| Actions |
| 2025-09-08 |
|
Read second time. Ordered to third reading. |
| 2025-09-08 |
|
Re-referred to Com. on RLS. pursuant to Senate Rule 29.10(b). |
| 2025-09-08 |
|
Re-referred to Com. on L., P.E. & R. pursuant to Senate Rule 29.10(b). |
| 2025-09-08 |
|
(Ayes 5. Noes 0. Page 2570.) |
| 2025-09-08 |
|
Withdrawn from committee. |
| 2025-09-08 |
|
Re-referred to Com. on RLS. |
| 2025-09-05 |
|
Read third time and amended. Ordered to second reading. |
| 2025-08-20 |
|
Read second time. Ordered to third reading. |
| 2025-08-19 |
|
From committee: Be ordered to second reading pursuant to Senate Rule 28.8. |
| 2025-07-09 |
|
From committee: Do pass and re-refer to Com. on APPR. (Ayes 5. Noes 0.) (July 9). Re-referred to Com. on APPR. |
| 2025-06-18 |
|
Referred to Com. on L., P.E. & R. |
| 2025-06-05 |
|
In Senate. Read first time. To Com. on RLS. for assignment. |
| 2025-06-04 |
|
Read third time. Passed. Ordered to the Senate. (Ayes 76. Noes 0. Page 2057.) |
| 2025-05-27 |
|
Read second time. Ordered to third reading. |
| 2025-05-23 |
|
From committee: Do pass. (Ayes 12. Noes 0.) (May 23). |
| 2025-05-21 |
|
In committee: Set, second hearing. Referred to APPR. suspense file. |
| 2025-05-21 |
|
Joint Rule 62(a), file notice suspended. (Page 1627.) |
| 2025-05-14 |
|
In committee: Set, first hearing. Hearing canceled at the request of author. |
| 2025-04-23 |
|
From committee: Do pass and re-refer to Com. on APPR. (Ayes 17. Noes 0.) (April 23). Re-referred to Com. on APPR. |
| 2025-04-21 |
|
Re-referred to Com. on INS. |
| 2025-04-10 |
|
From committee chair, with author's amendments: Amend, and re-refer to Com. on INS. Read second time and amended. |
| 2025-03-25 |
|
Re-referred to Com. on INS. |
| 2025-03-24 |
|
Referred to Com. on INS. |
| 2025-03-24 |
|
From committee chair, with author's amendments: Amend, and re-refer to Com. on INS. Read second time and amended. |
| 2025-02-21 |
|
From printer. May be heard in committee March 23. |
| 2025-02-20 |
|
Read first time. To print. |
|
| Last Version Text |
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<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Assembly Member Chen</ns0:AuthorText>
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<ns0:Title> An act to amend Section 4603.3 of the Labor Code, relating to workers’ compensation. </ns0:Title>
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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 for injuries sustained in the course of employment. Existing law requires an employer to provide medical, surgical, chiropractic, acupuncture, and hospital treatment that is reasonably required to cure or relieve the injured worker from the effects of the injury. Upon payment, adjustment, or denial of a complete or incomplete itemization of medical services, existing law requires an employer to provide an explanation of review that includes, among other information, the amount paid and the basis for any adjustment, change, or denial of the item or procedure billed. </html:p>
<html:p>This bill would, when the basis for any adjustment, change, or denial of an item or procedure is a contract, require the explanation of review to include information on that underlying contract, including whom the medical provider may contact to seek a copy of the relevant, applicable contract. The bill would state that disclosure of a medical provider network does not satisfy this requirement and would state that if the contract is not received within 30 business days of the provider’s request, the bill shall be reprocessed and paid, as specified.</html:p>
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Section 4603.3 of the
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(a)
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Upon payment, adjustment, or denial of a complete or incomplete itemization of medical services, an employer shall provide an explanation of review in the manner prescribed by the administrative director that shall include all of the following:
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(1)
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A statement of the items or procedures billed and the amounts requested by the provider to be paid.
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(2)
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The amount paid.
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The basis for any adjustment, change, or denial of the item or procedure billed.
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If the adjustment, change, or denial is based on a contract, then the explanation of review shall include specific information on the underlying contract that was relied upon to justify the discount and contact information, including an address and phone number for whom the medical provider may contact to receive a copy of the relevant, applicable contract. Disclosure of a medical provider network does not satisfy this requirement. If the contract is not received by the provider within 30 business days of the provider’s request, the bill shall be automatically reprocessed and paid at rates mandated by the official medical fee schedule.
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The additional information required to make a decision for an incomplete itemization.
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If a denial of payment is for some reason other than a fee
dispute, the reason for the denial.
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Information on whom to contact on behalf of the employer if a dispute arises over the payment of the billing. The explanation of review shall inform the medical provider of the time limit to raise any objection regarding the items or procedures paid or disputed and how to obtain an independent review of the medical bill pursuant to Section 4603.6.
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(b)
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The administrative director may adopt regulations as necessary to implement and make specific the provisions of this section, including, but not limited to, a requirement to use electronic explanations of review.
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|
| Last Version Text Digest |
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 employment. Existing law requires an employer to provide medical, surgical, chiropractic, acupuncture, and hospital treatment that is reasonably required to cure or relieve the injured worker from the effects of the injury. Upon payment, adjustment, or denial of a complete or incomplete itemization of medical services, existing law requires an employer to provide an explanation of review that includes, among other information, the amount paid and the basis for any adjustment, change, or denial of the item or procedure billed. This bill would, when the basis for any adjustment, change, or denial of an item or procedure is a contract, require the explanation of review to include information on that underlying contract, including whom the medical provider may contact to seek a copy of the relevant, applicable contract. The bill would state that disclosure of a medical provider network does not satisfy this requirement and would state that if the contract is not received within 30 business days of the provider’s request, the bill shall be reprocessed and paid, as specified. |