FEE SCHEDULE NEWS:

• Inpatient Hospital Fee Schedule has been updated with an effective date of January 1, 2017. The DWC has adopted the final rule of August 22, 2016 and the correction notice of October 5, 2016, published in the Federal Register, which changes the Medicare payment system.  Updates to the Composite Rate, Hospital Specific Outlier Factor, and Cost to Charge Ratio for the listed hospitals have been adopted.  The next update is scheduled for January 2018.
• The DMEPOS and Clinical Lab fee schedules have been updated with an effective date of January 1, 2017. The DWC has adjusted the Pathology and Clinical Laboratory fee schedule and also the DMEPOS schedule to conform with the changes to the Medicare payment system adopted by CMS for calendar year 2017. New changes to the Physician and Practitioner Services Medically Unlikely Edits and the National Correct Coding Initiative Practitioner PTP Edits are expected to become effective January 1, 2017.
• Medi-Cal rates have been released with an effective date of December 15, 2016 however; no changes were present in the data file.  The next update is scheduled for January 15, 2017.
• Ambulance Fee Schedule has been updated with an effective date of January 15, 2016. The state has adopted the 2016 changes to the Medicare Payment System for ambulance.  The next update is expected in January 2017.
• The Copy fee schedule was adopted with an effective date of May 1, 2015.
• The Outpatient and ASC fee schedule was updated with an effective date of December 15, 2016. The state has adopted the Medicare 2016 update to the hospital outpatient prospective payment system.

REGULATORY ACTIVITY:

• WCAB Issues Notice of January 4 Public Hearing on Proposed Amendments to Rules on Lien Claims Filing.  The public hearing is scheduled on Wednesday, January 4 2017 at 10 a.m. in the Milton Marks Conference Center, Santa Barbara Room of the Hiram Johnson State Office Building at 455 Golden Gate Avenue, San Francisco, CA 94102. Members of the public may also submit written comment on the proposed rules amendments until 5 p.m. that day.
• DWC Posts Proposed Further Amendments to its WCIS Regulations and EDI Implementation Guides.  The Division of Workers’ Compensation (DWC) posted proposed regulations further revising its Workers’ Compensation Information System (WCIS) regulations and Electronic Data Interchange (EDI) Implementation Guides. Members of the public were invited to present written comments regarding the proposed modifications to dwcrules@dir.ca.gov until 5 p.m. on Thursday, December 15, 2016.  Following the Office of Administrative Law’s publication of DWC’s initial draft of these regulations, a public hearing was held March 28. A second draft of the regulations was released for a 15-day comment period, which ended on June 9.  Additional revisions to the regulations and to the EDI Implementation Guide for First and Subsequent Reports of Injury (FROI/SROI), Version 3.1, and the EDI Implementation Guide for Medical Bill Payment Records, Version 2.0, have been made in response to changes suggested by trading partners and other stakeholders, and a few additional changes were made to improve the quality and integrity of the data to be reported to WCIS following implementation of these changes.
• The Workers’ Compensation Appeals Board (WCAB) has issued a notice of public hearing regarding a proposed addition and amendments to its Rules of Practice and Procedure. The primary purpose of this rulemaking is to implement legislative changes to the filing requirements for lien claims mandated by Senate Bill 1160.  SB 1160 amended Labor Code section 4903.05 to require that section 4903(b) lien claimants file a declaration that includes information regarding the type of services provided by the lien claimant. A lien claimant’s failure to timely file this declaration shall result in the dismissal of the lien with prejudice by operation of law per Labor Code section 4903.05(c) (3). This rulemaking will mandate use of an e-filed declaration form in order to ensure uniform procedures for lien claimants who first file their liens after January 1, 2017 and current lien claimants who are required to file a declaration by July 1, 2017.
