AB 2883, as amended, Committee on Insurance. Workers’ compensation: utilization review.
Existing law establishes a workers’ compensation system, administered by the Administrative Director of the Division of Workers’ Compensation, within the Department of Industrial Relations, to compensate an employee for injuries sustained in the course of his or her employment. Existing law requires every employer to establish a utilization review process, and defines “utilization review” as utilization review or utilization management functions 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 an injured worker from the effects of his or her injury, treatment recommendations by physicians, prior to, retrospectively, or concurrent with providing medical treatment services.
Existing law also establishes the Commission on Health and Safety and Workers’ Compensation in the department. Existing law directs the commission to conduct a continuing examination of the workers’ compensation system and of the state’s activities to prevent industrial injuries and occupational diseases. Existing law also authorizes the commission to conduct or contract for studies it deems necessary to carry out its responsibilities.
This bill would require the commission to conduct, or contract for the conduct of, a feasibility study regarding the extent to which physicians’ requests for authorization of medical treatment for injured employees may be processed using an entirely paperless system. The bill would provide that thebegin delete primaryend delete focus of the feasibility study shall be to determine whether the change to a paperless system would reduce the time required to provide medical treatment services to injuredbegin delete employees.end deletebegin insert
employees and improve the clarity and quality of communication between physicians and the employer’s utilization review process.end insert The bill would require the commission to consult with stakeholders, as specified, and would grant the commission discretion to decide whether to conduct or contract for the conduct of the feasibility study. The bill would also delete obsolete provisions.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 77.7 is added to the Labor Code, to read:
(a) The commission shall conduct, or contract for the
3conduct of, a feasibility study regarding the extent to which
4physicians’ requests for authorization of medical treatment for
5injured employees may be processed using an entirely paperless
6system. Thebegin delete primaryend delete focus of the feasibility study shall be to
7determine whether the change to a paperless system would reduce
8the time required to provide medical treatment services to injured
9
begin delete employees.end deletebegin insert employees and improve the clarity and quality of
10communication between
physicians and the employer’s utilization
11review process. To make that determination, the study shall also
12include an assessment regarding the current state of infrastructure
13in place to meet this goal, and any additional costs and
14requirements for providers and the state that may be deemed
15necessary to ensure efficiency, interoperability, and privacy
16protections in making the change to a paperless system.end insert
P3 1(b) The commission shall consult with stakeholders, including
2employers, employees, and medical providers, in conducting or
3contracting for the feasibility study pursuant to subdivision (a).
4(c) The commission shall have discretion to decide whether to
5conduct or contract for the conduct of the feasibility study pursuant
6to this section.
Section 6354.7 of the Labor Code, as added by Section
884 of Chapter 6 of the Statutes of 2002, is repealed.
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