DWC Issues Notice of Public Hearing on July 25 for Utilization Review Regulations

The Division of Workers’ Compensation (DWC) has issued a notice of public hearing for regulations concerning the utilization review (UR) procedures under Labor Code section 4610. Additional regulatory changes related to physician reporting and coordination of care requirements are also included.

The proposed rulemaking primarily implements exemptions to prospective UR created under Senate Bill 1160 (for treatment rendered within the first 30 days from the initial date of injury) and Assembly Bill 1124 (for drugs listed as exempt on the drug formulary). Additionally, the proposal implements the statutory accreditation requirement and DWC’s oversight of UR plans, which includes extensive changes to UR enforcement rules; makes changes to improve or fix issues related to coordination of medical treatment; and would add a physician reporting form, the PR-1, which combines other reports (the Form RFA and the PR-2) to centralize reporting duties of a treating physician.

Implementation of these regulations is anticipated to harmonize regulations with statutory changes from SB 1160 and AB 1124, and fix system inefficiencies with respect to the delivery of medical treatment.

Members of the public may attend the in-person public hearing on Thursday, July 25, 2024, at 11 a.m. at the:

Written public comments can be submitted via US mail, facsimile transmission (FAX) or by email until the end of the day on Thursday, July 25, 2024 to the attention of:

Maureen Gray, Regulations Coordinator
Department of Industrial Relations
P.O. Box 420603
San Francisco, CA 94142
Fax: (510) 286-0687
Email: dwcrules@dir.ca.gov

DWC will consider all public comments. The notice of rulemaking, text of the regulations, and the initial statement of reasons can be found on the DIR website.

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