BILL ANALYSIS Ó
SENATE COMMITTEE ON LABOR AND INDUSTRIAL RELATIONS
Senator Tony Mendoza, Chair
2015 - 2016 Regular
Bill No: SB 542 Hearing Date: April 22,
2015
-----------------------------------------------------------------
|Author: |Mendoza |
|-----------+-----------------------------------------------------|
|Version: |April 6, 2015 |
-----------------------------------------------------------------
-----------------------------------------------------------------
|Urgency: |No |Fiscal: |Yes |
-----------------------------------------------------------------
-----------------------------------------------------------------
|Consultant:|Gideon Baum |
| | |
-----------------------------------------------------------------
Subject: Workers' compensation: home health care services:
fee schedules
KEY ISSUE
Should the Legislature allow the Division of Workers'
Compensation to follow the recommendations of the RAND
Corporation in the creation of a home healthcare fee schedule?
ANALYSIS
Existing law 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.
Existing law 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
SB 542 (Mendoza) Page 2
of ?
injured worker from the effects of his or her injury shall be
provided by the employer.
(Labor Code §4600)
Existing law requires the Division of Workers' Compensation to
adopt, after public hearings, a fee schedule for payment of home
health care services. The fee schedule must set forth fees and
requirements for home healthcare service providers. (Labor Code
§5307.8)
Existing law requires that home healthcare fee schedule must be
based on maximum service hours and fees for In-Home Supportive
Service (IHSS) program. (Labor Code §5307.8)
This bill would allow the Division of Workers' Compensation to
base the home healthcare fee schedule on state or federal home
healthcare, including fee schedules authorized by Medi-Cal or
the federal Office of Workers' Compensation Programs.
COMMENTS
1. Need for this bill?
Under existing law, the Division of Workers' Compensation has
the responsibility to create and update a variety of fee
schedules in California's workers' compensation system for
medical services. These fee schedules are designed to increase
stability in California's workers' compensation system by
setting the market for medical services - payors know what
they will pay for medical services, and medical service
providers know what they will be paid for providing their
services. Similar fee schedules are common in other states,
as well as in federal programs, most notably Medicare.
In 2012, SB 863 (DeLeon), Statutes of 2012, Chapter 363
required the Division of Workers' Compensation (DWC) to create
a home healthcare fee schedule by July 1, 2013. This fee
schedule has not yet been created. In January of 2015, the DWC
released a study from the RAND Corporation which recommended
SB 542 (Mendoza) Page 3
of ?
expanding the source material which can be utilized to create
a home healthcare fee schedule beyond the IHSS fee schedule.
SB 542 follows the RAND Corporation recommendation to expand
the source material that can be used to create a home
healthcare fee schedule to include state and federal fee
schedules, such as Medi-Cal and the Office of Workers'
Compensation Programs.
2. Proponent Arguments :
The author notes that the use of fee schedules in California's
workers' compensation system is a common occurrence, and
argues that they have shown a high degree of success in
helping to control costs by setting a transparent and
predictable market price for goods and services in the
workers' compensation system. The author believes that home
healthcare services are a vital service for California's
injured workers, and argues that it is of paramount importance
that a successful home healthcare fee schedule is created in
order to ensure that home healthcare services are provided
readily and with a minimum of friction. The author believes
that SB 542 accomplishes this by following the recommendations
of the RAND Corporation study in drawing from multiple
existing fee schedules to create the home healthcare fee
schedule.
3. Opponent Arguments :
None on file.
4. Prior Legislation :
SB 863 (DeLeon), Statutes of 2012, Chapter 363, was discussed
above.
SUPPORT
None received.
OPPOSITION
None received.
SB 542 (Mendoza) Page 4
of ?
-- END --