Workers’ compensation.

Assembly Member Chen's workers' compensation legislation expands the scope of medical payment disputes eligible for independent review by explicitly including contract-based discounts and reductions from California's official medical fee schedule. The bill modifies the independent bill review process to require written explanations when reviewers uphold percentage-based payment reductions, including references to the specific provider contracts used to justify these decisions.

Under the new provisions, independent bill review organizations must document their rationale when affirming disputed fee schedule discounts and provide medical providers with copies of the relevant contracts used in their determination. In cases where payers cannot produce valid contracts to support payment reductions, reviewers must authorize payment at rates consistent with the official medical fee schedule. The bill maintains existing timelines and procedures for requesting reviews, submitting documentation, and appealing determinations.

The legislation preserves the current framework where providers initially cover review costs, with employers required to reimburse these fees if additional payments are ultimately ordered. It also retains the administrative director's authority to set review fees based on factors like billing complexity while specifying that reviewers need not share contracts with providers who are not party to those agreements.