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House of Representatives
Session of 2023 - 2024 Regular Session


Posted: March 17, 2023 11:37 AM
From: Representative Ryan E. Mackenzie
To: All House members
Subject: Modernizing Standards for Utilization Review in Workers’ Compensation
I am preparing to introduce legislation that would finally apply standards to the organizations that provided medical treatment review for injured workers in Pennsylvania. Although workers’ compensation works a bit differently as a payment system than other types of insurance, I believe there should be similar medical treatment review standards and time limits for these patients, regardless of the payment system.

As you may remember, the General Assembly enacted unanimously bipartisan legislation (Senator Phillips-Hill’s SB 225) in the prior session to provide for standards and timely review of decision-making in group health insurance and Medicaid. My legislation would require the organizations that perform medical treatment review in workers’ compensation to be accredited, just as review organizations in these other health care payment systems must now be accredited. 

In addition to ensuring that medical treatment review for injured workers is subject to standards that consider medical best practices, leading accreditation standards require specific timeframes for different types of review – which, under current law and regulations, can take up to 65 days for all types of review. By requiring treatment review to be conducted within timeframes recognized as best practices by the accreditation standards, my bill will bring the wait-times for workers’ compensation review more closely in line with those passed unanimously last session.

Finally, my bill will allow review organizations who successfully complete the accreditation process to receive reimbursement from the Workers’ Compensation Administration Fund for their accreditation costs.

I hope you will join me in bringing treatment review for injured workers more in line with those we just set for patients covered by private group health insurance and Medicaid.

Introduced as HB881