State Legislation

CorVel is a pioneer in industry-leading technology to automate and streamline the management of workers’ compensation claims for California employers. Our continued investments in systems and a focus on customer service provide the only integrated risk management solution in the industry.

We provide immediate intervention for your employees through Advocacy 24/7 and access to our innovative telehealth services. Early interaction with a doctor can facilitate expedited prescriptions and referrals for additional care services. Telehealth is just one of the ways CorVel is here for your employees. By connecting your employees to appropriate care from the onset of an injury, we deliver better care in a timely manner.

As a service to our clients, CorVel is providing links to information related to the COVID-19 pandemic provided by the states.

California has released the following updates in response to the COVID-19 outbreak:

State of Emergency – Executive Order N-62-20

Emergency Measures for Medical-Legal Evaluations

FAQ

Essential Workers

En Banc Decision

DWC and WCAB Expand Hearing Schedule at the District Offices

Legislature Status: Session suspended until May 4.

• California Department of Public health coronavirus resource page.

• April 15, 2020 – San Francisco is unveiling a program to streamline coronavirus contact tracing as part of its response to the pandemic. Contacts will receive text messages or phone calls monitoring their health during a 14-day period.
• April 14, 2020 – The Governor signed an executive order that addresses the release and reentry process at the Division of Juvenile Justice (DJJ) so that eligible youth serving time at DJJ can be discharged safely and expeditiously.

• April 14, 2020 – The Governor outlined six critical indicators the state will consider before modifying the stay-at-home order and other interventions.
• April 13, 2020 – The Governor announced $42 million in new investments to protect younger residents who are at heightened risk for abuse and mistreatment. The Governor is making more than $27 million available to help families stay together, nearly $7 million to support social workers and $3 million to support Family Resource Centers.
• April 13, 2020 – The Governor announced a Western States Pact with Oregon Governor Kate Brown and Washington Governor Jay Inslee to focus on reopening their economies and controlling COVID-19 into the future.
• April 10, 2020 – The Governor announced the release of $100 million to support child care services, and to support child care providers who are stepping up to serve essential infrastructure workers and vulnerable populations and their children during this critical time.
• April 10, 2020 – The Governor announced 600 nurses have been retrained to support facility compliance with COVID-19 guidance and to assist facilities with positive cases.
• The state will call each facility daily to understand needs and get early warning of any symptomatic patients as well.

Legislation

• SB 89  Appropriates $500 million from the General Fund for purposes related to the COVID-19 Proclamation of Emergency. Allows the appropriation to be increased in $50 million increments up to a total to not exceed $1 Billion. Enacted.
• SB 117  Appropriates $100 million for local education agencies to purchase protective equipment and supplies and labor related to cleaning school sites. Enacted.
• AB 828 Provides a temporary moratorium on foreclosures and unlawful detainer actions during the COVID-19 emergency and until 15 days after the state of emergency has ended. Pending.
• SB 939 Makes it unlawful to evict the tenant of a commercial property during the COVID-19 Emergency. Pending.
• SB 943 Authorizes wage replacement benefits to workers who take time off work to care for a minor child whose school has been closed due to the COVID-19 virus outbreak. Pending.
• SB 1088 Would require a city, county, or continuum of care to use at least 12% of specified homelessness prevention or support moneys for services for domestic violence survivors experiencing or at risk of homelessness. Addresses increase in domestic violence incidents as a result of the state’s shelter-in-place order. Pending.
• SB 1276 Eliminates the requirement for local domestic violence centers to provide cash or in-kind matches for funds they receive from non-state sources, in response to funds received from federal, COVID-19 stimulus. Pending.
• SB 1322 Authorizes a notary public to apply for registration with the Secretary of State to be a remote online notary public, while promoting physical distancing during the COVID-19 outbreak, so long as there is a declaration of a state emergency by the Governor related to the COVID-19 virus. Pending.
• AB 3216  Requires certain workforce protections related to family and medical leave due to the coronavirus. Pending.
• SB 1435 Requires the Governor’s Office of Business and Economic Development, in cooperation with the Office of Planning and Research, to track specified information regarding California opportunity zone investments and to post some of that information on the Governor’s Office of Business and Economic Development’s internet website, in recognition of the COVID-19 public health crisis, the importance of keeping people housed to curb the spread of diseases, and to anticipate the need for affordable housing following major job losses during the COVID-19 emergency. Pending.
• SB 1064 Requires the Governor’s Office of Business and Economic Development, in cooperation with the Office of Planning and Research, to track specified information regarding California opportunity zone investments and to post some of that information on the Governor’s Office of Business and Economic Development’s internet website, in recognition of the COVID-19 public health crisis, the importance of keeping people housed to curb the spread of diseases, and to anticipate the need for affordable housing following major job losses during the COVID-19 emergency. Enacted.

California Regulatory Updates 10/08/2024

AB 2337 – Workers’ Compensation: Electronic Signatures. An Act to Amend Sections 17 and 5003 of the Labor Code, Relating to Workers’ Compensation.

Issues: Workers’ Compensation: Any Proposal

Summary:

This measure includes electronic signatures as valid signatures for purposes of the workers’ compensation system.

Most Recent Update:

• 09/22/2024 – Signed by Governor Gavin Newsom (D)

California Regulatory Updates 08/06/2024

AB 1870 – Notice to Employees: Legal Services. An Act to Amend Section 3550 of the Labor Code, Relating to Workers’ Compensation.

Issues: Workers’ Compensation: Any Proposal

Summary:

This measure requires the notice that employers must make available to employees regarding workers’ compensation to include information concerning an injured employee’s ability to consult a licensed attorney to advise them of their rights under workers’ compensations laws, and that in most instances, attorney’s fees will be paid from an injured employee’s recovery. This measure takes effect January 1, 2025.

Most Recent Update:

• 07/14/2024 – Signed by Governor Gavin Newsom (D)

AB 171 – Budget Act of 2023. An Act Relating to the Budget Act of 2023. 

Issues: Workers’ Compensation: Any Proposal

Summary:

This measure makes various changes regarding payroll, and workers’ compensation. This measure would take effect immediately.

Most Recent Update:

• 07/02/2024 – Signed by Governor Gavin Newsom (D)

California Regulatory Updates 07/11/2024

SB 1205 – Workers’ Compensation: Medical Benefits. An Act to Add Section 4600.03 to the Labor Code, Relating to Workers’ Compensation.

Issues: Workers’ Compensation: Any Proposal

Summary:

This measure entitles workers’ to transportation, lodging, and meal expenses when receiving treatment under workers’ compensation, as well as a day (or proportion thereof) of temporary disability indemnity for each day of wages lost receiving treatment. It prohibits employers from discriminating against workers for receiving treatment during customary working hours. It allows the employer to require the employee to first exhaust leave before providing temporary disability indemnity leave.

Most Recent Update:

• 06/26/2024 – Hearing Held; Passed Committee; Referred to Senate Appropriations Committee

California Regulatory Updates 11/03/2023

AB 1213 – Workers’ Compensation: Aggregate Disability Payments. An Act to Amend Section 4656 of the Labor Code, Relating to Workers’ Compensation.

Issues: Workers’ Compensation: Any Proposal

Summary:

This measure requires that if a denial of treatment requested by a treating physician is subsequently overturned by independent medical review or the Workers’ Compensation Appeals Board, any temporary disability paid or owing from the date of the denial until the treatment is authorized would not be included in the calculation of the aggregate disability payments. It also sets the maximum extension period to 90 days per dispute. It takes effect January 1, 2024. It is effective until January 1, 2027.

