DIR Stakeholder Meetings and Legislative Proposal

This week the Department of Industrial Relations held a series of meetings with various workers’ compensation stakeholders (including representatives from CWCI) to consider proposals that address a number of practical issues related to the 2012 reforms.  Among the topics addressed were utilization review, medical liens, and provider fraud.  The stated goals of the proposed changes are to:

• Promote consistency in the delivery of medical care to injured workers;
• Expedite the provision of medically appropriate treatment to injured workers by “fast-tracking” UR;
• Improve communication between UR reviewers and treating physicians;
• Reduce delays in the current UR and IMR processes;
• Accommodate formulary-related disputes in the UR and IMR processes;
• Improve quality, accuracy and functioning of UR services.

 The utilization review proposals include a number of significant changes such as exempting some treatments from UR; relaxing UR for medical service requests within the first 30 days of injury; adding a second UR appeal process; and mandating electronic reporting of information and reports related to all UR decisions. Given the scope of these changes, the proposals would require amending current statutory language governing UR.

The stakeholder meetings were spearheaded by DIR Director Christine Baker, who was the Brown Administration’s point person in negotiating and implementing SB 863, and one of this week’s meetings was attended by Gideon Baum, Senior Consultant to the Senate Labor and Industrial Relations Committee, who has shepherded numerous workers’ comp bills through the Legislature in recent years.  The proposed language is a work in progress, but once the details are hammered out, it is likely that the proposals will be added as a rider to an existing bill, or that another bill will be gutted and amended to include the new language. 

The Institute will continue to offer industry perspectives and practical input to DIR as the language continues to be developed.  In the meantime, CWCI General Counsel Ellen Langille has prepared the attached summary of the specific UR proposals that were vetted at this week’s meetings, and CWCI Claims and Medical Director Brenda Ramirez and Senior Research Associate Stacy Jones have added their comments, which will be sent to Christine Baker.  You may wish to share the summary with your staff as well.  If you have additional comments or input, please email them to Ellen Langille at elangille@cwci.org.  Stay tuned.

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