BILL ANALYSIS Ó
AB 2086
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GOVERNOR'S VETO
AB
2086 (Cooley and Mathis)
As Enrolled September 2, 2016
2/3 vote
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|ASSEMBLY: |76-0 |(April 28, |SENATE: |39-0 |(August 22, |
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|ASSEMBLY: |79-0 |(August 25, | | | |
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Original Committee Reference: INS.
SUMMARY: Provides a statutory authorization for
neuropsychologists to perform the services of a qualified
medical examiner (QME) in the workers' compensation system.
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The Senate amendments:
1)Delete the listing of the organizations that issue "board
certifications" to neuropsychologists, thereby qualifying the
practitioner to become a QME, and instead delegate to the
Administrative Director of the Division of Workers'
Compensation the responsibility to determine which certifying
organizations are acceptable for this purpose.
2)Make technical and conforming amendments.
EXISTING LAW:
1)Establishes a comprehensive system to provide workers'
compensation benefits to employees who suffer injuries or
conditions that arise out of or in the course of employment.
Benefits include medical care to cure and relieve the effects
of the injury or condition, temporary disability benefits for
injured employees who are unable to work during the period of
recovery, permanent disability benefits for injured employees
who suffer permanent disabilities as a consequence of the
injury or condition, among other benefits.
2)Provides for a formal system of administrative dispute
resolution for cases where the employer and employee are not
in agreement over any issue associated with the delivery of
workers' compensation benefits.
3)Provides for the appointment of a QME to evaluate the injured
employee whenever disputed medical-legal issues arise.
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4)Specifies the qualifications necessary for workers'
compensation physicians to be appointed as QMEs, including
with respect to physicians and surgeons, that they
successfully completed a residency program accredited by the
Accreditation Council for Graduate Medical Education (ACGME) -
the body recognized as the accrediting organization for
medical specialty training programs.
5)Authorized, until the adoption by the Division of Workers'
Compensation (DWC) of a regulation in 2015, neuropsychologists
to perform the function of a QME is appropriate brain trauma
cases.
6)Provides for agreed medical evaluators (AMEs), who perform
essentially the same functions as QMEs, but who are not
selected randomly from DWC-generated lists and instead are
selected by mutual agreement of the parties.
FISCAL EFFECT: Unknown
COMMENTS:
1)Purpose. According to the author, AB 2086 is necessary
because neuropsychologists provide valuable input in serious
brain injury cases in the workers' compensation system.
Neuropsychologists appointed as QMEs have been providing this
input in workers' compensation cases for 22 years until the
DWC's regulation was adopted in 2015. This bill is intended
to override the regulation, and reinstate the opportunity for
neuropsychologists to perform QME functions.
2)QME process. When a medical-legal dispute arises, a QME is
appointed to evaluate the injured employee. "Medical-legal"
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does not refer to whether or not a treatment at issue is
legally required. There is a separate medical treatment
dispute resolution process. "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 dispute on
an issue of this nature, 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 a neuropsychologist
is the expertise required, but only general psychologists are
on the QME lists, there is no guarantee that a person with the
proper expertise will be the QME. In that case, the
under-qualified QME will be forced, with additional expense
and delay, to "consult" with a neuropsychologist. No
stakeholder group involved in workers' compensation has
suggested that this would be a desirable result.
3)ACGME. Currently, ACGME is the accepted entity that accredits
medical specialty training programs, and as a consequence the
Labor Code refers to completion of ACGME-accredited programs
as a basis to qualify to perform QME functions. However, there
are practicing physicians and surgeons who completed their
residency prior to the establishment of ACGME in the early
1980's, and who could otherwise qualify as QMEs. The bill
also seeks to authorize the AD to accept as QMEs those
physicians who obtained their specialty training from a
predecessor accrediting organization.
4)Prior legislation. AB 1542 (Mathis and Cooley) of 2015 was
substantially similar to this bill, and was unanimously
approved by the Legislature. However, the Governor vetoed AB
1542.
GOVERNOR'S VETO MESSAGE:
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I am returning Assembly Bill 2086 without my signature.
This bill requires the Division of Worker's Compensation to
appoint qualified clinical neuropsychologists as Qualified
Medical Examiners (QMEs).
I have the same concerns with this bill as with its predecessor,
AB 1542, which I vetoed last year. The changes contemplated by
this bill relate to legal evaluations, not medical treatment of
injured workers as suggested by the declaratory text of the
measure. If enacted, the bill would create a unique lower
standard for a select group of providers with a direct financial
interest in being appointed as QMEs in California's workers'
compensation system.
In addition to increasing benefits and stabilizing costs, the
2013 workers' compensation reforms were intended to return
medical treatment decisions to doctors and reduce the excessive
litigation relating to medical treatment disputes. Treatment of
injuries by neuropsychologists where medically appropriate as
determined by injured workers' physicians will be unchanged by a
signature or veto of this measure. However, a signature would
be a step backwards in the ongoing efforts to reduce unnecessary
costs that do not benefit injured workers.
Analysis Prepared by:
Mark Rakich / INS. / (916) 319-2086 FN:
0005119
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