BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 2503|
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THIRD READING
Bill No: AB 2503
Author: Obernolte (R)
Amended: 8/29/16 in Senate
Vote: 21
SENATE LABOR & IND. REL. COMMITTEE: 4-0, 6/8/16
AYES: Mendoza, Stone, Leno, Mitchell
NO VOTE RECORDED: Jackson
ASSEMBLY FLOOR: 78-0, 5/12/16 (Consent) - See last page for
vote
SUBJECT: Workers compensation: utilization review
SOURCE: California Orthopaedic Association
DIGEST: This bill requires that all physician requests for
medical treatment authorization (RFAs) be sent directly to the
claims administrator for the employer or insurer.
Senate Floor Amendments of 8/29/16 double-joint the provisions
of this bill with SB 1160 (Mendoza).
ANALYSIS:
Existing law:
1)Establishes a workers' compensation system that provides
benefits to an employee who suffers from an injury or illness
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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 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:
1)Requires that all physician RFAs, with supporting
documentation, be sent directly to the claims administrator
for the employer or insurer, unless otherwise indicated by
rules promulgated by the administrative director.
2)Requires the administrative director to promulgate rules and
regulations to effectuate this bill.
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3)Contains double-jointing language with SB 1160 (Mendoza).
Comments
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 requires 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.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
SUPPORT: (Verified8/22/16)
California Orthopaedic Association (source)
Police Officers Research Association of California
OPPOSITION: (Verified 8/22/16)
None received
ARGUMENTS IN SUPPORT: 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. 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
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to better medical treatment for injured workers.
ASSEMBLY FLOOR: 78-0, 5/12/16
AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker,
Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Calderon,
Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper,
Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth Gaines,
Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson,
Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Roger
Hernández, Holden, Irwin, Jones, Kim, Lackey, Levine, Linder,
Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina,
Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen,
Patterson, Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago,
Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,
Wilk, Williams, Wood, Rendon
NO VOTE RECORDED: Burke, Jones-Sawyer
Prepared by:Gideon L. Baum / L. & I.R. / (916) 651-1556
8/30/16 19:57:04
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