Bill Text

Bill Information

PDF |Add To My Favorites |Track Bill | print page

SB-617 Workers’ compensation: providers.(2017-2018)

SHARE THIS:share this bill in Facebookshare this bill in Twitter
Date Published: 08/21/2017 04:00 AM
SB617:v95#DOCUMENT

Amended  IN  Assembly  August 21, 2017
Amended  IN  Senate  May 26, 2017
Amended  IN  Senate  April 27, 2017
Amended  IN  Senate  April 17, 2017

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Senate Bill No. 617


Introduced by Senator Bradford

February 17, 2017


An act to amend Section 138.7 of, and to add Sections 127.1 and 138.8 to, add Section 4665 to the Labor Code, relating to workers’ compensation.


LEGISLATIVE COUNSEL'S DIGEST


SB 617, as amended, Bradford. Workers’ compensation: providers.
Existing law establishes a workers’ compensation system, administered by the Administrative Director of the Division of Workers’ Compensation, to compensate an employee for injuries sustained in the course of his or her employment. The California Public Records Act requires state and local agencies to make public records available for inspection by the public, subject to specified criteria and with specified exceptions. Existing law exempts from disclosure specified records, including, among others, personnel, medical, or similar files when disclosure would constitute an unwarranted invasion of personal privacy.

This bill would require the administrative director, with input from the Commission on Health and Safety and Workers’ Compensation, to issue a report to the Legislature, on or before January 1, 2019, comparing potential payment alternatives for providers, as specified, to the current fee-for-service fee schedules.

The bill would require the administrative director, on or before January 1, 2020, and annually thereafter, to issue outreach reports to physicians who treated 30 or more injured workers during the 12 months prior to July 1 of the previous year. The bill would require the outreach reports to contain information about, among other things, the number of injured workers treated by the physician and the physician’s percentile rank in comparison to peers, and the number of utilization review decisions that resulted in a modification or denial of a request for authorization of medical treatment and the physician’s percentile rank in comparison to peers. The bill would authorize the administrative director to use individually identifiable information for purposes of creating those reports. This bill would exempt the individually identifiable information in these reports from the California Public Records Act on the grounds that the disclosure of that information could constitute an unwarranted invasion of personal privacy. The bill would make the outreach reports privileged and exempt the outreach reports from subpoena in a civil proceeding, unless specified conditions are met.

Existing law makes an employer liable only for the percentage of permanent disability directly caused by the injury arising out of and occurring in the course of employment. Existing law also requires that apportionment of permanent disability be based on causation and requires a physician who prepares a report addressing the issue of permanent disability due to a claimed industrial injury to address in that report the issue of causation of the permanent disability.
This bill would require that heredity and genetics be excluded as bases of causation for purposes of determining the apportionment of permanent disability.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YESNO   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 4665 is added to the Labor Code, to read:

4665.
 Notwithstanding any other law, including, but not limited to, Section 4663, heredity and genetics shall be excluded as bases of causation for purposes of determining the apportionment of permanent disability.

SECTION 1.Section 127.1 is added to the Labor Code, to read:
127.1.

(a)The administrative director, with input from the Commission on Health and Safety and Workers’ Compensation, shall issue a report to the Legislature, on or before January 1, 2019, comparing potential payment alternatives for providers to the current fee-for-service fee schedule, including, but not limited to, capitation, bundled payments, quality incentives, and value-based payment systems.

(b)The report shall address advantages and disadvantages of each alternative payment system to the current fee-for-service fee schedule, and make recommendations to the Legislature on alternative payment pilot programs.

(c)The report shall be submitted in compliance with Section 9795 of the Government Code. The requirement for submitting a report imposed by this section shall be inoperative on January 1, 2022, pursuant to Section 10231.5 of the Government Code.

SEC. 2.Section 138.7 of the Labor Code is amended to read:
138.7.

(a)Except as expressly permitted in subdivision (b), a person or public or private entity not a party to a claim for workers’ compensation benefits shall not obtain individually identifiable information obtained or maintained by the division on that claim. For purposes of this section, “individually identifiable information” means any data concerning an injury or claim that is linked to a uniquely identifiable employee, employer, claims administrator, or any other person or entity.

(b)(1)(A)The administrative director, or a statistical agent designated by the administrative director, may use individually identifiable information for purposes of creating and maintaining the workers’ compensation information system as specified in Section 138.6.

(B)The administrative director may publish the identity of claims administrators in the annual report disclosing the compliance rates of claims administrators pursuant to subdivision (d) of Section 138.6.

(C)The administrative director shall use individually identifiable information for purposes of creating provider outreach reports as specified in Section 138.8.

(2)(A)The State Department of Public Health may use individually identifiable information for purposes of establishing and maintaining a program on occupational health and occupational disease prevention as specified in Section 105175 of the Health and Safety Code.

(B)(i)The State Department of Health Care Services may use individually identifiable information for purposes of seeking recovery of Medi-Cal costs incurred by the state for treatment provided to injured workers that should have been incurred by employers and insurance carriers pursuant to Article 3.5 (commencing with Section 14124.70) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.

