California 2019-2020 Regular Session Status: In Committee

AB 2294 — Workers' compensation.

Last action — Re-referred to Com. on INS.

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  1. ✓
    Introduced
  2. 2
    In Committee
  3. 3
    Passed Assembly
  4. 4
    Passed Senate
  5. 5
    To Executive
  6. 6
    Enacted

This bill died with 2019-2020 Regular Session. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.

Summary

Existing law establishes a workers' compensation system, administered by the Administrative Director of the Division of Workers' Compensation, to compensate an employee for injuries sustained in the course of employment. Existing law requires the employer to provide medical, surgical, chiropractic, acupuncture, and hospital treatment that is reasonably required to cure or relieve the injured worker from the effects of the injury. Existing law requires the administrative director to adopt and revise periodically an official medical fee schedule establishing reasonable maximum fees paid for medical services other than physician services, drugs and pharmacy services, health care facility fees, home health care, and all other treatment, care, services, and goods. Existing law also establishes the Workers' Compensation Appeals Board (appeals board) to exercise all judicial powers vested in it, including workers' compensation proceedings for the recovery of compensation. Existing law authorizes an insurer, employer, or entity that provides physician network services to establish or modify a medical provider network for providing medical treatment to injured employees and imposes various duties upon the insurer, employer, or entity in connection with the network. Existing law requires every medical provider network to post on its internet website a roster of all treating physicians in the medical provider network and requires every network to provide to the administrative director the internet website address of the network and of its roster of treating physicians. Existing law requires an insurer, employer, or entity that provides physician network services to submit a plan for the medical provider network to the administrative director for approval. Existing law requires the administrative director to adopt a medical treatment utilization schedule. Existing law authorizes the administrative director to investigate complaints and to conduct random reviews of approved medical provider networks. This bill 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 bill 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 bill 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 bill 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 bill 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 bill 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 bill 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 speciality and denied an injured worker the right to seek care outside of the medical provider network. This bill 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 bill 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. Existing law requires each employer to establish a utilization review process to review and approve, modify, or deny treatment recommendations and establishes an independent medical review process to resolve disputes over a utilization review decision. Existing law requires various requirements to be met in determining whether to approve, modify, or deny requests by a physician for medical services. Existing law requires the administrative director to contract with one or more independent medical review organizations to conduct independent medical reviews. This bill would require 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. The bill would further require that if the reimbursement is not made, a penalty of $1,000 per month would accrue. The bill would require 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. The bill would require 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. The bill would require the administrative director, by July 1, 2022, to report to the Legislature on the status of the EAMS requirement. This bill would provide a provider the right to file a petition for determination of nonindependent bill review for matters not eligible for independent bill review, as specified. The bill would require a defendant to be deemed to have waived all objections to a provider's billing, if one of 2 conditions occurs. The bill would require 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, as provided. The bill would require 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 various requirements, as provided. This bill would make related findings and declarations.

Bill Text

Action History

  1. Re-referred to Com. on INS.

  2. From committee chair, with author's amendments: Amend, and re-refer to Com. on INS. Read second time and amended.

  3. Referred to Com. on INS.

  4. From printer. May be heard in committee March 16.

  5. Read first time. To print.

Sponsors

  • Salas · Primary

Sponsorship breakdown

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1 sponsors · 0 co-sponsors · 121 not signed on

Sponsors (1)

  • Salas

Co-sponsors (0)

None.

Not signed on (121)

121 members have not signed on to this bill.

Show all 121 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Subjects

healthcare labor health-insurance
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Frequently asked questions

What does AB 2294 do?
Existing law establishes a workers' compensation system, administered by the Administrative Director of the Division of Workers' Compensation, to compensate an employee for injuries sustained in the course of employment. Existing law requires the employer to provide medical, surgical, chiropractic, acupuncture, and hospital treatment that is reasonably required to cure or relieve the injured worker from the effects of the injury. Existing law requires the administrative director to adopt and revise periodically an official medical fee schedule establishing reasonable maximum fees paid for medical services other than physician services, drugs and pharmacy services, health care facility fees, home health care, and all other treatment, care, services, and goods. Existing law also establishes the Workers' Compensation Appeals Board (appeals board) to exercise all judicial powers vested in it, including workers' compensation proceedings for the recovery of compensation. Existing law authorizes an insurer, employer, or entity that provides physician network services to establish or modify a medical provider network for providing medical treatment to injured employees and imposes various duties upon the insurer, employer, or entity in connection with the network. Existing law requires every medical provider network to post on its internet website a roster of all treating physicians in the medical provider network and requires every network to provide to the administrative director the internet website address of the network and of its roster of treating physicians. Existing law requires an insurer, employer, or entity that provides physician network services to submit a plan for the medical provider network to the administrative director for approval. Existing law requires the administrative director to adopt a medical treatment utilization schedule. Existing law authorizes the administrative director to investigate complaints and to conduct random reviews of approved medical provider networks. This bill 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 bill 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 bill 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 bill 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 bill 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 bill 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 bill 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 speciality and denied an injured worker the right to seek care outside of the medical provider network. This bill 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 bill 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. Existing law requires each employer to establish a utilization review process to review and approve, modify, or deny treatment recommendations and establishes an independent medical review process to resolve disputes over a utilization review decision. Existing law requires various requirements to be met in determining whether to approve, modify, or deny requests by a physician for medical services. Existing law requires the administrative director to contract with one or more independent medical review organizations to conduct independent medical reviews. This bill would require 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. The bill would further require that if the reimbursement is not made, a penalty of $1,000 per month would accrue. The bill would require 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. The bill would require 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. The bill would require the administrative director, by July 1, 2022, to report to the Legislature on the status of the EAMS requirement. This bill would provide a provider the right to file a petition for determination of nonindependent bill review for matters not eligible for independent bill review, as specified. The bill would require a defendant to be deemed to have waived all objections to a provider's billing, if one of 2 conditions occurs. The bill would require 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, as provided. The bill would require 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 various requirements, as provided. This bill would make related findings and declarations.
Who sponsors AB 2294?
AB 2294 is sponsored by Salas.
What is the current status of AB 2294?
This bill died with 2019-2020 Regular Session. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track AB 2294?
Track AB 2294 free on One Click Politics — get push/email alerts when it moves.

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