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<ns0:ActionText>INTRODUCED</ns0:ActionText>
<ns0:ActionDate>2025-02-21</ns0:ActionDate>
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<ns0:SessionYear>2025</ns0:SessionYear>
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<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Assembly Member Soria</ns0:AuthorText>
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<ns0:Name>Soria</ns0:Name>
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<ns0:Title> An act to add Section 4617 to the Labor Code, relating to workers’ compensation. </ns0:Title>
<ns0:RelatingClause>workers’ compensation</ns0:RelatingClause>
<ns0:GeneralSubject>
<ns0:Subject>Workers’ compensation: medical treatment.</ns0:Subject>
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<html:p>Existing law establishes a workers’ compensation system, administered by the Administrative Director of the Division of Workers’ Compensation, to compensate an employee, as defined, for injuries sustained in the course of employment. Existing law requires an employer to provide medical treatment that is reasonably required to cure or relieve an employee from the effects of the injury. Existing law allows employers to create networks of medical treatment providers to send employees to for treatment. Existing law sets out criteria for these networks and exceptions for when an employee may be treated outside of the network.</html:p>
<html:p>This bill would require the administrative director to establish a statewide medical provider network database, consisting of physicians who are willing and able to treat injured employees in the San Joaquin Valley region. The
bill would require an employee to first seek treatment within their employer’s or insurer’s network, unless the employer’s or insurer’s network is unable to treat the employee within 30 days of the request for medical treatment. The bill would require physicians, in order to be included in the network, to, among other things, be in good standing with the Medical Board of California and agree to comply with the official medical fee schedule, as specified. The bill would require the administrative director to implement the network on or before January 1, 2027.</html:p>
<html:p>The bill would state the Legislature’s intent to address the shortage of available medical treatment for workplace injuries in the central valley region.</html:p>
<html:p>This bill would make legislative findings and declarations as to the necessity of a special statute for the Counties of Fresno, Kern, Kings, Madera, Merced, San Joaquin, Stanislaus, and Tulare.</html:p>
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<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
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<ns0:Num>SECTION 1.</ns0:Num>
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<html:p>It is the intent of the Legislature to address the shortage of available medical treatment for workplace injuries in the central valley region as identified by the University of California, Merced study published in December 2024. This identified shortage causes people living in the central valley region who sustain workplace injuries to remain out of work for longer periods of time.</html:p>
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<ns0:Num>SEC. 2.</ns0:Num>
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Section 4617 is added to the
<ns0:DocName>Labor Code</ns0:DocName>
, to read:
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<ns0:Num>4617.</ns0:Num>
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(a)
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The administrative director shall establish a statewide medical provider network database consisting of physicians, as described in Section 3209.3, who are willing and able to provide medical treatment to injured workers in the San Joaquin Valley region, including the Counties of Fresno, Kern, Kings, Madera, Merced, San Joaquin, Stanislaus, and Tulare.
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(b)
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(1)
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Notwithstanding any other provision of law, if the employer or insurer has established a medical provider network (MPN) pursuant to Section 4616, or a health care organization (HCO) pursuant to Section 4600.3, the injured employee shall first seek treatment with a physician in that MPN or HCO.
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(2)
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If
an employee demonstrates an inability to obtain a medical treatment visit with a qualified physician within the employer’s MPN within 30 days of the request for medical treatment, the employee may seek treatment with a physician in the statewide medical provider network database.
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(3)
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If the employer or insurer has not established an MPN, the employee may choose to receive treatment with a physician of the employee’s choice, as provided in subdivision (c) of Section 4600, or receive treatment with a physician in the statewide medical provider network.
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<html:p>
(4)
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This subdivision does not limit the right of an employee to receive treatment with their personal physician as described in subdivision (d) of Section 4600.
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<html:p>
(c)
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A physician who possesses the requisite license for practice of their medical specialty is eligible for
inclusion in the statewide medical provider network database for injured workers in the San Joaquin Valley region, if all of the following apply:
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(1)
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The physician is in good standing with the Medical Board of California.
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(2)
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The physician has not been suspended pursuant to Section 139.21.
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(3)
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The physician does not meet any of the criteria specified in paragraph (1) or subdivision (a) of Section 139.21.
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(4)
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The physician agrees to treat injured workers within the scope of their medical practice.
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(5)
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The physician agrees to bill in accordance with the official medical fee schedule established pursuant to Section 5307.1.
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(6)
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The physician agrees to practice in accordance with rules and regulations applicable to the workers’ compensation system, including preparation of required reports.
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(7)
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The physician was listed on an employer, insurer, or private entity MPN on January 1, 2025.
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(d)
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All treatment within the statewide medical provider network shall be provided in accordance with the medical treatment utilization schedule established pursuant to Section 5307.27, which remains presumptively correct.
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(e)
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Treatment within the statewide medical provider network shall be subject to utilization review, as described in Section 4610, and independent medical review, as described in Section 4610.5.
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(f)
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The administrative director shall, on or before January 1, 2027,
and after public hearings, establish rules and procedures governing the statewide medical provider network for injured workers in the San Joaquin Valley region. The administrative director shall include a continuity of care policy meeting the requirements of Section 4616.2.
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<ns0:Num>SEC. 3.</ns0:Num>
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<html:p>The Legislature finds and declares that a special statute is necessary and that a general statute cannot be made applicable within the meaning of Section 16 of Article IV of the California Constitution because of the unique needs of the Counties of Fresno, Kern, Kings, Madera, Merced, San Joaquin, Stanislaus, and Tulare to address the shortage of available medical treatment for workplace injuries.</html:p>
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