House File 2308 - Introduced HOUSE FILE 2308 BY ISENHART A BILL FOR An Act relating to the state’s workers’ compensation laws by 1 modifying alternate care procedures for medical treatment, 2 creating registries of physicians who treat and evaluate 3 work-related injuries, providing for the retention of 4 a medical director, creating a state workplace injury 5 care providers registry fund, establishing a workers’ 6 compensation advisory board, providing for and appropriating 7 fees, and including for effective date provisions. 8 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 9 TLSB 5492HH (5) 83 av/rj

H.F. 2308 Section 1. Section 85.27, subsection 4, Code 2009, is 1 amended by striking the subsection and inserting in lieu 2 thereof the following: 3 4. a. For purposes of this section, the employer is 4 obligated to furnish reasonable services and supplies to 5 treat an injured employee and has the right to predesignate 6 the initial provider of medical care. Upon receiving 7 notification of an injury, the employer is also obligated 8 to provide the injured employee with written information on 9 the state’s workers’ compensation laws, including the rights 10 and responsibilities of the employee and the employer and to 11 document in writing that the employee received the information 12 in a timely manner. The commissioner shall provide, by 13 administrative rule, the format, content, and procedure for the 14 predesignation of the initial provider of medical care by the 15 employer and the provision of this information to the injured 16 employee. 17 (1) The employer shall promptly provide medical care for 18 the injury and may predesignate a licensed physician to treat 19 the injury and any condition the physician believes is causally 20 related to the injury. If the employer has not predesignated 21 a licensed physician to treat the injury and any condition 22 causally related to the injury, the employee may designate a 23 licensed physician of the employee’s choosing to provide that 24 treatment. 25 (2) The employer may predesignate a physician listed in the 26 state registry of workplace injury care providers, as provided 27 in section 85.73, to treat the injury and any condition 28 causally related to the injury. 29 (3) The physician predesignated by the employer or 30 designated by the employee shall be authorized by the employer 31 to treat the injury at the employer’s expense in any manner 32 deemed appropriate by the physician, without a requirement of 33 preapproval for such referrals by the employer, by an agent or 34 representative of the employer, or the employer’s insurer. 35 -1- LSB 5492HH (5) 83 av/rj 1/ 13

H.F. 2308 (4) The physician predesignated by the employer or 1 designated by the employee shall be authorized to make 2 referrals to other physicians, therapists, or health care 3 providers of specialized services at the employer’s expense 4 without a requirement of preapproval for such referrals by the 5 employer, an agent or representative of the employer, or the 6 employer’s insurer. 7 b. The physician predesignated by the employer or designated 8 by the employee to treat the injured employee shall provide 9 ongoing written documentation of the physician’s opinions, 10 treatment recommendations, and care plan to the employee. Such 11 documentation shall indicate whether or not the physician’s 12 opinions, treatment recommendations, and care plan are in 13 accord with the most recent edition of either the official 14 disability guidelines and treatment guidelines in workers’ 15 compensation published by the work loss data institute or the 16 American college of occupational and environmental medicine 17 practice guidelines published by the American college of 18 occupational and environmental medicine, and if so, shall cite 19 the appropriate guidelines. 20 c. (1) If an employee receives treatment for an injury 21 from a physician predesignated by the employer and prior to 22 an evaluation of permanent disability by that predesignated 23 physician, the injured employee may be examined by and obtain a 24 second opinion, treatment recommendations, or a care plan from 25 another licensed physician of the employee’s choosing. The 26 employee may request and the employer shall pay the reasonable 27 costs associated with this examination, including reimbursement 28 for transportation expenses incurred by the employee for 29 the examination. The employee shall notify the physician 30 predesignated by the employer that the employee is consulting 31 with another physician of the employee’s choosing. 32 (2) If an employee receives treatment for an injury from 33 a physician designated by the employee, the employer is not 34 responsible for the costs of obtaining a second opinion, 35 -2- LSB 5492HH (5) 83 av/rj 2/ 13

