BILL NUMBER: SB 186 ENROLLED
BILL TEXT
PASSED THE SENATE APRIL 27, 2009
PASSED THE ASSEMBLY SEPTEMBER 3, 2009
INTRODUCED BY Senator DeSaulnier
FEBRUARY 17, 2009
An act to amend, repeal, and add Section 4600 of the Labor Code,
relating to workers' compensation.
LEGISLATIVE COUNSEL'S DIGEST
SB 186, DeSaulnier. Workers' compensation: medical treatment:
predesignation of physician.
Existing workers' compensation law generally requires employers to
secure the payment of workers' compensation, including medical
treatment, for injuries incurred by their employees that arise out
of, or in the course of, employment. Existing law, until December 31,
2009, provides an employee with the right to be treated by his or
her personal physician from the date of injury if specified
requirements are met, including a requirement that the physician
agrees to be predesignated.
This bill would delete the December 31, 2009, repeal date for
those provisions pertaining to an employee's predesignation of a
personal physician.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 4600 of the Labor Code is amended to read:
4600. (a) 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. In the case of his or her neglect
or refusal reasonably to do so, the employer is liable for the
reasonable expense incurred by or on behalf of the employee in
providing treatment.
(b) As used in this division and notwithstanding any other
provision of law, medical treatment that is reasonably required to
cure or relieve the injured worker from the effects of his or her
injury means treatment that is based upon the guidelines adopted by
the administrative director pursuant to Section 5307.27 or, prior to
the adoption of those guidelines, the updated American College of
Occupational and Environmental Medicine's Occupational Medicine
Practice Guidelines.
(c) Unless the employer or the employer's insurer has established
a medical provider network as provided for in Section 4616, after 30
days from the date the injury is reported, the employee may be
treated by a physician of his or her own choice or at a facility of
his or her own choice within a reasonable geographic area.
(d) (1) If an employee has notified his or her employer in writing
prior to the date of injury that he or she has a personal physician,
the employee shall have the right to be treated by that physician
from the date of injury if either of the following conditions exist:
(A) The employer provides nonoccupational group health coverage in
a health care service plan, licensed pursuant to Chapter 2.2
(commencing with Section 1340) of Division 2 of the Health and Safety
Code.
(B) The employer provides nonoccupational health coverage in a
group health plan or a group health insurance policy as described in
Section 4616.7.
(2) For purposes of paragraph (1), a personal physician shall meet
all of the following conditions:
(A) The physician is the employee's regular physician and surgeon,
licensed pursuant to Chapter 5 (commencing with Section 2000) of
Division 2 of the Business and Professions Code.
(B) The physician is the employee's primary care physician and has
previously directed the medical treatment of the employee, and who
retains the employee's medical records, including his or her medical
history. "Personal physician" includes a medical group, if the
medical group is a single corporation or partnership composed of
licensed doctors of medicine or osteopathy, which operates an
integrated multispecialty medical group providing comprehensive
medical services predominantly for nonoccupational illnesses and
injuries.
(C) The physician agrees to be predesignated.
(3) If the employer provides nonoccupational health care pursuant
to Chapter 2.2 (commencing with Section 1340) of Division 2 of the
Health and Safety Code, and the employer is notified pursuant to
paragraph (1), all medical treatment, utilization review of medical
treatment, access to medical treatment, and other medical treatment
issues shall be governed by Chapter 2.2 (commencing with Section
1340) of Division 2 of the Health and Safety Code. Disputes regarding
the provision of medical treatment shall be resolved pursuant to
Article 5.55 (commencing with Section 1374.30) of Chapter 2.2 of
Division 2 of the Health and Safety Code.
(4) If the employer provides nonoccupational health care, as
described in Section 4616.7, all medical treatment, utilization
review of medical treatment, access to medical treatment, and other
medical treatment issues shall be governed by the applicable
provisions of the Insurance Code.
