Today's Law As Amended


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AB-1465 Workers’ compensation: medical treatment.(2021-2022)



As Amends the Law Today


SECTION 1.

 Section 4617 is added to the Labor Code, to read:

4617.
 (a) The administrative director shall establish a statewide medical provider network to be called the California Medical Provider Network (CAMPN). The CAMPN shall consist of physicians, as described in Section 3209.3, throughout the state who are willing and able to provide medical treatment to injured employees.
(b) Notwithstanding any other provision of law, if the employer or insurer has established a medical provider network (MPN) pursuant to Section 4616, or a health care organization (HCO) pursuant to Section 4600.3, the injured employee may choose to treat with a physician in that MPN or HCO, or may choose to transfer treatment to a physician in the CAMPN. If the employer or insurer has not established an MPN, the employee may choose to treat with a physician of the employee’s choice, as provided in subdivision (c) of Section 4600, or to treat with a physician in the CAMPN. An employee who is treating with a physician in the CAMPN may, at any time, change to a different treating physician within the CAMPN. Nothing in this section shall be construed to limit the right of an employee to treat with their personal physician as described in subdivision (d) of Section 4600.
(c)  The number of physicians in the CAMPN shall be sufficient to enable treatment for injuries or conditions to be provided in a timely manner and shall, to the extent feasible, include within the CAMPN physicians in all medical specialties. The CAMPN shall include an adequate number and type of physicians, as described in Section 3209.3, to treat common injuries experienced by injured employees based on the type of occupation or industry in which the employee is engaged, and the geographic area where the employees are employed. With respect to availability and accessibility of treatment, the administrative director shall consider the needs of rural areas, specifically those in which health facilities are located at least 30 miles apart and areas in which there is a health care shortage.
(d)  A physician who possesses the requisite license for practice of their medical specialty is eligible for inclusion in the CAMPN, if all of the following apply:
(1) The physician is in good standing with the Medical Board of California.
(2) The physician has not been suspended pursuant to Section 139.21.
(3) The physician does not meet any of the criteria specified in paragraph (1) of subdivision (a) of Section 139.21.
(4) The physician agrees to treat injured workers within the scope of their medical practice.
(5) The physician agrees to bill in accord with the official medical fee schedule established pursuant to Section 5307.1.
(6) The physician agrees to practice in accord with rules and regulations applicable to the workers’ compensation system, including preparation of required reports.
(e) A physician who meets the criteria in subdivision (d) shall be included in the CAMPN. In no event shall economic profiling, as defined in subdivision (c) of Section 4616.1, be a factor to be considered for inclusion in or expulsion from the CAMPN.
(f) All treatment within the CAMPN shall be provided in accordance with the medical treatment utilization schedule established pursuant to Section 5307.27, which remains presumptively correct.
(g) Treatment within the CAMPN shall be subject to utilization review, as described in Section 4610, and independent medical review, as described in Section 4610.5.
(h) Nothing contained herein shall be construed to limit or eliminate utilization review as described in Section 4610, independent medical review as described in Section 4610.5 or 4610.6, or the antifraud provisions contained in Sections 139.21 and 4906 of this code, and Section 14123 of the Welfare and Institutions Code.
(i) The initial list of CAMPN physicians shall be created by including any physician who meets the criteria in subdivision (d) and was listed as of January 1, 2021, on any MPN created pursuant to Section 4616. Within 60 days of the effective date of this section, each employer, insurer, or private entity, that has established an MPN pursuant to Section 4616, shall file with the administrative director a list of those physicians in the MPN as of January 1, 2021.
(j) The administrative director shall, on or before April 30, 2022, and after public hearings, establish rules and procedures governing the CAMPN. The administrative director shall include a continuity of care policy meeting the requirements of Section 4616.2. The CAMPN shall be implemented no later than June 30, 2022.
(k) A physician in the CAMPN may, at any time, leave the CAMPN pursuant to the rules and procedures created by the administrative director.