BILL ANALYSIS
AB 1073
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 1073 (Nava)
As Amended September 5, 2007
Majority vote
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|ASSEMBLY: |43-27|May 10, 2007 |SENATE: |21-14|(September 10, |
| | | | | |2007) |
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Original Committee Reference: INS.
SUMMARY : Provides that the 24-visit cap on chiropractic,
physical therapy, and occupational therapy treatments in the
workers' compensation system does not apply to these services if
they are provided pursuant to a utilization schedule adopted by
the Administrative Director (AD) of the Division of Workers'
Compensation.
The Senate amendments provide that physical medicine services
may be provided outside the 24-visit cap based on utilization
standards that may be adopted by the AD.
EXISTING LAW :
1)Establishes a system of workers' compensation that provides
injured employees benefits that include, among other benefits,
medical care to treat injuries that occur during and in the
course of employment.
2)Places utilization limits on medical services designed to
ensure that only appropriate, effective treatment is provided
to injured employees. Among these limitations is a 24-visit
cap on chiropractic, occupational therapy and physical therapy
services.
3)Provides that an employer or insurer has discretion to waive
the 24-visit cap.
AS PASSED BY THE ASSEMBLY , this bill allowed the surgeon to
prescribe physical medicine outside the cap without limitation.
FISCAL EFFECT : Minor increase in the state's workers'
compensation costs.
AB 1073
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COMMENTS :
1)Purpose: According to the author, the goal is to ensure that
injured employees who have to undergo surgery to repair their
injuries are never left in a situation where appropriate
physical medicine services such as physical therapy are
unavailable due to the 24-visit cap.
2)Current guidelines encourage conservative approach to treating
injuries: When the Legislature adopted the American College
of Occupational and Environmental Medicine (ACOEM) guidelines
as the presumptive appropriate medical treatment for injured
workers, and further delegated to the AD of the Division of
Workers Compensation the authority to adopt other
peer-reviewed, evidence-based, nationally recognized standards
of care, the intent was to ensure that appropriate treatment,
but only appropriate treatment, was provided to injured
employees. Data was presented that many surgical
interventions were not ultimately successful treatment for
certain injuries, and that early surgical intervention was
often not appropriate. The new treatment rules are fairly
conservative in approach, favoring non-surgical intervention.
As a result, physical therapy and other physical medicine
approaches may be undertaken in an attempt to avoid surgery.
However, in the cases where surgical intervention is
ultimately required, the injured employee may have used up
most or all of the allotted 24 visits when they were pursuing
the conservative treatment that the guidelines suggest.
As the proponents correctly point out, many surgical procedures
require post-surgery physical therapy or other physical
medicine therapy in order for the surgery to be successful.
Indeed, many surgical procedures can leave the patient worse
off if not followed by proper post-surgery therapy. This bill
would ensure that the injured worker has these services
available.
3)Is existing employer discretion sufficient? Under existing
law, an employer or insurer has the discretion in all
circumstances to waive the 24-visit cap. However, the
proponents of this bill argue that some reviewers are
reasonable, and others are firm on the 24-visit cap. They
further point out that due to the importance of post-surgery
therapy in the success of the procedure, access to physical
medicine therapy ought to be a matter of right, as opposed to
AB 1073
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the discretion of the reviewer. The opposition, on the other
hand, makes the case that the discretion in current law is
adequate, and working. They argue that the current cap was
adopted as a result of significant abuse of these services,
and that creating further exceptions to the cap will encourage
abuse such as occurred in the past.
Analysis Prepared by : Mark Rakich / INS. / (916) 319-2086
FN: 0003471