(5) The insurer may require prior authorization of any
nonemergency treatment or diagnostic service and may conduct
reasonably necessary utilization review pursuant to Section 4610.
(6) An employee shall be entitled to all medically appropriate
referrals by the personal physician to other physicians or medical
providers within the nonoccupational health care plan. An employee
shall be entitled to treatment by physicians or other medical
providers outside of the nonoccupational health care plan pursuant to
standards established in Article 5 (commencing with Section 1367) of
Chapter 2.2 of Division 2 of the Health and Safety Code.
(7) The division shall conduct an evaluation of this program and
present its findings to the Governor and the Legislature on or before
December 31, 2008.
(8) This subdivision shall remain in effect only until December
31, 2009, and as of that date is repealed, unless a later enacted
statute that is enacted before December 31, 2009, deletes or extends
that date.
(e) (1) When at the request of the employer, the employer's
insurer, the administrative director, the appeals board, or a workers'
compensation administrative law judge, the employee submits to
examination by a physician, he or she shall be entitled to receive,
in addition to all other benefits herein provided, all reasonable
expenses of transportation, meals, and lodging incident to reporting
for the examination, together with one day of temporary disability
indemnity for each day of wages lost in submitting to the
examination.
(2) Regardless of the date of injury, "reasonable expenses of
transportation" includes mileage fees from the employee's home to the
place of the examination and back at the rate of twenty-one cents
($0.21) a mile or the mileage rate adopted by the Director of the
Department of Personnel Administration pursuant to Section 19820 of
the Government Code, whichever is higher, plus any bridge tolls. The
mileage and tolls shall be paid to the employee at the time he or she
is given notification of the time and place of the examination.
(f) When at the request of the employer, the employer's insurer,
the administrative director, the appeals board, or a workers'
compensation administrative law judge, an employee submits to
examination by a physician and the employee does not proficiently
speak or understand the English language, he or she shall be entitled
to the services of a qualified interpreter in accordance with
conditions and a fee schedule prescribed by the administrative
director. These services shall be provided by the employer. For
purposes of this section, "qualified interpreter" means a language
interpreter certified, or deemed certified, pursuant to Article 8
(commencing with Section 11435.05) of Chapter 4.5 of Part 1 of
Division 3 of Title 2 of, or Section 68566 of, the Government Code.
(g) This section shall remain in effect only until January 1,
2010, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2010, deletes or extends
that date.
SEC. 2. Section 4600 is added to the Labor Code, to read:
4600. (a) 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. In the case of his or her neglect
or refusal reasonably to do so, the employer is liable for the
reasonable expense incurred by or on behalf of the employee in
providing treatment.
(b) As used in this division and notwithstanding any other
provision of law, medical treatment that is reasonably required to
cure or relieve the injured worker from the effects of his or her
injury means treatment that is based upon the guidelines adopted by
the administrative director pursuant to Section 5307.27 or, prior to
the adoption of those guidelines, the updated American College of
Occupational and Environmental Medicine's Occupational Medicine
Practice Guidelines.
(c) Unless the employer or the employer's insurer has established
a medical provider network as provided for in Section 4616, after 30
days from the date the injury is reported, the employee may be
treated by a physician of his or her own choice or at a facility of
his or her own choice within a reasonable geographic area.
(d) (1) If an employee has notified his or her employer in writing
prior to the date of injury that he or she has a personal physician,
the employee shall have the right to be treated by that physician
from the date of injury if either of the following conditions exist:
(A) The employer provides nonoccupational group health coverage in
a health care service plan, licensed pursuant to Chapter 2.2
(commencing with Section 1340) of Division 2 of the Health and Safety
Code.
(B) The employer provides nonoccupational health coverage in a
group health plan or a group health insurance policy as described in
Section 4616.7.
(2) For purposes of paragraph (1), a personal physician shall meet
all of the following conditions:
(A) Be the employee's regular physician and surgeon, licensed
pursuant to Chapter 5 (commencing with Section 2000) of Division 2 of
the Business and Professions Code.
