SACRAMENTO, CA, April 15, 2016 -- The Senate Industrial Relations Committee heard a number of workers’ compensation bills this week. Probably the most watched was SB 1160 by Committee Chair, Senator Tony Mendoza (D-Artesia). This bill was framed as an “evolving reform bill.” Senator Mendoza mentioned at the Committee that this bill is a work in progress. The Senator also stated that his plan is to move the bill to the Assembly where he will stall it in order to work with all interests.
The bill currently reforms three different areas of the workers’ compensation system: the Workers’ Compensation Information System (WCIS), the MTUS and the UR/IMR process.
WCIS is a database that is run by the Division of Workers' Compensation (DWC) that is populated by employer data on workplace injuries and medical bills. Through this data, the DWC is able to monitor and measure how well the workers' compensation system is operating. Additionally, researchers use the WCIS to study the system in order to better understand how laws and regulations impact injured workers and employers. Without this system, the DWC is reduced to educated guesses and anecdotes in regulating and improving the workers' compensation system. Under current law, the maximum penalty for not providing data to the WCIS is $5,000 per year.
SB 1160 seeks to double the penalty to $10,000 per year and then create a gradually increasing penalty schedule designed to encourage non-compliant employers to comply with the data requirements. In order to reach maximum penalties allowed under SB 1160, an employer would need to be significantly out of compliance for at least three years and not showing any improvement in a pattern or practice of refusing to provide data to the WCIS.
Regarding the MTUS, SB 1160 expands an existing chapter on post-surgical physical medicine, which provides specific physical/occupational therapy duration guidelines for recovering from surgeries. By expanding this guideline to include pre-surgical and return-to-work physical medicine, SB 1160 would provide additional guidance to employers and medical providers on appropriate physical/occupational therapy treatments. Further, by placing this guideline in the MTUS and excluding the physical medicine guidelines from the 24 visit caps, SB 1160 provides the DWC with the opportunity to craft regulations that would specify the application of UR to this new physical medicine guideline.
Additionally, SB 1160 would require that, for injuries covered by the MTUS, if a specific clinical topic in the MTUS has not been updated in 5 or more years, medical treatment needs to be in accordance with other, more current medical treatment guidelines that are recognized generally by the national medical community and scientifically based.
Then regarding UR, SB 1160 first requires that, if a UR process needs additional information in order to approve or deny a treatment, the medical provider must be given at least 72 hours to respond to the request for additional information. Currently, a medical provider can be given as little as 24 or 48 hours to respond to a voicemail asking for additional information, which can be difficult for a medical provider seeing a full complement of injured workers each day. Second, this bill requires all UR processes to be accredited by an independent, nonprofit entity to certify that the UR process meets specified criteria. SB 1160 explicitly includes both timeliness in issuing UR decisions and policies preventing financial incentives to doctors based on medical decisions as criteria for review. One existing accreditation entity, URAC, currently measures UR processes against those criteria, as well as more than 70 other components.
The California Chamber of Commerce and a number of employer groups testified that they are not opposed right now because they understand the intent of the Senator to work with them on this bill. SB 1160 was passed with a vote of 4-1 and will be heard in the Senate Appropriations Committee.