CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 1832Introduced by Assembly Member Salas(Coauthor: Assembly Member Reyes)July 11, 2019 An act to amend Section 5307.6 of the Labor Code, relating to workers compensation, and declaring the urgency thereof, to take effect immediately. LEGISLATIVE COUNSEL'S DIGESTAB 1832, as introduced, Salas. Workers compensation: medical-legal expenses. 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 the employees employment. Existing law requires the employer to provide medical, surgical, chiropractic, acupuncture, and hospital treatment, as specified, that is reasonably required to cure or relieve the injured worker from the effects of the workers injury. Existing law also requires the employer to reimburse the employee for the employees medical-legal expenses, as specified. Existing law requires the administrative director to adopt and revise a fee schedule for medical-legal expenses and requires the fee schedule to consist of a series of procedure codes, relative values, and a conversion factor to produce the fees that provide remuneration to physicians performing the medical-legal evaluations, as provided. This bill would require the conversion factor to be at least $18.75. The bill would require the administrative director to increase the conversion factor quarterly, as necessary, to reflect any increase in the Bureau of Labor Statistics Consumer Price Index for medical care, as specified. The bill would also require the administrative director, on or before January 15, 2020, to assign a reasonable relative value, greater than zero, for a missed or failed appointment for a comprehensive or follow-up medical-legal evaluation and for a review of medical records associated with a missed or failed appointment.This bill would declare that it is to take effect immediately as an urgency statute.Digest Key Vote: 2/3 Appropriation: NO Fiscal Committee: YES Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 5307.6 of the Labor Code is amended to read:5307.6. (a) The administrative director shall adopt and revise a fee schedule for medical-legal expenses as defined by Section 4620, which shall be prima facie evidence of the reasonableness of fees charged for medical-legal expenses at the same time he or she adopts and revises the medical fee schedule pursuant to Section 5307.1. expenses.The (b) The schedule shall consist of a series of procedure codes, relative values, and a conversion factor producing fees which that provide remuneration to physicians performing medical-legal evaluations at a level equivalent to that provided to physicians for reasonably comparable work, and which that additionally recognizes recognize the relative complexity of various types of evaluations, the amount of time spent by the physician in direct contact with the patient, and the need to prepare a written report.(1) Commencing on the effective date of the act adding this paragraph, the conversion factor for medical-legal expenses shall be at least eighteen dollars and seventy-five cents ($18.75).(A) The administrative director shall increase the conversion factor quarterly, as necessary, to reflect any increase in the Bureau of Labor Statistics Consumer Price Index (CPI) for medical care.(B) If a quarterly increase is warranted based on an increase in the CPI for medical care, the administrative director shall implement the increase by issuing an order within 48 hours of the end of each calendar quarter, excluding Saturdays, Sundays, and holidays.(C) The order shall be exempt from Sections 5307.3 and 5307.4 and the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). The administrative director shall inform the public of the increase and its effective date. All orders issued pursuant to this paragraph shall be published on the internet website of the Division of Workers Compensation.(D) If a quarterly increase is warranted and the administrative director does not increase the conversion factor within 48 hours of the end of each quarter as required by this paragraph, the administrative director shall send a written notice to the Secretary of Labor and Workforce Development, the chair of the Senate Committee on Labor, Public Employment and Retirement, and the chair of the Assembly Committee on Labor and Employment explaining why the increase was not implemented.(E) The administrative director shall appoint a panel of qualified medical evaluators and insurers, or their representatives, to serve on an ex officio board to oversee the timely increases to the conversion factor.(2) On or before January 15, 2020, the administrative director shall assign a reasonable relative value, greater than zero, for both of the following:(A) A missed or failed appointment for a comprehensive or follow-up medical-legal evaluation.(B) A review of medical records associated with a missed or failed appointment.(b)(c) A provider shall not be paid fees in excess of those set forth in the fee schedule established under this section unless the provider provides an itemization and explanation of the fee that shows that it is both a reasonable fee and that extraordinary circumstances relating to the medical condition being evaluated justify a higher fee; provided, however, that in no event shall fee, except that a provider shall not charge in excess of his or her the providers usual fee. The employer and employee shall have standing to contest fees in excess of those set forth in the fee schedule.