(B) Be the employee's primary care physician and has previously
directed the medical treatment of the employee, and who retains the
employee's medical records, including his or her medical history.
"Personal physician" includes a medical group, if the medical group
is a single corporation or partnership composed of licensed doctors
of medicine or osteopathy, which operates an integrated
multispecialty medical group providing comprehensive medical services
predominantly for nonoccupational illnesses and injuries.
(C) The physician agrees to be predesignated.
(3) If the employer provides nonoccupational health care pursuant
to Chapter 2.2 (commencing with Section 1340) of Division 2 of the
Health and Safety Code, and the employer is notified pursuant to
paragraph (1), all medical treatment, utilization review of medical
treatment, access to medical treatment, and other medical treatment
issues shall be governed by Chapter 2.2 (commencing with Section
1340) of Division 2 of the Health and Safety Code. Disputes regarding
the provision of medical treatment shall be resolved pursuant to
Article 5.55 (commencing with Section 1374.30) of Chapter 2.2 of
Division 2 of the Health and Safety Code.
(4) If the employer provides nonoccupational health care, as
described in Section 4616.7, all medical treatment, utilization
review of medical treatment, access to medical treatment, and other
medical treatment issues shall be governed by the applicable
provisions of the Insurance Code.
(5) The insurer may require prior authorization of any
nonemergency treatment or diagnostic service and may conduct
reasonably necessary utilization review pursuant to Section 4610.
(6) An employee shall be entitled to all medically appropriate
referrals by the personal physician to other physicians or medical
providers within the nonoccupational health care plan. An employee
shall be entitled to treatment by physicians or other medical
providers outside of the nonoccupational health care plan pursuant to
standards established in Article 5 (commencing with Section 1367) of
Chapter 2.2 of Division 2 of the Health and Safety Code.
(e) (1) When at the request of the employer, the employer's
insurer, the administrative director, the appeals board, or a workers'
compensation administrative law judge, the employee submits to
examination by a physician, he or she shall be entitled to receive,
in addition to all other benefits herein provided, all reasonable
expenses of transportation, meals, and lodging incident to reporting
for the examination, together with one day of temporary disability
indemnity for each day of wages lost in submitting to the
examination.
(2) Regardless of the date of injury, "reasonable expenses of
transportation" includes mileage fees from the employee's home to the
place of the examination and back at the rate of twenty-one cents
($0.21) a mile or the mileage rate adopted by the Director of the
Department of Personnel Administration pursuant to Section 19820 of
the Government Code, whichever is higher, plus any bridge tolls. The
mileage and tolls shall be paid to the employee at the time he or she
is given notification of the time and place of the examination.
(f) When at the request of the employer, the employer's insurer,
the administrative director, the appeals board, or a workers'
compensation administrative law judge, an employee submits to
examination by a physician and the employee does not proficiently
speak or understand the English language, he or she shall be entitled
to the services of a qualified interpreter in accordance with
conditions and a fee schedule prescribed by the administrative
director. These services shall be provided by the employer. For
purposes of this section, "qualified interpreter" means a language
interpreter certified, or deemed certified, pursuant to Article 8
(commencing with Section 11435.05) of Chapter 4.5 of Part 1 of
Division 3 of Title 2 of, or Section 68566 of, the Government Code.
(g) This section shall become operative on January 1, 2010.
SENATE THIRD READING
SB 186 (DeSaulnier)
As Introduced February 17, 2009
Majority vote
SENATE VOTE :29-10
INSURANCE 9-1
-----------------------------------------------------------------
|Ayes:|Solorio, Garrick, | | |
| |Anderson, | | |
| |Charles Calderon, Carter, | | |
| |Feuer, Hayashi, Nava, | | |
| |Torres | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Niello | | |
| | | | |
-----------------------------------------------------------------
SUMMARY : Removes the sunset date on the law that authorizes a
worker to predesignate his or her personal treating physician as
the treating physician in the event of a workplace injury.