H.F. 2308 treatment recommendations, or a care plan from an additional 1 licensed physician of the employee’s choosing. 2 d. If the employer or employee has reason to be dissatisfied 3 with the care of a treating physician predesignated or 4 designated by the other party or with any referral made by that 5 physician, the employer and employee may mutually agree upon 6 alternate care. 7 e. If the employer and employee cannot agree on alternate 8 care, either the employer or employee may notify an insurance 9 claims specialist within the division of workers’ compensation, 10 who shall, within five working days schedule a conference 11 between the employer and employee by any reasonable manner 12 available to review the basis for dissatisfaction and provide 13 an advisory opinion to resolve the medical care dispute. 14 f. If, following the conference with the insurance claims 15 specialist, the employer and employee cannot agree on such 16 alternate care, the workers’ compensation commissioner 17 may, upon application and reasonable proof of the necessity 18 therefor, allow and order alternate care. 19 (1) The employee is responsible to make the application 20 for alternate care and to provide reasonable proof for the 21 necessity of alternate care if all of the following actions 22 occurred: 23 (a) The employer provided written information about the 24 state’s workers’ compensation laws as provided in paragraph 25 “a” . 26 (b) The employer predesignated a treating physician listed 27 on the state registry of workplace injury care providers as 28 provided in paragraph “a” , subparagraph (2). 29 (c) The treating physician predesignated by the employer 30 provided written documentation of the physician’s opinions, 31 treatment recommendations, and care plan to the employee along 32 with a citation to appropriate treatment guidelines as provided 33 in paragraph “b” . 34 (2) The employer is responsible to make the application 35 -3- LSB 5492HH (5) 83 av/rj 3/ 13

H.F. 2308 for alternate care and to provide reasonable proof for the 1 necessity of alternate care if all of the actions specified in 2 subparagraph (1) did not occur or if the employee designated 3 the treating physician to treat the injury. 4 (3) The commissioner shall not be bound by the advisory 5 opinion of the insurance claims specialist. Upon application, 6 the workers’ compensation commissioner shall conduct a hearing 7 in any reasonable manner to effectuate a prompt resolution of 8 the alternate care dispute. The commissioner shall issue a 9 decision within ten working days of receipt of an application 10 for alternate care. 11 (4) The employer or its insurer is liable for the costs of 12 all medical care provided by a physician predesignated by the 13 employer or designated by the employee pursuant to paragraph 14 “a” , subparagraph (1), or from referrals from the predesignated 15 or designated physician, and shall hold the employee harmless 16 for the cost of care by the predesignated or designated care 17 providers. 18 (5) In an emergency, the employee may choose the employee’s 19 care at the employer’s expense, provided the employer or the 20 employer’s agent cannot be immediately contacted to indicate 21 who the employer has predesignated as a treating physician. 22 (6) The employer shall notify an injured employee of the 23 employee’s ability to contest the employer’s choice of the 24 predesignated treating physician or other provider of medical 25 care as part of the information given to the employee as 26 required under paragraph “a” . 27 g. (1) The employer has the right to request an employee 28 to submit, as often as is reasonable and at a reasonable time 29 and place, to an examination by a licensed physician chosen 30 by the employer for any purpose relevant to the employer’s 31 duties to provide benefits to the employee under this chapter, 32 or chapters 85A, 85B, and 86. If the employer makes such a 33 request to an employee in writing and offers to advance or 34 reimburse the employee’s transportation expenses incurred 35 -4- LSB 5492HH (5) 83 av/rj 4/ 13

