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California’s Department of Industrial Relations will soon be required to publicly post utilization data for workers compensation physicians — including the number of utilization review decisions that resulted in denials — under a new law.
S.B. 537, signed into law Tuesday by California Gov. Gavin Newsom, requires the that UR data for physicians who have treated 10 or more injured workers during the prior 12 months before July 1 of the previous year be publicly posted on the DIR website on or before Jan. 1, 2024. The bill also stipulates that the data include decisions that resulted in a modification or denial of a request based on a determination of medical necessity.
In addition, beginning on or before Jan. 1, 2023, the DIR’s administrative director must issue a report to the California Legislature comparing potential payment alternatives for providers to the official medical fee schedule.
Beginning July 1, 2021, medical provider networks will also be required to post a roster of their participating providers online and provide the DIR with the authority to investigate complaints, conduct random reviews and take enforcement action against medical provider networks that fail to comply with roster posting requirements. Providers will also be required to submit itemized requests for payment with their national provider identifier number and required to provide payers with written disclosure of reimbursement rates paid if they are more than 20% below the official medical fee schedule.
The California Supreme Court will weigh in on a lower court decision that would have a chilling effect on the state's workers compensation medical treatment approval process and expand potential liability for providers of utilization review.