EXISTING LAW :
1)Establishes a comprehensive system of workers' compensation
benefits, including medical benefits, for workers who are
injured on the job.
2)Allows the employer to select the treating physician for the
first 30 days after an injury, and, if the employer has
established a Medical Provider Network (MPN), allows the
employer to require injured employees to obtain treatment
within the MPN at all times.
3)Requires treatment of work-related injuries to be in
conformity with the American College of Occupational and
Environmental Medicine (ACOEM) Guidelines, or such other
guidelines as the Administrative Director (AD) of the Division
of Workers' Compensation may adopt.
4)Establishes a comprehensive system to adjudicate medical
treatment disputes, including utilization review that is
SB 186
Page 2
intended to ensure that treatment is provided in conformity
with the applicable treatment guidelines.
5)Authorizes an employee to "predesignate" a personal treating
physician who is authorized, in the event that employee is
injured on the job, to be the treating physician within the
first 30 days after the injury, and indefinitely even if the
employer has established an MPN.
6)Limits the right to predesignate a personal treating physician
by:
a) Authorizing predesignation only by employees whose
employer offers group health insurance; and,
b) Requiring that a predesignated physician be a licensed
physician and surgeon who is the employee's primary care
physician who has previously directed the patient's care
and who maintains the patient's medical records and
history.
7)Provides that the predesignated physician may make all
appropriate referrals to other providers who are within the
employer-provided nonoccupational health insurance program.
8)Provides that any disputes that arise about the
appropriateness of medical treatment recommended by a
predesignated physician, or another provider to whom the
injured worker was referred by the predesignated physician, be
resolved within the dispute resolution system applicable to
the nonoccupational group health insurance program provided by
the employer.
9)Sunsets the right to predsignate as of December 31, 2009.
FISCAL EFFECT : The bill is tagged as "nonfiscal," although some
employers have argued there is a cost implication for a workers'
compensation program, including the state's program.
Proponents disagree with this argument (see comment 1, below).
COMMENTS :
1)The author introduced this bill to ensure that employees have
the right to select their own regular doctor as their provider
SB 186
Page 3
of choice in the event of a workplace injury. The author and
sponsors believe that medical treatment will be more effective
if provided by a doctor who is familiar with the patient, and
who the patient trusts. In support of this argument, the
sponsors point to a study by the Public Policy Institute of
California that concluded that employee satisfaction was
higher and costs were no different for employee's who
predesignated their physician.
2)Opponents object to continuing the element of current law that
allows a predesignated physician to refer to specialists
outside of the MPN. The MPN, in the view of most employers,
is one of the primary ways that the 2004 reforms enacted
effective cost controls. The opponents believe for the same
reasons articulated by the sponsors that it is good for an
injured worker to see their own, regular treating physician.
However, the employee does not have that same relationship
with physicians to whom they will be referred, and the
opposition believes that referrals should be within the MPN.
3)Some of the opponents are additionally concerned that disputes
about medical treatment will not be properly resolved, and the
results will be increased costs. They believe it is unclear
whether the ACOEM Guidelines and other approved guidelines
apply or, in a case where the group health insurance is
provided by an HMO, the Knox-Keene Health Care Service Plan
rules apply. Further, the opposition is concerned that even
if ACOEM and other approved guidelines do apply, the group
health doctors who would be resolving disputes are not
familiar with the workers' compensation rules. According to
an informal analysis from the DMHC, which indicates it has not
yet had a workers' compensation-related request for
independent medical review (IMR), only a patient who is denied
treatment is eligible under the Knox-Keene rules to request an
IMR. Thus, it is unclear whether an employer can even seek an
IMR if it believes a recommended treatment is not appropriate.
Without clarifying these problems, the employers are opposed
to repealing the sunset date.