• DWC Administrative Director Announced 2017 Profile Audit Review and Full Compliance Audit Performance.  Labor Code §§129 and 129.5 require the Audit and Enforcement Unit of the Division of Workers’ Compensation (DWC) to conduct a profile audit review (PAR) for all adjusting locations of California workers’ compensation claims at least once every five years. Performance of the adjusting locations is measured in five areas of claims administration:
  • The payment of accrued and undisputed indemnity
  • The late first payment of temporary disability / first notice of salary continuation
  • The late first payment of permanent disability and death benefits
  • The late subsequent indemnity payments
  • The provision of notices with QME/AME advice.
• The administrative director annually establishes profile audit review and full compliance audit (FCA) standards in accordance with Labor Code §§129(b) (1) and (2) and Title 8, California Code of Regulations §10107.1. The 2016 standards are based on the audit results of calendar years 2013 through 2015. The PAR performance standard for audits conducted in 2017 is 1.47885. Audit subjects with PAR performance ratings of 1.47885 or lower will be required to pay any unpaid compensation, but no penalties will be assessed.  If an audit subject’s PAR performance rating is 1.147886 or higher, the audit will expand to a FCA, and an additional sample of indemnity claims will be audited. The FCA performance standard for audits conducted in 2017 is 1.67487.  Audit subjects with an FCA performance rating of 1.67487 or less will be required to pay any unpaid compensation and penalties will be assessed for all violations involving unpaid and late paid compensation.  If an audit subject’s full compliance audit performance rating is 1.67488 or higher, an additional sample of denied claims as well as the expanded sample of indemnity claims will be audited.  Penalties will be assessed for all violations as appropriate pursuant to 8CCR §§10111 through 10111.2.  For additional information go to:  http://www.dir.ca.gov/dwc/audit.html.
• The Division of Workers’ Compensation (DWC) has announced the decrease of the mileage rate for medical and medical-legal travel expenses by one-half cent to 53.5 cents per mile effective January 1, 2017.  This rate must be paid for travel on or after January 1, 2017 regardless of the date of injury. Labor Code section 4600, in conjunction with Government Code section 19820 and the Department of Personnel Administration regulations, establishes the rate payable for mileage reimbursement for medical and medical-legal expenses and ties it to the Internal Revenue Service (IRS).  IRS Bulletin Number IR-2016-169 dated December 13, 2016 announced the rate decrease. The updated mileage reimbursement form is posted on the DWC website.
• The Division of Workers’ Compensation (DWC) issued its Notice of Emergency Regulatory Action to implement the provider suspension process required under Assembly Bill 1244. The bill, a major step to combat fraud in the workers’ compensation system, requires the suspension of medical providers found to have committed a felony or misdemeanor involving fraud or abuse of the Medi-Cal or Medicare programs, the workers’ compensation system itself, or fraud or abuse of any patient. The regulations provide for a hearing process should the provider wish to contest the suspension order.  The emergency regulations will be filed with the state’s Office of Administrative Law (OAL) on December 21, 2016. The regulations to be filed with OAL can be found on the DWC website. OAL has up to 10 days to consider the rules, but may approve them before the 10 days have elapsed. Upon OAL approval and filing with the Secretary of State, the regulations are effective for 180 days while the Division initiates formal rulemaking procedures to adopt permanent regulations. For information on the OAL procedure, and to learn how you may comment on the emergency regulations, go to the OAL’s website. A notice will be posted at the DWC website when the emergency regulations become effective.

