BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 2086|
|Office of Senate Floor Analyses | |
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THIRD READING
Bill No: AB 2086
Author: Cooley (D) and Mathis (R)
Amended: 8/1/16 in Senate
Vote: 27 - Urgency
SENATE LABOR & IND. REL. COMMITTEE: 4-0, 6/8/16
AYES: Mendoza, Stone, Leno, Mitchell
NO VOTE RECORDED: Jackson
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/11/16
AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen
ASSEMBLY FLOOR: 76-0, 4/28/16 (Consent) - See last page for
vote
SUBJECT: Workers compensation: neuropsychologists
SOURCE: California Society of Industrial Medicine and Surgery
DIGEST: This bill permits the Division of Workers Compensation
(DWC) 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,
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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)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.
For medical doctors or doctors of osteopathy, the applicant
must:
a) 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
b) Have successfully completed a residency training program
accredited by the Accreditation Council for Graduate
Medical Education (ACGME) or the osteopathic equivalent.
For psychologists, the applicant must:
a) Be board certified in clinical psychology by a board
recognized by the AD; or
b) 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
c) 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
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eight or more occasions prior to January 1, 1990.
(Labor Code §139.2)
This bill:
1)Contains legislative findings and declarations concerning the
role and importance of neuropsychologists in evaluating
permanent disability for injured workers who have experienced
brain trauma.
2)Clarifies that a physician and surgeon can be appointed as a
QME if he or she is either board certified by a specialty
board recognized by the American Board of Medical Specialties,
or completed a residency program accredited by ACGME.
3)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 or the American Osteopathic Association.
4)Permits the appointment of a clinical neuropsychologist as a
QME if:
a) The clinical neuropsychologist is by the American Board
of Clinical Neuropsychology, the American Board of
Professional Neuropsychology, or another organization
recognized by the AD.
b) The clinical neuropsychologist is licensed to practice
psychology in this state and 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, and has served
as an agreed medical evaluator in neuropsychology on five
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or more occasions.
5)Provides that the bill is an urgency measure, to take effect
immediately.
Comments
1)QMEs and Medical-Legal Disputes
As was noted above, 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
(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 2086 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.
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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 recognized 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 2086 returns the QME process to the prior status quo,
allowing clinical neuropsychologists to be appointed as QMEs.
Related/Prior Legislation
AB 1542 (Mathis) of 2015 was very similar to this bill, and it
was vetoed by Governor Brown. The Governor's veto message
stated:
This bill requires the Division of Worker's Compensation to
appoint qualified clinical neuropsychologists as Qualified
Medical Examiners.
This bill undermines the Division of Workers' Compensation's
authority to apply consistent standards when it determines
eligible medical specialties for the Qualified Medical
Evaluator panel. The Division is not in the position to
determine the validity of a physician's qualifications. That
power resides with the physician's licensing board. If the
Board of Psychology believes there is value in recognizing
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neuropsychology as a subspecialty, it should do so.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee, DIR would
incur minor and absorbable costs to develop new regulations.
However, DIR anticipates that this bill will result in unknown,
potentially significant costs to the workers' compensation
system as a consequence of an increase in requests for QME
panels.
SUPPORT: (Verified8/12/16)
California Society of Industrial Medicine and Surgery (source)
California Conference of Machinists
California Neurology Society
California Professional Firefighters
California Psychological Association
California School Employees Association
California Society of Industrial Medicine and Surgery
California Society of Physical Medicine and Rehabilitation
Voters Injured at Work
Western Occupational and Environmental Medical Association
OPPOSITION: (Verified8/12/16)
Department of Finance
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
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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 Finance (DOF) is
opposed to AB 2086, arguing that it infringes upon the authority
of the AD of the DWC to determine specialties within the
qualified medical evaluator process. DOF also notes the
Department recently amended its existing qualified medical
evaluator regulations, under which a clinical neuropsychologist
would continue to qualify as an appointed QME under the general
psychology category. Additionally, DOF argues that AB 2086 may
encourage attempts to include other specialties within the
qualified medical evaluation process, which could result in
additional costs to the workers' compensation system.
ASSEMBLY FLOOR: 76-0, 4/28/16
AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker,
Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke,
Calderon, Campos, Chang, Chau, Chiu, Chu, Cooley, Cooper,
Dababneh, Dahle, Dodd, Eggman, Frazier, Beth Gaines,
Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson,
Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Roger
Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey,
Levine, Linder, Lopez, Low, Maienschein, Mayes, McCarty,
Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell,
Patterson, Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago,
Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,
Wilk, Williams, Wood, Rendon
NO VOTE RECORDED: Chávez, Daly, Mathis, Olsen
Prepared by:Gideon L. Baum / L. & I.R. / (916) 651-1556
8/15/16 20:22:13
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