Analysis Prepared by : Mark Rakich / INS. / (916) 319-2086
FN: 0001834
BILL TEXT
PASSED THE SENATE APRIL 27, 2009
PASSED THE ASSEMBLY SEPTEMBER 3, 2009
INTRODUCED BY Senator DeSaulnier
FEBRUARY 17, 2009
An act to amend, repeal, and add Section 4600 of the Labor Code,
relating to workers' compensation.
LEGISLATIVE COUNSEL'S DIGEST
SB 186, DeSaulnier. Workers' compensation: medical treatment:
predesignation of physician.
Existing workers' compensation law generally requires employers to
secure the payment of workers' compensation, including medical
treatment, for injuries incurred by their employees that arise out
of, or in the course of, employment. Existing law, until December 31,
2009, provides an employee with the right to be treated by his or
her personal physician from the date of injury if specified
requirements are met, including a requirement that the physician
agrees to be predesignated.
This bill would delete the December 31, 2009, repeal date for
those provisions pertaining to an employee's predesignation of a
personal physician.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 4600 of the Labor Code is amended to read:
4600. (a) 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. In the case of his or her neglect
or refusal reasonably to do so, the employer is liable for the
reasonable expense incurred by or on behalf of the employee in
providing treatment.
(b) As used in this division and notwithstanding any other
provision of law, medical treatment that is reasonably required to
cure or relieve the injured worker from the effects of his or her
injury means treatment that is based upon the guidelines adopted by
the administrative director pursuant to Section 5307.27 or, prior to
the adoption of those guidelines, the updated American College of
Occupational and Environmental Medicine's Occupational Medicine
Practice Guidelines.
(c) Unless the employer or the employer's insurer has established
a medical provider network as provided for in Section 4616, after 30
days from the date the injury is reported, the employee may be
treated by a physician of his or her own choice or at a facility of
his or her own choice within a reasonable geographic area.
(d) (1) If an employee has notified his or her employer in writing
prior to the date of injury that he or she has a personal physician,
the employee shall have the right to be treated by that physician
from the date of injury if either of the following conditions exist:
(A) The employer provides nonoccupational group health coverage in
a health care service plan, licensed pursuant to Chapter 2.2
(commencing with Section 1340) of Division 2 of the Health and Safety
Code.
(B) The employer provides nonoccupational health coverage in a
group health plan or a group health insurance policy as described in
Section 4616.7.
(2) For purposes of paragraph (1), a personal physician shall meet
all of the following conditions:
(A) The physician is the employee's regular physician and surgeon,
licensed pursuant to Chapter 5 (commencing with Section 2000) of
Division 2 of the Business and Professions Code.
(B) The physician is the employee's primary care physician and has
previously directed the medical treatment of the employee, and who
retains the employee's medical records, including his or her medical
history. "Personal physician" includes a medical group, if the
medical group is a single corporation or partnership composed of
licensed doctors of medicine or osteopathy, which operates an
integrated multispecialty medical group providing comprehensive
medical services predominantly for nonoccupational illnesses and
injuries.
(C) The physician agrees to be predesignated.
(3) If the employer provides nonoccupational health care pursuant
to Chapter 2.2 (commencing with Section 1340) of Division 2 of the
Health and Safety Code, and the employer is notified pursuant to
paragraph (1), all medical treatment, utilization review of medical
treatment, access to medical treatment, and other medical treatment
issues shall be governed by Chapter 2.2 (commencing with Section
1340) of Division 2 of the Health and Safety Code. Disputes regarding
the provision of medical treatment shall be resolved pursuant to
Article 5.55 (commencing with Section 1374.30) of Chapter 2.2 of
Division 2 of the Health and Safety Code.
(4) If the employer provides nonoccupational health care, as
described in Section 4616.7, all medical treatment, utilization
review of medical treatment, access to medical treatment, and other
medical treatment issues shall be governed by the applicable
provisions of the Insurance Code.
(5) The insurer may require prior authorization of any
nonemergency treatment or diagnostic service and may conduct
reasonably necessary utilization review pursuant to Section 4610.