Most Recent Update:

• 10/08/2023 – Vetoed by Governor Gavin Newsom (D)

AB 336 – Contractors: Workers’ Compensation Insurance. An Act to Amend Section 12303 of the Business and Professions Code, Relating to Weights and Measures. an Act to Amend, Repeal, and Add Section 7125.5 of the Business and Professions Code, Relating to Contractors.

Issues: Workers’ Compensation (General)

Summary:

09/18/2023  This measure requires applicants for a license to certify on their renewal form the three classifications with the highest payroll on their workers’ compensation policy. This applies for renewal of licenses as well. The board is not required to verify classification codes, and is not liable for misreported codes. It takes effect July 1, 2024.

Most Recent Update:

• 10/07/2023 – Signed by Governor Gavin Newsom (D)

California Regulatory Updates 10/11/2023

AB 1213 – Workers’ Compensation: Aggregate Disability Payments. An Act to Amend Section 4656 of the Labor Code, Relating to Workers’ Compensation.

Issues: Workers’ Compensation: Any Proposal

Summary:

This measure requires that if a denial of treatment requested by a treating physician is subsequently overturned by independent medical review or the Workers’ Compensation Appeals Board, any temporary disability paid or owing from the date of the denial until the treatment is authorized would not be included in the calculation of the aggregate disability payments. It also sets the maximum extension period to 90 days per dispute. It takes effect January 1, 2024. It is effective until January 1, 2027.

Most Recent Update:

• 09/19/2023 – Sent to Governor

AB 336 – Contractors: Workers’ Compensation Insurance. An Act to Amend Section 12303 of the Business and Professions Code, Relating to Weights and Measures. an Act to Amend, Repeal, and Add Section 7125.5 of the Business and Professions Code, Relating to Contractors.

Issues: Workers’ Compensation (General)

Summary:

09/18/2023  This measure requires applicants for a license to certify on their renewal form the three classifications with the highest payroll on their workers’ compensation policy. This applies for renewal of licenses as well. The board is not required to verify classification codes, and is not liable for misreported codes. It takes effect July 1, 2024.

Most Recent Update:

• 09/13/2023 – Sent to Governor

AB 138 – Human Services. An Act Relating to the Budget Act of 2023. to Amend Sections 8609 and 8610 of the Family Code, to Amend Section 14670.35 of the Government Code, and to Amend Sections 4418.7, 4642, 6500, 6509, and 7505 Of, and to Add Sections 4418.8, 4435, 4435.1, 4435.2, and 19629.5 To, the Welfare and Institutions Code, Relating to Human Services, and Making an Appropriation Therefor, to Take Effect Immediately, Bill Related to the Budget.

Issues: Workers’ Compensation: Any Proposal

Summary:

09/08/2023  This measure would authorize Business Enterprises Programs for the Blind vendors licensed by the Department of Rehabilitation to operate a facility with workers’ compensation insurance provided by the Business Enterprises Program’s group policy.

Most Recent Update:

• 09/13/2023 – Referred to Senate Budget and Fiscal Review Committee

SB 138 – Human Services. An Act Relating to the Budget Act of 2023. to Amend Sections 8609 and 8610 of the Family Code, to Amend Section 14670.35 of the Government Code, and to Amend Sections 4418.7, 4642, 6500, 6509, and 7505 Of, and to Add Sections 4418.8, 4435, 4435.1, 4435.2, and 19629.5 To, the Welfare and Institutions Code, Relating to Human Services, and Making an Appropriation Therefor, to Take Effect Immediately, Bill Related to the Budget.

Issues: Workers’ Compensation: Any Proposal

Summary:

09/14/2023  This measure would authorize Business Enterprises Programs for the Blind vendors licensed by the Department of Rehabilitation to operate a facility with workers’ compensation insurance provided by the Business Enterprises Program’s group policy. This measure would take effect immediately.

Most Recent Update:

• 09/13/2023 – Signed by Governor Gavin Newsom (D)

California Regulatory Updates 08/08/2023

AB 489 – Workers’ Compensation: Disability Payments. An Act to Amend Section 4651 of the Labor Code, Relating to Workers’ Compensation.

Issues: Workers’ Compensation (Medical Coverage and Reimbursement), Workers’ Compensation (General)

Summary:

This measure extends the disability indemnity payments deposited via prepaid card program to January 1, 2025. It previously expired January 1, 2024.

Most Recent Update:

• 07/13/2023 – Signed by Governor

AB 1213 – Workers’ Compensation: Aggregate Disability Payments. An Act to Amend Section 4656 of the Labor Code, Relating to Workers’ Compensation.

Issues: Workers’ Compensation (General)

Summary:

04/28/2023  This measure requires that if a denial of treatment requested by a treating physician is subsequently overturned by independent medical review or the Workers’ Compensation Appeals Board, any temporary disability paid or owing from the date of the denial until the treatment is authorized would not be included in the calculation of the aggregate disability payments.  It does not list an effective date. It is effective until January 1, 2027.

Most Recent Update:

• 07/03/2023 – Hearing held; Advanced to suspense file

California Regulatory Updates 3/3/2023

AB 489 – Workers’ Compensation: Disability Payments. An Act to Amend Section 4651 of the Labor Code, Relating to Workers’ Compensation.

Issues: Workers’ Compensation (Medical Coverage and Reimbursement), Workers’ Compensation (General)

Summary:

This measure extends the disability indemnity payments deposited via prepaid card program to January 1, 2025. It previously expired January 1, 2024.

Most Recent Update:

03/22/2023  This measure has been scheduled for a hearing in the Assembly Committee on Insurance on March 22. In California, hearings are open to the public with limited access and seating. Anyone wishing to attend the hearing in person must observe mask and social distancing guidelines. The hearing will also be available via livestream. Anyone wishing to testify must do so by emailing the committee Chair or committee staff member. Testimony must be submitted 24 hours before the hearing. A vote may occur at the discretion of the Chair. The measure may be referred to multiple committees. Due note, that most committees have different procedures for receiving testimonies: https://www.senate.ca.gov/dailyfile or https://www.assembly.ca.gov/dailyfile.

AB 1156 – Workers’ Compensation: Hospital Employees. An Act to Add Sections 3212.21, 3212.22, 3212.24, 3212.26, and 3212.28 to the Labor Code, Relating to Workers’ Compensation.

Issues: Workers’ Compensation Managed Care, Workers’ Compensation (General)

Summary:

02/24/2023 This measure expands the definition of injury for purposes of workers’ compensation for hospital employees providing direct patient care in an acute care hospital. It includes infectious diseases, cancer, musculoskeletal injuries, post-traumatic stress disorder, and respiratory diseases. The rebuttable presumption of these diseases arising in the course of employment persists for 3 months for every year of employment in the case of a terminated employee, but no more than 120 months total. It does not list an effective date.

Most Recent Update:

02/16/2023 This measure has been introduced by Assemblywoman Mia Bonta (D)This measure awaits committee referral.

AB 1213 – Workers’ Compensation: Aggregate Disability Payments. An Act to Amend Section 4656 of the Labor Code, Relating to Workers’ Compensation.

Issues: Workers’ Compensation (Medical Coverage and Reimbursement), Workers’ Compensation (General)

Summary:

This measure has been introduced by Assemblywoman Liz Ortega (D).This measure awaits committee referral.

