California Governor Vetoes SB-636 Limiting Utilization Review

At Medrina, we understand how frustrating the delays caused by utilization review can be. California's workers' compensation system is already a complex web of approvals, and SB-636 represented a glimmer of hope for speeding up care delivery. With the Governor’s recent veto, the future of workers’ compensation reform remains uncertain, and injured workers, medical providers, and insurers are left wondering what comes next.

At Medrina Technology Management, we regularly explore key legislative updates that impact the workers' compensation system, and the recent veto of SB-636 is no exception. California’s Senate Bill 636, which aimed to streamline care for injured workers by restricting the use of utilization review (UR) in recurring treatments, was vetoed by the Governor, halting what many saw as much-needed reform in the state's workers' compensation process.

Understanding SB-636

SB-636 was introduced to address one of the most persistent complaints in the workers’ compensation system: delays in care caused by repeated utilization reviews. Under the proposed bill, once a treatment had been approved for an injury, future requests for the same treatment would have bypassed the utilization review process. Proponents of the bill argued that eliminating redundant reviews would speed up access to care for injured workers, reducing prolonged recovery times.

This bill was especially relevant to those familiar with the daily struggles of medical billing and workers' compensation management. As we wrote earlier at Medrina, the current utilization review process often creates unnecessary administrative burdens on medical providers and introduces delays in delivering critical treatment.

Governor’s Rationale for the Veto

In a statement explaining the veto, the Governor expressed concerns about the risks associated with bypassing utilization review entirely, even in cases of previously approved treatments. While acknowledging the frustrations caused by UR delays, the Governor cited the need for continued oversight to prevent overtreatment, protect patients from potentially harmful procedures, and control costs within the system.

Supporters of the Governor's veto maintain that utilization review is a critical safeguard, ensuring that injured workers receive care that is both necessary and evidence-based. The Governor’s stance underscores the balancing act between timely care for workers and the overall cost and quality controls in the workers’ compensation system.

Reaction from the Workers’ Compensation Community

The veto of SB-636 has polarized stakeholders across the workers' compensation landscape:

• Injured Workers’ Advocates argue that the current UR process causes undue harm by delaying access to needed care. They viewed SB-636 as a chance to rectify some of these issues and provide a smoother treatment path for injured workers. With the Governor’s veto, they fear more workers will continue to face delays, exacerbating their injuries and recovery periods.

• Medical Providers have echoed these concerns, noting that repeated UR requests for the same treatment increase their administrative workload. Providers hoped that SB-636 would reduce the time they spend navigating bureaucratic hurdles, allowing them to focus on delivering care.

• Insurers and Employers, on the other hand, praised the Governor’s decision. They argue that the utilization review process is vital for preventing unnecessary or harmful treatments, protecting both workers and the integrity of the workers’ compensation system. Many feared that SB-636 could lead to increased costs and diminished care quality.

What’s Next for Workers' Compensation Reform?

The veto of SB-636 marks a setback for those seeking to reform California’s workers' compensation system, but the conversation is far from over. Advocates for change are likely to continue pushing for reforms that reduce delays without compromising care quality.

At Medrina Technology Management, we’ll be closely following developments in this space and will continue to offer insights on how these changes impact medical providers, injured workers, and the billing and collections processes. As stakeholders continue to weigh in on the future of utilization review in California, we remain committed to helping our clients navigate these complex systems to achieve better outcomes.