BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                     SB 542


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          SENATE THIRD READING


          SB  
          542 (Mendoza)


          As Amended  August 27, 2015


          Majority vote


          SENATE VOTE:  37-0


           -------------------------------------------------------------------- 
          |Committee       |Votes|Ayes                   |Noes                 |
          |                |     |                       |                     |
          |                |     |                       |                     |
          |                |     |                       |                     |
          |----------------+-----+-----------------------+---------------------|
          |Insurance       |13-0 |Daly, Beth Gaines,     |                     |
          |                |     |Travis Allen,          |                     |
          |                |     |Calderon, Cooley,      |                     |
          |                |     |Cooper, Dababneh,      |                     |
          |                |     |Frazier, Gatto,        |                     |
          |                |     |Gonzalez, Grove,       |                     |
          |                |     |Mayes, Rodriguez       |                     |
          |                |     |                       |                     |
          |----------------+-----+-----------------------+---------------------|
          |Appropriations  |17-0 |Gomez, Bigelow, Bloom, |                     |
          |                |     |Bonta, Calderon,       |                     |
          |                |     |Chang, Daly, Eggman,   |                     |
          |                |     |Gallagher, Eduardo     |                     |
          |                |     |Garcia, Holden, Jones, |                     |
          |                |     |Quirk, Rendon, Wagner, |                     |
          |                |     |Weber, Wood            |                     |
          |                |     |                       |                     |








                                                                     SB 542


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          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  
            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  
            results in a new four-year approval of the MPN, but that an  
            approval of minor modifications does not operate to grant an  
            automatic extension of its four-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.








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          7)Deletes a reference to the American College of Occupational  
            and Environmental Medicine's practice guidelines, thereby  
            eliminating that alternative means of selecting independent  
            medical reviewers, and leaving the standards of the Labor Code  
            to govern selections.





          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 four years,  
            unless material changes are made to the MPN.


          5)Provides that if an MPN files and receives approval for  
            material changes, the four-year approval period runs from the  
            date of the approval of those changes.









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          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:  According to the Assembly Appropriations  
          Committee, negligible state fiscal impact. 


          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 León), Chapter 363, Statutes of  
            2012, 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 and federal programs  
            should be used as guidance to the DWC on this schedule, and  
            this bill conforms the statute to the RAND recommendations.











                                                                     SB 542


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          Analysis Prepared by:                                             
          Mark Rakich / INS. / (916) 319-2086  FN: 0001545