Most Recent Update:

02/24/2023 This measure requires that if a denial of treatment requested by a treating physician is subsequently overturned by independent medical review or the Workers’ Compensation Appeals Board, any temporary disability paid or owing from the date of the denial until the treatment is authorized would not be included in the calculation of the aggregate disability payments. It does not list an effective date.

AB 1278 – Workers’ Compensation: Medical Provider Networks: Employee Notifications. An Act to Amend Section 4616 of the Labor Code, Relating to Workers’ Compensation.

Issues: Workers’ Compensation Managed Care, Workers’ Compensation (General)

Summary:

02/21/2023  This measure allows an employee to request a copy of an electronic notification of a network requirement or network transfer requirement if applicable to their injury. This notification may be sent to a treating physician or another designee of the employee. It does not specify an effective date.

Most Recent Update:

02/16/2023 This measure has been introduced by Assemblyman Freddie Rodriguez (D). This measure awaits committee referral.

SB 636 – Workers’ Compensation: Utilization Review. An Act to Amend Sections 3209.3 and 4610 of the Labor Code, and to Amend Section 2708 Of, and to Add Section 2708.2 To, the Unemployment Insurance Code, Relating to Workers’ Compensation.

Issues: Workers’ Compensation Managed Care, Workers’ Compensation (General)

Summary:

02/24/2023 This measure requires, for purposes of workers’ compensation, psychologists and physicians to be licensed under California state law. It does this by differentiating the standards between private and public employers, applying that standard to private employers. It also allows disability benefits claims to be supported by health professionals, including a psychologist, optometrist, dentist, podiatrist, or chiropractor.
It does not list an effective date.

Most Recent Update:

02/16/2023 This measure has been introduced by Senator Dave Cortese (D). This measure awaits committee referral.

California Regulatory Updates 9/13/2022

SB 1064 – Structural Pest Control: Workers’ Compensation Insurance Coverage. An Act to Add Section 8693 to the Business and Professions Code, Relating to Structural Pest Control.

Issues: Workers’ Compensation (Medical Coverage and Reimbursement), Workers’ Compensation (General)

Summary:

See 4/11/2022 update below for full summary.

Most Recent Update:

8/26/2022 This measure was signed by Governor Gavin Newsom (D) on August 26. This measure was signed without urgency. It will take effect on January 1.

AB 404 – Workers’ Compensation: Medical-Legal Expenses: Fee Schedule. An Act to Amend Section 5307.6 of the Labor Code, Relating to Workers’ Compensation.

Issues: Workers’ Compensation Managed Care, Workers’ Compensation (General)

Summary:

This measure requires that the workers’ compensation medical-legal fee schedule be updated at least annually to increase the conversion factor by the percentage increase in the most recent federal Medicare Economic Index. This measure is applicable to workers’ compensation. This measure provides that the administrative director will annually update the schedule to reflect the rising costs of maintaining a medical practice by increasing the conversion factor and the per-page cost of reviewing records based on the percentage increase in the most current federal Medicare Economic Index. If the federal Medical Economic Index shows a decrease, the fee schedule will not be reduced. This measure does not yet specify an effective date.

Most Recent Update:

8/11/2022  This measure was heard on August 11 in the Senate Committee on Appropriations chaired by Senator Anthony Portantino (D). This measure was held under submission. Held under submission is an action taken by a committee when a measure is heard in committee and there is an indication that the  author and the committee members want to work on or discuss the measure further, but there is no motion for the measure to progress out of committee. This does not preclude the measure from being set for another hearing.

California Regulatory Updates 8/2/2022

SB 1064 – Structural Pest Control: Workers’ Compensation Insurance Coverage. An Act to Add Section 8693 to the Business and Professions Code, Relating to Structural Pest Control.

Issues: Workers’ Compensation (Medical Coverage and Reimbursement), Workers’ Compensation (General)

Summary:

See 4/11/2022 update below for full summary.

Most Recent Update:

6/21/2022 This measure has been scheduled for a hearing on August 3 in the Assembly Appropriations Committee, chaired by Assemblymember Chris Holden (D). In California, hearings are open to the public with limited access and seating. Anyone wishing to attend the hearing in-person must observe mask and social distancing guidelines. The hearing will also be available via livestream. Anyone wishing to testify must do so by emailing the committee Chair or committee staff member. Testimony must be submitted 24 hours before the hearing. A vote may occur at the discretion of the Chair. The measure may be referred to multiple committees.

California Regulatory Updates 7/11/2022

SB 1064 – Structural Pest Control: Workers’ Compensation Insurance Coverage. An Act to Add Section 8693 to the Business and Professions Code, Relating to Structural Pest Control.

Issues: Workers’ Compensation (Medical Coverage and Reimbursement), Workers’ Compensation (General)

Summary:

See 4/11/2022 update below for full summary.

Most Recent Update:

6/14/2022 This measure was heard and passed on June 14 in the Assembly Business and Professions Committee, it was then referred to the Insurance Committee This measure awaits consideration in the committee of referral.

California Regulatory Updates 6/8/2022

AB 399 – Workers’ Compensation. An Act to Amend Sections 139.5, 4603.2, 4603.6, 4610, 4616, 4616.2, and 5307.1 of the Labor Code, Relating to Workers’ Compensation.

Issues: Workers’ Compensation (Direction of Care), Workers’ Compensation (General)

Summary:

See 2/3/2022 update below for full summary.

Most Recent Update:

6/1/2022 The June 1 hearing in the Senate Labor, Public Employment and Retirement Committee, chaired by Senator Dave Cortese (D) was canceled. This measure is eligible for further consideration in the committee of referral.

SB 213 – Workers’ Compensation: Hospital Employees. An Act to Add Sections 3212.21, 3212.22, 3212.24, 3212.26, and 3212.28 to 3212.22, 3212.24, and 3212.26 To, and to Add and Repeal Sections 3212.21 and 3212.28 Of, the Labor Code, Relating to Workers’ Compensation.

Issues: Workers’ Compensation (Medical Coverage and Reimbursement), Workers’ Compensation (General)

Summary:

See 2/3/2022 update below for full summary.

Most Recent Update:

5/5/2022 This measure was amended on by the author. This measure has been referred to the Assembly Insurance Committee. This measure is eligible for consideration in the committee of referral.

California Regulatory Updates 4/11/2022

SB 1064 – Structural Pest Control: Workers’ Compensation Insurance Coverage. An Act to Add Section 8693 to the Business and Professions Code, Relating to Structural Pest Control.

Issues: Workers’ Compensation (Medical Coverage and Reimbursement), Workers’ Compensation (General)

Summary:

This measure applies to employers and workers compensation insurance carriers. This measure would prohibit the Structural Pest Control Board from issuing, reinstating, or continuing to maintain any structural pest control operator company registration unless the applicant or existing company has filed a current and valid Certificate of Workers’  Compensation Insurance as evidence of current and valid Workers’ Compensation Insurance coverage, or a statement certifying that they have no employees and are not required to obtain or maintain workers’ compensation insurance. This measure is effective January 1 of the year after enactment.

Most Recent Update:

3/21/2022 At the hearing, this measure passed the committee unanimously and was referred to the Senate Committee on Labor, Public Employment and Retirement. This measure is eligible for consideration in the committee of referral.

