BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 1542| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: AB 1542 Author: Mathis (R) and Cooley (D) AmendedIntroduced:4/23/15 Vote: 27 - Urgency SENATE LABOR & IND. REL. COMMITTEE: 4-0, 8/24/15 AYES: Mendoza, Jackson, Leno, Mitchell NO VOTE RECORDED: Stone SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8 ASSEMBLY FLOOR: 79-0, 7/16/15 (Consent) - See last page for vote SUBJECT: Workers'compensation: neuropsychologists SOURCE: California Society of Industrial Medicine and Rehabilitation DIGEST: This bill permits the Division of Worker's Compensation to appoint qualified clinical neuropsychologists as Qualified Medical Examiners (QMEs). 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 AB 1542 Page 2 the Department of Industrial Relations to self-insure or by securing insurance against liability from an insurance company duly authorized by the state. 2)Requires that the administrative director (AD) appoints qualified medical evaluators (QMEs) in each of the respective specialties as required for the evaluation of medical-legal issues. In order to be appointed as a QME, the applicant must pass a written examination and meet additional requirements specific to each specialty. a) For medical doctors or doctors of osteopathy, the applicant must: i) Be board certified in a specialty by a board recognized by the AD and either the Medical Board of California or the Osteopathic Medical Board of California; or ii) Have successfully completed a residency training program accredited by the Accreditation Council for Graduate Medical Education (ACGME) or the osteopathic equivalent. b) For psychologists, the applicant must: i) Be board certified in clinical psychology by a board recognized by the AD; or ii) Hold a doctoral degree in psychology, or a doctoral degree deemed equivalent for licensure by the Board of Psychology from a university or professional school recognized by the AD and has not less than five years' postdoctoral experience in the diagnosis and treatment of emotional and mental disorders; or iii) Has not less than five years' postdoctoral experience in the diagnosis and treatment of emotional and mental disorders, and has served as an agreed medical evaluator on eight or more occasions prior to January 1, 1990. (Labor Code §139.2) This bill: 1)Permits a medical doctor to be appointed as a QME if his or her residency training program was certified by a predecessor to the ACGME. AB 1542 Page 3 2)Permits the appointment of a clinical neuropsychologist as a QME if: a) The clinical neuropsychologist is certified by the American Board of Clinical Neuropsychology, the American Board of Professional Neuropsychology, or another organization recognized by the AD, or was appointed as a qualified medical evaluator in neuropsychology before January 1, 2015; or b) The clinical neuropsychologist is licensed to practice psychology in this state who has a doctoral degree in psychology from an accredited university or college training program, has completed an internship or its equivalent in a clinically relevant area of professional psychology, and has at least two years of experience and specialized training, at least one year of which is at the post-doctoral level in the study and practice of clinical neuropsychology and related neurosciences under the supervision of a clinical neuropsychologist. 3)Provides that the bill is an urgency measure, to take effect immediately. Comments 1)QMEs and Medical-Legal Disputes: As was noted above, Qualified Medical Examiners (QMEs) are medical examiners who have taken an exam and met certain specific requirements that are authorized to conduct an evaluation of medical-legal issues. Medical-legal does NOT refer to if an injured worker will or will not receive medical treatment. Rather, medical-legal relates to the legal consequences of medical conditions, frequently the extent to which an injured employee's injuries or conditions are disabling, or whether the injuries or conditions have become permanent and stationary. When there is a medical-legal dispute, a party can request appointment of a QME. The requesting party specifies what sort of expertise is needed to resolve the dispute, and the DWC appoints a panel, from which a single QME is selected. If both parties can agree to a single medical examiner, than the agreed upon doctor, known as an Agreed Medical Evaluator AB 1542 Page 4 (AME), is used instead of the QME panel to resolve the Medical-legal issues. Until recently, Clinical Neuropsychologists were included as being eligible for selection as QMEs. Generally, Clinical Neuropsychologists were selected for their expertise in cases involving head trauma. For reasons discussed below, that is no longer the case. However, Clinical Neuropsychologists may still be selected as AMEs. 2)AB 1542 and Clinical Neuropsychologists as QMEs: According to the American Neuropsychiatric Association (ANPA), clinical neuropsychology is distinct from traditional psychology due to the focus on understanding brain function. The ANPA states: "A clinical neuropsychologist usually holds an advanced degree in clinical psychology (Ph.D., Psy.D.), and has completed a clinical internship and specialized post-doctoral training in clinical neuropsychology. What distinguishes a clinical neuropsychologist from other clinical psychologists is knowledge of the brain, including an understanding of areas such as neuroanatomy and neurological disease?. They use neuropsychological tests to assess cognitive deficits, and they are involved in the management, treatment and rehabilitation of cognitively impaired patients." As noted above, the DWC may only certify a psychologist if the psychologist is board certified by the Board of Psychology or a board recognize by the DWC. Currently, Clinical Neuropsychology is not a recognized specialty by the Board of Psychology. Despite this, the DWC recognized Clinical Neuropsychologists as QMEs until recent regulations removed Clinical Neurologists from the list of potential QMEs. While this decision brought the QME regulations in line with statute, it was met with disappointment from some stakeholders. AB 1542 returns the QME process to the prior status quo, allowing clinical neuropsychologists to be appointed as QMEs. FISCAL EFFECT: Appropriation: No Fiscal Com.:YesLocal: No AB 1542 Page 5 SUPPORT: (Verified8/24/15) California Society of Industrial Medicine and Rehabilitation (source) Brain Injury Coalition of California California Conference of Machinists California Neurology Society California Psychological Association California Society of Physical Medicine and Rehabilitation Californian Applicants' Attorney Association 2 individuals OPPOSITION: (Verified8/24/15) California Department of Industrial Relations ARGUMENTS IN SUPPORT: Proponents note that, until recently, clinical neuropsychologists were eligible for appointment as QMEs. Proponents further note that clinical neuropsychologists are trained in understanding neuro-diseases and neuro-anatomy, differentiating neuropsychologists from traditional psychologists. Proponents argue that neuropsychologists are needed to evaluate a number of serious head and brain injuries including penetrating brain injuries, anoxia/Hypoxia, Diffuse Axonal Injury, and Coup-contrecoup injuries. Proponents also argue that denying injured workers access to neuropsychologists as QMEs will require traditional psychologists serving as QMEs to contact clinical neuropsychologists in order to adequately perform their duties as a QME, creating unnecessary delay and cost for injured workers and employers. ARGUMENTS IN OPPOSITION: The Department of Industrial Relations (DIR) respectfully opposes AB 1542. Specifically, DIR AB 1542 Page 6 notes that it is the Administrative Director's policy to recognize only specialty boards that are recognized by one of the state's professional licensing boards, such as the California Board of Psychology, as licensing boards have the requisite professional background and expertise to evaluate and identify subspecialties as appropriate. DIR notes that the Administrative Director has proposed regulations on QMEs enacting this policy so as to be consistent across all disciplines. DIR also notes concern because the California Board of Psychology does not recognize neuropsychology as a subspecialty in psychology. As a result, DIR argues that AB 1542 would contravene the Division's proposal and would also undermine DWC's current policy of applying uniform criteria for QME specialty certification that meet professional standards accepted by the wider lay and professional communities. ASSEMBLY FLOOR: 79-0, 7/16/15 AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gray, Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins NO VOTE RECORDED: Gordon Prepared by:Gideon L. Baum / L. & I.R. / (916) 651-1556 8/31/15 22:14:42 **** END ****