(c)(d) In the event of a dispute between the provider and the employer, employee, or carrier concerning the fees charged, the provider may be allowed a reasonable fee for testimony if the provider testified pursuant to the employers or carriers subpoena and the judge or referee determines that the fee charged was reasonable and justified by extraordinary circumstances.(d)(e) (1) No A provider may shall not request nor or accept any compensation, including, but not limited to, any kind of remuneration, discount, rebate, refund, dividend, distribution, subsidy, or other form of direct or indirect payment, whether in money or otherwise, from any source for medical-legal expenses if such the compensation is in addition to the fees authorized by this section. In addition to being subject to discipline pursuant to the provisions of subdivision (k) of Section 139.2, any a provider violating this subdivision is subject to disciplinary action by the appropriate licensing board.(2) This subdivision does not apply to medical-legal expenses for which the administrative director has not adopted a fee schedule.SEC. 2. This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are: In order to save a critical aspect of the workers compensation system from collapse due to inadequate reimbursement of qualified medical evaluators, to reduce prejudicial delays in the required treatment of injured workers, and to lower costs to insurers by resolving claims more quickly, it is necessary that this act take effect immediately.
CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 1832Introduced by Assembly Member Salas(Coauthor: Assembly Member Reyes)July 11, 2019 An act to amend Section 5307.6 of the Labor Code, relating to workers compensation, and declaring the urgency thereof, to take effect immediately. LEGISLATIVE COUNSEL'S DIGESTAB 1832, as introduced, Salas. Workers compensation: medical-legal expenses. 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 the employees employment. Existing law requires the employer to provide medical, surgical, chiropractic, acupuncture, and hospital treatment, as specified, that is reasonably required to cure or relieve the injured worker from the effects of the workers injury. Existing law also requires the employer to reimburse the employee for the employees medical-legal expenses, as specified. Existing law requires the administrative director to adopt and revise a fee schedule for medical-legal expenses and requires the fee schedule to consist of a series of procedure codes, relative values, and a conversion factor to produce the fees that provide remuneration to physicians performing the medical-legal evaluations, as provided. This bill would require the conversion factor to be at least $18.75. The bill would require the administrative director to increase the conversion factor quarterly, as necessary, to reflect any increase in the Bureau of Labor Statistics Consumer Price Index for medical care, as specified. The bill would also require the administrative director, on or before January 15, 2020, to assign a reasonable relative value, greater than zero, for a missed or failed appointment for a comprehensive or follow-up medical-legal evaluation and for a review of medical records associated with a missed or failed appointment.This bill would declare that it is to take effect immediately as an urgency statute.Digest Key Vote: 2/3 Appropriation: NO Fiscal Committee: YES Local Program: NO
CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION
Assembly Bill
No. 1832
Introduced by Assembly Member Salas(Coauthor: Assembly Member Reyes)July 11, 2019
Introduced by Assembly Member Salas(Coauthor: Assembly Member Reyes)
July 11, 2019
An act to amend Section 5307.6 of the Labor Code, relating to workers compensation, and declaring the urgency thereof, to take effect immediately.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
AB 1832, as introduced, Salas. Workers compensation: medical-legal expenses.
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 the employees employment. Existing law requires the employer to provide medical, surgical, chiropractic, acupuncture, and hospital treatment, as specified, that is reasonably required to cure or relieve the injured worker from the effects of the workers injury. Existing law also requires the employer to reimburse the employee for the employees medical-legal expenses, as specified. Existing law requires the administrative director to adopt and revise a fee schedule for medical-legal expenses and requires the fee schedule to consist of a series of procedure codes, relative values, and a conversion factor to produce the fees that provide remuneration to physicians performing the medical-legal evaluations, as provided. This bill would require the conversion factor to be at least $18.75. The bill would require the administrative director to increase the conversion factor quarterly, as necessary, to reflect any increase in the Bureau of Labor Statistics Consumer Price Index for medical care, as specified. The bill would also require the administrative director, on or before January 15, 2020, to assign a reasonable relative value, greater than zero, for a missed or failed appointment for a comprehensive or follow-up medical-legal evaluation and for a review of medical records associated with a missed or failed appointment.This bill would declare that it is to take effect immediately as an urgency statute.
