By now, you’ve heard the news: Changes are coming to California workers’ compensation once again, by way of a legislative trio signed into law by Governor Brown.
The bills in question? SB 1160, SB 1175, and AB 1244. We’ll cover the first two in depth during our October 20th webinar. For now, here’s a rundown of why these bills matter and what changes they bring to California workers’ comp.
Think of SB 1160 as an extension of the 2012 workers’ comp reform SB 863. Both reforms share a lot of the same DNA and aligned goals: increase benefits and improve medical care for workers while controlling costs for employers.
Specifically, SB 1160 zeroes in on two issues that continue to plague California workers’ comp system – reducing treatment delays and stamping out fraud. Admirable goals. Here’s how SB 1160 plans to achieve them:
- Reducing or eliminating the need for utilization review (UR) for most treatments in the first 30 days after an injury.
- For treatment not subject to prospective UR, introduction of a timely billing requirement for providers: within 30 days of date of service.
- Medication now subject to the Independent Medical Review process.
- Mandating electronic reporting of UR data by claims administrators to the DWC.
- Placing major restrictions on liens, both current and future. This is in response to a DIR report that over $600 million in workers’ comp liens filed between 2011 and 2015 were done so by convicted or criminally indicted parties.
There’s an old saying that timing is everything in life. If SB 1175 is anything to judge by, the California Senate agrees. This bill is all about timely bill submission, and it kicks into effect on January 1, 2017. The highlights:
- Providers required to submit a bill for services within 12 months of rendering those services. This also applies to medical-legal bills.
- No payment due for untimely bill submissions.
- A reminder: Employers must accept electronic billing.
This is where the DWC really cracks down on fraud. AB 1244 requires the DWC Administrative Director to “suspend any medical provider, physician or practitioner from participating in the workers’ compensation system when convicted of fraud,” per a September 30th DIR news release.
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