UTILIZATION REVIEW (UR) BY NON-CALIFORNIA LICENSED DOCTORS

AB 1687 (Fong) misses the target

AB 1687 states that employers, insurers, or other entities shall employ or designate medical directors who hold unrestricted California licensure to practice medicine in California pursuant to the relevant Business and Professions Codes.

However, it is already law that the medical director must be licensed in California. What is not required is that the doctors retained by the medical director to do utilization review (UR) also be licensed in California. The currently proposed bill overlooks this loophole by not mentioning the inconvenient fact that companies may use doctors without California licenses even though the Medical Board of California has repeatedly stated that UR is part of medical practice. What is needed is a requirement that any doctor who does utilization review in California must be licensed to practice in California. Language so stating should be amended into the bill.

The crux of the issue in past years was precisely this point. The insurance companies skillfully and successfully opposed requiring California state licensure for UR doctors. Three bills so stating have passed the California legislature: AB 2969 (Lieber), AB 933 (Fong), and AB 584 (Fong). The first two were vetoed by Governor Schwarzenegger, no surprise there since his mission was to protect the insurance companies. The last one was vetoed by Governor Brown, much to the astonishment of many who did not think he'd bend to insurance company wishes. However, lobbying credit has to go to the insurance companies -- they succeeded in convincing two different and supposedly opposed administrations to veto nearly identical bills that would have assisted injured workers' access to care.

Our judgement is that AB 1687 is inadequate and disappointing. We await an amendment stating that UR doctors play by the same rules as treating doctors and must be licensed to practice in California.

Stay tuned. We'll have more to say on this subject.