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 the employees employment. Existing law requires the employer to provide medical, surgical, chiropractic, acupuncture, and hospital treatment, as specified, that is reasonably required to cure or relieve the injured worker from the effects of the workers injury. Existing law also requires the employer to reimburse the employee for the employees medical-legal expenses, as specified. Existing law requires the administrative director to adopt and revise a fee schedule for medical-legal expenses and requires the fee schedule to consist of a series of procedure codes, relative values, and a conversion factor to produce the fees that provide remuneration to physicians performing the medical-legal evaluations, as provided.
This bill would require the conversion factor to be at least $18.75. The bill would require the administrative director to increase the conversion factor quarterly, as necessary, to reflect any increase in the Bureau of Labor Statistics Consumer Price Index for medical care, as specified. The bill would also require the administrative director, on or before January 15, 2020, to assign a reasonable relative value, greater than zero, for a missed or failed appointment for a comprehensive or follow-up medical-legal evaluation and for a review of medical records associated with a missed or failed appointment.
This bill would declare that it is to take effect immediately as an urgency statute.
## Digest Key
## Bill Text
The people of the State of California do enact as follows:SECTION 1. Section 5307.6 of the Labor Code is amended to read:5307.6. (a) The administrative director shall adopt and revise a fee schedule for medical-legal expenses as defined by Section 4620, which shall be prima facie evidence of the reasonableness of fees charged for medical-legal expenses at the same time he or she adopts and revises the medical fee schedule pursuant to Section 5307.1. expenses.The (b) The schedule shall consist of a series of procedure codes, relative values, and a conversion factor producing fees which that provide remuneration to physicians performing medical-legal evaluations at a level equivalent to that provided to physicians for reasonably comparable work, and which that additionally recognizes recognize the relative complexity of various types of evaluations, the amount of time spent by the physician in direct contact with the patient, and the need to prepare a written report.(1) Commencing on the effective date of the act adding this paragraph, the conversion factor for medical-legal expenses shall be at least eighteen dollars and seventy-five cents ($18.75).(A) The administrative director shall increase the conversion factor quarterly, as necessary, to reflect any increase in the Bureau of Labor Statistics Consumer Price Index (CPI) for medical care.(B) If a quarterly increase is warranted based on an increase in the CPI for medical care, the administrative director shall implement the increase by issuing an order within 48 hours of the end of each calendar quarter, excluding Saturdays, Sundays, and holidays.(C) The order shall be exempt from Sections 5307.3 and 5307.4 and the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). The administrative director shall inform the public of the increase and its effective date. All orders issued pursuant to this paragraph shall be published on the internet website of the Division of Workers Compensation.(D) If a quarterly increase is warranted and the administrative director does not increase the conversion factor within 48 hours of the end of each quarter as required by this paragraph, the administrative director shall send a written notice to the Secretary of Labor and Workforce Development, the chair of the Senate Committee on Labor, Public Employment and Retirement, and the chair of the Assembly Committee on Labor and Employment explaining why the increase was not implemented.(E) The administrative director shall appoint a panel of qualified medical evaluators and insurers, or their representatives, to serve on an ex officio board to oversee the timely increases to the conversion factor.(2) On or before January 15, 2020, the administrative director shall assign a reasonable relative value, greater than zero, for both of the following:(A) A missed or failed appointment for a comprehensive or follow-up medical-legal evaluation.(B) A review of medical records associated with a missed or failed appointment.(b)(c) A provider shall not be paid fees in excess of those set forth in the fee schedule established under this section unless the provider provides an itemization and explanation of the fee that shows that it is both a reasonable fee and that extraordinary circumstances relating to the medical condition being evaluated justify a higher fee; provided, however, that in no event shall fee, except that a provider shall not charge in excess of his or her the providers usual fee. The employer and employee shall have standing to contest fees in excess of those set forth in the fee schedule.(c)(d) In the event of a dispute between the provider and the employer, employee, or carrier concerning the fees charged, the provider may be allowed a reasonable fee for testimony if the provider testified pursuant to the employers or carriers subpoena and the judge or referee determines that the fee charged was reasonable and justified by extraordinary circumstances.