Workers’ compensation: medical-legal expenses: fee schedule.

Plain English Breakdown

The bill summary and digest text do not provide exact details on the specifics of cost increases or how much the fee schedule will change, leaving these points open-ended.

Workers' Compensation Medical-Legal Expenses Fee Schedule

This law allows the administrative director to update the fee schedule for medical-legal expenses every two years based on changes in medical practice costs and requires updates when other medical treatment fees are revised.

What This Bill Does

• Allows the administrative director to adjust the fee schedule for medical-legal evaluations every two years.
• Requires these adjustments to consider increases in medical practice costs, including higher conversion factors and record review costs.
• Requires updating the fee schedule at specific times when other medical treatment fees are revised.

Who It Names or Affects

• Injured workers who need medical-legal evaluations for their claims.
• Physicians and healthcare providers involved in these evaluations.
• The administrative director of the Division of Workers’ Compensation.

Terms To Know

Administrative Director

A person responsible for managing the operations of the Division of Workers' Compensation, including setting fee schedules.

Conversion Factor

A multiplier used to calculate fees based on the relative value of medical procedures.

Limits and Unknowns

• The bill does not specify how much the fee schedule will change.
• It is unclear what specific costs will be considered in future adjustments.

Official Summary Text

SB 668, as amended, Hurtado.
Workers’ compensation: medical-legal expenses: fee schedule.
Existing law establishes a workers’ compensation system, which provides for comprehensive medical-legal evaluations to assist in the resolution of contested claims. Under existing law, fees for medical-legal evaluations are charged at a rate not to exceed a physician’s regular fee, or the fee schedule set by the Administrative Director of the Division of Workers’ Compensation, whichever is lower. Existing law requires that the schedule set fees for procedures according to relative values and a conversion factor, allowing for modifiers, as specified. Existing law requires the medical-legal fee schedule to be revised at the same time the fee schedule for medical treatment is revised.
This bill would authorize the
medical
administrative
director to adjust the fee schedule every 2 years based on an evaluation of certain medical practice costs, including increases in the conversion factor and the per-page cost of reviewing records, as specified. The bill would require the
medical
administrative
director to update the fee schedule
at specified times, including
at the time they adopt and revise the reasonable maximum fees for, among other things, drugs and pharmacy services provided to an injured employee.

Current Bill Text

Download Bill PDF