BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 542|
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UNFINISHED BUSINESS
Bill No: SB 542
Author: Mendoza (D)
Amended: 8/27/15
Vote: 21
SENATE LABOR & IND. REL. COMMITTEE: 5-0, 4/22/15
AYES: Mendoza, Stone, Jackson, Leno, Mitchell
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
SENATE FLOOR: 37-0, 5/7/15
AYES: Allen, Anderson, Bates, Beall, Berryhill, Block,
Cannella, De León, Gaines, Galgiani, Hall, Hancock, Hernandez,
Hertzberg, Hill, Hueso, Huff, Jackson, Lara, Leno, Leyva,
McGuire, Mendoza, Mitchell, Monning, Moorlach, Morrell,
Nguyen, Nielsen, Pan, Pavley, Roth, Runner, Stone, Vidak,
Wieckowski, Wolk
NO VOTE RECORDED: Fuller, Liu
ASSEMBLY FLOOR: 79-0, 8/31/15 - See last page for vote
SUBJECT: Workers compensation: medical provider networks: fee
schedules
SOURCE: Author
DIGEST: This bill is an omnibus workers compensation clean-up
bill that makes a number of technical, clarifying, or
noncontroversial changes to the workers' compensation laws.
SB 542
Page 2
Assembly Amendments add technical language on medical provider
network (MPN) notices and MPN website information, as well as
create a definition for "entity that provides physician network
services" for the purposes of MPN regulation.
ANALYSIS:
Existing law:
1)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.
2)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 injured worker from
the effects of his or her injury shall be provided by the
employer. (Labor Code § 4600)
3)Allows an insurer, employer, or entity that provides physician
network services to establish an MPN for the provision of
medical treatment to injured employees. The network shall
include physicians primarily engaged in the treatment of
occupational injuries to treat common injuries experienced by
injured employees based on the type of occupation or industry
in which the employee is engaged, and the geographic area
where the employees are employed. (Labor Code §4616)
4)Requires the Division of Workers' Compensation (DWC) to adopt,
SB 542
Page 3
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)
5)Requires that home healthcare fee schedule must be based on
maximum service hours and fees for In-Home Supportive Services
program. (Labor Code § 5307.8)
This bill:
1)Clarifies the distinction between independent medical reviews
that are conducted within an MPN and the recently adopted
Independent Medical Review program that provides review of
utilization review 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 an 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 the MPN, and not the employer who contracts
with that MPN, has the duty to provide specified disclosures
to employees.
5)Authorizes the DWC to use additional materials upon which to
base a home healthcare fee schedule.
SB 542
Page 4
6)Clarifies and defines term "entity that provides physician
network services" for the purposes of MPN regulation.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Assembly Appropriations Committee, negligible
state fiscal impact.
SUPPORT: (Verified8/31/15)
None received
OPPOSITION: (Verified8/31/15)
None received
ARGUMENTS IN SUPPORT: 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.
ASSEMBLY FLOOR: 79-0, 8/31/15
SB 542
Page 5
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle,
Daly, Dodd, Eggman, Frazier, Beth Gaines, Cristina Garcia,
Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray,
Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones,
Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low,
Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin,
Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea,
Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,
Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,
Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Gallagher
Prepared by:Gideon L. Baum / L. & I.R. / (916) 651-1556
8/31/15 19:51:19
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