(d)(e) (1) No A provider may shall not request nor or accept any compensation, including, but not limited to, any kind of remuneration, discount, rebate, refund, dividend, distribution, subsidy, or other form of direct or indirect payment, whether in money or otherwise, from any source for medical-legal expenses if such the compensation is in addition to the fees authorized by this section. In addition to being subject to discipline pursuant to the provisions of subdivision (k) of Section 139.2, any a provider violating this subdivision is subject to disciplinary action by the appropriate licensing board.(2) This subdivision does not apply to medical-legal expenses for which the administrative director has not adopted a fee schedule.SEC. 2. This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are: In order to save a critical aspect of the workers compensation system from collapse due to inadequate reimbursement of qualified medical evaluators, to reduce prejudicial delays in the required treatment of injured workers, and to lower costs to insurers by resolving claims more quickly, it is necessary that this act take effect immediately.
The people of the State of California do enact as follows:
## The people of the State of California do enact as follows:
SECTION 1. Section 5307.6 of the Labor Code is amended to read:5307.6. (a) The administrative director shall adopt and revise a fee schedule for medical-legal expenses as defined by Section 4620, which shall be prima facie evidence of the reasonableness of fees charged for medical-legal expenses at the same time he or she adopts and revises the medical fee schedule pursuant to Section 5307.1. expenses.The (b) The schedule shall consist of a series of procedure codes, relative values, and a conversion factor producing fees which that provide remuneration to physicians performing medical-legal evaluations at a level equivalent to that provided to physicians for reasonably comparable work, and which that additionally recognizes recognize the relative complexity of various types of evaluations, the amount of time spent by the physician in direct contact with the patient, and the need to prepare a written report.(1) Commencing on the effective date of the act adding this paragraph, the conversion factor for medical-legal expenses shall be at least eighteen dollars and seventy-five cents ($18.75).(A) The administrative director shall increase the conversion factor quarterly, as necessary, to reflect any increase in the Bureau of Labor Statistics Consumer Price Index (CPI) for medical care.(B) If a quarterly increase is warranted based on an increase in the CPI for medical care, the administrative director shall implement the increase by issuing an order within 48 hours of the end of each calendar quarter, excluding Saturdays, Sundays, and holidays.(C) The order shall be exempt from Sections 5307.3 and 5307.4 and the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). The administrative director shall inform the public of the increase and its effective date. All orders issued pursuant to this paragraph shall be published on the internet website of the Division of Workers Compensation.(D) If a quarterly increase is warranted and the administrative director does not increase the conversion factor within 48 hours of the end of each quarter as required by this paragraph, the administrative director shall send a written notice to the Secretary of Labor and Workforce Development, the chair of the Senate Committee on Labor, Public Employment and Retirement, and the chair of the Assembly Committee on Labor and Employment explaining why the increase was not implemented.(E) The administrative director shall appoint a panel of qualified medical evaluators and insurers, or their representatives, to serve on an ex officio board to oversee the timely increases to the conversion factor.(2) On or before January 15, 2020, the administrative director shall assign a reasonable relative value, greater than zero, for both of the following:(A) A missed or failed appointment for a comprehensive or follow-up medical-legal evaluation.(B) A review of medical records associated with a missed or failed appointment.(b)(c) A provider shall not be paid fees in excess of those set forth in the fee schedule established under this section unless the provider provides an itemization and explanation of the fee that shows that it is both a reasonable fee and that extraordinary circumstances relating to the medical condition being evaluated justify a higher fee; provided, however, that in no event shall fee, except that a provider shall not charge in excess of his or her the providers usual fee. The employer and employee shall have standing to contest fees in excess of those set forth in the fee schedule.(c)(d) In the event of a dispute between the provider and the employer, employee, or carrier concerning the fees charged, the provider may be allowed a reasonable fee for testimony if the provider testified pursuant to the employers or carriers subpoena and the judge or referee determines that the fee charged was reasonable and justified by extraordinary circumstances.(d)(e) (1) No A provider may shall not request nor or accept any compensation, including, but not limited to, any kind of remuneration, discount, rebate, refund, dividend, distribution, subsidy, or other form of direct or indirect payment, whether in money or otherwise, from any source for medical-legal expenses if such the compensation is in addition to the fees authorized by this section. In addition to being subject to discipline pursuant to the provisions of subdivision (k) of Section 139.2, any a provider violating this subdivision is subject to disciplinary action by the appropriate licensing board.(2) This subdivision does not apply to medical-legal expenses for which the administrative director has not adopted a fee schedule.
