BILL ANALYSIS Ó
SB 1175
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Date of Hearing: June 22, 2016
ASSEMBLY COMMITTEE ON INSURANCE
Tom Daly, Chair
SB
1175 (Mendoza) - As Amended June 14, 2016
SENATE VOTE: 36-0
SUBJECT: Workers' compensation: requests for payment
SUMMARY: Requires providers of medical services in the workers'
compensation system to submit bills within 12 months of
providing the services. Specifically, this bill:
1)Requires that, for treatment provided on or after January 1,
2017, a medical provider must submit the request for payment
within 12 months of the date of service or 12 months of the
date of discharge for inpatient facility services.
2)Requires that, for medical-legal services or expenses, the
request for payment must be submitted within 12 months of the
date of service.
3)Requires the administrative director (AD) of the Division of
Workers' Compensation (DWC) to adopt rules and regulations to
implement the 12 month limitation period for both medical
charges and medical-legal charges, including circumstances
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that constitute good cause for an exception to the 12 month
period, including procedures for billing in cases when
treatment of injuries thought to be non-industrial turn out,
after 12 months, to be industrial injuries.
4)Provides that, absent good cause, a request for payment after
the 12-month limitation period is barred.
EXISTING LAW:
1)Establishes a comprehensive system to provide benefits,
including medical treatment, to employees who are injured or
suffer conditions that arise out of or in the course of
employment.
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.
3)Requires a medical provider who provides any of the medical
services described above for an injured worker to submit its
request for payment with an itemization of services provided
and the charge for each service, a copy of all reports showing
the services performed, the prescription or referral from the
primary treating physician if the services were performed by a
person other than the primary treating physician, and any
evidence of authorization for the services that may have been
received.
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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, multiple stakeholders report
persistent fraudulent or unnecessarily belligerent billing
activity by some medical providers. One example is the
submission of medical bills more than a year after services
were provided. In some cases, the bills were old enough that
the underlying documentation may have been destroyed or would
be difficult for the employer to find. This can raise the
possibility of a medical employer being paid twice for
providing the same service. Additionally, processing old
medical bills can create frictional costs for payors, limiting
resources to injured workers and lawful medical providers.
In other medical systems, there are time limitations for when a
medical bill can be submitted for payment. In Medi-Cal, for
example, the limitation is 6 months. In Texas's workers'
compensation system, the medical bill submission time limit is
90 days.
The bill would create a medical bill submission time limit of 12
months from date of service or 12 months of date of discharge
for inpatient facility services, which is the same as the
medical bill time limitations for Medicare. The bill applies
a similar time limitation for medical-legal services, and
provides that the AD create good-cause exceptions to the 12
month limitation.
REGISTERED SUPPORT / OPPOSITION:
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Support
ALPHA Fund
Small Business California
Opposition
None received.
Analysis Prepared by:Mark Rakich / INS. / (916)
319-2086