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

Plain English Breakdown

The official source material does not provide specific details on how often or under what conditions the fee schedule will be updated in relation to drug and pharmacy service fees.

Workers' Compensation Medical-Legal Fees

This law allows the Administrative Director of Workers’ Compensation to update the fee schedule for medical-legal evaluations every two years based on certain costs.

What This Bill Does

• Allows the Administrative Director of Workers’ Compensation to adjust the fee schedule for medical-legal evaluations every two years based on an evaluation of certain medical practice costs, including increases in the conversion factor and per-page cost of reviewing records.

Who It Names or Affects

• Workers who need medical-legal evaluations as part of their workers' compensation claims.
• Physicians and other healthcare providers involved in these evaluations.
• The Administrative Director of the Division of Workers’ Compensation.

Terms To Know

Administrative Director

A person who manages the operations of the Division of Workers' Compensation, including setting fees and rules for medical-legal evaluations.

Conversion Factor

A number used to calculate payment rates in healthcare fee schedules based on the relative value of different services.

Limits and Unknowns

• The bill does not specify how much fees will change or what exact costs will be considered.
• It is unclear when the first adjustment to the fee schedule will occur after this law passes.

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