SECTION 1. Section 5307.6 of the Labor Code is amended to read:
### SECTION 1.
5307.6. (a) The administrative director shall adopt and revise a fee schedule for medical-legal expenses as defined by Section 4620, which shall be prima facie evidence of the reasonableness of fees charged for medical-legal expenses at the same time he or she adopts and revises the medical fee schedule pursuant to Section 5307.1. expenses.The (b) The schedule shall consist of a series of procedure codes, relative values, and a conversion factor producing fees which that provide remuneration to physicians performing medical-legal evaluations at a level equivalent to that provided to physicians for reasonably comparable work, and which that additionally recognizes recognize the relative complexity of various types of evaluations, the amount of time spent by the physician in direct contact with the patient, and the need to prepare a written report.(1) Commencing on the effective date of the act adding this paragraph, the conversion factor for medical-legal expenses shall be at least eighteen dollars and seventy-five cents ($18.75).(A) The administrative director shall increase the conversion factor quarterly, as necessary, to reflect any increase in the Bureau of Labor Statistics Consumer Price Index (CPI) for medical care.(B) If a quarterly increase is warranted based on an increase in the CPI for medical care, the administrative director shall implement the increase by issuing an order within 48 hours of the end of each calendar quarter, excluding Saturdays, Sundays, and holidays.(C) The order shall be exempt from Sections 5307.3 and 5307.4 and the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). The administrative director shall inform the public of the increase and its effective date. All orders issued pursuant to this paragraph shall be published on the internet website of the Division of Workers Compensation.(D) If a quarterly increase is warranted and the administrative director does not increase the conversion factor within 48 hours of the end of each quarter as required by this paragraph, the administrative director shall send a written notice to the Secretary of Labor and Workforce Development, the chair of the Senate Committee on Labor, Public Employment and Retirement, and the chair of the Assembly Committee on Labor and Employment explaining why the increase was not implemented.(E) The administrative director shall appoint a panel of qualified medical evaluators and insurers, or their representatives, to serve on an ex officio board to oversee the timely increases to the conversion factor.(2) On or before January 15, 2020, the administrative director shall assign a reasonable relative value, greater than zero, for both of the following:(A) A missed or failed appointment for a comprehensive or follow-up medical-legal evaluation.(B) A review of medical records associated with a missed or failed appointment.(b)(c) A provider shall not be paid fees in excess of those set forth in the fee schedule established under this section unless the provider provides an itemization and explanation of the fee that shows that it is both a reasonable fee and that extraordinary circumstances relating to the medical condition being evaluated justify a higher fee; provided, however, that in no event shall fee, except that a provider shall not charge in excess of his or her the providers usual fee. The employer and employee shall have standing to contest fees in excess of those set forth in the fee schedule.(c)(d) In the event of a dispute between the provider and the employer, employee, or carrier concerning the fees charged, the provider may be allowed a reasonable fee for testimony if the provider testified pursuant to the employers or carriers subpoena and the judge or referee determines that the fee charged was reasonable and justified by extraordinary circumstances.(d)(e) (1) No A provider may shall not request nor or accept any compensation, including, but not limited to, any kind of remuneration, discount, rebate, refund, dividend, distribution, subsidy, or other form of direct or indirect payment, whether in money or otherwise, from any source for medical-legal expenses if such the compensation is in addition to the fees authorized by this section. In addition to being subject to discipline pursuant to the provisions of subdivision (k) of Section 139.2, any a provider violating this subdivision is subject to disciplinary action by the appropriate licensing board.(2) This subdivision does not apply to medical-legal expenses for which the administrative director has not adopted a fee schedule.