LEGISLATIVE ACTIONS:

• Assembly Bill 1244
  Under existing law, the Director of Health Care Services is authorized, for purposes of administering the Medi-Cal program, to suspend a provider of service from further participation under the program for specified reasons, including conviction of any felony or any misdemeanor involving fraud, abuse of the Medi-Cal program or any patient, or otherwise substantially related to the qualifications, functions, or duties of a provider of service. Existing law requires the director, upon receipt of written notification from the Secretary of the United States Department of Health and Human Services that a physician or other individual practitioner has been suspended from participation in the Medicare or Medicaid programs, to promptly suspend the practitioner from participation in the Medi-Cal program. Existing law establishes a workers’ compensation system, administered by the Administrative Director of the Division of Workers’ Compensation, that generally requires employers to secure the payment of workers’ compensation for injuries incurred by their employees that arise out of, or during, employment. Existing law requires an employer to provide all medical services reasonably required to cure or relieve the injured worker from the effects of the injury.  Existing law authorizes an insurer, employer, or entity that provides physician network services to establish or modify a medical provider network for the provision of medical treatment to injured employees and requires the administrative director to contract with individual physicians or an independent medical review organization to perform medical provider network independent medical reviews.
  The enacted legislation requires the administrative director to promptly suspend any physician, practitioner, or provider from participating in the workers’ compensation system if as a physician, practitioner, or provider the individual or entity meets specified criteria, including if that individual has been convicted of any felony or misdemeanor involving fraud or abuse of the Medi-Cal program, Medicare program, or workers’ compensation system, if that individual’ s license, certificate, or approval to provide health care has been surrendered or revoked, or if that individual or entity has been suspended, due to fraud or abuse, from participation in the Medicare or Medicaid programs. It requires the administrative director to adopt regulations for suspending a physician, practitioner, or provider from participating in the workers’ compensation system pursuant to these provisions, as specified, and would require the administrative director to furnish to the physician, practitioner, or provider written notice of the right to a hearing regarding the suspension and the procedure to follow to request that hearing. As enacted it also requires the administrative director to promptly notify the appropriate state licensing, certifying, or registering authority of a physician’s, practitioner’s, or provider’s suspension and to update the division’s databases of qualified medical evaluators and medical provider networks. The bill requires the administrative director to notify the chief judge of the division of a suspension under these provisions, as specified, and post a notice on the department’s Internet Web site. It enacts special lien proceedings for the adjudication of any liens of a physician, practitioner, or provider who has been suspended pursuant to these provisions because he or she has been convicted of a felony or misdemeanor that meets specified criteria. The bill also requires the Director of Health Care Services to notify the administrative director of a suspension of a physician from participation in the Medi-Cal program imposed pursuant to the provisions described above authorizing the director to suspend a provider of service from participation. Existing law establishes the Workers’ Compensation Appeals Board to exercise all judicial powers vested in it, as specified, including workers’ compensation proceedings for the recovery of compensation, or concerning any right or liability arising out of or incidental to the recovery of compensation. Existing law vests the appeals board with full power, authority, and jurisdiction to try and determine finally those matters, subject only to the review by the courts, as specified. Existing law authorizes the appeals board to determine, and allow as liens against any sum to be paid as compensation, as specified, a reasonable attorney’s fee for legal services and disbursements about those legal services. Existing law provides that a charge, claim, or agreement for those legal services or disbursements is not enforceable, valid, or binding more than a reasonable amount. Existing law also requires an attorney to furnish to the employee a written disclosure form describing the procedures available to the injured employee or his or her dependents and specified information regarding attorney’s fees. Existing law requires that a copy of the disclosure form be signed by the employee and the attorney and sent to the employer, or insurer or 3rd-party administrator, if either is known, by the attorney within 15 days of the employee’s and attorney’s execution of the form. Existing law also requires the employee, the insurer, the employer, and the attorneys for each party to sign and file with the board a statement, signed under penalty of perjury, attesting that the signatories have not violated specified laws prohibiting conflicts of interest. Existing law authorizes the appeals board, a workers’ compensation judge, or any party to the action or proceeding, as specified, to cause the deposition of witnesses in any investigation or hearing before the appeals board, and provides that the deponent is entitled to receive specified benefits, such as reasonable expenses of transportation, meals, and lodging, as specified. This bill prohibits payment for legal services or disbursements about those legal services, or expenses relating to the deposition of witnesses, incurred under the provisions described above, as specified, prior to the filing of the disclosure form with the appeals board and the sending of that form to the employer, or to the insurer or 3rd-party administrator, if either is known, by the attorney. The bill requires the disclosure form described above to contain a paragraph setting forth the exact location of the district office of the appeals board at which the employee’s case will be filed and to include a specified statement. It imposes other requirements regarding the signing and content of the form, including that the form be signed under penalty of perjury by the attorney representing the employee, and would require the form to be filed with the appeals board. The bill requires an attorney who subsequently assumes the representation of the employee in the same action or proceeding too complete and sign under penalty of perjury a disclosure form that meets the above-described requirements and the statement attesting that the signatories have not violated specified laws prohibiting conflicts of interest. As enacted it requires the attorney to file the form and statement with the appeals board, and send them to the employer, or insurer or 3rd-party administrator, if either is known, within 15 days of the employee’s and attorney’s execution of the form and statement. By expanding the scope of the crime of perjury under these provisions, this bill would impose a state-mandated local program.  Effective Date January 1, 2017.
