BILL ANALYSIS Ó
AB 2503
Page 1
(Without Reference to File)
CONCURRENCE IN SENATE AMENDMENTS
AB
2503 (Obernolte)
As Amended August 29, 2016
Majority vote
--------------------------------------------------------------------
|ASSEMBLY: |78-0 |(May 12, 2016) |SENATE: | 39-0 |(August 31, |
| | | | | |2016) |
| | | | | | |
| | | | | | |
--------------------------------------------------------------------
Original Committee Reference: INS.
SUMMARY: Requires a treating physician to file requests for
authorization of treatment with the appropriate entity, as set
forth in regulations to be adopted by the Administrative
Director (AD) of the Division of Workers' Compensation (DWC).
The Senate amendments add chaptering language and a requirement
that the AD adopt regulations.
EXISTING LAW:
AB 2503
Page 2
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.
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: Unknown.
COMMENTS: 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
AB 2503
Page 3
is sent to the "correct" location. The bill 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.
Analysis Prepared by:
Mark Rakich / INS. / (916) 319-2086 FN: 0005028