CA UR Bill - BIG Update

On 5/16/2023, I wrote about California SB 636 which would require UR physicians to be CA licensed and also have the same duty of care as physicians providing care for their patients.

The “duty of care” portion of the bill is a HUGE change and would jeopardize the entire UR process in California.

Duty of care has now been removed in the amended version.

What does this mean for you?

• UR decisions are about payment responsibility by the insurer and do not prevent the injured employee from receiving the requested care.
• UR physicians (who are not the attending provider) will continue to make 3rd party medical necessity decisions (UR) without the same risk they would as medical providers.
• Requiring UR physicians to be CA licensed won’t be a major change but has a couple downsides.?
• Medical providers in other states don’t have substantially different training from providers in CA. Why limit the pool of reviewers?
• It increases conflict of interest scenarios where some UR physicians have to recuse themselves from reviewing the case.

Positive step forward.

The information provided does not, and is not intended to, constitute legal advice; instead, all information, content, and materials available are for general informational purposes only.