H.F. 2308 in traveling to and from the place of the examination, the 1 employee shall submit to the examination. 2 (2) Each time that an employee is requested to and submits 3 to an examination requested by the employer as provided in 4 subparagraph (1), the employee has the right to be examined by 5 a licensed physician chosen by the employee for any purpose 6 relevant to the employer’s duties to provide benefits to the 7 employee as described in subparagraph (1). 8 (3) Each time that an employer obtains an evaluation of 9 an employee’s permanent disability by a physician chosen 10 by the employer, if the injured employee believes that the 11 evaluation of the extent of the employee’s permanent disability 12 is too low, the employee may obtain a subsequent examination 13 and evaluation of the employee’s permanent disability by a 14 physician of the employee’s choice. The physician chosen by 15 the employee has the right to confer with and obtain sufficient 16 medical history of the employee from the physician who examined 17 the employee on behalf of the employer to make a proper 18 evaluation of the employee’s permanent disability. 19 (4) The employer shall promptly pay the costs of any 20 examination obtained pursuant to this paragraph “g” , or if 21 necessary to obtain the examination, advance the costs of 22 the examination, and pay the employee’s reasonably necessary 23 transportation expenses incurred in traveling to and from the 24 place of any examination and shall hold the employee harmless 25 for the cost of all examinations and medical care provided 26 pursuant to this paragraph “g” as well as the employee’s 27 reasonably necessary transportation expenses. 28 Sec. 2. NEW SECTION . 85.73 State workplace injury care 29 providers —— registries —— fees —— medical director. 30 1. The workers’ compensation commissioner shall establish 31 and maintain a registry of physicians licensed in the state 32 that offer or provide treatment of work-related injuries. 33 a. The commissioner shall, by administrative rule, establish 34 requirements for a physician to be listed on the registry and 35 -5- LSB 5492HH (5) 83 av/rj 5/ 13

H.F. 2308 establish a registration fee. 1 b. This subsection shall not be construed to require a 2 physician to be listed on the registry in order to offer or 3 provide treatment of work-related injuries. 4 c. This subsection shall not be construed to prohibit an 5 employer from predesignating or an employee from designating a 6 physician to provide treatment of a work-related injury who is 7 not listed on the registry. 8 2. The commissioner shall establish and maintain a separate 9 registry of licensed physicians trained to perform independent 10 medical evaluations and to issue impairment ratings of injured 11 employees. 12 a. The commissioner shall establish, by administrative rule, 13 minimum training requirements for a physician to be listed on 14 the registry and establish a registration fee. 15 b. The commissioner shall also provide by administrative 16 rule that a physician must be listed on the registry in order 17 to perform independent medical evaluations and issue impairment 18 ratings of injured employees in this state. The commissioner 19 may prohibit an employer or employee from using an independent 20 medical evaluation or an impairment rating of an injured 21 employee from a physician who is not listed on the registry 22 as evidence at a hearing to determine benefits under Iowa’s 23 workers’ compensation laws. 24 3. The workers’ compensation commissioner may retain 25 the services of a medical director to assist the division of 26 workers’ compensation in advancing occupational health in Iowa 27 and to advise the commissioner on how to successfully apply and 28 administer the state’s workers’ compensation laws, including 29 assessments of the use of evidence-based care in treating 30 work-related injuries. 31 4. All fees collected pursuant to this section shall be 32 credited to the state workplace injury care providers registry 33 fund created in section 85.74 and are appropriated to the 34 division to be used to carry out the provisions of this section 35 -6- LSB 5492HH (5) 83 av/rj 6/ 13

