SB 563, as introduced, Pan. Workers’ compensation: utilization review.
Existing law requires every employer, for purposes of workers’ compensation, to establish a utilization review process to prospectively, retrospectively, or concurrently review requests by physicians for authorization to provide recommended medical treatment to injured employees. Existing law establishes timeframes for an employer to make a determination regarding a physician’s request. Existing law requires the utilization review process to be governed by written policies and procedures, and requires that these policies and procedures be disclosed to employees, physicians, and the public upon request.
This bill would require each employer, insurer, or other entity that is subject to the utilization review process to disclose the payment methodology for each person who is involved in the process of reviewing, approving, modifying, delaying, or denying requests by physicians for authorization prior to, retrospectively to, or concurrently with the provision of medical treatment services to injured workers by providing this information to employees, physicians, and the public upon request.
Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 4610.2 is added to the Labor Code, to
2read:
Each employer, insurer, or other entity that is subject
4to Section 4610 shall disclose the payment methodology for each
5person who is involved in the process of reviewing, approving,
6modifying, delaying, or denying requests by physicians for
7authorization prior to, retrospectively to, or concurrently with the
8provision of medical treatment services to injured workers by
9providing this information to employees, physicians, and the public
10upon request.
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