§ 138.8. — 138.8. (Added by Stats. 2019, Ch. 647, Sec. 3.)

(a)
On or before January 1, 2024, and annually thereafter, the administrative director shall publish on the division’s internet website provider utilization data, as reported to the Division of Workers’ Compensation, for physicians who treated 10 or more injured workers during the 12 months before July 1 of the previous year. The provider utilization data shall include all of the
following:
(1)
The physician’s first and last name.
(2)
The physician’s specialty.
(3)
The physician’s National Provider Identifier.
(4)
The number of injured workers treated by the physician.
(5)
The International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) codes by both diagnosis and procedure.
(6)
A short description of the ICD-10 codes used by the physician.
(7)
The number of utilization review decisions that resulted in a
modification or denial of a request for authorization of medical treatment based upon a determination of medical necessity.
(8)
The number of independent medical review decisions issued in response to an appeal of a utilization review decision that resulted in a modification or denial based upon medical necessity and the number of independent
medical review decisions that resulted in the utilization review modification or denial being overturned.
(9)
Any additional data as determined by the administrative
director.
(b)
For purposes of this section, “physician” has the same meaning as set forth in Section 3209.3.
(c)
The administrative director may withhold data contained in subdivision (a) if deemed necessary to protect patient privacy.

Legislative History

Added by Stats. 2019, Ch. 647, Sec. 3. (SB 537) Effective January 1, 2020.