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