H.F. 2308 including but not limited to establishing and maintaining 1 the registries described in subsections 1 and 2, retaining a 2 medical director as set forth in subsection 3, and providing 3 for the expenses of the workers’ compensation advisory board 4 created in section 85.75. 5 Sec. 3. NEW SECTION . 85.74 State workplace injury care 6 providers registry fund. 7 1. A state workplace injury care providers registry fund 8 is created in the state treasury as a separate fund under the 9 control of the division of workers’ compensation. All moneys 10 appropriated or transferred to the fund shall be credited to 11 the fund. All moneys deposited or paid into the fund shall 12 only be appropriated to the workers’ compensation commissioner 13 to be used for the purposes set forth in section 85.73. 14 2. Notwithstanding section 8.33, any balance in the fund 15 on June 30 of each fiscal year shall not revert to the general 16 fund of the state, but shall be available for purposes of 17 section 85.73 in subsequent fiscal years. Notwithstanding 18 section 12C.7, interest earnings on moneys in the fund shall 19 be credited to the fund. 20 Sec. 4. NEW SECTION . 85.75 Workers’ compensation advisory 21 board. 22 1. A workers’ compensation advisory board is established 23 within the division of workers’ compensation. The board shall 24 be composed of the following persons: 25 a. Two members appointed by the governor and subject to 26 confirmation by the senate pursuant to section 2.32, one 27 representing employers, and one representing organized labor. 28 b. Two members appointed jointly by the president and the 29 minority leader of the senate, one representing employers, and 30 one representing organized labor. 31 c. Two members appointed jointly by the speaker and 32 the minority leader of the house of representatives, one 33 representing employers and one representing organized labor. 34 2. The members shall serve six-year terms beginning and 35 -7- LSB 5492HH (5) 83 av/rj 7/ 13

H.F. 2308 ending as provided in section 69.19. However, the initial 1 members shall be appointed to serve for less than six years to 2 ensure members serve staggered terms. A member is eligible for 3 reappointment. A vacancy on the board shall be filled for the 4 unexpired portion of the regular term in the same manner as 5 regular appointments are made. 6 3. One representative of employers and one of organized 7 labor shall be elected as co-chairpersons by the board and 8 shall serve for two-year staggered terms. However, one of 9 the initial co-chairpersons shall be elected to serve for 10 a three-year term to ensure that the co-chairpersons serve 11 staggered terms. 12 4. Four members constitute a quorum. The affirmative vote 13 of a majority of the voting members present as well as the 14 approval of at least two employer representatives and two labor 15 representatives is necessary for any substantive action to be 16 taken by the board. The majority shall not include any member 17 who has a conflict of interest and a statement by a member 18 that the member has a conflict of interest is conclusive for 19 this purpose. A vacancy in the membership does not impair the 20 duties of the board. 21 5. The board shall meet on a regular basis and at the call 22 of the co-chairpersons or upon the written request to the 23 co-chairpersons of two or more members. 24 6. The members are entitled to receive a per diem allowance 25 and actual expense reimbursement as specified in section 7E.6. 26 7. The purpose of the board is to assist the workers’ 27 compensation commissioner in the successful administration 28 of the division of workers’ compensation and to make 29 recommendations to the governor and the general assembly 30 regarding workplace safety and improvements to the state’s 31 workers’ compensation system. 32 8. The responsibilities of the board are as follows: 33 a. Monitor and support the successful implementation of the 34 state’s workers’ compensation laws. 35 -8- LSB 5492HH (5) 83 av/rj 8/ 13

H.F. 2308 b. Identify problems and recommend solutions and 1 improvements with respect to the effectiveness of the state’s 2 workers’ compensation system, to the division of workers’ 3 compensation and to the governor and the general assembly. 4 c. Assist the workers’ compensation commissioner in 5 developing and implementing a program to train and certify 6 claims adjusters for practice in Iowa. 7 d. Work with all stakeholders, including the medical 8 director retained pursuant to section 85.73, to develop and 9 promote a system of high-performance, transparent, accountable, 10 and evidence-based health care for the treatment and prevention 11 of workplace injuries. 12 e. Make recommendations to and receive recommendations from 13 the nonprofit Iowa workers’ compensation advisory committee 14 regarding topics for stakeholder and public education with 15 respect to the application of workers’ compensation law and 16 successful workers’ compensation programs and strategies, as 17 well as the prevention of workplace injuries. 18 Sec. 5. EFFECTIVE DATE. The following provision or 19 provisions of this Act take effect January 1, 2011: 20 1. The section of this Act enacting section 85.73, 21 subsections 1, 3, and 4. 22 2. The sections of this Act enacting sections 85.74 and 23 85.75. 24 Sec. 6. EFFECTIVE DATE. The following provision or 25 provisions of this Act take effect July 1, 2011: 26 1. The section of this Act amending section 85.27, 27 subsection 4. 28 2. The section of this Act enacting section 85.73, 29 subsection 2. 30 EXPLANATION 31 This bill relates to the state’s workers’ compensation laws 32 by modifying alternate care procedures for medical treatment, 33 creating registries of physicians who treat and evaluate 34 work-related injuries, providing for the retention of a medical 35 -9- LSB 5492HH (5) 83 av/rj 9/ 13