(6) An employee shall be entitled to all medically appropriate
referrals by the personal physician to other physicians or medical
providers within the nonoccupational health care plan. An employee
shall be entitled to treatment by physicians or other medical
providers outside of the nonoccupational health care plan pursuant to
standards established in Article 5 (commencing with Section 1367) of
Chapter 2.2 of Division 2 of the Health and Safety Code.
(7) The division shall conduct an evaluation of this program and
present its findings to the Governor and the Legislature on or before
December 31, 2008.
(8) This subdivision shall remain in effect only until December
31, 2009, and as of that date is repealed, unless a later enacted
statute that is enacted before December 31, 2009, deletes or extends
that date.
(e) (1) When at the request of the employer, the employer's
insurer, the administrative director, the appeals board, or a workers'
compensation administrative law judge, the employee submits to
examination by a physician, he or she shall be entitled to receive,
in addition to all other benefits herein provided, all reasonable
expenses of transportation, meals, and lodging incident to reporting
for the examination, together with one day of temporary disability
indemnity for each day of wages lost in submitting to the
examination.
(2) Regardless of the date of injury, "reasonable expenses of
transportation" includes mileage fees from the employee's home to the
place of the examination and back at the rate of twenty-one cents
($0.21) a mile or the mileage rate adopted by the Director of the
Department of Personnel Administration pursuant to Section 19820 of
the Government Code, whichever is higher, plus any bridge tolls. The
mileage and tolls shall be paid to the employee at the time he or she
is given notification of the time and place of the examination.
(f) When at the request of the employer, the employer's insurer,
the administrative director, the appeals board, or a workers'
compensation administrative law judge, an employee submits to
examination by a physician and the employee does not proficiently
speak or understand the English language, he or she shall be entitled
to the services of a qualified interpreter in accordance with
conditions and a fee schedule prescribed by the administrative
director. These services shall be provided by the employer. For
purposes of this section, "qualified interpreter" means a language
interpreter certified, or deemed certified, pursuant to Article 8
(commencing with Section 11435.05) of Chapter 4.5 of Part 1 of
Division 3 of Title 2 of, or Section 68566 of, the Government Code.
(g) This section shall remain in effect only until January 1,
2010, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2010, deletes or extends
that date.
SEC. 2. Section 4600 is added to the Labor Code, to read:
4600. (a) 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. In the case of his or her neglect
or refusal reasonably to do so, the employer is liable for the
reasonable expense incurred by or on behalf of the employee in
providing treatment.
(b) As used in this division and notwithstanding any other
provision of law, medical treatment that is reasonably required to
cure or relieve the injured worker from the effects of his or her
injury means treatment that is based upon the guidelines adopted by
the administrative director pursuant to Section 5307.27 or, prior to
the adoption of those guidelines, the updated American College of
Occupational and Environmental Medicine's Occupational Medicine
Practice Guidelines.
(c) Unless the employer or the employer's insurer has established
a medical provider network as provided for in Section 4616, after 30
days from the date the injury is reported, the employee may be
treated by a physician of his or her own choice or at a facility of
his or her own choice within a reasonable geographic area.
(d) (1) If an employee has notified his or her employer in writing
prior to the date of injury that he or she has a personal physician,
the employee shall have the right to be treated by that physician
from the date of injury if either of the following conditions exist:
(A) The employer provides nonoccupational group health coverage in
a health care service plan, licensed pursuant to Chapter 2.2
(commencing with Section 1340) of Division 2 of the Health and Safety
Code.
(B) The employer provides nonoccupational health coverage in a
group health plan or a group health insurance policy as described in
Section 4616.7.
(2) For purposes of paragraph (1), a personal physician shall meet
all of the following conditions:
(A) Be the employee's regular physician and surgeon, licensed
pursuant to Chapter 5 (commencing with Section 2000) of Division 2 of
the Business and Professions Code.
