BILL ANALYSIS
Senate Committee on Labor and Industrial Relations
Richard Alarcon, Chair
Date of Hearing: June 28, 2006 2005-2006 Regular
Session
Consultant: Rodger Dillon Fiscal:Yes
Urgency:No
Bill No: AB 1209
Author: Yee
Amended: February 6, 2006
Subject: Workers' Compensation: medical treatment
utilization schedule.
Purpose: To remove the 24-visit cap on chiropractic,
occupational therapy, and physical therapy services.
Analysis:
Existing law:
Specifies that medical treatment that is reasonably
required to cure or relieve the injured worker from the
effects of his or her injury means treatment that is
based upon the guidelines adopted by the administrative
director pursuant to Labor Code Section 5307.27 or, prior
to the adoption of those guidelines, the updated American
College of Occupational and Environmental Medicine's
Occupational Medicine (ACOEM) Practice Guidelines.
Requires that the medical treatment utilization schedule
(i.e., the guidelines) adopted by the AD address, at a
minimum, the frequency, duration, intensity, and
appropriateness of all treatment procedures and
modalities commonly performed in workers' compensation
cases.
Specifies that the recommended guidelines set forth in
the medical treatment utilization schedule, adopted by
the AD, shall be presumptively correct on the issue of
extent and scope of medical treatment.
Explains that the presumption is rebuttable and may be
controverted by a preponderance of the scientific medical
evidence establishing that a variance from the guidelines
is reasonably required to cure or relieve the injured
worker from the effects of his or her injury.
Specifies that for all injuries not covered by the
American College of Occupational and Environmental
Medicine's Occupational Medicine Practice Guidelines or
official utilization schedule, authorized treatment shall
be in accordance with other evidence based medical
treatment guidelines generally recognized by the national
medical community and that are scientifically based.
Limits the injured worker to not more than 24
chiropractic, 24 occupational therapy, and 24 physical
therapy visits per industrial injury, for injuries
occurring on or after January 1, 2004 and specifies that
the subdivision setting the 24-visit caps on
chiropractic, occupational therapy, or physical therapy
shall not apply when an employer authorizes, in writing,
additional visits to a health care practitioner for
physical medicine services.
This Bill deletes the provisions prescribing the maximum
number of chiropractic, occupational therapy, and physical
therapy visits an employee is entitled to receive per
industrial injury.
Comments:
1. Proponents :
The author states that although the vast majority of
conditions are resolved before the 24 visits, for
patients with serious conditions the 24-visit limitation
has created a significant barrier to medically necessary
care. The 24-visit cap is especially problematic for
firefighters, police officers, truckers, and others who
can't take pain medications and continue to work.
Supporters point out that the reform legislation was
Hearing Date: June 28, 2006 AB
1209
Consultant: Rodger Dillon
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Senate Committee on Labor and Industrial Relations
enacted before the relevant ACOEM guidelines were
published, and at that time no one knew if the guidelines
would adequately prevent over-utilization of physical
medicine services - so the Legislature added the 24-visit
caps. Since then, say supporters, ACOEM has been shown
to have significantly reduced the number of authorized
visits. Proponent say this is clear evidence the
arbitrary caps have outlived their usefulness.
2. Opponents :
Opponents point out that before reform chiropractic care
was 148% higher in California than in 12 other states
surveyed. They argue that the caps are responsible for
much of the total savings in the workers' compensation
system. They believe repealing the caps would send the
wrong signal to employers and insurers and would result
in increased workers' compensation costs. They hold that
the caps are reasonable and should be retained.
Support:
California Chiropractic Association (sponsor)
American Occupational Association
American Occupational Therapy Association
American Specialty Health Plans
California Chiropractic Association (Sponsor)
California Federation of Teachers
Crawford Chiropractic, Inc., Stockton, CA
Diversified Chiropractic
Eureka Square Chiropractic
GEIGER, Chiropractic Center, Granite Bay, CA
Independent Employees of Merced County
International Chiropractors' Association
Jerry H. Wolfe, D.C. [Diversified Chiropractic, San Diego,
CA.]
John Arakelian, D.C. [San Joaquin Chiropractic &
Rehabilitation, Fresno, CA.]
Kenneth A. Thomas, D.C. [Eureka Square Chiropractic,
Pacifica, CA.]
Hearing Date: June 28, 2006 AB
1209
Consultant: Rodger Dillon
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Senate Committee on Labor and Industrial Relations
Latch, So & Hwang Chiropractic [San Francisco, CA]
Michael J. Moore, D.C. [Moore Chiropractic Wellness Centre,
Redding, CA.]
Occupational Therapy Association of California
Organization of SMUD Employees
Palmer College of Chiropractic-West Federation of Teachers,
AFT Local 6166
Richard E. Lind, D.C.[Lind Non-Force Chiropractic, Orange,
CA.]
San Bernardino Public Employees Association
San Diego County Court Employees Association
San Francisco District, CA Chiropractic Assoc.
San Luis Obispo County Employees Association
San Mateo District, CA Chiropractic Assoc.
Santa Rosa City Employees Association
Steven D. Jensen, D.C. [Jensen Sports Chiropractic,
Camarillo, CA.]
Whalen Chiropractic, Santee, CA.
Numerous additional chiropractors and individuals
Opposition:
California Association of Joint Powers Authorities (CAJPA)
California Chamber of Commerce
California Coalition on Workers' Compensation
California Joint Powers Authorities
California Joint Powers Insurance Authority (CJPIA)
California Manufacturers Technology Association
California State Association of Counties
City of Corona
City of Torrance
CNA Insurance Company
County of San Diego
County of Stanislaus
CSAC-Excess Insurance Authority a California Joint Powers
Authority
Department of Industrial Relations
Independent Maintenance Contractors Association
League of California Cities
Los Angeles County Board of Supervisors [as amended Feb. 6,
Hearing Date: June 28, 2006 AB
1209
Consultant: Rodger Dillon
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Senate Committee on Labor and Industrial Relations
2006]
Pacific Association of Building Service Contractors
Regional Council of Rural Counties
Riverside Unified School District
Small Business California
Stanislaus County
Hearing Date: June 28, 2006 AB
1209
Consultant: Rodger Dillon
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Senate Committee on Labor and Industrial Relations