California Regulatory Updates 2/3/2022

AB 399 – Workers’ Compensation. An Act to Amend Sections 139.5, 4603.2, 4603.6, 4610, 4616, 4616.2, and 5307.1 of the Labor Code, Relating to Workers’ Compensation.

Issues: Workers’ Compensation (Direction of Care), Workers’ Compensation (General)

Summary:

This measure amends code related to workers’ compensation and health care providers. This measure would impose new requirements on a medical provider network, including, among other things, requiring a participating provider to participate at each location at which they treat patients for 8 or more hours per week, on a monthly average. The measure would also prohibit authorizations or certifications issued by a carrier, claims administrator, medical provider network, or utilization review entity from providing instruction or imposing a requirement as to the location of where a treatment takes place or the provider who will perform the treatment. The measure would prohibit a vendor, provider, or group within the medical provider from being preferentially cited on an authorization or certification and would require the administrative director to impose a fine of $10,000 per authorization or certification that preferentially directs care within a medical provider network. The measure would require all treatment authorization or certification, adjuster correspondence, or billing explanation of review or explanation of benefits to include the medical provider network identification number, medical provider network name, and the name of the network covering the claimant provided in that correspondence. The measure would require the administrative director to fine a medical provider network $5,000 per document that fails to include the required medical provider network information.

This measure would require the administrative director to maintain a written record of compliance and approval for all plans and modifications and to approve the plan or modification in writing and with attestation of compliance. The measure would require the administrative director to fine a medical provider network $50,000 per occurrence, and to fine a carrier utilizing a medical network $50,000, if the administrative director determines that a medical provider  network failed to meet the access standard for a given specialty and denied an injured worker the right to seek care outside of the medical provider network.

This measure would require the administrative director to adopt a medical fee schedule establishing reasonable minimum fees paid for medical services other than physician services, drug and pharmacy services, health care facility fees, home care facility fees, home health care, and all other treatment care, services, and goods. The measure would prohibit an insurance carrier, agent, or third party contracting entity from contracting with providers of medical services for rates less than the official medical fee schedule adopted by the administrative director.

Additionally, this measure provides that a provider will reimbursed with all fees associated with the filing of the review if that provider is found to be owed additional reimbursement by an independent medical review organization.

Most Recent Update:

1/27/2022 This measure passed the Assembly unanimously. This measure is eligible for consideration in the Senate chamber.

AB 991 – Workers’ Compensation: Presumed Injuries. An Act to Amend Section 200 Sections 3212, 3212.1, 3212.15, 3212.6, 3212.8, 3212.85, 3212.9, and 3212.11 of the Labor Code, Relating to Employment. 

Issues: Worker’s Compensation (Medical Coverage and Reimbursement), Workers’ Compensation (General)

Summary:

This measure expands presumptions for hernia, pneumonia, heart trouble, cancer, tuberculosis, bloodborne infectious disease, methicillin-resistant Staphylococcus aureus skin infection, and meningitis-related illnesses and injuries to a lifeguard employed on a year-round, full-time basis by the City of San Diego. The bill would increase the period of time after termination of employment that a lifeguard employed on a year-round, full-time basis by the City of San Diego can file a claim for skin cancer. The bill would expand the presumptions for illness or injury related to post-traumatic stress disorder or exposure to biochemical substances, as defined, to a lifeguard employed by the City of San Diego Fire-Rescue Department.

Most Recent Update:

1/11/2022 On January 3, this measure was amended. The January 11 hearing was then canceled at the request of the author. This measure is eligible for further consideration in the Assembly Insurance Committee, chaired by Assemblymember Tom Daly (D).

SB 213 – Workers’ Compensation: Hospital Employees. An Act to Add Sections 3212.21, 3212.22, 3212.24, 3212.26, and 3212.28 to 3212.22, 3212.24, and 3212.26 To, and to Add and Repeal Sections 3212.21 and 3212.28 Of, the Labor Code, Relating to Workers’ Compensation.

Issues: Workers’ Compensation (Medical Coverage and Reimbursement), Workers’ Compensation (General)

Summary:

This measure amends California code to create a workers’ compensation presumption for COVID-19. This measure creates a COVID-19 presumption under workers compensation. This measure includes COVID-19 in the definitions of infectious and respiratory diseases. If enacted, this measure would take effect on January 1, 2023. The measure would extend rebuttable presumptions that these injuries that develop or manifest in a hospital employee who provides direct patient care in an acute care hospital arose out of and in the course of the employment. The measure would extend these presumptions for specified time periods after the hospital employee’s termination of employment. This measure also introduces a definition of cancer for this purpose. It is defined as liver cancer, myeloid leukemia, kidney cancer, multiple myeloma, ovarian cancer, breast cancer, nasopharyngeal cancer, thyroid cancer, cancers of the brain and nervous system, HPV-positive tonsillar cancer, and those cancers that develop or manifest as a result of exposure to antineoplastic drugs, anesthetic gases, or surgical smoke. If enacted, this measure would take effect on January 1, 2023.

Most Recent Update:

1/25/2022 This measure was removed from the inactive file and amended on January 20. This measure was further amended on the Senate floor on January 25. This measure is eligible for consideration in the Senate.

California Regulatory Updates 10/4/2021

AB 404 – Workers’ Compensation: Workers

Issues: Workers’ Compensation Managed Care, Workers’ Compensation (General)

Summary:

This measure requires that the workers’ compensation medical-legal fee schedule be updated at least annually to increase the conversion factor by the percentage increase in the most recent federal Medicare Economic Index. This measure is applicable to workers’ compensation. This measure provides that the administrative director will annually update the schedule to reflect the rising costs of maintaining a medical practice by increasing the conversion factor and the per-page cost of reviewing records based on the percentage increase in the most current federal Medicare Economic Index. If the federal Medical Economic Index shows a decrease, the fee schedule will not be reduced. This measure does not yet specify an effective date.

Most Recent Update:

8/26/2021 This measure has been scheduled for a hearing on August 26 in the Assembly Committee on Appropriations. The hearing will be open to the public  but public testimony will not be accepted, as is usual for Suspense File hearings. A vote may occur at the discretion of the Chair. In response to the COVID-19 pandemic, public attendance in committee and overflow rooms will be limited and on a first come, first served basis. Social distancing and mask  requirements will be observed. All are encouraged to watch the hearing from its live stream on the Assembly’s website at https://www.assembly.ca.gov/todaysevents. The Capitol will be open for attendance at this hearing, but the public is strongly encouraged to participate via the web portal or phone. Information regarding Remote Testimony Station locations and phone lines will be made available on the committee website closer to  the hearing date. Any member of the public attending a hearing in the Capitol will need to wear a mask at all times while in the building.

California Regulatory Updates 9/1/2021

AB 1148 – Workers’ Compensation Insurance Reporting. An Act to Amend Sections 11752.75 and 11752.8 Of, and to Repeal Section 11759.2 Of, the Insurance Code, Relating to Insurance.

Issues: Workers’ Compensation (General)

Summary:

This measure amends statute relating to workers’ compensation. This measure is applicable to workers’ compensation. This measure requires the commissioner to review and evaluate the operation of a licensed rating organization’s internet website and assess whether the internet website is achieving its purpose at least every 5 years, beginning in 2023. The measure requires the commissioner to provide a written report on the findings no later than July 1, 2023, and no later than July 1 of each reporting year thereafter.

Most Recent Update:

5/19/2021 This measure has been referred to the Senate Committee on Labor, Public Employment and Retirement. This measure awaits further consideration by the Committee.