(B) Be the employee's primary care physician and has previously
directed the medical treatment of the employee, and who retains the
employee's medical records, including his or her medical history.
"Personal physician" includes a medical group, if the medical group
is a single corporation or partnership composed of licensed doctors
of medicine or osteopathy, which operates an integrated
multispecialty medical group providing comprehensive medical services
predominantly for nonoccupational illnesses and injuries.
(C) The physician agrees to be predesignated.
(3) If the employer provides nonoccupational health care pursuant
to Chapter 2.2 (commencing with Section 1340) of Division 2 of the
Health and Safety Code, and the employer is notified pursuant to
paragraph (1), all medical treatment, utilization review of medical
treatment, access to medical treatment, and other medical treatment
issues shall be governed by Chapter 2.2 (commencing with Section
1340) of Division 2 of the Health and Safety Code. Disputes regarding
the provision of medical treatment shall be resolved pursuant to
Article 5.55 (commencing with Section 1374.30) of Chapter 2.2 of
Division 2 of the Health and Safety Code.
(4) If the employer provides nonoccupational health care, as
described in Section 4616.7, all medical treatment, utilization
review of medical treatment, access to medical treatment, and other
medical treatment issues shall be governed by the applicable
provisions of the Insurance Code.
(5) The insurer may require prior authorization of any
nonemergency treatment or diagnostic service and may conduct
reasonably necessary utilization review pursuant to Section 4610.
(6) An employee shall be entitled to all medically appropriate
referrals by the personal physician to other physicians or medical
providers within the nonoccupational health care plan. An employee
shall be entitled to treatment by physicians or other medical
providers outside of the nonoccupational health care plan pursuant to
standards established in Article 5 (commencing with Section 1367) of
Chapter 2.2 of Division 2 of the Health and Safety Code.
(e) (1) When at the request of the employer, the employer's
insurer, the administrative director, the appeals board, or a workers'
compensation administrative law judge, the employee submits to
examination by a physician, he or she shall be entitled to receive,
in addition to all other benefits herein provided, all reasonable
expenses of transportation, meals, and lodging incident to reporting
for the examination, together with one day of temporary disability
indemnity for each day of wages lost in submitting to the
examination.
(2) Regardless of the date of injury, "reasonable expenses of
transportation" includes mileage fees from the employee's home to the
place of the examination and back at the rate of twenty-one cents
($0.21) a mile or the mileage rate adopted by the Director of the
Department of Personnel Administration pursuant to Section 19820 of
the Government Code, whichever is higher, plus any bridge tolls. The
mileage and tolls shall be paid to the employee at the time he or she
is given notification of the time and place of the examination.
(f) When at the request of the employer, the employer's insurer,
the administrative director, the appeals board, or a workers'
compensation administrative law judge, an employee submits to
examination by a physician and the employee does not proficiently
speak or understand the English language, he or she shall be entitled
to the services of a qualified interpreter in accordance with
conditions and a fee schedule prescribed by the administrative
director. These services shall be provided by the employer. For
purposes of this section, "qualified interpreter" means a language
interpreter certified, or deemed certified, pursuant to Article 8
(commencing with Section 11435.05) of Chapter 4.5 of Part 1 of
Division 3 of Title 2 of, or Section 68566 of, the Government Code.
(g) This section shall become operative on January 1, 2010.
SENATE THIRD READING
SB 186 (DeSaulnier)
As Introduced February 17, 2009
Majority vote
SENATE VOTE :29-10
INSURANCE 9-1
-----------------------------------------------------------------
|Ayes:|Solorio, Garrick, | | |
| |Anderson, | | |
| |Charles Calderon, Carter, | | |
| |Feuer, Hayashi, Nava, | | |
| |Torres | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Niello | | |
| | | | |
-----------------------------------------------------------------
SUMMARY : Removes the sunset date on the law that authorizes a
worker to predesignate his or her personal treating physician as
the treating physician in the event of a workplace injury.
