CA SB636

Requires physicians performing utilization review for private employers' workers' compensation claims to be licensed under California state law, effective July 1, 2026.

Establishes that only licensed physicians competent to evaluate specific clinical issues can modify or deny medical treatment authorization requests based on medical necessity.

Maintains existing utilization review procedures including prospective, retrospective, and concurrent review processes with specified timeframes (5 business days standard, 72 hours for emergency conditions).

Requires utilization review processes to be accredited by an independent nonprofit organization and comply with written policies ensuring decisions are consistent with the state's medical treatment utilization schedule.

Prohibits financial incentives to physicians based on the number of modifications or denials they make in utilization review decisions.