Transcript of "Oal (office of administrative law) nod for ca dwc’s final versions of the imr and ibr regulations"
OAL (Office of Administrative Law) Nod
for CA DWC’s Final Versions of the IMR
and IBR Regulations
The Office of Administrative Law has approved both the
IMR and IBR regulations. Both sets of regulations have
been filed with the Secretary of State on February 12, 2014
and are effective immediately.
Senate Bill 863 is California’s landmark workers’
compensation reform signed by Governor Edmund G.
Brown Jr. in 2012, which has the objective of saving
businesses millions of dollars in unnecessary costs while
simultaneously improving worker protections. According to
DIR (Department of Industrial Relations) director Christine
Baker, “these reforms are engineered to reduce unnecessary
costs while redirecting some of the savings to increase
benefits for disabled workers." On January 1, 2013 the key
components of Senate Bill 863 became law and included a
30% increase in permanent disability indemnity rates for
workers phased in over two years. Other aspects of the bill
such as those designed to reduce costs for businesses are
being implemented through regulatory action.
The DIR was established to boost working conditions for
California’s workers and also to improve opportunities for
profitable employment in California. A division within
DIR, the DWC (Division of Workers’ Compensation)
monitors the administration of WC claims and provides
administrative as well as judicial services to help resolve
disputes that arise in relation to workers’ compensation
claims. The DWC has the following achievements to its
credit as a result of its focus on implementing SB 863.
• Adopted regulations such as:
o Lien filing fee and activation fee
o QME (Qualified Medical Evaluation)
o Supplemental job displacement benefit (SJDB)
o Interpreter certification process
o IBR (Independent Bill Review)
o IMR ( Independent Medical Review)
• Revised the inpatient hospital fee schedule to reduce
duplicate payments for spinal implant surgeries.
• Revised the ASC (Ambulatory Surgical Center) fee
schedule, thereby reducing the payment from 120% to
• Implemented the medical RBRVS (resource-based
relative value scale) fee schedule effective from
January 1, 2014.
• Started formal rulemaking for the pre-
designation/chiropractor primary treating physician
• Began formal rulemaking to revise the MPN (medical
provider network) regulations.
IMR and IBR Regulations
The (DWC) filed the certificate of compliance for IMR
(Independent Medical Review) regulations and the IBR
(Independent Bill Review) regulations on December 20,
2013 with the Office of Administrative Law (OAL). These
were the last 2 sets of emergency regulations implementing
IMR (Independent Medical Review) is an efficient process
through which all medical treatment disputes will be
resolved by physicians. This will help avoid the more
arduous and costly adjudication system. If the utilization
review delays, denies or modifies a treating physician’s
request for a specific course of medical treatment on the
grounds that the treatment is not medically necessary, the
injured employee has the right to request a review of that
decision via IMR conducted by a physician. This
evaluation which involves a detailed medical record
review of the relevant medical records will be prompt and
based on evidence-based standards to ensure that the
injured employee receives appropriate and timely medical
The IBR applies to any medical service bill where the fee is
determined on the basis of a fee schedule adopted by the
DWC. An IBR can be requested by a medical provider who
disagrees with the amount paid by a claims administrator
on a properly documented bill after a second review. This
regulation can help eliminate costly, unnecessary litigation.
Core Inclusions in OAL-approved IMR and IBR
The OAL has approved both the IMR and IBR regulations.
Both sets of regulations have been filed with the Secretary
of State on February 12, 2014 and are effective
immediately. Before March 1, 2014 any version of the IMR
application form adopted by the Administrative Directory
under section 9792.10.2 can be used.
The following are included in the final IMR regulations:
• Improved instructions and revisions to the IMR
• Provision for penalties to be assessed against an
administrator of claims for not producing medical
records in a timely manner.
• Clarification that IMR determination cannot be based
solely on the information provided by a UR
(utilization review) determination.
Here are the inclusions in the final IBR regulations:
• Consolidation of separate IBR requests has been
limited to 20 requests.
• Required index of supporting documentation.
• Revisions made to the forms providers use to request a
second bill review and IBR.
• Electronic Medical Billing and Payment Companion
Guide and the California Division of Workers’
Compensation Medical Billing and Payment Guide –
Comprehensive details regarding workers’ rights and
employers’ responsibilities, and information for small
business owners, are available on the DIR website. Their
rulemaking webpage carries a quick overview of important
regulations. The page is updated regularly.