• Assembly Bill 2503
  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 during his or her employment. Existing law requires every employer, for purposes of workers’ compensation, to establish a utilization review process to prospectively, retrospectively, or concurrently review and approve, modify, delay, or deny, based in whole or in part on medical necessity to cure and relieve, treatment recommendations by physicians prior to, retrospectively, or concurrent with the provision of medical treatment services, as provided. Existing law requires prospective or concurrent decisions to be made in a timely fashion that is appropriate for the nature of the employee’s condition. Existing law also requires that decisions to approve, modify, delay, or deny requests by physicians for authorization prior to, or concurrent with, the provision of medical treatment services to employees be communicated to the requesting physician within 24 hours of the decision. This bill would require a physician providing treatment to an injured worker to send any request for authorization for medical treatment, with supporting documentation, to the claims administrator for the employer, insurer, or other entity per rules adopted by the administrative director. The bill would also make technical changes. Effective Date January 1, 2017.
• Senate Bill 482
  The enacted legislation requires a health care practitioner authorized to prescribe, order, administer, or furnish a controlled substance to consult the CURES database to review a patient’s controlled substance history no earlier than 24 hours, or the previous business day, before prescribing a Schedule II, Schedule III, or Schedule IV controlled substance to the patient for the first time and at least once every 4 months thereafter if the substance remains part of the treatment of the patient. It exempts a veterinarian and a pharmacist from this requirement. The legislation also exempts a health care practitioner from this requirement under specified circumstances, including, among others, if prescribing, ordering, administering, or furnishing a controlled substance to a patient receiving hospice care, to a patient admitted to a specified facility for use while on facility premises, or to a patient as part of a treatment for a surgical procedure in a specified facility if the quantity of the controlled substance does not exceed a non-refillable 5-day supply of the controlled substance that is to be used in accordance with the directions for use. The bill would require, if a health care practitioner authorized to prescribe, order, administer, or furnish a controlled substance is not required to consult the CURES database the first time he or she prescribes, orders, administers, or furnishes a controlled substance to a patient pursuant to one of those exemptions, the health care practitioner to consult the CURES database before subsequently prescribing a Schedule II, Schedule III, or Schedule IV controlled substance to the patient and at least once every 4 months thereafter if the substance remains part of the treatment of the patient. The bill provides that a health care practitioner who fails to consult the CURES database is required to be referred to the appropriate state professional licensing board solely for administrative sanctions, as deemed appropriate by that board. The bill makes the above-mentioned provisions operative 6 months after the Department of Justice certifies that the CURES database is ready for statewide use and that the department has adequate staff, user support, and education, as specified. It also exempts a health care practitioner, pharmacist, and any person acting on behalf of a health care practitioner or pharmacist, when acting with reasonable care and in good faith, from civil or administrative liability arising from any false, incomplete, inaccurate, or misattributed information submitted to, reported by, or relied upon in the CURES database or for any resulting failure of the CURES database to accurately or timely report that information. The enacted legislation authorizes a health care practitioner to provide a patient with a copy of the patient’s CURES patient activity report if no additional CURES data is provided. The bill would also prohibit a regulatory board whose licensees do not prescribe, order, administer, furnish, or dispense controlled substances from obtaining data from the CURES database. Effective Date January 1, 2017.