H.F. 2308 director, creating a state workplace injury care providers 1 registry fund, establishing a workers’ compensation advisory 2 board, providing for fees, and providing effective dates. 3 ALTERNATE CARE. Code section 85.27(4), concerning the 4 provision of medical services, requires an employer to provide 5 written information about the state’s workers’ compensation 6 laws to an employee upon receiving notification that the 7 employee has suffered a work-related injury. The employer has 8 the right to predesignate a licensed physician to treat the 9 injury and make necessary referrals and may predesignate a 10 physician listed on the state registry of workplace injury care 11 providers. If the employer does not predesignate a treating 12 physician, the employee may designate a physician of the 13 employee’s choosing to provide the treatment. 14 The physician predesignated by the employer or designated 15 by the employee is required to provide ongoing written 16 documentation of the physician’s opinions, treatment 17 recommendations, and care plan to the employee along with 18 information about whether the opinions, recommendations, and 19 care plan are in accord with either the official disability 20 guidelines and treatment guidelines in workers’ compensation 21 published by the work loss data institute or the American 22 college of occupational and environmental medicine practice 23 guidelines (ACOEM), and if so, citation to the appropriate 24 guidelines. The employee has the right to request and obtain 25 a second opinion from another licensed physician of the 26 employee’s choosing at the employer’s expense. 27 If the employer or employee is dissatisfied with the care 28 of a treating physician predesignated or designated by the 29 other party or with any referral made by that physician, the 30 employer and employee may mutually agree to alternate care. If 31 they cannot agree on alternate care, either party may notify 32 an insurance claims specialist within the division of workers’ 33 compensation, who shall, within five working days, schedule 34 a conference between the parties to review the basis for 35 -10- LSB 5492HH (5) 83 av/rj 10/ 13

H.F. 2308 dissatisfaction and provide an advisory opinion to resolve the 1 dispute. If the parties still cannot agree on alternate care 2 after this conference, the workers’ compensation commissioner 3 may, upon application and reasonable proof of the necessity, 4 allow and order alternate care. 5 The employee is responsible to make the application for 6 alternate care and to provide such reasonable proof to the 7 commissioner if the employer provided written information 8 about the state’s workers’ compensation laws at the time of 9 notification of the employee’s injury, and predesignated a 10 treating physician listed on the state registry of workplace 11 injury care providers, and if the treating physician 12 predesignated by the employer provided written documentation 13 to the employee of the physician’s opinions, treatment 14 recommendations, and care plan to the employee along with 15 citation to the appropriate treatment guidelines. 16 The employer is responsible for making the application for 17 alternate care and providing reasonable proof if the employer 18 and predesignated treating physician did not act as described 19 above or if the employee designated the treating physician to 20 treat the work injury. 21 The commissioner is not bound by the advisory opinion of 22 the claims specialist and must conduct a hearing and issue 23 a decision within 10 days of receipt of an application for 24 alternate care. 25 The employer has the right to request an employee to submit, 26 as often as is reasonable and at a reasonable time and place 27 to an examination by a licensed physician chosen by the 28 employer for any purpose relevant to the employer’s duties to 29 provide benefits to the employee under the state’s workers’ 30 compensation laws and at the employer’s expense. If the 31 employer makes the request in writing and pays all expenses, 32 including transportation, the employee shall submit to the 33 examination. Each time that the employer obtains an evaluation 34 of an employee’s permanent disability by a physician chosen by 35 -11- LSB 5492HH (5) 83 av/rj 11/ 13