5307.6. (a) The administrative director shall adopt and revise a fee schedule for medical-legal expenses as defined by Section 4620, which shall be prima facie evidence of the reasonableness of fees charged for medical-legal expenses at the same time he or she adopts and revises the medical fee schedule pursuant to Section 5307.1. expenses.The (b) The schedule shall consist of a series of procedure codes, relative values, and a conversion factor producing fees which that provide remuneration to physicians performing medical-legal evaluations at a level equivalent to that provided to physicians for reasonably comparable work, and which that additionally recognizes recognize the relative complexity of various types of evaluations, the amount of time spent by the physician in direct contact with the patient, and the need to prepare a written report.(1) Commencing on the effective date of the act adding this paragraph, the conversion factor for medical-legal expenses shall be at least eighteen dollars and seventy-five cents ($18.75).(A) The administrative director shall increase the conversion factor quarterly, as necessary, to reflect any increase in the Bureau of Labor Statistics Consumer Price Index (CPI) for medical care.(B) If a quarterly increase is warranted based on an increase in the CPI for medical care, the administrative director shall implement the increase by issuing an order within 48 hours of the end of each calendar quarter, excluding Saturdays, Sundays, and holidays.(C) The order shall be exempt from Sections 5307.3 and 5307.4 and the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). The administrative director shall inform the public of the increase and its effective date. All orders issued pursuant to this paragraph shall be published on the internet website of the Division of Workers Compensation.(D) If a quarterly increase is warranted and the administrative director does not increase the conversion factor within 48 hours of the end of each quarter as required by this paragraph, the administrative director shall send a written notice to the Secretary of Labor and Workforce Development, the chair of the Senate Committee on Labor, Public Employment and Retirement, and the chair of the Assembly Committee on Labor and Employment explaining why the increase was not implemented.(E) The administrative director shall appoint a panel of qualified medical evaluators and insurers, or their representatives, to serve on an ex officio board to oversee the timely increases to the conversion factor.(2) On or before January 15, 2020, the administrative director shall assign a reasonable relative value, greater than zero, for both of the following:(A) A missed or failed appointment for a comprehensive or follow-up medical-legal evaluation.(B) A review of medical records associated with a missed or failed appointment.(b)(c) A provider shall not be paid fees in excess of those set forth in the fee schedule established under this section unless the provider provides an itemization and explanation of the fee that shows that it is both a reasonable fee and that extraordinary circumstances relating to the medical condition being evaluated justify a higher fee; provided, however, that in no event shall fee, except that a provider shall not charge in excess of his or her the providers usual fee. The employer and employee shall have standing to contest fees in excess of those set forth in the fee schedule.(c)(d) In the event of a dispute between the provider and the employer, employee, or carrier concerning the fees charged, the provider may be allowed a reasonable fee for testimony if the provider testified pursuant to the employers or carriers subpoena and the judge or referee determines that the fee charged was reasonable and justified by extraordinary circumstances.(d)(e) (1) No A provider may shall not request nor or accept any compensation, including, but not limited to, any kind of remuneration, discount, rebate, refund, dividend, distribution, subsidy, or other form of direct or indirect payment, whether in money or otherwise, from any source for medical-legal expenses if such the compensation is in addition to the fees authorized by this section. In addition to being subject to discipline pursuant to the provisions of subdivision (k) of Section 139.2, any a provider violating this subdivision is subject to disciplinary action by the appropriate licensing board.(2) This subdivision does not apply to medical-legal expenses for which the administrative director has not adopted a fee schedule.