• Senate Bill 1160
  This bill requires the administrative director to adopt regulations to provide employees with notice regarding access to medical treatment following the denial of a claim under the workers’ compensation system. Existing law requires the Administrative Director of the Division of Workers’ Compensation of the Department of Industrial Relations to develop a workers’ compensation information system in consultation with the Insurance Commissioner and the Workers’ Compensation Insurance Rating Bureau, with certain data to be collected electronically and to be compatible with the Electronic Data Interchange System of the International Association of Industrial Accident Boards and Commissions. Existing law requires the administrative director to assess an administrative penalty of not more than $5,000 in a single year against a claims administrator for a violation of those data reporting requirements. This bill increases that penalty assessment to not more than $10,000. It requires the administrative director to post on the Division of Workers’ Compensation Internet Web site, a list of claims administrators who are in violation of the data reporting requirements.
  The enacted legislation bill revises and recast provisions relating to utilization review, as specified, about injuries occurring on or after January 1, 2018. Among other things, the bill would set forth the medical treatment services that would be subject to prospective utilization review under these provisions, as provided. The bill authorizes retrospective utilization review for treatment provided under these provisions under limited circumstances, as specified. The bill would establish procedures for prospective and retrospective utilization reviews and set forth provisions for removal of a physician or provider under designated circumstances. On and after January 1, 2018, the bill would establish new procedures for reviewing determinations regarding the medical necessity of medication prescribed pursuant to the drug formulary adopted by the administrative director, as provided. The bill makes conforming changes to related provisions to implement these changes. The bill would, commencing July 1, 2018, require each utilization review process to be accredited by an independent, nonprofit organization to certify that the utilization review process meets specified criteria, including, but not limited to, timeliness in issuing a utilization review decision, the scope of medical material used in issuing a utilization review decision, and requiring a policy preventing financial incentives to doctors and other providers based on the utilization review decision. The bill would require the administrative director to adopt rules to implement the selection of an independent, nonprofit organization for accreditation purposes, as specified. It authorizes the administrative director to adopt rules to require additional specific criteria for measuring the quality of a utilization review process for purposes of accreditation and provide for certain exemptions. The bill requires the administrative director to develop a system for electronic reporting of documents related to utilization review performed by each employer, to be administered by the division. It requires the administrative director, on or after March 1,2019, to contract with an outside independent research organization to evaluate and report on the impact of provision of medical treatment within the first 30 days after a claim is filed, for claims filed on or after January 1, 2017, to January 1, 2019. The enacted legislation requires the report to be completed before January 1, 2020, and to be distributed to the administrative director, the Senate Committee on Labor and Industrial Relations, and the Assembly Committee on Insurance.
  The legislation requires certain lien claimants that file a lien under these provisions to do so by filing a declaration, under penalty of perjury, that includes specified information. The bill would require current lien claimants to also file the declaration by a specified date. The bill would make a failure to file a declaration under these provisions grounds for dismissal of a lien. Because the bill would expand the crime of perjury, the bill would impose a state-mandated local program. The bill also automatically stays any physician or provider lien upon the filing of criminal charges against that person or entity for specified offenses involving medical fraud, as provided. The bill would authorize the administrative director to adopt regulations to implement that provision. The bill would state findings and declarations of the Legislature about these provisions. Currently the law prohibits the assignment of a lien under these provisions, except under limited circumstances, as specified. This legislation would, for liens filed after January 1, 2017, invalidate any assignment of a lien made in violation of these provisions, by operation of law.
