On September 30, 2016, SB 1160 was approved by Governor Jerry Brown. Here is a brief look at some of the changes from this bill.
The bill requires the Administrative Director (“AD”) to adopt regulations that will provide notice to employees of access to medical treatment following the denial of a claim under the workers’ compensation system.
It increases the penalty to up to $10,000.00 for claims administrators who are in violation of data reporting requirements. It also requires the AD to post a list of the violators on the Division of Workers’ Compensation Internet website.
The bill revises and recasts provisions relating to Utilization Review (“UR”) for injuries occurring on or after January 1, 2018. The UR changes include: setting forth treatment subject to prospective review; authorizing retrospective review under limited circumstances; establishing provisions for removal of a physician or provider under designated circumstances; establishing new procedures for reviewing determinations regarding medical necessity of medication prescribed pursuant to drug formulary; requirement for each UR process to be accredited by an independent, nonprofit organization to certify that the UR process meets specified criteria; and for the AD to contract with an outside independent research organization to evaluate and report on the impact of provision of medical treatment within the first 30 days after a claim is filed between 1/1/17 and 1/1/19, to be completed before 1/1/20.
Lien claimants will now be required to file a declaration, under penalty of perjury, that includes specified information when filing the lien. Failure to file the declaration will be grounds for dismissal of the lien.
Liens will be automatically stayed for any physician or provider upon the filing of criminal charges against that person or entity for specific offenses.
There is existing law prohibiting assignment of liens except under limited circumstances. For liens filed after 1/1/17, this bill invalidates any assignment of a lien in violation of provisions, by operation of law.
Existing law allows a deponent to receive certain expenses and reimbursements, including reasonable allowance for attorneys’ fees. This bill authorizes the AD to determine the range of reasonable fees to be paid to a deponent.
This bill also requires the AD to promulgate regulations establishing criteria to verify the identity and credentials of individuals that provide interpreter services under the existing law.