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Reform the Reforms: SB 489 Aims to Clean Up SB 1160

April 13, 2017 by Catherine Montgomery

Let’s start with some simple facts. Each two-year session of the California legislature can see as many as 5,000 bills introduced. Of those 5,000, Governor Brown will probably sign 800 to 1,000 into law. That’s a lot of bills, even for the state with the longest-running legislative session in the country. It stands to reason, then, that some of the passed bills need a little cleaning up after the fact. Last year’s Senate Bill 1160 is one of those bills. And Senate Bill 489, introduced by Democratic senator Steven Bradford, is acting as its janitor.

As you all know by now, one of the most important provisions in Senate Bill 1160 reduced or eliminated the need for utilization review (UR) for most treatments in the first 30 days after an injury. In turn, a timely billing requirement was introduced for providers: For all treatment not subject to prospective UR, bills must be submitted within 30 days of the date of service.

This is all well and good, as it aims to trim fat from the current system and speed both treatment and payment. But potential problems arise when those rules are applied to certain emergency services. The Senate Labor and Industrial Relations Committee voiced concern that the tight 30-day billing deadline could lead to a scenario where a severely injured worker is unable to communicate the location and circumstances of their injury until after the billing period had passed. In such a scenario, treating hospitals or physicians would be at risk of receiving no reimbursement, as it would be difficult to prove that a given injury was occupational in nature.

Senate Bill 489, which has the backing of the California Hospital Association, aims to curb this possibility. Rather than the standard 30-day billing deadline, SB 489 cedes up to 180 days for providers of emergency services to submit their bills. The bill passed the Senate Labor and Industrial Relations Committee unanimously earlier this month, and is due for a hearing in front of the Senate Committee on Appropriations on April 17.

Stay tuned in the coming weeks and months for more updates – both on Senate Bill 489 and any other proposed cleanup bills in the wake of last year’s landmark reforms.


Work Comp Reforms: Senate Bills 1160 & 1175

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