In September 2016, Governor Brown signed SB 1160. This bill is intended to streamline emergency medical services and treatment for accepted industrial injuries. To offset the expected costs of less control over early treatment, SB 1160 also created California Labor Code Section 4615, which imposes new hurdles on medical providers who are subject to criminal charges of fraudulent practices.
A second bill, AB 1244, also enacted in September 2016, provides a mechanism for adjudication of liens filed by providers convicted of fraud or subject to surrender or revocation of the provider’s license, or suspension from Medicare/Medi-Cal due to fraud or abuse. Under this provision such providers are suspended from participating in the workers’ compensation system.
SB 1160 amends California Labor Code Section 4610 and applies to dates of injury occurring on or after January 1, 2018, the law removes the right of the employer to submit to utilization review (“UR”) prescriptions of medical treatment for injury or illness accepted as compensable by the employer and addressed by the medical treatment utilization schedule when prescribed by a member of the employer’s medical provider network, by a physician selected by the employer or by the employee’s predesignated physician within the 30 days following the initial date of injury. This change does not apply to nonemergency surgery, psychological treatment services, home health care services, imaging and radiology services, excluding x-rays, durable medical equipment, whose combined total value exceeds $250, electro-diagnostic medicine, or any other service designated and defined through rules adopted by the administrative director.
The law further amends Section 4903.05 to require that all liens filed after January 1, 2017 include a declaration attesting that the lien is not subject to Independent Medical Review or Independent Bill Review, and that the provider of services was either a treating physician within the Medical Provider Network (MPN) used by the employer, an Agreed Medical Examiner or Qualified Medical Examiner, or provided treatment authorized by Utilization Review. If the treatment was not performed by an MPN participant, the provider must attest that the employer does not utilize an MPN (after conducting a reasonable search), that the medical treatment at issue was neglected or unreasonably refused, or that the expense was for an emergency medical condition. For liens filed between January 1, 2013 and December 31, 2016, lien claimants must file this declaration by July 1, 2017. Failure to timely file the declarations will result in dismissal of the liens with prejudice by operation of law. Beginning January 1, 2017, all liens must also be accompanied by an original bill or statement in support of the lien, with proof that the documents were served on the injured worker.
The governor signed additional legislation addressing California’s lien problems by creating a new and clear statute of limitations. SB 1175 requires that requests for medical services, hospital services or medical-legal services be submitted for payment with an itemization of services to the employer within 12 months of the date of service or within 12 months of the date of discharge for inpatient facility services. The bill also provides that requests for payment and bills for medical-legal charges are barred unless timely submitted.
The Administrative Director will be publishing regulations for the implementation of these laws, in particular SB 1160 during 2017. The public comment period regarding the proposed regulations implementing these changes was originally scheduled to close on January 4, 2017, but has been extended to January 31, 2017. Regardless of the form of the final regulations, it is clear that lien claimants will be very busy completing and filing their declarations by July 1, 2017 for all liens filed since January 1, 2013.
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