AB 1393 – Insurance: Liability Insurers. An Act to Amend Section 108.1 of the Insurance Code, Relating to Insurance.

Issues: Workers’ Compensation (General)

Summary:

This measure establishes the Department of Insurance to regulate liability insurance providers. This measure applies to liability insurers. This measure establishes the Department of Insurance, which would be headed by the Insurance Commissioner, and would regulate both insurers and insurance practices.
This measure directs insurers which have been permitted to provide liability insurance by the Department to also provide worker’s compensation insurance.
This measure will take effect 90 days after enactment.

Most Recent Update:

3/25/2021 This measure has been referred to the Assembly Committee on Insurance, chaired by Representative Tom Daly (D). The sponsor does not serve on the committee. This measure awaits further consideration before the committee of referral at the discretion of the chair.

AB 1541 – Insurance: Guarantee Association. An Act to Amend Section 1063.75 of the Insurance Code, Relating to Insurance.

Issues: Workers’ Compensation (General)

Summary:

This measure amends statute relating to workers’ compensation. This measure is applicable to worker’s compensation. This measure extends the date for bonds to be issued to provide funds for covered claim obligations for workers’ compensation claims, as specified, to January 1, 2026. This measure takes effect the January 1 following enactment.

Most Recent Update:

7/15/2021 This measure was sent to the floor without a hearing pursuant to Senate Rule 28.8. Senate Rule 28.8 provides that if the Chair determines that any state costs of a bill are not significant, the measure will be sent directly to the Senate Floor for Second Reading without a hearing in the committee. This  measure is eligible for consideration in the Senate Chamber.

AB 334 – Workers’ Compensation: Skin Cancer. An Act to Amend Section 3212.11 of the Labor Code, Relating to Workers’ Compensation.

Issues: Workers’ Compensation (General)

Summary:

This measure would expand the scope of certain workers’ compensation provisions to certain peace officers of the Department of Fish and Wildlife and the  Department of Parks and Recreation. This measure is applicable to workers’ compensation. This measure expands skin cancer presumptions for workers’ compensation purposes to peace officers of the Department of Fish and Wildlife and the Department of Parks and Recreation. This measure does not specify an effective date.

Most Recent Update:

7/15/2021 This measure was sent to the floor without a hearing pursuant to Senate Rule 28.8. Senate Rule 28.8 provides that if the Chair determines that any state costs of a bill are not significant, the measure will be sent directly to the Senate Floor for Second Reading without a hearing in the committee. This measure is eligible for consideration on the floor.

AB 772 – Workers’ Compensation: Medical Treatment. An Act to Amend Section 4600.05 Relating to Workers’ Compensation Insurance.

Issues: Workers’ Compensation (General)

Summary:

This measure amends statute relating to workers’ compensation. This measure is applicable to workers’ compensation. This measure replaces “shall apply only” to “applies only” for statute relating to workers’ compensation during an act of domestic terrorism. This measure takes effect the January 1st of the year following enactment.

Most Recent Update:

3/25/2021 This measure has been referred to the Assembly Committee on Insurance, chaired by Representative Tom Daly (D). The sponsor does not serve on the committee. This measure awaits further consideration before the committee of referral at the discretion of the chair.

SB 216 – Contractors: Workers’ Compensation Insurance: Mandatory Coverage. An Act to Amend, Repeal, and Add Sections 7125 and 7125.4 of the Business and Professions Code, Relating to Professions and Vocations.

Issues: Workers’ Compensation (General)

Summary:

This measure amends existing state statute to require certain contractors and employees to be covered by or to purchase workers’ compensation insurance.
This measure is applicable to workers’ compensation insurance and certain contractors as defined by the measure. This measure provides that concrete contractors holding a C-8 license, warm-air heating, ventilation and air-conditioning (HVAC) contractors holding a C-20 license, or tree service contractors  holding a D-49 license to also obtain and maintain workers’ compensation insurance even if that contractor has no employees. The measure, as of January 1, 2025, would require all licensed contractors or applicants for licensure to obtain and maintain workers’ compensation insurance even if that contractor has no  employees and would also prohibit the filing of a certificate of exemption. These provisions are set to expire on January 25, 2025.

Most Recent Update:

5/26/2021 This measure was ordered to the inactive file on May 26. The inactive file is the portion of the Daily File containing legislation that is ready for floor consideration, but, for a variety of reasons, is dormant. An author may move a measure to the inactive file if he or she wishes to take it up at a later date. Once a measure is on the inactive file, one day’s public notice is needed to place it back on the agenda.

SB 284 – Workers’ Compensation: Firefighters and Peace Officers: Post-Traumatic Stress. An Act to Amend Section 3212.15 of the Labor Code, Relating to Workers’ Compensation.

Issues: Workers’ Compensation (General)

Summary:

This measure applies existing workers’ compensation provisions to active firefighters and professionals as specified by the measure text. This measure is applicable to workers’ compensation. This measure applies workers’ compensation provisions to active firefighting members of the State Department of State Hospitals, the State Department of Developmental Services, and the Military Department, and the Department of Veterans Affairs, and to additional peace  officers, including security officers of the Department of Justice when performing assigned duties as security officers and the officers of a state hospital under the jurisdiction of the State Department of State Hospitals or the State Department of Developmental Services, among other officers. The bill would only apply prospectively to individuals, as specified, to injuries occurring on or after January 1, 2022. This measure will take effect on January 1, 2022.

Most Recent Update:

6/28/2021 During the June 24 hearing in the Assembly Insurance Committee, this measure was amended and passed unanimously. The amendments were released on June 28. The measure has since been referred to the Assembly Committee on Appropriations.

SB 335 – Workers’ Compensation: Proceedings: Payment Delay.An Act to Amend Section 5814 of the Labor Code, Relating to Workers’ Compensation.

Issues: Workers’ Compensation (General)

Summary:

This measure makes several changes to Workers’ Compensation code in California. This measure is applicable to workers’ compensation. This measure reduces a liability 90-day time periods to 45 days and, for certain injuries or illnesses, including hernia, heart trouble, pneumonia, or tuberculosis, among others,  sustained in the course of employment of a specified member of law enforcement or a specified first responder, would reduce those time periods to 30 days. This measure increases limits liability for medical treatment to $17,000. This measure will require, if payment of compensation has been unreasonably delayed or refused, either prior to or subsequent to the issuance of an award, for specified claims of injury or illness, including hernia, heart trouble, pneumonia, or tuberculosis, among others, sustained in the course of employment of a specified member of law enforcement or a specified first responder, the full amount of the order, decision, or award to be increased by 10%. This measure will take effect on January 1, 2022 following enactment.

Most Recent Update:

7/13/2021 At the July 13 hearing, this measure failed to pass the committee. This measure is unlikely to receive further consideration.

SB 788 – Workers’ Compensation: Risk Factors. An Act to Amend Section 4663 of the Labor Code, Relating to Workers’ Compensation. 

Issues: Workers’ Compensation (General)

Summary:

This measure prohibits certain social factors to be used for the determination of workers’ compensation disability benefits. This measure is applicable to workers’ compensation. This measure prohibits consideration of race, religious creed, color, national origin, gender, marital status, sex, sexual identity, sexual orientation to determine the approximate percentage of the permanent disability caused by other factors. The measure would also express the Legislature’s intent to eliminate bias and discrimination in the workers’ compensation system. If enacted, this measure will take effect on January 1, 2022.

