California Labor Code ARTICLE 2 - Medical and Hospital Treatment

• Section 4600.
  (a) Medical, surgical, chiropractic, acupuncture, and hospital treatment, including nursing, medicines, medical and surgical supplies, crutches, and apparatuses, including orthotic and prosthetic devices and services, that...
• Section 4600.05.
  (a) An employer, as defined in Section 3300, shall provide immediate support from a nurse case manager for employees injured by an act of domestic terrorism,...
• Section 4600.1.
  (a) Subject to subdivision (b), any person or entity that dispenses medicines and medical supplies, as required by Section 4600, shall dispense the generic drug equivalent.(b) A...
• Section 4600.2.
  (a) Notwithstanding Section 4600, if a self-insured employer, group of self-insured employers, insurer of an employer, or group of insurers contracts with a pharmacy, group of...
• Section 4600.3.
  (a) (1) Notwithstanding Section 4600, when a self-insured employer, group of self-insured employers, or the insurer of an employer contracts with a health care organization certified pursuant...
• Section 4600.35.
  Any entity seeking to reimburse health care providers for health care services rendered to injured workers on a capitated, or per person per month basis,...
• Section 4600.4.
  (a) A workers’ compensation insurer, third-party administrator, or other entity that requires, or pursuant to regulation requires, a treating physician to obtain either utilization review or...
• Section 4600.5.
  (a) Any health care service plan licensed pursuant to the Knox-Keene Health Care Service Plan Act, a disability insurer licensed by the Department of Insurance, or...
• Section 4600.6.
  Any workers’ compensation insurer, third-party administrator, or other entity seeking certification as a health care organization under subdivision (e) of Section 4600.5 shall be subject...
• Section 4600.7.
  (a) The Workers’ Compensation Managed Care Fund is hereby created in the State Treasury for the administration of Sections 4600.3 and 4600.5 by the Division of...
• Section 4601.
  (a) If the employee so requests, the employer shall tender the employee one change of physician. The employee at any time may request that the employer...
• Section 4602.
  If the employee so requests, the employer shall procure certification by either the administrative director or the appeals board as the case may be of...
• Section 4603.
  If the employer desires a change of physicians or chiropractor, he may petition the administrative director who, upon a showing of good cause by the...
• Section 4603.2.
  (a) (1) Upon selecting a physician pursuant to Section 4600, the employee or physician shall notify the employer of the name and address, including the name of...
• Section 4603.3.
  (a) Upon payment, adjustment, or denial of a complete or incomplete itemization of medical services, an employer shall provide an explanation of review in the manner...
• Section 4603.4.
  (a) The administrative director shall adopt rules and regulations to do all of the following:(1) Ensure that all health care providers and facilities submit medical bills for...
• Section 4603.5.
  The administrative director shall adopt rules pertaining to the format and content of notices required by this article; define reasonable geographic areas for the purposes...
• Section 4603.6.
  (a) If the only dispute is the amount of payment and the provider has received a second review that did not resolve the dispute, the provider...
• Section 4604.
  Controversies between employer and employee arising under this chapter shall be determined by the appeals board, upon the request of either party, except as otherwise...
• Section 4604.5.
  (a) The recommended guidelines set forth in the medical treatment utilization schedule adopted by the administrative director pursuant to Section 5307.27 shall be presumptively correct on...
• Section 4605.
  Nothing contained in this chapter shall limit the right of the employee to provide, at his or her own expense, a consulting physician or any...
• Section 4606.
  Any county, city and county, city, school district, or other public corporation within the state which was a self-insured employer under the “Workmen’s Compensation, Insurance...
• Section 4607.
  Where a party to a proceeding institutes proceedings to terminate an award made by the appeals board to an applicant for continuing medical treatment and...
• Section 4608.
  No workers’ compensation insurer, self-insured employer, or agent of an insurer or self-insured employer, shall refuse to pay pharmacy benefits solely because the claim form...
• Section 4609.
  (a) In order to prevent the improper selling, leasing, or transferring of a health care provider’s contract, it is the intent of the Legislature that every...
• Section 4610.
  (a) For purposes of this section, “utilization review” means utilization review or utilization management functions that prospectively, retrospectively, or concurrently review and approve, modify, or deny,...
• Section 4610.1.
  An employee shall not be entitled to an increase in compensation under Section 5814 for unreasonable delay in the provision of medical treatment for periods...
• Section 4610.3.
  (a) Regardless of whether an employer has established a medical provider network pursuant to Section 4616 or entered into a contract with a health care organization...
• Section 4610.5.
  (a) This section applies to the following disputes:(1) Any dispute over a utilization review decision regarding treatment for an injury occurring on or after January 1, 2013.(2) Any...
• Section 4610.6.
  (a) Upon receipt of a case pursuant to Section 4610.5, an independent medical review organization shall conduct the review in accordance with this article and any...
• Section 4611.
  (a) When a contracting agent sells, leases, or transfers a health provider’s contract to a payor, the rights and obligations of the provider shall be governed...
• Section 4614.
  (a) (1) Notwithstanding Section 5307.1, where the employee’s individual or organizational provider of health care services rendered under this division and paid on a fee-for-service basis is...
• Section 4614.1.
  Notwithstanding subdivision (f) of Section 1345 of the Health and Safety Code, a health care service plan licensed pursuant to the Knox-Keene Health Care Service...
• Section 4615.
  (a) Upon the filing of criminal charges against a physician, practitioner, or provider for any crime described in subparagraph (A) of paragraph (1) of subdivision (a)...

Last modified: October 22, 2018