Workers’ Compensation 

SB 809 (DeSaulnier) – Request for Comment
As Introduced on February 22, 2013

Senate Bill 809, by Senator Mark DeSaulnier, would create the CURES Fund (Fund) within the State Treasury and require licensed health practitioners and pharmacists, prior to providing patients with Schedule II, III, or IV controlled substances, to access information regarding a patient’s history of controlled substance prescriptions. The bill is aimed at curbing workers’ compensation claimants’ misuse and abuse of prescribed opioids, an increasing concern to, and cost for, employers.

The Controlled Substance Utilization Review and Evaluation System (CURES), maintained by the Department of Justice (DOJ), is an electronic monitoring system of Schedule II, III, and IV controlled substances and provides for the electronic transmission of those controlled substance prescriptions data to the DOJ when they are dispensed. The purpose of creating CURES was to assist law enforcement in controlling the abuse of these drugs. When a pharmacist fills a prescription for a Schedule II, III, or IV drug, current law requires him or her to provide DOJ with the name, prescribing physician’s name, quantity and the form of the drug. 

SB 809 would require health practitioners that prescribe or dispense controlled substances and certain drug wholesalers to pay increased licensing, certification and renewal fees to the CURES Fund. The bill would also require qualified manufactures (those making controlled substances and doing business in California) and health insurers, workers’ compensation licensed insurers and health care service plans to pay an annual tax that would be administered by the State Board of Equalization and deposited into the Fund.

SB 809 is currently awaiting assignment to a policy committee.

SB 626 (Beall) – Oppose
As Introduced on February 22, 2013

Senate Bill 626, by Senator Jim Beall, would roll back several of the workers’ compensation system reforms achieved in last year’s SB 863 (Chapter 363, Statutes of 2012). Counties will recall the CSAC-supported workers’ compensation reform measure that, among other things, increased permanent disability benefits to injured workers while making necessary administrative and procedural changes within the system. 

SB 626 would:

1. Permit chiropractors to serve as Primary Treating Physicians beyond the 24 chiropractic visit cap.
2. Allows the Workers’ Compensation Appeals Board to overrule decisions made by an Independent Medical Review (IMR).
3. Requires utilization review and IMR physicians reviewing treatment requests to hold the same type of license as the requesting physician (for example, an orthopedic surgeon would not be able to review a chiropractor’s request, only a chiropractor could do so).
4. Permits an increase in permanent disability ratings for psychological injuries that arise out of a physical injury.
5. Eliminates the confidentiality of IMR reviewers.

CSAC was part of a coalition of management and labor that worked closely with Governor Brown to ensure that the reform included fair benefits to injured employees, but also contained provisions that reduced administrative burdens on and costs to employers. SB 626 undermines last year’s collaborative effort.

This bill is awaiting assignment to a policy committee. 

SB 146 (Lara) – Watch
As Introduced on January 31, 2013

Senate Bill 146, by Senator Ricardo Lara, is a bill intended to provide technical clean-up for last year’s workers’ compensation reform legislation. 

Included in SB 863 was a requirement that the medical billing process, specifically that service providers (including physicians, hospitals, pharmacies, interpreters, copy services, transportation services and home health care services) must include the prescription or referral from the primary treating physician in a request for payment of a workers’ compensation pharmacy claim if the services were performed by a person other than the primary treating physician. 

Accordingly, the Division of Workers’ Compensation adopted a new electronic billing standard for pharmacy bills – however, that standard does not currently support the inclusion of attachments (i.e., a prescription). Approval of a claim is at risk if lack of compliance with the inclusion of the prescription deems a bill incomplete, to avoid unnecessarily denied claims, SB 146 proposes to remove the requirement to include a copy of the prescription and give pharmacy providers the ability to re-bill for any claims denied for not including a copy until a correction can be implemented into law. 

SB 146 will be heard in the Senate Labor and Industrial Relations Committee on March 13, 2013.