California revising comp utilization review rules

The California Division of Workers’ Compensation will revise its proposed utilization review rules after the Office of Administrative Law rejected portions for ambiguity and procedural flaws.

OAL on July 28 said a couple of sections in the proposed rules that the division submitted in June were ambiguous, and in one instance, the DWC failed to use underline or strikethrough to note proposed additions and deletions of regulatory text released for public comment.

The DWC said in a statement that it plans to address concerns identified by the Office of Administrative Law and resubmit the rules in time to meet the originally requested effective date of Jan. 1.

In 2024, the division proposed rules to implement provisions in 10-year-old state laws to reduce delays by exempting certain treatments from prospective utilization review.

A.B. 1124, enacted in 2015, created the prescription drug formulary. Rules that the division adopted to implement the bill allow drugs that are designated as “exempt” to be dispensed to injured workers without prior UR.

S.B. 1160, enacted in 2016, included a provision allowing a member of a medical provider network to provide certain treatments for an accepted body part without prospective review in the first 30 days following an injury if the treatment is consistent with the Medical Treatment Utilization Schedule guidelines.

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