  This bill authorizes the administrative director to make updates to the utilization schedule by order, which would not be subject to the Administrative Procedure Act, as specified. The bill requires any order adopted pursuant to these provisions to be published on the Internet Web site of the division. Currently the statute requires a deponent to receive certain expenses and reimbursements if an employer or insurance carrier requests a deposition to be taken of an injured employee, or any person claiming benefits as a dependent of an injured employee. Existing law authorizes the deponent to receive a reasonable allowance for attorney’s fees, if represented by an attorney licensed in this state. This bill authorizes the administrative director to determine the range of reasonable fees to be paid to a deponent. The current statute provides that it is the responsibility of any party producing a witness requiring an interpreter to arrange for the presence of a qualified interpreter. It sets forth the qualifications of a qualified interpreter for these purposes, and provides for the settings under which a qualified interpreter may render services.  The enacted law requires the administrative director to promulgate regulations establishing criteria to verify the identity and credentials of individuals that provide interpreter services under these provisions.
  Currently the statute requires physicians, as defined, who attend to injured or ill employees to file reports with specific information prescribed by law. This bill revises those reporting requirements, as prescribed. Effective Date January 1, 2017.
• Assembly Bill 2710
  Existing law creates the California Insurance Guarantee Association (CIGA) and requires all insurers admitted to transact specified insurance lines in this state to become members. Each time an insurer becomes insolvent, to the extent necessary to secure funds for payment of covered claims of that insolvent insurer and also for payment of reasonable costs of adjusting the claims; CIGA is required to collect premium payments from its member insurers sufficient to discharge its obligations, as specified. This bill, among other things, would no longer require an insurer to become insolvent in order for CIGA to collect premium payments from the member insurers and would require CIGA to collect premiums in order to secure funds for the payment of its administrative expenses. Under existing law, CIGA is required to be a party in interest in all proceedings involving a covered claim, and has the same rights as the insolvent insurer would have had if not in liquidation, but CIGA has no cause of action against the insureds of the insolvent insurer for any sums it has paid out, except as provided.  This bill would provide that the above-stated provision denying CIGA a cause of action against insureds does not limit CIGA’s right to pursue unpaid reimbursements owed by an employer pursuant to a workers’ compensation insurance policy with a deductible if the employer was obligated to reimburse the insurer for benefits payments and related expenses paid by the insurer or CIGA from a special deposit or from other CIGA funds pursuant to the terms of the policy and related agreements.  Existing law requires that the rate of premium charged be a uniform percentage of net direct written premium, as defined, in the preceding calendar year applicable to specific categories of insurance. The rate of premium charges to each member insurer in the appropriate categories are initially based on the written premium of each insurer as shown in the latest year’s annual financial statement on file with the Insurance Commissioner and are later adjusted, as provided. Existing law authorizes CIGA to refund any credit due in a specific category of insurance to a member insurer as a result of the adjusted premium calculation, as provided. This bill would instead require CIGA, with regard to premium charges paid prior to January 1, 2017, to refund to a member insurer any credit due in a specific category as a result of the adjusted premium calculation.  This bill, with regard to premium charges paid on or after January 1, 2017, would delete the requirements that the rate of premium charges be initially based on the written premium of each insurer, that the premium charges be adjusted later as provided, and that the member insurer be eligible for a refund of any credit due to that member insurer as a result of the adjusted premium calculation, and would instead require that the rate of premium charges to each member insurer in the appropriate categories be based on the net direct written premium of each insurer as shown in the latest year’s annual financial statement on file with the commissioner. The bill would also make conforming changes.  Existing law authorizes CIGA to exempt or defer a member insurer from paying the premium charge if the payment would cause the member insurer’s financial statement to reflect an amount of capital or surplus less than the minimum amounts required for a certificate of authority by any jurisdiction in which the member insurer is authorized to transact insurance. Deferred premium charges are required to be paid when the payment will not reduce capital or surplus below required minimums. These payments are credited against future premium charges to those companies receiving larger premium charges by virtue of the deferment. This bill would delete the requirement that the payments be credited against future premium charges to those companies receiving larger premium charges by virtue of the deferment.  Existing law requires CIGA’s plan of operations to contain provisions requiring each member insurer to recoup the premium charge paid to CIGA from its insureds over a reasonable length of time by way of a reasonably calculated surcharge on insurance policies to which the provisions of CIGA apply.  This bill would instead require each member insurer to recoup the premium charge from its insureds in the year following the charge. The bill, with regard to premium charges paid on or after January 1, 2017, among other things, would require the member insurer to file a report in accordance with the provisions of the plan of operation indicating the number of surcharges it has collected, and would prohibit a member insurer electing to omit collecting surcharges from any of its insureds from being entitled to any reimbursement from CIGA, as specified. Effective January 1, 2016.
