The Medical Provider Network Transparency Act of 2022.

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 employment. Existing law requires the employer to provide medical, surgical, chiropractic, acupuncture, and hospital treatment that is reasonably required to cure or relieve the injured worker from the effects of the injury. Existing law requires the administrative director to adopt and revise periodically an official medical fee schedule establishing reasonable maximum fees paid for medical services other than physician services, drugs and pharmacy services, health care facility fees, home health care, and all other treatment, care, services, and goods. Existing law also establishes the Workers' Compensation Appeals Board (appeals board) to exercise all judicial powers vested in it, including workers' compensation proceedings for the recovery of compensation. Existing law authorizes an insurer, employer, or entity that provides physician network services to establish or modify a medical provider network for providing medical treatment to injured employees and imposes various duties upon the insurer, employer, or entity in connection with the network. Existing law requires every medical provider network to post on its internet website a roster of all treating physicians in the medical provider network and requires every network to provide to the administrative director the internet website address of the network and of its roster of treating physicians. Existing law requires an insurer, employer, or entity that provides physician network services to submit a plan for the medical provider network to the administrative director for approval. Existing law requires the administrative director to adopt a medical treatment utilization schedule. Existing law authorizes the administrative director to investigate complaints and to conduct random reviews of approved medical provider networks. Existing law permits a medical provider to request an independent bill review for disputes relating to the amount of payment and authorizes the imposition of fees for this purpose, as specified. This bill, the Medical Provider Network Transparency Act of 2022, would limit the independent bill review fee for the independent bill review organization to determine the eligibility of a request to $50 and would authorize additional fees, as specified, for a request that is reviewable. If the independent bill review organization finds that an employer owes the medical provider, the bill would require the independent bill review organization to bill the employer for the additional review fees, as specified. If the employer is found to not owe the medical provider, the bill would require the independent bill review organization to bill the provider for the additional review fees, as specified. The bill would require employers to pay any additional amounts found owed within 30 days of the final determination.