EXISTING LAW :
1)Establishes a comprehensive system of workers' compensation
benefits, including medical benefits, for workers who are
injured on the job.
2)Allows the employer to select the treating physician for the
first 30 days after an injury, and, if the employer has
established a Medical Provider Network (MPN), allows the
employer to require injured employees to obtain treatment
within the MPN at all times.
3)Requires treatment of work-related injuries to be in
conformity with the American College of Occupational and
Environmental Medicine (ACOEM) Guidelines, or such other
guidelines as the Administrative Director (AD) of the Division
of Workers' Compensation may adopt.
4)Establishes a comprehensive system to adjudicate medical
treatment disputes, including utilization review that is
SB 186
Page 2
intended to ensure that treatment is provided in conformity
with the applicable treatment guidelines.
5)Authorizes an employee to "predesignate" a personal treating
physician who is authorized, in the event that employee is
injured on the job, to be the treating physician within the
first 30 days after the injury, and indefinitely even if the
employer has established an MPN.
6)Limits the right to predesignate a personal treating physician
by:
a) Authorizing predesignation only by employees whose
employer offers group health insurance; and,
b) Requiring that a predesignated physician be a licensed
physician and surgeon who is the employee's primary care
physician who has previously directed the patient's care
and who maintains the patient's medical records and
history.
7)Provides that the predesignated physician may make all
appropriate referrals to other providers who are within the
employer-provided nonoccupational health insurance program.
8)Provides that any disputes that arise about the
appropriateness of medical treatment recommended by a
predesignated physician, or another provider to whom the
injured worker was referred by the predesignated physician, be
resolved within the dispute resolution system applicable to
the nonoccupational group health insurance program provided by
the employer.
9)Sunsets the right to predsignate as of December 31, 2009.
FISCAL EFFECT : The bill is tagged as "nonfiscal," although some
employers have argued there is a cost implication for a workers'
compensation program, including the state's program.
Proponents disagree with this argument (see comment 1, below).
COMMENTS :
1)The author introduced this bill to ensure that employees have
the right to select their own regular doctor as their provider
SB 186
Page 3
of choice in the event of a workplace injury. The author and
sponsors believe that medical treatment will be more effective
if provided by a doctor who is familiar with the patient, and
who the patient trusts. In support of this argument, the
sponsors point to a study by the Public Policy Institute of
California that concluded that employee satisfaction was
higher and costs were no different for employee's who
predesignated their physician.
2)Opponents object to continuing the element of current law that
allows a predesignated physician to refer to specialists
outside of the MPN. The MPN, in the view of most employers,
is one of the primary ways that the 2004 reforms enacted
effective cost controls. The opponents believe for the same
reasons articulated by the sponsors that it is good for an
injured worker to see their own, regular treating physician.
However, the employee does not have that same relationship
with physicians to whom they will be referred, and the
opposition believes that referrals should be within the MPN.
3)Some of the opponents are additionally concerned that disputes
about medical treatment will not be properly resolved, and the
results will be increased costs. They believe it is unclear
whether the ACOEM Guidelines and other approved guidelines
apply or, in a case where the group health insurance is
provided by an HMO, the Knox-Keene Health Care Service Plan
rules apply. Further, the opposition is concerned that even
if ACOEM and other approved guidelines do apply, the group
health doctors who would be resolving disputes are not
familiar with the workers' compensation rules. According to
an informal analysis from the DMHC, which indicates it has not
yet had a workers' compensation-related request for
independent medical review (IMR), only a patient who is denied
treatment is eligible under the Knox-Keene rules to request an
IMR. Thus, it is unclear whether an employer can even seek an
IMR if it believes a recommended treatment is not appropriate.
Without clarifying these problems, the employers are opposed
to repealing the sunset date.
Analysis Prepared by : Mark Rakich / INS. / (916) 319-2086
FN: 0001834
 |  |  |  |