H.F. 2308 the employer, if the employee believes that the evaluation of 1 disability is too low, the employee may obtain a subsequent 2 examination and evaluation by a physician of the employee’s 3 choosing at the employer’s expense, including transportation 4 expenses to and from the place of the examination. 5 PROVIDER REGISTRIES —— FEES —— MEDICAL DIRECTOR. New Code 6 section 85.73 requires the workers’ compensation commissioner 7 to establish and maintain a registry of licensed physicians 8 that offer or provide treatment of work-related injuries. 9 The commissioner shall, by administrative rule, establish 10 requirements for a physician to be listed on the registry and 11 establish a registration fee. The provision shall not be 12 construed to require a physician to be listed on the registry 13 in order to offer or provide treatment of work-related injuries 14 or to prohibit an employer or employee from predesignating or 15 designating a physician to provide treatment who is not listed 16 on the registry. 17 The commissioner is also required to establish and maintain 18 a separate registry of licensed physicians trained to perform 19 independent medical evaluations and to issue impairment ratings 20 of injured employees. The commissioner shall establish, by 21 administrative rule, minimum training requirements for a 22 physician to be listed on the registry and establish a fee. A 23 physician must be listed on the registry in order to perform 24 independent medical evaluations and issue impairment ratings 25 of injured employees in this state. The commissioner may 26 prohibit an employer or employee from using an independent 27 medical evaluation or impairment rating of an injured employee 28 from a physician who is not listed on the registry as evidence 29 at a hearing to determine benefits under Iowa’s workers’ 30 compensation laws. 31 The commissioner is authorized to retain the services 32 of a medical director to assist the division of workers’ 33 compensation in advancing the field of occupational health in 34 Iowa and to advise the commissioner on how to successfully 35 -12- LSB 5492HH (5) 83 av/rj 12/ 13

H.F. 2308 apply and administer the state’s workers’ compensation laws. 1 STATE WORKPLACE INJURY CARE PROVIDERS REGISTRY FUND. All 2 registration fees collected pursuant to new Code section 3 85.73 shall be credited to the state workplace injury care 4 providers registry fund created in new Code section 85.74 and 5 are appropriated to the division of workers’ compensation to 6 carry out the provisions of new Code section 85.73 including 7 establishing and maintaining the two physician registries, 8 retaining a medical director, and for the expenses of the 9 workers’ compensation advisory board created in new Code 10 section 85.75. 11 WORKERS’ COMPENSATION ADVISORY BOARD. New Code section 12 85.75 establishes a workers’ compensation advisory board within 13 the division of workers’ compensation that is composed of six 14 members, three representing employers and three representing 15 organized labor. The governor appoints two of the members, 16 the president and the minority leader of the senate appoint 17 two members, and the speaker and the minority leader of the 18 house of representatives appoint two members. The members 19 serve six-year staggered terms. The purpose of the board is to 20 assist the workers’ compensation commissioner in the successful 21 administration of the division of workers’ compensation and to 22 make recommendations to the governor and the general assembly 23 regarding workplace safety and improvements to the state’s 24 workers’ compensation system. 25 EFFECTIVE DATES. The sections of the bill creating the 26 provider registry for treatment of work injuries, the provider 27 registry fund, and the advisory board take effect January 1, 28 2011. The sections of the bill pertaining to alternate care 29 procedures and required registration of physicians performing 30 independent medical evaluations and impairment ratings take 31 effect July 1, 2011. 32 -13- LSB 5492HH (5) 83 av/rj 13/ 13