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Proposed Legislation: No UR for Maintenance Rx

Hello, dear readers!  Another Friday is upon us, and all is well in California.  The jobs are evaporating with the water, Governor Brown has declared war on grass (they type you grow on your lawn, not the type that you inhale) and here we are with another blog post to launch us into the weekend.

Earlier in the year, various organs of the state government warned us about heat exhaustion, the need to provide outdoor workers with shade and water, and the dangers of exposure to the sun and dehydration.  All wonderful advice that went unheeded in the state legislature, as SB 563, previously discussed on this blog, continues to be amended from bad to worse.

Deciding that forcing UR vendors to disclose their bargained-for compensation was not enough, 563’s authors have amended it to prohibit Utilizaiton Review from denying or modifying treatment previously authorized and used to keep an injured worker at his current health level.  In other words, if you previously authorized a gym membership for 1 year, and the doctor says the injured worker needs a gym membership year after year to stay at his current level, guess what you can’t send to UR… the gym membership RFA!

Now, I’m sure you’re thinking what everyone has thought, now and then: “Greg, you handsome devil you, what’s wrong with a gym membership?  $300 will buy you a two-year gym membership to 24 hour fitness at Costco.”  Yeah, sure, that’s great.  Now substitute gym membership with narcotics and opioids.  Recall, if you will the case of Buitendag and Kohrumel, wherein an “injured” worker was convicted of insurance fraud.  During the investigation, 20 boxes of unused prescription medication were found in applicant’s garage.

Now, you take the steady prescription of opioids, and the demand and their lucrative value on the market, well… that’s big bucks.  Accordingly, you could have an applicant receiving and either abusing or re-selling medication, without UR being in much of a position to challenge the prolonged use of opioids.

Subsection (C) of SB-563 would require the employer to show that there is evidence of a change in the employee’s circumstances or condition showing that the services are no longer reasonably required to cure or relieve the injured worker from the effects of the industrial injury.  However, would a drug test showing the absence of the prescribed medication meet such a definition?  It would have to be litigated, of course, should this ever become law, but the language does not lend itself to such a defense.

So, dear readers, here’s some advice from the private sector to all the citizenry: make sure your elected officials are well hydrated, and working in the shade.  Don’t let them suffer heat exhaustion or it could lead to serious injuries to California’s economy.

Have a good weekend folks – your humble blogger will be eager to greet you bright and early, Monday morning.

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