BILL ANALYSIS
SB 186
Page 1
SENATE THIRD READING
SB 186 (DeSaulnier)
As Introduced February 17, 2009
Majority vote
SENATE VOTE :29-10
INSURANCE 9-1
-----------------------------------------------------------------
|Ayes:|Solorio, Garrick, | | |
| |Anderson, | | |
| |Charles Calderon, Carter, | | |
| |Feuer, Hayashi, Nava, | | |
| |Torres | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Niello | | |
| | | | |
-----------------------------------------------------------------
SUMMARY : Removes the sunset date on the law that authorizes a
worker to predesignate his or her personal treating physician as
the treating physician in the event of a workplace injury.
EXISTING LAW :
1)Establishes a comprehensive system of workers' compensation
benefits, including medical benefits, for workers who are
injured on the job.
2)Allows the employer to select the treating physician for the
first 30 days after an injury, and, if the employer has
established a Medical Provider Network (MPN), allows the
employer to require injured employees to obtain treatment
within the MPN at all times.
3)Requires treatment of work-related injuries to be in
conformity with the American College of Occupational and
Environmental Medicine (ACOEM) Guidelines, or such other
guidelines as the Administrative Director (AD) of the Division
of Workers' Compensation may adopt.
4)Establishes a comprehensive system to adjudicate medical
treatment disputes, including utilization review that is
SB 186
Page 2
intended to ensure that treatment is provided in conformity
with the applicable treatment guidelines.
5)Authorizes an employee to "predesignate" a personal treating
physician who is authorized, in the event that employee is
injured on the job, to be the treating physician within the
first 30 days after the injury, and indefinitely even if the
employer has established an MPN.
6)Limits the right to predesignate a personal treating physician
by:
a) Authorizing predesignation only by employees whose
employer offers group health insurance; and,
b) Requiring that a predesignated physician be a licensed
physician and surgeon who is the employee's primary care
physician who has previously directed the patient's care
and who maintains the patient's medical records and
history.
7)Provides that the predesignated physician may make all
appropriate referrals to other providers who are within the
employer-provided nonoccupational health insurance program.
8)Provides that any disputes that arise about the
appropriateness of medical treatment recommended by a
predesignated physician, or another provider to whom the
injured worker was referred by the predesignated physician, be
resolved within the dispute resolution system applicable to
the nonoccupational group health insurance program provided by
the employer.
9)Sunsets the right to predsignate as of December 31, 2009.
FISCAL EFFECT : The bill is tagged as "nonfiscal," although some
employers have argued there is a cost implication for a workers'
compensation program, including the state's program.
Proponents disagree with this argument (see comment 1, below).
COMMENTS :
1)The author introduced this bill to ensure that employees have
the right to select their own regular doctor as their provider
SB 186
Page 3
of choice in the event of a workplace injury. The author and
sponsors believe that medical treatment will be more effective
if provided by a doctor who is familiar with the patient, and
who the patient trusts. In support of this argument, the
sponsors point to a study by the Public Policy Institute of
California that concluded that employee satisfaction was
higher and costs were no different for employee's who
predesignated their physician.
2)Opponents object to continuing the element of current law that
allows a predesignated physician to refer to specialists
outside of the MPN. The MPN, in the view of most employers,
is one of the primary ways that the 2004 reforms enacted
effective cost controls. The opponents believe for the same
reasons articulated by the sponsors that it is good for an
injured worker to see their own, regular treating physician.
However, the employee does not have that same relationship
with physicians to whom they will be referred, and the
opposition believes that referrals should be within the MPN.
3)Some of the opponents are additionally concerned that disputes
about medical treatment will not be properly resolved, and the
results will be increased costs. They believe it is unclear
whether the ACOEM Guidelines and other approved guidelines
apply or, in a case where the group health insurance is
provided by an HMO, the Knox-Keene Health Care Service Plan
rules apply. Further, the opposition is concerned that even
if ACOEM and other approved guidelines do apply, the group
health doctors who would be resolving disputes are not
familiar with the workers' compensation rules. According to
an informal analysis from the DMHC, which indicates it has not
yet had a workers' compensation-related request for
independent medical review (IMR), only a patient who is denied
treatment is eligible under the Knox-Keene rules to request an
IMR. Thus, it is unclear whether an employer can even seek an
IMR if it believes a recommended treatment is not appropriate.
Without clarifying these problems, the employers are opposed
to repealing the sunset date.
Analysis Prepared by : Mark Rakich / INS. / (916) 319-2086
FN: 0001834