5307.6. (a) The administrative director shall adopt and revise a fee schedule for medical-legal expenses as defined by Section 4620, which shall be prima facie evidence of the reasonableness of fees charged for medical-legal expenses at the same time he or she adopts and revises the medical fee schedule pursuant to Section 5307.1. expenses.The (b) The schedule shall consist of a series of procedure codes, relative values, and a conversion factor producing fees which that provide remuneration to physicians performing medical-legal evaluations at a level equivalent to that provided to physicians for reasonably comparable work, and which that additionally recognizes recognize the relative complexity of various types of evaluations, the amount of time spent by the physician in direct contact with the patient, and the need to prepare a written report.(1) Commencing on the effective date of the act adding this paragraph, the conversion factor for medical-legal expenses shall be at least eighteen dollars and seventy-five cents ($18.75).(A) The administrative director shall increase the conversion factor quarterly, as necessary, to reflect any increase in the Bureau of Labor Statistics Consumer Price Index (CPI) for medical care.(B) If a quarterly increase is warranted based on an increase in the CPI for medical care, the administrative director shall implement the increase by issuing an order within 48 hours of the end of each calendar quarter, excluding Saturdays, Sundays, and holidays.(C) The order shall be exempt from Sections 5307.3 and 5307.4 and the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). The administrative director shall inform the public of the increase and its effective date. All orders issued pursuant to this paragraph shall be published on the internet website of the Division of Workers Compensation.(D) If a quarterly increase is warranted and the administrative director does not increase the conversion factor within 48 hours of the end of each quarter as required by this paragraph, the administrative director shall send a written notice to the Secretary of Labor and Workforce Development, the chair of the Senate Committee on Labor, Public Employment and Retirement, and the chair of the Assembly Committee on Labor and Employment explaining why the increase was not implemented.(E) The administrative director shall appoint a panel of qualified medical evaluators and insurers, or their representatives, to serve on an ex officio board to oversee the timely increases to the conversion factor.(2) On or before January 15, 2020, the administrative director shall assign a reasonable relative value, greater than zero, for both of the following:(A) A missed or failed appointment for a comprehensive or follow-up medical-legal evaluation.(B) A review of medical records associated with a missed or failed appointment.(b)(c) A provider shall not be paid fees in excess of those set forth in the fee schedule established under this section unless the provider provides an itemization and explanation of the fee that shows that it is both a reasonable fee and that extraordinary circumstances relating to the medical condition being evaluated justify a higher fee; provided, however, that in no event shall fee, except that a provider shall not charge in excess of his or her the providers usual fee. The employer and employee shall have standing to contest fees in excess of those set forth in the fee schedule.(c)(d) In the event of a dispute between the provider and the employer, employee, or carrier concerning the fees charged, the provider may be allowed a reasonable fee for testimony if the provider testified pursuant to the employers or carriers subpoena and the judge or referee determines that the fee charged was reasonable and justified by extraordinary circumstances.(d)(e) (1) No A provider may shall not request nor or accept any compensation, including, but not limited to, any kind of remuneration, discount, rebate, refund, dividend, distribution, subsidy, or other form of direct or indirect payment, whether in money or otherwise, from any source for medical-legal expenses if such the compensation is in addition to the fees authorized by this section. In addition to being subject to discipline pursuant to the provisions of subdivision (k) of Section 139.2, any a provider violating this subdivision is subject to disciplinary action by the appropriate licensing board.(2) This subdivision does not apply to medical-legal expenses for which the administrative director has not adopted a fee schedule.
5307.6. (a) The administrative director shall adopt and revise a fee schedule for medical-legal expenses as defined by Section 4620, which shall be prima facie evidence of the reasonableness of fees charged for medical-legal expenses at the same time he or she adopts and revises the medical fee schedule pursuant to Section 5307.1. expenses.
