Workers’ compensation.

Plain English Breakdown

The official source material does not provide specific details about enforcement or penalties for non-compliance, leaving these aspects uncertain.

Workers' Compensation Changes

This law updates the workers’ compensation system to provide more detailed explanations for medical service denials and requires doctors to sign requests for medical services.

What This Bill Does

• Requires employers to include information about any contracts involved when denying or adjusting medical bills, if the denial is based on a contract.
• Specifies that if an employer does not send the requested contract within 30 business days of the provider’s request, the bill must be reprocessed and paid.
• Mandates doctors to sign requests for medical services and allows these requests to be sent by mail, fax, or email.

Who It Names or Affects

• Injured workers who need medical treatment from their employer.
• Doctors who request medical services for injured workers.
• Employers who provide workers' compensation insurance.

Terms To Know

Utilization Review

A process where employers check if the medical treatments requested by doctors are necessary and should be covered under workers’ compensation.

Independent Medical Review

A way to solve disagreements between injured workers or their doctors and employers about whether a treatment is needed.

Limits and Unknowns

• The bill does not specify what happens if the contract information is sent but still doesn't fully explain why an item was denied.
• It's unclear how this will affect medical providers who do not use contracts with employers.
• There are no details on enforcement or penalties for non-compliance.

Official Summary Text

AB 1048, as amended, Chen.
Workers’ compensation.
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 an 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. Upon payment, adjustment, or denial of a complete or incomplete itemization of medical services, existing law requires an employer to provide an explanation of review that includes, among other information, the amount paid and the basis for any adjustment, change, or denial of the item or procedure billed.
This bill would, when the basis for any adjustment, change, or denial of an item or procedure is a contract,
require the explanation of review to include information on that underlying contract, including whom the
rendering
medical provider may contact to seek a copy of the
relevant, applicable
underlying
contract. The bill would state that disclosure of a medical provider network does not satisfy this requirement and would state that if the contract is not
received
sent to the rendering provider or their agent
within 30 business days of the provider’s request, the bill shall be reprocessed and paid, as specified.
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.
This bill would require a request for authorization of medical services by a physician to be signed by that physician, and would authorize a request to be sent via mail, fax, or electronic methods, as specified. The bill would make other conforming changes.

Current Bill Text

Download Bill PDF