DWC releases report on Senate Bill 1160’s impact on utilization review

NEWSLINE

The Division of Workers' Compensation (DWC) has posted a new research report examining the impact of Senate Bill (SB) 1160, including provisions that reduced prospective utilization review (UR) requirements for certain medical treatments provided during the first 30 days after a work-related injury.

Conducted by RAND and funded by the California Department of Industrial Relations (DIR), the study provides the first empirical analysis of whether the 2016 law reduced administrative burdens for providers and improved the timeliness and quality of care for injured workers.

Using data covering January 2017 through January 2024 from two large claims administrators, the Independent Medical Review database and the Workers' Compensation Information System, the study examined three key questions:

• Whether UR approval rates for treatment requests submitted during the first 30 days after an injury changed following implementation of SB 1160.
• Whether injured workers were more likely to receive guideline-concordant medical treatment during the first 30 days after an injury.
• Whether injured workers received treatment more quickly following implementation of SB 1160.

Among the report's findings, UR approval rates for treatment requests submitted during the first 30 days after an injury consistently exceeded 90 percent both before and after SB 1160 took effect, with no statistically significant change. The report notes that prior authorization programs already exempted many routine early treatments from UR before the law was implemented.

The study also found a modest but statistically significant increase in guideline-concordant physical therapy during the first 30 days after an injury. Among injured workers with diagnoses for which physical therapy is recommended, the odds of receiving physical therapy within 30 days were 13 percent higher following the implementation of SB 1160. The average wait for a worker's first physical therapy visit also declined from 13.4 days to 11.9 days.

RAND has posted its report, Examining the Impact of Senate Bill 1160 on Utilization Review and Medical Treatment in California Workers' Compensation , on its website.

DIR's Division of Workers' Compensation monitors the administration of workers' compensation claims and provides administrative and judicial services to help resolve disputes related to claims for workers' compensation benefits.