(ii)The Department of Industrial Relations shall furnish individually identifiable information to the State Department of Health Care Services, and the State Department of Health Care Services may furnish the information to its designated agent, provided that the individually identifiable information shall not be disclosed for use other than the purposes described in clause (i). The administrative director may adopt regulations solely for the purpose of governing access by the State Department of Health Care Services or its designated agents to the individually identifiable information as defined in subdivision (a).

(3)(A)Individually identifiable information may be used by the Division of Workers’ Compensation and the Division of Occupational Safety and Health as necessary to carry out their duties. The administrative director shall adopt regulations governing the access to the information described in this subdivision by these divisions. Any regulations adopted pursuant to this subdivision shall set forth the specific uses for which this information may be obtained.

(B)Individually identifiable information maintained in the workers’ compensation information system and the Division of Workers’ Compensation may be used by researchers employed by or under contract to the Commission on Health and Safety and Workers’ Compensation as necessary to carry out the commission’s research. The administrative director shall adopt regulations governing the access to the information described in this subdivision by commission researchers. These regulations shall set forth the specific uses for which this information may be obtained and include provisions guaranteeing the confidentiality of individually identifiable information. Individually identifiable information obtained under this subdivision shall not be disclosed to commission members. No individually identifiable information obtained by researchers under contract to the commission pursuant to this subparagraph may be disclosed to any other person or entity, public or private, for a use other than that research project for which the information was obtained. Within a reasonable period of time after the research for which the information was obtained has been completed, the data collected shall be modified in a manner so that the subjects cannot be identified, directly or through identifiers linked to the subjects.

(4)The administrative director shall adopt regulations allowing reasonable access to individually identifiable information by other persons or public or private entities for the purpose of bona fide statistical research. This research shall not divulge individually identifiable information concerning a particular employee, employer, claims administrator, or any other person or entity. The regulations adopted pursuant to this paragraph shall include provisions guaranteeing the confidentiality of individually identifiable information. Within a reasonable period of time after the research for which the information was obtained has been completed, the data collected shall be modified in a manner so that the subjects cannot be identified, directly or through identifiers linked to the subjects.

(5)(A)This section shall not operate to exempt from disclosure any information that is considered to be a public record pursuant to the California Public Records Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code) contained in an individual’s file once an application for adjudication has been filed pursuant to Section 5501.5.

(B)Individually identifiable information shall not be provided to any person or public or private entity who is not a party to the claim unless that person identifies himself or herself or that public or private entity identifies itself and states the reason for making the request. The administrative director may require the person or public or private entity making the request to produce information to verify that the name and address of the requester is valid and correct. If the purpose of the request is related to preemployment screening, the administrative director shall notify the person about whom the information is requested that the information was provided and shall include the following in 12-point type:


“IT MAY BE A VIOLATION OF FEDERAL AND STATE LAW TO DISCRIMINATE AGAINST A JOB APPLICANT BECAUSE THE APPLICANT HAS FILED A CLAIM FOR WORKERS’ COMPENSATION BENEFITS.”


(C)Any residence address is confidential and shall not be disclosed to any person or public or private entity except to a party to the claim, a law enforcement agency, an office of a district attorney, any person for a journalistic purpose, or other governmental agency.

(D)This paragraph does not prohibit the use of individually identifiable information for purposes of identifying bona fide lien claimants.

(c)Except as provided in subdivision (b), individually identifiable information obtained by the division is privileged and is not subject to subpoena in a civil proceeding unless, after reasonable notice to the division and a hearing, a court determines that the public interest and the intent of this section will not be jeopardized by disclosure of the information. This section shall not operate to restrict access to information by any law enforcement agency or district attorney’s office or to limit admissibility of that information in a criminal proceeding.

(d)It is unlawful for any person who has received individually identifiable information from the division pursuant to this section to provide that information to any person who is not entitled to it under this section.

SEC. 3.Section 138.8 is added to the Labor Code, to read:
138.8.

(a)On or before January 1, 2020, and annually thereafter, the administrative director shall issue outreach reports to physicians who treated 30 or more injured workers during the 12 months prior to July 1 of the previous year. These outreach reports shall include all of the following:

(1)The number of injured workers treated by the physician and the physician’s percentile rank in comparison to his or her peers.

(2)The number of utilization review decisions that resulted in a modification or denial of a request for authorization of medical treatment and the physician’s percentile rank in comparison to his or her peers.

(3)The number of independent medical review decisions requested due to a utilization review decision that resulted in a modification or denial, the number of independent review decisions that resulted in the utilization review modification or denial being overturned, and the physician’s percentile rank in comparison to his or her peers.

(4)Any educational or training resources offered by the division.

(5)Any additional report information as determined by the administrative director.

(b)The individually identifiable information in the outreach reports required by this section is exempt from the California Public Records Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code), pursuant to subdivision (c) of Section 6254 of the Government Code.

(c)Outreach reports required by this section are privileged and are not subject to subpoena in a civil proceeding unless, after reasonable notice to the division and a hearing, a court determines that the public interest and the intent of this section will not be jeopardized by disclosure of the reports. This section shall not operate to restrict access to information by any law enforcement agency or district attorney’s office or to limit admissibility of that information in a criminal proceeding.