Most Recent Update:

6/24/2021 This measure will be heard on June 24, 2021, in the Assembly Insurance Committee. The hearing will be open to the public, and testimony will be accepted at the discretion of the Chair. A vote may occur at the discretion of the Chair. In response to the COVID-19 pandemic, public attendance in committee and overflow rooms will be limited and on a first-come, first-served basis. Social distancing and mask requirements will be observed. The public is encouraged to provide written testimony before the hearing by visiting the committee website. All are encouraged to watch the hearing from its live stream on the Assembly’s website at https://www.assembly.ca.gov/todaysevents. The Capitol will be open for attendance at this hearing, but the public is strongly encouraged to participate via the web portal or phone. Information regarding Remote Testimony Station locations and phone lines will be made available on the committee website closer to the hearing date. Any member of the public attending a hearing in the Capitol will need to wear a mask at all times while in the building.

California Regulatory Updates 8/5/2021

AB 399 – Workers’ Compensation: Workers

Issues: Workers’ Compensation (Direction of Care), Workers’ Compensation (General)

Summary:

This measure amends code related to workers’ compensation and health care providers. This measure would impose new requirements on a medical provider  network, including, among other things, requiring a participating provider to participate at each location at which they treat patients for 8 or more hours per week, on a monthly average. The measure would also prohibit authorizations or certifications issued by a carrier, claims administrator, medical provider network, or utilization review entity from providing instruction or imposing a requirement as to the location of where a treatment takes place or the provider who will perform the treatment. The measure would prohibit a vendor, provider, or group within the medical provider from being preferentially cited on an authorization or certification and would require the administrative director to impose a fine of $10,000 per authorization or certification that preferentially directs care within a medical provider network. The measure would require all treatment authorization or certification, adjuster correspondence, or billing explanation of review or explanation of benefits to include the medical provider network identification number, medical provider network name, and the name of the network covering the claimant provided in that correspondence. The measure would require the administrative director to fine a medical provider network $5,000 per document that fails to include the required medical provider network information.

This measure would require the administrative director to maintain a written record of compliance and approval for all plans and modifications and to approve the plan or modification in writing and with attestation of compliance. The measure would require the administrative director to fine a medical provider network
$50,000 per occurrence, and to fine a carrier utilizing a medical network $50,000, if the administrative director determines that a medical provider network failed to meet the access standard for a given specialty and denied an injured worker the right to seek care outside of the medical provider network.

This measure would require the administrative director to adopt a medical fee schedule establishing reasonable minimum fees paid for medical services other than physician services, drug and pharmacy services, health care facility fees, home care facility fees, home health care, and all other treatment care,
services, and goods. The measure would prohibit an insurance carrier, agent, or third party contracting entity from contracting with providers of medical services for rates less than the official medical fee schedule adopted by the administrative director.

Additionally, this measure provides that a provider will reimbursed with all fees associated with the filing of the review if that provider is found to be owed additional reimbursement by an independent medical review organization.

Most Recent Update:

2/12/2021 More information recently became available for this measure. On February 12, this measure was referred to the Assembly Insurance Committee which is chaired by Assembly member Tom Daly (D). This measure is eligible to be scheduled for a hearing.

AB 404 – Workers’ Compensation: Workers

Issues: Workers’ Compensation Managed Care, Workers’ Compensation (General)

Summary:

This measure requires that the workers’ compensation medical-legal fee schedule be updated at least annually to increase the conversion factor by the percentage increase in the most recent federal Medicare Economic Index. This measure is applicable to workers’ compensation. This measure provides that the administrative director will annually update the schedule to reflect the rising costs of maintaining a medical practice by increasing the conversion factor and the per-page cost of reviewing records based on the percentage increase in the most current federal Medicare Economic Index. If the federal Medical Economic Index shows a decrease, the fee schedule will not be reduced. This measure does not yet specify an effective date.

Most Recent Update:

7/5/2021  At the July 5 hearing, this measure was considered in the Senate Committee on Appropriations and was placed in the suspense file for further consideration at a later date by an undisclosed vote. The committee will hear a bill on the Suspense File just prior to the fiscal committee deadlines. During the suspense file hearing no testimony will be taken and the authors need not be present.

SB 213 – Workers’ Compensation: Hospital Employees

Issues: Workers’ Compensation (Medical Coverage and Reimbursement), Workers’ Compensation (General)

Summary:

This measure amends California code to create a workers’ compensation presumption for COVID-19. This measure creates a COVID-19 presumption under workers compensation. This measure includes COVID-19 in the definitions of infectious and respiratory diseases. If enacted, this measure would take effect on January 1, 2023.

Most Recent Update:

6/3/2021 This measure was ordered to the inactive file on June 3. The inactive file is the portion of the Daily File containing legislation that is ready for floor consideration, but, for a variety of reasons, is dormant. An author may move a measure to the inactive file if he or she wishes to take it up at a later date.

SB 284 – Workers’ Compensation: Firefighters and Peace Officers: Post-Traumatic Stress

Issues: Workers’ Compensation (Medical Coverage and Reimbursement), Workers’ Compensation (General)

Summary:

This measure applies existing workers’ compensation provisions to active firefighters and professionals as specified by the measure text. This measure is applicable to workers’ compensation. This measure applies workers’ compensation provisions to active firefighting members of the State Department of State Hospitals, the State Department of Developmental Services, and the Military Department, and to additional peace officers, including security officers of the Department of Justice when performing assigned duties as security officers and the officers of a state hospital under the jurisdiction of the State Department of State Hospitals or the State Department of Developmental Services, among other officers. This measure will take effect on January 1, 2022.

Most Recent Update:

6/28/2021 During the hearing in the Assembly Insurance Committee, this measure was amended and passed unanimously. The amendments were released on June 28. The measure has since been referred to the Assembly Committee on Appropriations.

California Regulatory Updates 7/12/2021

SB 213 – Workers’ compensation: hospital employees

Issues: Workers’ Compensation (Medical Coverage and Reimbursement), Workers’ Compensation (General)

Summary:

This measure amends California code to create a workers’ compensation presumption for COVID-19. This measure creates a COVID-19 presumption under workers compensation. This measure includes COVID-19 in the definitions of infectious and respiratory diseases. If enacted, this measure would take effect on January 1, 2023.

Most Recent Update:

5/20/2021 This measure passed the Senate Committee on Appropriations with a vote of 5-2. This measure awaits further consideration in the Senate.

AB 404 – An Act to Amend Section 5307.6 of the Labor Code, Relating to Workers Compensation.

Issues: Workers’ Compensation Managed Care, Workers’ Compensation (General)

Summary:

This measure requires that the workers’ compensation medical-legal fee schedule be updated at least annually to increase the conversion factor by the percentage increase in the most recent federal Medicare Economic Index. This measure is applicable to workers’ compensation. This measure provides that the administrative director will annually update the schedule to reflect the rising costs of maintaining a medical practice by increasing the conversion factor and the per-page cost of reviewing records based on the percentage increase in the most current federal Medicare Economic Index. If the federal Medical Economic Index shows a decrease, the fee schedule will not be reduced. This measure does not yet specify an effective date.

Most Recent Update:

6/21/2021 This measure passed the Senate Committee on Labor, Public Employees, and Retirement with a vote of 5-0. The measure was then referred to the Senate Appropriations Committee where it is scheduled  to be heard on July 5.

