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California AB 1465 CAMPN State Sponsored Medical Networks Debate

CAMPN – California AB 1465 Alters Workers’ Comp Medical Treatment Networks

The term CAMPN – California AB 1465 is an Assembly Bill that proposes to increase the injured workers’ access to medical treatment. The California Workers’ Compensation Institute (CWCI) published a study this month that possibly surprised quite a few of the California AB 1465 proponents.

map of workers comp california ab 1465 — (c) Wikimedia – Photohound

Let us look at the whole Assembly Bill and then see what the CWCI had to say about this pending legislation. By the way, what happens in the California Workers’ Comp system eventually spreads to other parts of the country. Please do not consider this “an isolated west coast problem.”

Physician networks called MPN’s in California have always been one of my Six Keys To Workers Compensation savings. Changing the provider network structure would have a major impact on workers’ comp costs.

The debate covers whetther the impact would be positive or negative.

I have provided the Bill below or you can find it here. There may be additional changes to the Bill after I published this article.

AMENDED IN ASSEMBLY APRIL 15, 2021

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

ASSEMBLY BILL

NO. 1465

Introduced by Assembly Members Reyes and Lorena Gonzalez

February 19, 2021

An act to add Section 4617 to the Labor Code, relating to workers’ compensation.

LEGISLATIVE COUNSEL’S DIGEST

AB 1465, as amended, Reyes. Workers’ compensation: medical treatment.

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 the network.

This bill would require the administrative director to establish a statewide medical provider network, called the California Medical Provider Network (CAMPN). The bill would establish that an employee may choose to treat within their employer’s network or the CAMPN. The bill would require that the providers in the CAMPN be sufficient to enable treatment for a variety of injuries in all parts of the state. The bill would specify criteria physicians must meet to be included in the CAMPN and would require inclusion for those physicians that meet the criteria. The bill would require the administrative director director, no later than April 30, 2022, to establish rules and procedures for the CAMPN and create and adopt a continuity of care policy. The bill would require that the administrative director implement the CAMPN on or before June 30, 2022. The bill would authorize a treatment provider to leave the CAMPN at any time.

DIGEST KEY

Vote: majority Appropriation: no Fiscal Committee: yes Local Program: no

BILL TEXT

THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

SECTION 1.

Section 4617 is added to the Labor Code, to read:

4617.

(a) The administrative director shall establish a statewide medical provider network to be called the California Medical Provider Network (CAMPN). The CAMPN shall consist of physicians, as described in Section 3209.3, throughout the state who are willing and able to provide medical treatment to injured employees.

(b) 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 may choose to treat with a physician in that MPN or HCO, or may choose to treat with transfer treatment to a physician in the CAMPN. If the employer or insurer has not established a an MPN, the employee may choose to treat with a physician of the employee’s choice, as provided in subdivision (c) of Section 4600, or to treat with a physician in the CAMPN. An employee who is treating with a physician in the CAMPN may, at any time, change to a different treating physician within the CAMPN. Nothing in this section shall be construed to limit the right of an employee to treat with their personal physician as described in subdivision (d) of Section 4600.

(c) The number of physicians in the CAMPN shall be sufficient to enable treatment for injuries or conditions to be provided in a timely manner and shall, to the extent feasible, include within the CAMPN physicians in all medical specialties. The provider network CAMPN shall include an adequate number and type of physicians, as described in Section 3209.3, to treat common injuries experienced by injured employees based on the type of occupation or industry in which the employee is engaged, and the geographic area where the employees are employed. Medical treatment for injuries shall be readily available at reasonable times to all employees. To the extent feasible, all medical treatment for injuries shall be readily accessible to all employees. With respect to availability and accessibility of treatment, the administrative director shall consider the needs of rural areas, specifically those in which health facilities are located at least 30 miles apart and areas in which there is a health care shortage.

(d) A physician who possesses the requisite license for practice of their medical specialty is eligible for inclusion in the CAMPN, if all of the following apply:

(1) The physician is in good standing with the Medical Board of California.

(2) The physician has not been suspended pursuant to Section 139.21.

(3) The physician does not meet any of the criteria specified in paragraph (1) of subdivision (a) of Section 139.21.

(4) The physician agrees to treat injured workers within the scope of their medical practice.

(5) The physician agrees to bill in accord with the official medical fee schedule established pursuant to Section 5307.1.

(6) The physician agrees to practice in accord with rules and regulations applicable to the workers’ compensation system, including preparation of required reports.

(e) A physician who meets the criteria in subdivision (d) shall be included in the CAMPN. In no event shall economic profiling, as defined in subdivision (b) (c) of Section 4616.1, be a factor to be considered for inclusion in or expulsion from the CAMPN.

(f) All treatment within the CAMPN shall be provided in accordance with the medical treatment utilization schedule established pursuant to Section 5307.27, which remains presumptively correct.

(g) Treatment within the CAMPN shall be subject to utilization review, as described in Section 4610, and independent medical review, as described in Section 4610.5.

(h) Nothing contained herein shall be construed to limit or eliminate utilization review as described in Section 4610, independent medical review as described in Section 4610.5, Section 4610.5 or 4610.6, or the antifraud provisions contained in Sections 139.21 and 4906 of this code, and Section 14123 of the Welfare and Institutions Code.

(i) The initial list of CAMPN physicians shall be created by including any physician who meets the criteria in subdivision (d) and was listed on any employer or insurer or private entity MPN on January 1, 2022. as of January 1, 2021, on any MPN created pursuant to Section 4616. Within 60 days of the effective date of this section, each employer, insurer, or private entity, that has established a an MPN pursuant to Section 4616, shall file with the administrative director a list of those physicians in the MPN as of January 1, 2022. 2021.

(j) The administrative director shall, on or before January 1, April 30, 2022, and after public hearings, establish rules and procedures governing the CAMPN. The administrative director shall include a continuity of care policy meeting the requirements of Section 4616.2. The CAMPN shall be implemented no later than January 1, June 30, 2022.

(k) A physician in the CAMPN may, at any time, leave the CAMPN pursuant to the rules and procedures created by the administrative director.

__________________________________

I will not attempt to analyze the Bill. The red lines indicate changes to the Bill.

CWCI April 2021 California AB 1465 Impact Analysis Report

You can find the full impact analysis report here. I encourage you to download the study. The conclusions drawn by the CWCI California AB 1465 analysis were:

it is unlikely that an arbitrary increase in the sheer number of physicians will increase the quality of care or MPN utilization and access beyond current levels
A combined initial cost estimate of $314+ million per year is unlikely to improve access to medical care.

Why Should Care About California AB 1465 If I Live In Another State?

I receive this question quite often when I cover any CA-specific subjects? Because California AB 1465 could be coming to a state near you such as AB 5 and gig workers.

How many other states addressed the gig workers after AB 5 was ratified? Please note that California AB 1465 has not yet been fully passed or signed into law.

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

Risk and Insurance Management Society (RIMS)
Entrepreneur Magazine
Bloomberg Business News
WorkCompCentral.com
Claims Magazine
Risk & Insurance Magazine
Insurance Journal
Workers Compensation.com
LinkedIn, Twitter, Facebook and other social media sites
Various trade publications

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