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California comp regulators propose rules to expedite utilization reviews


The California Division of Workers’ Compensation on Friday introduced a proposal to speed up the delivery of medical care to injured workers by implementing provisions from bills passed in 2015 and 2016 that exempted certain procedures and treatments from utilization review.

One law, which created a prescription drug formulary, states that certain drugs designated as “exempt” can be dispensed to injured workers without prospective utilization review, as can certain other drugs that are authorized for expedited dispensing immediately after an injury or in the period immediately before and after surgery.

Another law includes a provision allowing a member of a medical provider network to perform certain procedures without prospective review in the first 30 days of treatment if it is for a body part or condition that has been accepted by the claims administrator and is included in the state’s Medical Treatment Utilization Schedule.

DWC is also proposing statutory accreditation requirements and oversight for companies providing utilization reviews and more required forms for treating physicians.

A public hearing on the measures is slated for July 25.