SB 284 – Workers’ compensation: Firefighters and Peace Officers: Post-Traumatic Stress

Issues: Workers’ Compensation (Medical Coverage and Reimbursement), Workers’ Compensation (General)

Summary:

This measure applies existing workers’ compensation provisions to active firefighters and professionals as specified by the measure text. This measure is applicable to workers’ compensation. This measure applies workers’ compensation provisions to active firefighting members of the State Department of State Hospitals, the State Department of Developmental Services, and the Military Department, and to additional peace officers, including security officers of the Department of Justice when performing assigned duties as security officers and the officers of a state hospital under the jurisdiction of the State Department of State Hospitals or the State Department of Developmental Services, among other officers. This measure will take effect on January 1, 2022.

Most Recent Update:

6/10/2021 This measure will be heard on June 24, 2021, in the Assembly Insurance Committee. The  hearing will be open to the public, and testimony will be accepted at the discretion of the Chair. A vote may occur at the discretion of the Chair.

California Regulatory Updates 6/3/2021

SB 213 – Workers’ compensation: hospital employees

Issues: Workers’ Compensation (Medical Coverage and Reimbursement), Workers’ Compensation (General)

Summary:

This measure amends California code to create a workers’ compensation presumption for COVID-19. This measure creates a COVID-19 presumption under workers compensation. This measure includes COVID-19 in the definitions of infectious and respiratory diseases. If enacted, this measure would take effect on January 1, 2023.

Most Recent Update:

3/22/2021 This measure is scheduled for a hearing on April 19 in the Senate Committee on Appropriations, chaired by Senator Portantino (D).

AB 404 – An Act to Amend Section 5307.6 of the Labor Code, Relating to Workers Compensation.

Issues: Workers’ Compensation Managed Care, Workers’ Compensation (General)

Summary:

This measure requires that the workers’ compensation medical-legal fee schedule be updated at least annually to increase the conversion factor by the percentage increase in the most recent federal Medicare Economic Index. This measure is applicable to workers’ compensation. This measure provides that the administrative director will annually update the schedule to reflect the rising costs of maintaining a medical practice by increasing the conversion factor and the per-page cost of reviewing records based on the percentage increase in the most current federal Medicare Economic Index. If the federal Medical Economic Index shows a decrease, the fee schedule will not be reduced. This measure does not yet specify an effective date.

Most Recent Update:

5/20/2021 This measure passed the Assembly Committee on Appropriations on May 20, 2021 with a vote of 16-0. This measure awaits further consideration by the Assembly.

California Regulatory Updates 4/2/2021

AB 991 – Workers’ compensation: presumed injuries

Issues: Workers’ Compensation (General)

Summary:

This measure expands presumptions for hernia, pneumonia, heart trouble, cancer, tuberculosis, bloodborne infectious disease, methicillin-resistant Staphylococcus aureus skin infection, and meningitis-related illnesses and injuries to a lifeguard employed on a year-round, full-time basis by the City of San Diego. The bill would increase the period of time after termination of employment that a lifeguard employed on a year-round, full-time basis by the City of San Diego can file a claim for skin cancer. The bill would expand the presumptions for illness or injury related to post-traumatic stress disorder or exposure to biochemical substances, as defined, to a lifeguard employed by the City of San Diego Fire-Rescue Department.

Most Recent Update:

3/11/2021 This measure was amended and referred to the assembly health committee. This measure is eligible for further committee consideration.

SB 213 – Workers’ compensation: hospital employees

Issues: Workers’ Compensation (Medical Coverage and Reimbursement), Workers’ Compensation (General)

Summary:

This measure amends California code to create a workers’ compensation presumption for COVID-19. This measure creates a COVID-19 presumption under workers compensation. This measure includes COVID-19 in the definitions of infectious and respiratory diseases. If enacted, this measure would take effect on January 1, 2023.

Most Recent Update:

3/22/2021 This measure passed the Senate Committee on Labor, Public Employment and Retirement. This measure was referred to the Senate Appropriations Committee. This measure is eligible for consideration in the next committee of referral.

SB 284 – Workers’ compensation: Firefighters and Peace Officers: Post-Traumatic Stress

Issues: Workers’ Compensation (Medical Coverage and Reimbursement), Workers’ Compensation (General)

Summary:

This measure applies existing workers’ compensation provisions to active firefighters and professionals as specified by the measure text. This measure is applicable to workers’ compensation. This measure applies workers’ compensation provisions to active firefighting members of the State Department of State Hospitals, the State Department of Developmental Services, and the Military Department, and to additional peace officers, including security officers of the Department of Justice when performing assigned duties as security officers and the officers of a state hospital under the jurisdiction of the State Department of State Hospitals or the State Department of Developmental Services, among other officers. This measure will take effect on January 1, 2022.

Most Recent Update:

3/22/2021 This measure was considered in the Senate Committee on Appropriations and placed in the suspense file for further consideration at a later date by a vote of 7-0. The committee will hear a bill on the Suspense File just prior to the fiscal committee deadlines. During the suspense file hearing no testimony will be taken and the authors need not be present.

California Regulatory Updates 3/17/2021

AB 399 – Workers’ compensation: medical treatment: exemption from utilization review

Issues: Workers’ Compensation (General)

Summary:

This bill proposes sweeping changes which are expected to alter the landscape of workers’ compensation from a payor perspective in the State of California. Among other changes, this bill introduces a floor for provider reimbursement, establishing a minimum allowable.

Most Recent Update:

This measure was introduced on February 3, 2021.

California Regulatory Updates 09/01/2020

AB 1107 – Workers’ compensation: medical treatment: exemption from utilization review

During the August 20 hearing, the Senate Appropriations Committee held this measure under submission.
This measure is unlikely to receive further consideration.

See 8/17/2020 update below for more information.

California Regulatory Updates 08/17/2020

AB 1107 – Workers’ compensation: medical treatment: exemption from utilization review

Issues: Workers’ Compensation (General), Workers’ Compensation (Utilization Review And Appeals), Utilization Review

Summary:

Summary for 03/26/2019 Version

This measure exempts medical treatment requested by a primary or secondary treating physician from the utilization review process and from dispute on the grounds of medical necessity if either:

i. the employee suffers from a serious chronic condition; or

ii. the requested treatment has been previously authorized by the employer and the employer fails to demonstrate a change in the employee’s circumstances or condition which would render the treatment no longer reasonably required to cure or relieve the employee from the effects of the industrial injury.

The measure also exempts medical treatment requested by a primary or secondary treating physician from the utilization review process and from dispute on the grounds of medical necessity if the employer has established a medical provider network pursuant to Section 4616 and the requesting physician is a member of the medical provider network.

Summary for 4/22/2019 Version

The measure makes a final determination of the Administrative Director of the Division of Workers’ Compensation conclusive evidence that medical treatment was unreasonably delayed or denied.

Most Recent Update:

This measure was heard August 14 by the Senate Governmental Organization Committee. This measure was reported favorably from committee by a 16-0 vote. The measure was referred to the Senate Appropriations Committee. This measure will be heard August 19 by the Senate Appropriations Committee. The hearing will be open to the public and written testimony should be submitted to the Committee in advance. A vote may occur at the discretion of the Chair. Due to COVID-19 California has stopped taking in person public testimony, instructions for providing public testimony for this hearing can be found here: https://sapro.senate.ca.gov/.

