BILL ANALYSIS Ó
SENATE COMMITTEE ON LABOR AND INDUSTRIAL RELATIONS
Senator Tony Mendoza, Chair
2015 - 2016 Regular
Bill No: AB 2503 Hearing Date: June 8,
2016
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|Author: |Obernolte |
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|Version: |April 19, 2016 |
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|Urgency: |No |Fiscal: |No |
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|Consultant:|Gideon Baum |
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Subject: Workers' compensation: utilization review
KEY ISSUE
Should the Legislature require that all physician requests for
medical treatment authorization (RFAs) be sent directly to the
claims administrator for the employer or insurer?
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 the Department of Industrial Relations to
self-insure or by securing insurance against liability from
an insurance company duly authorized by the state.
2) Provides that medical, surgical, chiropractic,
acupuncture, and hospital treatment, including nursing,
medicines, medical and surgical supplies, crutches, and
AB 2503 (Obernolte) Page 2
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apparatuses, including orthotic and prosthetic devices and
services, that is reasonably required to cure or relieve
the injured worker from the effects of his or her injury
shall be provided by the employer. (Labor Code §4600)
3) Requires that all employers create a utilization review
process, which is a process that prospectively,
retrospectively, or concurrently review and approve,
modify, delay, or deny, based in whole or in part on
medical necessity to cure and relieve, treatment
recommendations by physicians, prior to, retrospectively,
or concurrent with the provision of medical treatment
services. (Labor Code §4610)
4) Requires that each utilization review (UR) process shall
be governed by written policies and that these policies and
procedures, and a description of the utilization process,
must be filed with the administrative director and shall be
disclosed by the employer to employees, physicians, and the
public upon request. (Labor Code §4610(c))
This bill would require that all physician RFAs be sent directly
to the claims administrator for the employer or insurer.
COMMENTS
1. Need for this bill?
According to the author and sponsor, the silence in existing
law on where a physician should send a RFA is creating
difficulty for healthcare providers and is creating delays in
the provision of medical treatment. Specifically, AB 2503
would require that a RFA is submitted directly to a claims
administrator, rather than a UR vendor or some other third
party. In doing so, AB 2503 will make precisely clear where a
RFA should be submitted so that a request for medical
treatment can be timely assessed, avoiding unnecessary delays.
2. Proponent Arguments :
The sponsor of this bill, the California Orthopaedic
Association (COA), argues that existing law's silence on where
a physician should submit a request for authorization of
medical treatment has the potential to create great mischief.
AB 2503 (Obernolte) Page 3
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Specifically, COA notes that different employers/insurers have
different policies for where a RFA should be submitted, which
can lead to confusion for physicians. COA argues that, by
specifically stating where a RFA must be submitted, AB 2503
will minimize confusion and delays, leading to better medical
treatment for injured workers.
3. Opponent Arguments :
None on file.
4. Prior Legislation :
SB 228 (Alarcon), Chapter 639, Statutes of 2003, required
employers to implement a utilization review process.
SUPPORT
California Orthopaedic Association (Sponsor)
Police Officers Research Association of California
OPPOSITION
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