Do UR Policies and Procedures and a description of the process have to be filed with the administrative director?

Do UR Policies and Procedures and a description of the process have to be filed with the administrative director?

• A. Yes
• B. Only if requested
• C. Only in the event of a dispute
• D. No

Answer: (A)

In California workers’ compensation, utilization review policies and procedures, along with a description of the process, must be filed with the Administrative Director for approval. This filing requirement ensures the UR program is reviewable by the state, supported by standardized criteria, and conducted in a way that protects injured workers while promoting timely and medically appropriate decisions. The Administrative Director can assess the methodologies, decision timelines, and personnel involved to ensure compliance with applicable laws and regulations. It's not optional or contingent on requests or disputes, and the directive isn’t a deterrent; the filing requirement exists to provide oversight and accountability for how medical necessity and treatment decisions are made under the self-insured plan.

In California workers’ compensation, utilization review policies and procedures, along with a description of the process, must be filed with the Administrative Director for approval. This filing requirement ensures the UR program is reviewable by the state, supported by standardized criteria, and conducted in a way that protects injured workers while promoting timely and medically appropriate decisions. The Administrative Director can assess the methodologies, decision timelines, and personnel involved to ensure compliance with applicable laws and regulations.

It's not optional or contingent on requests or disputes, and the directive isn’t a deterrent; the filing requirement exists to provide oversight and accountability for how medical necessity and treatment decisions are made under the self-insured plan.