The
(b) The schedule shall consist of a series of procedure codes, relative values, and a conversion factor producing fees which that provide remuneration to physicians performing medical-legal evaluations at a level equivalent to that provided to physicians for reasonably comparable work, and which that additionally recognizes recognize the relative complexity of various types of evaluations, the amount of time spent by the physician in direct contact with the patient, and the need to prepare a written report.
(1) Commencing on the effective date of the act adding this paragraph, the conversion factor for medical-legal expenses shall be at least eighteen dollars and seventy-five cents ($18.75).
(A) The administrative director shall increase the conversion factor quarterly, as necessary, to reflect any increase in the Bureau of Labor Statistics Consumer Price Index (CPI) for medical care.
(B) If a quarterly increase is warranted based on an increase in the CPI for medical care, the administrative director shall implement the increase by issuing an order within 48 hours of the end of each calendar quarter, excluding Saturdays, Sundays, and holidays.
(C) The order shall be exempt from Sections 5307.3 and 5307.4 and the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). The administrative director shall inform the public of the increase and its effective date. All orders issued pursuant to this paragraph shall be published on the internet website of the Division of Workers Compensation.
(D) If a quarterly increase is warranted and the administrative director does not increase the conversion factor within 48 hours of the end of each quarter as required by this paragraph, the administrative director shall send a written notice to the Secretary of Labor and Workforce Development, the chair of the Senate Committee on Labor, Public Employment and Retirement, and the chair of the Assembly Committee on Labor and Employment explaining why the increase was not implemented.
(E) The administrative director shall appoint a panel of qualified medical evaluators and insurers, or their representatives, to serve on an ex officio board to oversee the timely increases to the conversion factor.
(2) On or before January 15, 2020, the administrative director shall assign a reasonable relative value, greater than zero, for both of the following:
(A) A missed or failed appointment for a comprehensive or follow-up medical-legal evaluation.
(B) A review of medical records associated with a missed or failed appointment.
(b)
(c) A provider shall not be paid fees in excess of those set forth in the fee schedule established under this section unless the provider provides an itemization and explanation of the fee that shows that it is both a reasonable fee and that extraordinary circumstances relating to the medical condition being evaluated justify a higher fee; provided, however, that in no event shall fee, except that a provider shall not charge in excess of his or her the providers usual fee. The employer and employee shall have standing to contest fees in excess of those set forth in the fee schedule.
(c)
(d) In the event of a dispute between the provider and the employer, employee, or carrier concerning the fees charged, the provider may be allowed a reasonable fee for testimony if the provider testified pursuant to the employers or carriers subpoena and the judge or referee determines that the fee charged was reasonable and justified by extraordinary circumstances.
(d)
(e) (1) No A provider may shall not request nor or accept any compensation, including, but not limited to, any kind of remuneration, discount, rebate, refund, dividend, distribution, subsidy, or other form of direct or indirect payment, whether in money or otherwise, from any source for medical-legal expenses if such the compensation is in addition to the fees authorized by this section. In addition to being subject to discipline pursuant to the provisions of subdivision (k) of Section 139.2, any a provider violating this subdivision is subject to disciplinary action by the appropriate licensing board.
(2) This subdivision does not apply to medical-legal expenses for which the administrative director has not adopted a fee schedule.
SEC. 2. This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are: In order to save a critical aspect of the workers compensation system from collapse due to inadequate reimbursement of qualified medical evaluators, to reduce prejudicial delays in the required treatment of injured workers, and to lower costs to insurers by resolving claims more quickly, it is necessary that this act take effect immediately.
SEC. 2. This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are: In order to save a critical aspect of the workers compensation system from collapse due to inadequate reimbursement of qualified medical evaluators, to reduce prejudicial delays in the required treatment of injured workers, and to lower costs to insurers by resolving claims more quickly, it is necessary that this act take effect immediately.
SEC. 2. This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are:
### SEC. 2.
In order to save a critical aspect of the workers compensation system from collapse due to inadequate reimbursement of qualified medical evaluators, to reduce prejudicial delays in the required treatment of injured workers, and to lower costs to insurers by resolving claims more quickly, it is necessary that this act take effect immediately.