BILL ANALYSIS Ó
AB 2503
Page 1
Date of Hearing: May 4, 2016
ASSEMBLY COMMITTEE ON INSURANCE
Tom Daly, Chair
AB 2503
(Obernolte) - As Amended April 19, 2016
SUBJECT: Workers' compensation: utilization review
SUMMARY: Provides that, when an injured worker is referred to a
particular physician for treatment in the workers' compensation
system, any request for authorization of treatment submitted by
that physician shall be sent to the claims administrator for the
insurer or employer that referred the injured worker to that
physician.
EXISTING LAW:
1)Provides for a comprehensive system of employer-paid benefits
for employees who suffer injuries or conditions that arise out
of or occur in the course of employment, including medical
treatment to cure or relieve the injury or condition.
2)Requires each employer to establish, and file with the
Administrative Director (AD) of the Division of Workers'
Compensation (DWC) a utilization review (UR) process to be the
mechanism for evaluation of recommended treatment.
AB 2503
Page 2
3)Requires the UR procedure to have written policies and
procedures that ensure decisions on medical necessity are
based on the appropriate treatment guidelines, as provided by
law.
4)Specifies that only a qualified physician competent to
evaluate the specific clinical issues associated with a
treatment request may delay, modify, or deny a requested
treatment.
5)Provides for a standardized request for authorization (RFA)
form to be used by physicians when requesting treatment to be
authorized.
6)Requires UR organizations to respond to RFAs within specified
time frames, which vary depending on the urgency of the
requested treatment.
FISCAL EFFECT: Undetermined.
COMMENTS:
1)Purpose . According to the author, it is often difficult for
health care providers in the workers' compensation system to
obtain timely approval for treatment of injured workers
because it is difficult to know where to send RFAs. Whether
it is intentionally complex systems, or bureaucratic
inefficiency, physicians report that upon sending RFAs to what
appears to be the correct recipient, they are frequently
advised that the RFA and attendant medical materials must be
sent elsewhere. Further, the timeframes within which
responses from the UR entity must be provided do not begin to
run until the RFA is sent to the "correct" location. The bill
AB 2503
Page 3
is intended to clarify where the RFA and related materials
must be sent, so that the time frames specified in statute
will be more effective.
2)Support . According to the bill's sponsors, the California
Orthopaedic Association, the bill will reduce confusion in the
system, resulting in better communication, lower costs for
everyone, and more timely care for injured workers.
REGISTERED SUPPORT / OPPOSITION:
Support
California Orthopaedic Association
Peace Officers Research Association of California (PORAC)
Opposition
None received
Analysis Prepared by:Mark Rakich / INS. / (916) 319-2086
AB 2503
Page 4