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Policy Matters Alert

Important legislative and regulatory updates

California Rulemaking Heating Up

February 24, 2025 · Public Policy & Regulatory Affairs Team

In December, DWC adopted final rules governing its revised workers’ compensation pharmacy fee schedule. Those rules take effect on July 1, 2025, and can be found here: https://www.dir.ca.gov/dwc/DWCPropRegs/2024/Pharmaceutical-Fee-Schedule/Index.htm

In addition to adopting those rules, the DWC continues to develop policy changes to existing Utilization Review rules (https://www.dir.ca.gov/dwc/DWCPropRegs/2024/Utilization-Review/Index.htm) as well as to the Evidence Based Medical Treatment Utilization Schedule (MTUS) for both Chronic Pain and Cannabis https://www.dir.ca.gov/dwc/DWCPropRegs/2025/MTUS-Evidence-Based-Update/Index.htm These proposed changes are officially in the “formal” rule-making process with the last comment period for Utilization Rules closing in 2024, while the comment period for MTUS Rules closes on March 14, 2025.

Recently, the DWC provided notice that they would engage in an “informal” rule-making process to modify the existing Medical Provider Network (MPN) rules. This process utilizes what the Division calls a “Rule Forum” where stakeholders can provide feedback on proposed changes. On February 13, 2025, the DWC issued proposed changes to existing MPN rules via a “Forum” and stated they will accept stakeholder feedback until March 5, 2025. The proposed changes can be found here: https://www.dir.ca.gov/dwc/DWCWCABForum/1.asp

Throughout the later part of 2024 and thus far in 2025, the DWC has been very active in development of public policy. The Optum Public Policy and Regulatory Affairs (PPRA) team is tracking and, when necessary, providing relevant feedback on the rule proposals. In sharing this information, we hope to provide updates on policy information as well as assist stakeholders and our clients in engaging in the rule-making process to help the DWC develop balanced and sound regulations.

Additional Optum resources:

For more information on these policy developments and others we have been tracking this year, be sure to visit our Legislative and Regulatory Tracker. Bills or regulations can be filtered by insurance line, topic, status and jurisdiction.

If you have questions on these or any other public policy developments, please contact our team at OptumWC.PolicyMatters@optum.com.

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