As daisyNews reported previously, California’s Department of Industrial Relations (DIR) paid RAND $300,000 to study the impact of Senate Bill 1160 on Utilization Review (UR), the process by which payers decide whether to authorize the treatment recommended by injured workers’ physicians.

As it turned out, there wasn’t enough data to determine whether “automatic” treatment authorization under SB 1160 had any real impact on injured workers’ care (at least not one that RAND could discern).

From the minuscule amount of UR data RAND managed to collect and review, it determined that SB 1160, which (in theory) dispensed with UR for certain treatments during the first 30 days of an injury, had little measurable effect. With arguably negligible exceptions, injured workers did not receive significantly more care, or receive it much more quickly, than before the law passed.

RAND’s conclusions may reflect that the legislation was riddled with pitfalls and caveats. It may reflect that the CA DWC didn’t enact regulations to implement SB 1160’s UR changes until nearly a decade after it passed, and continues to leave newly injured workers at the mercy of claims administrators regardless of the law. And of course, it may reflect the paucity of data from which RAND had to work.

This is what happens when well-intentioned legislation slams into the brick wall of regulatory ineptitude.

The state Senate took action to remove some of the obstacles to care inherent in the UR system. The CA DWC sat on it for years, during which no one collected the data needed to measure its effects. California can glean only two firm conclusions from RAND’s $300,000 study:

• California needs comprehensive statewide UR data to determine whether injured workers are getting the care they need.
• California cannot legislate its way around dysfunctional regulatory agencies that ignore the law and fail to fulfill their missions.

As for UR and whether SB 1160 helped injured workers obtain treatment, RAND could only point out a few very modest changes, but urged “caution” in interpreting those changes as “direct causal effects of SB 1160.” That’s a very expensive non-answer to a very important question.

No one should be surprised by RAND’s findings, or lack thereof.

For years, daisyNews has warned about SB 1160’s inherent pitfalls and the lack of available UR data to meaningfully study its effects. These issues were foreseeable (and publicly decried) in advance of the DIR hiring RAND. That there would be no significant measurable impact of SB 1160 was a $300,000 conclusion that daisyNews reported for free.

SB 1160: Set Up to Fail

SB 1160 established so-called “automatic” authorization, allowing providers to bypass UR in the first 30 days of an injury. While that might seem to streamline access to care, the legislation was hampered by a snowfall of asterisks, declaring that treatment “shall be authorized without prospective utilization review” only if:

• The payer accepts the body part or condition as compensable, even though payers have up to 90 days to determine compensability
• The physician is in the applicable MPN, a condition so fraught that it almost negates the law on its own
• The treatment is not one of several exceptions, including pharmaceuticals, nonemergency surgery, imaging, Durable Medical Equipment, and more

The law was passed in 2016 and took effect in 2018. As for the details on how to implement SB 1160’s UR bypass, the CA DWC failed to promulgate any relevant regulations until 2025; not until April of 2026 did California Code of Regulations (CCR) 9792.9.7 take effect.

Most tellingly, the CA DWC continued (and continues) to instruct injured workers on the DWC 1 form that if a claims administrator refuses to authorize treatment immediately following an injury, the worker should use their own health insurance or seek free treatment. That alone says more than RAND could tell us.

SB 1160 Did Little (Based on What Little We Know)

The RAND study’s conclusions reflect the thin foundations upon which it was based.

Thanks to a longstanding lack of UR data resulting from the CA DWC’s disregard of state laws requiring the agency to collect such data, RAND did what it could with the UR information available and solicited what we’ll call “donated data” from two unnamed payers who were willing to chip in.

Overall, RAND found SB 1160’s impact to be…unimpressive. RAND determined that (emphases ours):

• Treatment approval rates in their “analytic sample” (the two unnamed payers) consistently exceeded 90% during the first 30 days of injuries, both before and after SB 1160 took effect, with “no significant change” occurring.
  
• There was a “modest but statistically significant increase” in “guideline-concordant” Physical Therapy (PT) after SB 1160 took effect, with the odds of receiving PT within 30 days increasing by 13%; the time to first visit decreased by about 1 day.
  
• SB 1160 was also “Associated with Small Changes” in the provision of other care, from X-rays to acupuncture and MRIs, none of which were headline-worthy on their own.

Of course, all of these findings come with a giant asterisk representing the lack of data to study. In fact, RAND refused to commit to the notion that SB 1160 definitively changed anything, repeatedly urging “caution in interpreting any of the post-implementation changes as direct causal effects of SB 1160.”

To recap: RAND’s task was to study the impact of a law riddled with caveats, for which no applicable regulations were in effect at the time of the study, and about which minimal data were available.

The result was a $300,000 shrug.

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