California Regulatory Updates 05/15/2020

AB 2294 – Workers’ compensation

Issues: Workers’ Compensation (General), Workers’ Compensation (Utilization Review And Appeals), Utilization Review

Summary:

This measure makes multiple changes to workers’ compensation requirements.

Specifically, this measure amends sections 139.5, 4603.2, 4603.6, 4610, 4616, 4616.2, and 5307.1 of the Labor Code to impose new requirements on medical provider networks, requiring a participating provider to participate at each location at which they treat patients for 8 or more hours per week, on a monthly average.

This measure also prohibits authorizations or certifications issued by a carrier, claims administrator, medical provider network, or utilization review entity from providing instruction or imposing a requirement as to the location of where a treatment takes place or the provider who will perform the treatment. This measure prohibits a vendor, provider, or group within the medical provider from being preferentially cited on an authorization or certification and would require the Administrative Director or the Division of Workers’ Compensation to impose a fine of $10,000 per authorization or certification that preferentially directs care within a medical provider network.

This measure requires all treatment authorization or certification, adjuster correspondence, or billing explanation of review or explanation of benefits to include the medical provider network identification number, medical provider network name, and the name of the network covering the claimant provided in that correspondence. This measure would require the Administrative Director to fine a medical provider network $5,000 per document that fails to include required network information.

This measure requires the administrative director to maintain a written record of compliance and approval for all plans and modifications and to approve the plan or modification in writing and with attestation of compliance. This measure would require the Administrative Director to fine a medical provider network $50,000 per occurrence, and to fine a carrier utilizing a medical network $50,000, if the administrative director determines that a medical provider network failed to meet the access standard for a given specialty and denied an injured worker the right to seek care outside of the medical provider network.

This measure also requires the Administrative Director to adopt a medical fee schedule establishing reasonable minimum fees paid for medical services other than physician services, drug and pharmacy services, health care facility fees, home care facility fees, home health care, and all other treatment care, services, and goods. This measure would prohibit an insurance carrier, agent, or third party contracting entity from contracting with providers of medical services for rates less than the official medical fee schedule adopted by the Administrative Director.

This measure requires a provider to be reimbursed with all fees associated with the filing of the review if that provider is found to be owed additional reimbursement by an independent medical review organization. This measure further requires that if the reimbursement is not made, a penalty of $1,000 per month will accrue. This measure requires that if prospective or concurrent decision of a request for authorization is not made within 5 days from transmission of the request for authorization, or if a final decision is not properly communicated, as specified, that the request for authorization be presumed authorized.

This measure requires the administrative director, no later than January 1, 2022, to ensure that the Electronic Adjudication Management System (EAMS) contains the medical provider network identification number for each injured worker contained in EAMS. This measure requires the administrative director, by July 1, 2022, to report to the Legislature on the status of the EAMS requirement.

This measure gives a provider the right to file a petition for determination of non-independent bill review for matters not eligible for independent bill review. This measure requires a defendant to be deemed to have waived all objections to a provider’s billing, if one of 2 conditions occurs. This measure requires that a defendant be liable for a fee of not less than $500 if the workers’ compensation appeals board determines that the defendant failed to comply with various requirements as a result of bad faith or tactics.

This measure requires that a provider be liable for a fee of not less than $500 if the workers’ compensation appeals board determines that the provider improperly asserted that a defendant failed to comply with requirements.

Most Recent Update: This measure was amended. This measure awaits further consideration before the Committee.

California Regulatory Updates 04/15/2020

SB 924 – Workers’ compensation: utilization review.

Issues: Workers’ Compensation (Utilization Review And Appeals), Workers’ Compensation (General)

Summary:

This measure makes changes to workers’ compensation evaluations.

Specifically, this measure would require the office of the Administrative Director’s of the Division of Workers’ Compensation evaluation to cover claims filed on or after January 1, 2017, and before January 1, 2021, and would require the report to be submitted to the Administrative Director and the relevant legislative committees before January 1, 2022.

Most Recent Update: The March 25 hearing before the Senate Labor, Public Employment and Retirement Committee, chaired by Senator Jerry Hill (D) was cancelled.

The California Legislature has suspended operations through April 13 due the COVID-19 pandemic.

January 1 2020 Regulatory Update: AB 1804 & AB 1805

California Governor Newsom signed two bills on August 30, 2019, which will impact the reporting of occupationally related injuries, illnesses, or deaths to Cal-OSHA.
These bills go in to effect on January 1, 2020.

The first, AB 1804, will remove an employer’s ability to report a serious occupational injury, illness, or death (see clarification on serious injury or illness below) to Cal-OSHA by email.  This bill now requires that the report be filed online through a Cal-OSHA established reporting mechanism.  Currently, Cal-OSHA has not yet released information on the newly required reporting mechanism to be used so has indicated reporting is to continue either by phone reporting to the nearest Cal-OSHA office relative to the injury/accident site or by email (https://www.dir.ca.gov/dosh/report-accident-or-injury-EM.html). Further information will be released by Cal-OSHA when the new reporting mechanism becomes available.

The second bill, AB 1805, revises two California Labor Code definitions regarding seriously injury or illness to better align with federal law and for purposes of Cal-OSHA reporting. A serious injury or illness requiring reporting is now defined as:

Any injury or illness occurring in a place of employment or in connection with employment that required inpatient hospitalization, for other than medical observation or diagnostic testing, or in which an employee suffers an amputation, the loss of an eye, or any serious degree of permanent disfigurement.  It does not include any injury or illness or death caused by an accident on a public street or highway unless the accident occurred in a construction zone.   Additionally, the law has clarified the meaning of serious exposure to include exposure to any hazardous substance when the exposure occurs as a result of an incident, accident, emergency, or exposure over time and in a degree or amount sufficient to create a realistic possibility that death or serious physical harm in the future could result from the actual hazard created by the exposure. 

As a reminder, employers are required to report a serious injury or illness including death, immediately but no later than eight hours after the employer knows, or with diligent inquiry, would have known of the death or serious injury or illness.  Failure to do so can ultimately result in serious civil financial fines or penalties to the employer of not less than $5000.

California Regulatory Updates 08/01/2019

SB 537 – Workers’ compensation: treatment and disability 

Issues: Workers’ Compensation (General), Network Adequacy, Workers’ Compensation Managed Care

Summary:

This measure requires the Administrative Director of the Division of Workers’ Compensation to issue a report to the Legislature, on or before January 1, 2023, comparing potential payment alternatives for providers to the official medical fee schedule.

This measure clarifies that an entity that provides physician network services or ancillary network services is prohibited from altering or amending a request for authorization for medical treatment from a physician or physical therapist before the submission of the request to the claims administrator.

This measure requires an itemized request for payment for services provided on or after July 1, 2020, to be submitted to an employer with the provider physician’s national provider identifier number.

This measure requires a contracting agent, employer, or carrier to provide a health care provider or health facility with a rate sheet if a contracted reimbursement rate is different from those in the official medical fee schedule.

This measure requires a contracting agent to provide a rate sheet to the employer, carrier, or entity for which the agent is acting if the contracted reimbursement rate is more than 15% below the official medical fee schedule.

Most Recent Update: During the July 10 hearing, the Assembly Insurance Committee amended and passed this measure with a vote of 14 – 0. The Committee also re-referred this measure to the Assembly Appropriations Committee, which is chaired by Assembly Member Lorena Gonzalez (D). The amendment text was read and released on August 13. This measure is eligible for a hearing in the Appropriations Committee. A timeline for further consideration has not yet been established.

 

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