BILL ANALYSIS                                                                                                                                                                                                    

                             Senator Tony Mendoza, Chair
                                2015 - 2016  Regular 

          Bill No:               SB 914       Hearing Date:    April 6,  
          |Author:    |Mendoza                                              |
          |Version:   |January 26, 2016                                     |
          |Urgency:   |No                     |Fiscal:    |No               |
          |Consultant:|Gideon Baum                                          |
          |           |                                                     |
            Subject:  Workers' compensation:  medical provider networks:   
                             independent medical reviews

          KEY ISSUE
          Should the Legislature strike an out-of-date reference to the  
          American College of Occupational and Environmental Medicine's  
          Occupational Medicine's Practice Guidelines in the California  
          Labor Code?

           Existing law  establishes a workers' compensation system that  
          provides benefits to an employee who suffers from an injury or  
          illness that arises out of and in the course of employment,  
          irrespective of fault.  This system requires all employers to  
          secure payment of benefits by either securing the consent of the  
          Department of Industrial Relations to self-insure or by securing  
          insurance against liability from an insurance company duly  
          authorized by the state.

           Existing law  provides that medical, surgical, chiropractic,  
          acupuncture, and hospital treatment, including nursing,  
          medicines, medical and surgical supplies, crutches, and  
          apparatuses, including orthotic and prosthetic devices and  


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          services, that is reasonably required to cure or relieve the  
          injured worker from the effects of his or her injury shall be  
          provided by the employer.  
          (Labor Code 4600)

           Existing law  provides that the Administrative Director must  
          adopt, after public hearings, a medical treatment utilization  
          schedule (MTUS), that shall incorporate the evidence-based,  
          peer-reviewed, nationally recognized standards of care and must  
          address, at a minimum, the frequency, duration, intensity, and  
          appropriateness of all treatment procedures and modalities  
          commonly performed in workers' compensation cases. (Labor Code  
          This bill  strikes an out-of-date reference to the American  
          College of Occupational and Environmental Medicine's  
          Occupational Medicine Practice Guidelines.

           This bill also  makes additional minor and technical changes to  
          existing law.


          1.  Need for this bill?

            In 2004, the Legislature passed SB 899 (Poochigian), Chapter  
            34, Statutes of 2004, which was a holistic reform of the  
            California workers' compensation system. As a part of that  
            reform, SB 899 required that the Division of Workers'  
            Compensation (DWC) create an evidence-based set of medical  
            guidelines to ensure that injured workers were receiving  
            consistent, appropriate treatment from physicians. In the  
            intervening period, SB 899 required that physicians use the  
            American College of Occupational Medicine's Medicine Practice  
            Guidelines (ACOEM), which are a set of widely-utilized  
            evidence-based, peer reviewed medical guidelines that continue  
            to be used in California's workers' compensation system and  
            many other state workers' compensation systems.

            In 2009, the DWC promulgated the California-specific workers'  


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            compensation system medical treatment guidelines. Known as the  
            Medical Treatment Utilization Schedule (MTUS), the guidelines  
            utilized many of the chapters that make up ACOEM, but also  
            referenced additional guidelines or developed independent  
            guidance on medical treatment. As such, while ACOEM is still  
            used as a part of the MTUS, it is no longer referred to as a  
            stand-alone guideline.

            SB 914 would strike references to the use of ACOEM as a  
            stand-alone medical guideline.

          2. Proponent Arguments  :
            The author notes that the Medical Treatment Utilization  
            Schedule (MTUS) was created in 2009, and since that time has  
            been the sole medical guideline for medical treatment in the  
            California workers' compensation system. Despite this, some  
            out-of-date Labor Code sections continue to reference the  
            predecessor American College of Occupational Medicine's  
            Medicine Practice Guidelines (ACOEM). SB 914 would strike  
            these out-of-date references, ensuring that existing law  
            accurately reflects the status of the MTUS as the sole medical  
            guideline, reducing confusion and increasing the clarity of  
            existing law.

          3.  Prior Legislation  :

            SB 542 (Mendoza), Chapter 542, Statutes of 2015, also struck  
            out-of-date references to the ACOEM Medical Practice  

          None on file.
          None on file.

                                      -- END --


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