BILL ANALYSIS Ó
SB 542
Page 1
Date of Hearing: July 8, 2015
ASSEMBLY COMMITTEE ON INSURANCE
Tom Daly, Chair
SB
542 (Mendoza) - As Amended June 23, 2015
SENATE VOTE: 37-0
SUBJECT: Workers' compensation
SUMMARY: Makes a number of technical, clarifying, or
noncontroversial changes to the workers' compensation laws.
Specifically, this bill:
1)Clarifies the distinction between independent medical reviews
that are conducted within a Medical Provider Network (MPN) and
the recently adopted Independent Medical Review (IMR) program
that provides review of utilization review (UR) decisions that
either delayed, denied, or modified recommended medical
treatment.
2)Requires every MPN to post on its Internet Web site
information about how to contact the network, its medical
access assistants, and how to obtain a copy of information
that the employee is entitled to receive.
3)Provides that an approval of a major modification of a MPN
SB 542
Page 2
results in a new 4-year approval of the MPN, but that an
approval of minor modifications does not operate to grant an
automatic extension of its 4-year approval period.
4)Clarifies that an "off-the-shelf" MPN, and not the employer
who contracts with that MPN, has the duty to provide specified
disclosures to employees.
5) Authorizes the Division of Workers' Compensation (DWC) to use
additional materials upon which to base a home healthcare fee
schedule.
6)Clarifies and defines terms in the MPN law.
EXISTING LAW:
1)Establishes an IMR system to resolve medical treatment or
necessity disputes in the workers compensation system.
2)Authorizes employers to establish or contract with MPNs to
provide medical services to employees injured on the job and
uses the phrase 'independent medical review" to describe what
is essentially a second opinion procedure within the MPN.
3)Requires every MPN to have a "medical access assistant" to
help injured employees navigate the MPN, assist in making
appointments, and provide related services.
4)Provides that MPNs must obtain approval from the DWC before
operating, and specifies the approval lasts for 4 years,
unless material changes are made to the MPN.
SB 542
Page 3
5)Provides that if an MPN files and receives approval for
material changes, the 4-year approval period runs from the
date of the approval of those changes.
6)Requires either the MPN or the employer to provide employees
with several notices either at the commencement of employment,
or at the time of injury.
7)Requires the DWC to adopt a home health care services and fee
schedule, and specifies that the In Home Support Services
program shall be the model for adoption of that schedule.
FISCAL EFFECT: The Senate Appropriations Committee referred
this bill to the Senate Floor pursuant to Senate Rule 28.8.
COMMENTS:
1)Purpose. According to the author, this bill is intended to
clarify and define a number of minor issues in the workers'
compensation system, all of which are consensus proposals
among workers' compensation stakeholders. The most
substantive provision addresses the scope of the DWC's
authority to adopt the home health care fee schedule, by
authorizing reliance on the recommendation of a recent RAND
report.
2)Home Health Care. One of the numerous issues delegated to the
DWC in 2012 by SB 863 (De Leon) was the obligation to adopt a
fee schedule for home health services. At that time, the DWC
was directed to follow the approach used in the IHSS program.
However, a subsequent RAND report recommended that other state
SB 542
Page 4
and federal programs should be used as guidance to the DWC on
this schedule, and the bill conforms the statute to the RAND
recommendations.
REGISTERED SUPPORT / OPPOSITION:
Support
None received
Opposition
None received
Analysis Prepared by:Mark Rakich / INS. / (916)
319-2086