursement, including the submission of documents that
appropriate detail the services provided and the cost of those
services. This included the provision of a copy of a
prescription for pharmaceutical services. After the passage of
SB 863, several stakeholders reached out to the Legislature
regarding the challenges of this requirement. Specifically,
proponents note that there is no electronic method to transmit a
paper prescription, and that the use of paper prescriptions is
becoming increasingly rare. Additionally, some stakeholders
have noted that other states have used electronic prescriptions,
rather than paper prescriptions, as a method for combating
opioid abuse.
According to the Senate Labor and Industrial Relations Committee
analysis, this bill addresses these concerns by:
1. Prohibiting the requirement of a prescription for
pharmaceutical services by an employer, insurer, or
third-party claims administrator, unless required by a
written agreement between a specific pharmacy and an
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employer, insurer, or third-party claims administrator;
2. Allowing an employer, insurer, or third-party claims
administrator to request a copy of the prescription during a
review of records; and
3. Ensuring that any pharmacy that was denied payment due to the
non-provision of a prescription shall have until March 31,
2014 to resubmit the bill.
FISCAL EFFECT : Appropriation: No Fiscal Com.: No Local:
No
SUPPORT : (Verified 6/14/13)
CompPharma (source)
California Pharmacists Association
California Retailers Association
CVS/Caremark
Express Scripts Holding Company
Healthesystems
Modern Medical, Inc.
National Association of Chain Drug Stores
Pharmacy Management Services Inc.
Progressive Medical
StoneRiver Pharmacy Solutions
ARGUMENTS IN SUPPORT : Proponents argue that the requirement
of a copy of a prescription with a request for payment is both
unnecessary and an undue burden. Proponents note that the
Division of Workers Compensation's electronic billing standard
for pharmacy bills does not currently support the inclusion of
attachments, making pharmacy billers unable to comply.
Proponents also argue that a list of billed components provides
the same information as prescription for pharmaceutical drugs,
and that the requirement of a prescription may impact a
pharmacy's ability to fill workers' compensation prescriptions,
limiting access to medically necessary medication. Proponents
believe that this bill will address this issue and ensure access
to pharmaceutical products for injured workers.
ASSEMBLY FLOOR : 36-30, 6/27/13
AYES: Bigelow, Bocanegra, Bonta, Brown, Buchanan, Ian Calderon,
Chau, Chávez, Dahle, Donnelly, Fong, Beth Gaines, Gomez,
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Gonzalez, Gorell, Gray, Hall, Harkey, Jones-Sawyer, Linder,
Logue, Lowenthal, Mansoor, Melendez, Mitchell, Morrell,
Muratsuchi, Olsen, Pan, Patterson, V. Manuel Pérez, Stone,
Waldron, Weber, Williams, Yamada
NOES: Achadjian, Alejo, Ammiano, Atkins, Blumenfield, Bonilla,
Bradford, Cooley, Daly, Dickinson, Eggman, Fox, Frazier,
Garcia, Gatto, Gordon, Grove, Roger Hernández, Holden, Levine,
Medina, Nestande, Perea, Quirk, Quirk-Silva, Skinner, Wagner,
Wieckowski, Wilk, John A. Pérez
NO VOTE RECORDED: Allen, Bloom, Campos, Chesbro, Conway,
Hagman, Jones, Maienschein, Mullin, Nazarian, Rendon, Salas,
Ting, Vacancy
ASSEMBLY FLOOR : 73-0, 7/1/13
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Bigelow, Bloom,
Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian
Calderon, Campos, Chau, Chávez, Chesbro, Conway, Cooley,
Dahle, Daly, Dickinson, Donnelly, Eggman, Fong, Fox, Beth
Gaines, Garcia, Gatto, Gomez, Gonzalez, Gordon, Gorell, Gray,
Grove, Hagman, Harkey, Roger Hernández, Holden, Jones,
Jones-Sawyer, Levine, Linder, Lowenthal, Mansoor, Medina,
Melendez, Mitchell, Morrell, Mullin, Muratsuchi, Nazarian,
Nestande, Olsen, Pan, Patterson, Perea, V. Manuel Pérez,
Quirk, Quirk-Silva, Rendon, Salas, Skinner, Stone, Ting,
Wagner, Waldron, Weber, Wilk, Williams, Yamada, John A. Pérez
NO VOTE RECORDED: Frazier, Hall, Logue, Maienschein,
Wieckowski, Vacancy, Vacancy
PQ:k 7/2/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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