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Assembly Bill 1177 (AB 1177) chaptering California Labor Code §5307.11
The California Legislature passed Assembly Bill 1177 (AB 1177) chaptering
California Labor Code §5307.11 to read as follows:
California Labor Code §15 defines the legal term “shall” as a mandatory term. Thus, Official Medical Fee
Schedule ceases to exist in the context of a contract. Any contract rates that are based on Official Medical Fee
Schedule, as well as the “lesser of” language, emphatically shall not be applicable to medical treatment of an
industrial injury.
AB1177 also amended §5307.1(b) to read as follows:
It is clear that the Legislative Intent was not to allow rates lower than fee schedule but rather greater. This would
give the provider the ability to be reimbursed properly, even if that amount exceeded what otherwise would be
the "maximum reimbursement" as defined by OMFS. A medical provider may not charge more for an industrial
injury then he/she would for a non-industrial injury. The converse is also true; a payer shall not pay less for an
industrial injury than it would pay for a non-industrial injury.
Assembly Bill 1177 (AB 1177) chaptering California Labor Code §5307.11
The California Legislature passed Assembly Bill 1177 (AB 1177) chaptering
California Labor Code §5307.11 to read as follows:
- “A health care provider or health facility licensed pursuant … and a contracting agent, employer, or
carrier may contract for reimbursement rates different from those in the fee schedule adopted and revised
pursuant to Section 5307.1. When a health care provider or health facility … and a contracting agent,
employer, or carrier contract for reimbursement rates [is] different from those in the fee schedule, the
medical fee schedule for that health care provider or health facility … shall not apply to the contracted
reimbursement rates.” (Emphasis mine)
California Labor Code §15 defines the legal term “shall” as a mandatory term. Thus, Official Medical Fee
Schedule ceases to exist in the context of a contract. Any contract rates that are based on Official Medical Fee
Schedule, as well as the “lesser of” language, emphatically shall not be applicable to medical treatment of an
industrial injury.
AB1177 also amended §5307.1(b) to read as follows:
- “Nothing in this section shall prohibit a medical provider or a licensed health care facility from being paid
by an employer or carrier fees in excess of those set forth on the official medical fee schedule”
(Emphasis mine)
It is clear that the Legislative Intent was not to allow rates lower than fee schedule but rather greater. This would
give the provider the ability to be reimbursed properly, even if that amount exceeded what otherwise would be
the "maximum reimbursement" as defined by OMFS. A medical provider may not charge more for an industrial
injury then he/she would for a non-industrial injury. The converse is also true; a payer shall not pay less for an
industrial injury than it would pay for a non-industrial injury.
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