Weinmann: The R&R Ride for SB 1160

Wednesday, December 7, 2016 | 0

Now that Gov. Jerry Brown has signed Senate Bill 1160 into law, it's time for the bill to enter the "rule-making" phase. That's when legislation either gets its teeth or gets its teeth kicked in.

Robert Weinmann

The rules and regulations (R&R) ride for SB 1160 starts at 10 a.m. Jan. 4 at the Hiram Johnson State Office Building, 455 Golden Gate Ave., San Francisco. Public testimony is supposedly limited to 10 minutes per speaker. The subject will be Title 8, CCRs, Section 10770 (amended) and 10770.7 (newly adopted).

Here is our opinion: Implementation of SB 1160 needs to be far more friendly to injured workers than it currently is. The rules and regulations as proposed will implement a lien process that may be expanded in the sense that it will apply not only to doctors who accept liens but also to any physician or other provider who runs into snags with payment so that the only way remaining to proceed with an unpaid claim is through the lien process.

That means if the lien process becomes the only viable option for a delayed or denied payment for medical or other service, it will be necessary to file a lien under new R&Rs. That means increased crunch and grind, especially for small offices. In turn that means progressive reduction in access to care for injured workers.  

We also believe that a hint of hypocrisy persists in the process. Here's how: Supposedly, treating doctors will get the first 30 days of treatment unimpeded by utilization review.

Not quite.

Not all procedures will be removed from the UR cauldron of dismissal: Magnetic resonance imaging will remain off limits. So will non-formulary medications and durable medical equipment costing more than $250.

Psychological treatment will remain on the proscribed list (remember in 2015 that neuropsych qualified medical evaluator was unilaterally and arbitrarily canceled by the director). Surgery will still require prior authorization by UR. 

For these reasons, we urge participants with a stake in this process to file statements:

• By mail — Workers' Comp Appeals Board, Annette Gabrielli, Regional Coordinator, P.O. Box 429459, San Francisco, CA, 94142-9459.
• By delivery service or personal delivery — WCAB, Annette Gabrielli, Regional Coordinator, 455 Golden Gate Ave., 9th floor, San Francisco.
• By fax — 415-703-4549.

Have fun over the New Year's holiday but keep your fingers crossed.

Robert Weinmann writes the blog Politics of Healthcare, from which this entry was taken with permission.