Health Committee Approves Additions to Medical Review Plan

by David Gorn

TOPIC ALERT:

The independent medical review process in California needs an update  according to Senate member Ed Hernandez (D-West Covina) who introduced SB 1410 at Wednesday's Senate Committee on Health hearing.

"This bill deals with the Independent Medical Review program as an important safeguard for consumers of health care in California," Hernandez said. "Collectively these changes will improve the effectiveness and transparency of the IMR program."

Hernandez said the bill adds three improvements to the current IMR process in the state.

"First, it will enhance the clinical experience qualifications of the reviewer," he said. "Second, the bill requires the creation of a searchable Internet with an accessible database with information on all of California's IMR decisions. And thirdly, it would require the collection of demographic information such as ethnicity and language."

Those legislative adjustments could improve a system that has proven effective for Californians, according to Beth Capell, a policy advocate for Health Access California.

"IMR is one of the success stories we have here in California," Capell said. It is a system that sets up an urgent review within 72 hours, and a non-urgent review within a month. Capell called it a laudable state effort.

Nick Louizos, director of legislative affairs for the California Association of Health Plans, said his organization has a support-if-amended position on the bill.

"We do have an issue with singling out the health plans in the publicly available [portion of the bill]," Louizos said. "We feel that, if it's in the public's best interest to know which health plans are involved in these cases, then the medical professionals who make the initial medical-necessity determination in these cases [should be included] as well."

The bill passed the Senate Committee on Health on a 6-3 vote, and now moves to Appropriations.


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