• Senate Bill 914
  Existing workers’ compensation 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 his or her employment. Existing law authorizes an insurer, employer, or entity that provides physician network services to establish or modify a medical provider network for the provision of medical treatment to injured employees, and requires the administrative director to contract with individual physicians or an independent medical review organization to perform medical provider network independent medical reviews. Existing law provides that if a treatment or diagnostic service remains disputed after a 3rd physician’s opinion, the injured employee may request a medical provider network independent medical review. Existing law requires the review to use standards established in statute or use the American College of Occupational and Environmental Medicine’s Occupational Medicine Practice Guidelines. This bill would delete the authorization to use the American College of Occupational and Environmental Medicine’s Occupational Medicine Practice Guidelines as standards for those independent medical reviews. The bill would make additional technical, non-substantive changes.  Effective Date January 1, 2017.
• Assembly Bill 2883
  Existing law establishes a workers’ compensation system, administered by the Administrative Director of the Division of Workers’ Compensation, within the Department of Industrial Relations, to compensate an employee for injuries sustained in the course of his or her employment. Existing law defines an employee, for purposes of the laws governing workers’ compensation, to include, among other persons, officers and members of boards of directors of quasi-public or private corporations while rendering actual service for the corporations for pay. Existing law excludes from that definition, among other persons, officers and directors of a private corporation who are the sole shareholders of the corporation and working members of a partnership or limited liability company, as specified, unless they elect to come under the compensation provisions of the laws governing workers’ compensation. This bill would revise those exceptions from the definition of an employee to apply to an officer or member of the board of directors, as specified, if he or she owns at least 15% of the issued and outstanding stock of the corporation, or an individual who is a general partner of a partnership or a managing member of a limited liability company, and that person elects to be excluded by executing a written waiver of his or her rights under the laws governing workers’ compensation, stating under penalty of perjury that he or she is a qualifying officer or director, or a qualifying general partner or managing member, as applicable. The bill would specify the effective date of the waivers. The bill would also make technical and clarifying changes to the provision excluding specified persons from the definition of employee.  Effective Date January 1, 2017.
• Senate Bill 1175
  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 his or her employment. Existing law requires the employer to provide medical, surgical, chiropractic, acupuncture, and hospital treatment, as specified that is reasonably required to cure or relieve the injured worker from the effects of his or her injury. Existing law requires a provider of those services to submit, among other documents, its request for payment with an itemization of services provided and the charge for each service. Existing law also requires the employer to reimburse the employee for his or her medical-legal expenses, as specified. This bill would require, effective for services on or after January 1, 2017, that requests for payment with an itemization of services provided and the charge for each service be submitted to the employer within 12 months of the date of service or within 12 months of the date of discharge for inpatient facility services. The bill would also require effective for services provided on or after January 1, 2017, that all bills for medical-legal evaluation or medical-legal expense be submitted to the employer within 12 months of the date of service in the manner prescribed by the administrative director. The bill would provide that requests for payment and bills for medical-legal charges are barred unless timely submitted. The bill would require the administrative director to adopt rules to implement the 12-month limitation period, as specified.  Effective Date January 1, 2017.