BILL ANALYSIS Ó SENATE COMMITTEE ON LABOR AND INDUSTRIAL RELATIONS Senator Tony Mendoza, Chair 2015 - 2016 Regular Bill No: SB 914 Hearing Date: April 6, 2016 ----------------------------------------------------------------- |Author: |Mendoza | |-----------+-----------------------------------------------------| |Version: |January 26, 2016 | ----------------------------------------------------------------- ----------------------------------------------------------------- |Urgency: |No |Fiscal: |No | ----------------------------------------------------------------- ----------------------------------------------------------------- |Consultant:|Gideon Baum | | | | ----------------------------------------------------------------- Subject: Workers' compensation: medical provider networks: independent medical reviews KEY ISSUE Should the Legislature strike an out-of-date reference to the American College of Occupational and Environmental Medicine's Occupational Medicine's Practice Guidelines in the California Labor Code? 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 SB 914 (Mendoza) Page 2 of ? 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) Existing law provides that the Administrative Director must adopt, after public hearings, a medical treatment utilization schedule (MTUS), that shall incorporate the evidence-based, peer-reviewed, nationally recognized standards of care and must address, at a minimum, the frequency, duration, intensity, and appropriateness of all treatment procedures and modalities commonly performed in workers' compensation cases. (Labor Code §5307.27) This bill strikes an out-of-date reference to the American College of Occupational and Environmental Medicine's Occupational Medicine Practice Guidelines. This bill also makes additional minor and technical changes to existing law. COMMENTS 1. Need for this bill? In 2004, the Legislature passed SB 899 (Poochigian), Chapter 34, Statutes of 2004, which was a holistic reform of the California workers' compensation system. As a part of that reform, SB 899 required that the Division of Workers' Compensation (DWC) create an evidence-based set of medical guidelines to ensure that injured workers were receiving consistent, appropriate treatment from physicians. In the intervening period, SB 899 required that physicians use the American College of Occupational Medicine's Medicine Practice Guidelines (ACOEM), which are a set of widely-utilized evidence-based, peer reviewed medical guidelines that continue to be used in California's workers' compensation system and many other state workers' compensation systems. In 2009, the DWC promulgated the California-specific workers' SB 914 (Mendoza) Page 3 of ? compensation system medical treatment guidelines. Known as the Medical Treatment Utilization Schedule (MTUS), the guidelines utilized many of the chapters that make up ACOEM, but also referenced additional guidelines or developed independent guidance on medical treatment. As such, while ACOEM is still used as a part of the MTUS, it is no longer referred to as a stand-alone guideline. SB 914 would strike references to the use of ACOEM as a stand-alone medical guideline. 2. Proponent Arguments : The author notes that the Medical Treatment Utilization Schedule (MTUS) was created in 2009, and since that time has been the sole medical guideline for medical treatment in the California workers' compensation system. Despite this, some out-of-date Labor Code sections continue to reference the predecessor American College of Occupational Medicine's Medicine Practice Guidelines (ACOEM). SB 914 would strike these out-of-date references, ensuring that existing law accurately reflects the status of the MTUS as the sole medical guideline, reducing confusion and increasing the clarity of existing law. 3. Prior Legislation : SB 542 (Mendoza), Chapter 542, Statutes of 2015, also struck out-of-date references to the ACOEM Medical Practice Guidelines. SUPPORT None on file. OPPOSITION None on file. -- END -- SB 914 (Mendoza) Page 4 of ?