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Utilization review accreditation bill filed in Pennsylvania


Pennsylvania lawmakers have proposed amending the utilization review process in the state’s workers compensation system. 

House Bill 881, introduced Tuesday, would amend the state’s Workers’ Compensation Act by mandating that requests for utilization review in injured worker claims be assigned only to organizations that are nationally accredited to handle utilization review issues for workers comp programs.

If the bill becomes law, the specific nationally recognized accreditation or certification programs that will be required of organizations seeking to be approved to handle utilization reviews will need to be published via public notice within 30 days of the bill’s passage.

Those organizations without the proper certification or accreditation will be permitted to continue engaging in utilization review for up to 18 months after the publication of the new notice so long as they are “actively attempting to achieve the selected certification or accreditation” during that timeframe, the measure states.

Utilization review is a process in workers compensation claims in which an impartial medical party can review the reasonableness or necessity of treatment being offered to injured and sick workers who are collecting comp benefits.

The bill was sent to the House Labor and Industry Committee for consideration.