Institute Analyzes Impact of California Medical Provider Network Option for Workers

Legislation intended to increase injured California workers’ access to medical care by requiring the state to create a medical provider network as an alternative to private networks that render 90% of California workers’ compensation treatment would significantly increase medical costs and require millions of dollars in ongoing administrative and infrastructure expense, a California Workers’ Compensation Institute analysis finds.

Assembly Bill 1465 would require the administrative director of the state’s workers’ compensation system to establish a statewide medical provider network, called the California Medical Provider Network, and give employees the choice to treat within their employer’s MPN or the CAMPN.

The bill was introduced in late February by Assemblywoman Eloise Gomez Reyes, D-San Bernardino, and Lorena Gonzalez, D-San Diego. It was referred to the Assembly Committee on Insurance.

The California Coalition on Workers’ Compensation, in partnership with American Property Casualty Insurance Association, California Chamber of Commerce, California Association of Joint Power Authorities, and Public Risk Innovation, Solutions, and Management, is opposing AB 1465, saying it would undermine the system of providing medical care in California’s workers’ comp system and “lead to significant cost increases for employers and lower quality care for injured workers.”

Despite an estimated cost of at least $314 million a year, the CWCI analysis concludes that the proposal is unlikely to improve access to care.

AB 1465 would require the Division of Workers’ Compensation to create the CAMPN as a statewide network comprised of all California licensed physicians who are: 1) currently in any MPN; 2) in good standing with the California Medical Board; and 3) who agree to comply with the fee schedule and reporting regulations. However, osteopaths, chiropractors, psychologists and other ancillary service providers not licensed by the CMB are not currently addressed in the legislation.

Under AB 1465, injured workers could choose to treat with a physician in their employer’s MPN or with a physician in the CAMPN, effectively eliminating the employer’s control over medical care afforded by their MPN.

The CWCI reviewed a sample of 181,309 work injury claims with 2019 and 2020 injury dates in which injured workers were treated by MPN and non-MPN providers and found little evidence of poor access to care in either group.

Measuring the time to initial treatment, the CWCI found that MPN claims averaged 5.9 days from employer notice of injury to initial treatment compared to 5.6 days for non-MPN claims, and that 90.6% of the MPN claims vs. 92.9% of the non-MPN claims received treatment within 14 days.

Additionally, 99% of the MPN claims and 98% of the non-MPN claims, the state’s access standards were met, as the injured workers had a choice of three workers’ comp primary care providers within 15 miles of their home, while a review of access to surgical specialists found 96% of the MPN claimants and 95 percent of the non-MPN claimants had a choice of three workers’ compensation surgeons within 30 miles of their home.

CWCI has released its Impact Analysis Report “AB 1465 and Medical Provider Networks in the California Workers’ Compensation System,” which is available to Institute members and research subscribers under the Research tab at www.cwci.org.

This article was first published on Insurance Journal.

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