House File 340 - Introduced HOUSE FILE 340 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 effective date provisions. 8 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 9 TLSB 1112YH (9) 84 av/rj

H.F. 340 Section 1. Section 85.27, subsection 4, Code 2011, 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 1112YH (9) 84 av/rj 1/ 14

H.F. 340 (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 1112YH (9) 84 av/rj 2/ 14

H.F. 340 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 1112YH (9) 84 av/rj 3/ 14

H.F. 340 for alternate care and to provide reasonable proof for the 1 necessity of alternate care if any 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 1112YH (9) 84 av/rj 4/ 14

H.F. 340 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 —— registry —— fees. 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 2. The commissioner shall, by administrative rule, 34 establish requirements for a physician to be listed on the 35 -5- LSB 1112YH (9) 84 av/rj 5/ 14

H.F. 340 registry and establish a registration fee. 1 3. This section 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 4. This section 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 Sec. 3. NEW SECTION . 85.74 Independent medical evaluations 9 —— provider —— registry —— fees. 10 1. The commissioner shall establish and maintain a separate 11 registry of licensed physicians trained to perform independent 12 medical evaluations and to issue impairment ratings of injured 13 employees. 14 2. The commissioner shall establish, by administrative 15 rule, minimum training requirements for a physician to be 16 listed on the registry and establish a registration fee. 17 3. The commissioner shall also provide by administrative 18 rule that a physician must be listed on the registry in order 19 to perform independent medical evaluations and issue impairment 20 ratings of injured employees in this state. The commissioner 21 may prohibit an employer or employee from using an independent 22 medical evaluation or an impairment rating of an injured 23 employee from a physician who is not listed on the registry 24 as evidence at a hearing to determine benefits under Iowa’s 25 workers’ compensation laws. 26 Sec. 4. NEW SECTION . 85.75 Fees appropriated. 27 All fees collected pursuant to sections 85.73 and 85.74 28 shall be credited to the state workplace injury care providers 29 registry fund created in section 85.77 and are appropriated to 30 the division to be used to carry out the provisions of sections 31 85.73, 85.74, 85.76, and 85.78, including but not limited 32 to establishing and maintaining the registries described in 33 sections 85.73 and 85.74, retaining a medical director as set 34 forth in section 85.76, and providing for the expenses of the 35 -6- LSB 1112YH (9) 84 av/rj 6/ 14

H.F. 340 workers’ compensation advisory board created in section 85.78. 1 Sec. 5. NEW SECTION . 85.76 Medical director. 2 The workers’ compensation commissioner may retain the 3 services of a medical director to assist the division of 4 workers’ compensation in advancing occupational health in Iowa 5 and to advise the commissioner on how to successfully apply and 6 administer the state’s workers’ compensation laws, including 7 assessments of the use of evidence-based care in treating 8 work-related injuries. 9 Sec. 6. NEW SECTION . 85.77 State workplace injury care 10 providers registry fund. 11 1. A state workplace injury care providers registry fund 12 is created in the state treasury as a separate fund under the 13 control of the division of workers’ compensation. All moneys 14 appropriated or transferred to the fund shall be credited to 15 the fund. All moneys deposited or paid into the fund shall 16 only be appropriated to the workers’ compensation commissioner 17 to be used for the purposes set forth in sections 85.73, 85.74, 18 85.75, and 85.76. 19 2. Notwithstanding section 8.33, any balance in the fund 20 on June 30 of each fiscal year shall not revert to the general 21 fund of the state, but shall be available for purposes of 22 sections 85.73, 85.74, 85.75, 85.76, and 85.78 in subsequent 23 fiscal years. Notwithstanding section 12C.7, interest earnings 24 on moneys in the fund shall be credited to the fund. 25 Sec. 7. NEW SECTION . 85.78 Workers’ compensation advisory 26 board. 27 1. A workers’ compensation advisory board is established 28 within the division of workers’ compensation. The board shall 29 be composed of the following persons: 30 a. Two members appointed by the governor and subject to 31 confirmation by the senate pursuant to section 2.32, one 32 representing employers, and one representing organized labor. 33 b. Two members appointed jointly by the president and the 34 minority leader of the senate, one representing employers, and 35 -7- LSB 1112YH (9) 84 av/rj 7/ 14

H.F. 340 one representing organized labor. 1 c. Two members appointed jointly by the speaker and 2 the minority leader of the house of representatives, one 3 representing employers and one representing organized labor. 4 2. The members shall serve six-year terms beginning and 5 ending as provided in section 69.19. However, the initial 6 members shall be appointed to serve for less than six years to 7 ensure members serve staggered terms. A member is eligible for 8 reappointment. A vacancy on the board shall be filled for the 9 unexpired portion of the regular term in the same manner as 10 regular appointments are made. 11 3. One representative of employers and one of organized 12 labor shall be elected as co-chairpersons by the board and 13 shall serve for two-year staggered terms. However, one of 14 the initial co-chairpersons shall be elected to serve for 15 a three-year term to ensure that the co-chairpersons serve 16 staggered terms. 17 4. Four members constitute a quorum. The affirmative vote 18 of a majority of the voting members present as well as the 19 approval of at least two employer representatives and two labor 20 representatives is necessary for any substantive action to be 21 taken by the board. The majority shall not include any member 22 who has a conflict of interest and a statement by a member 23 that the member has a conflict of interest is conclusive for 24 this purpose. A vacancy in the membership does not impair the 25 duties of the board. 26 5. The board shall meet on a regular basis and at the call 27 of the co-chairpersons or upon the written request to the 28 co-chairpersons of two or more members. 29 6. The members are entitled to receive a per diem allowance 30 and actual expense reimbursement as specified in section 7E.6. 31 7. The purpose of the board is to assist the workers’ 32 compensation commissioner in the successful administration 33 of the division of workers’ compensation and to make 34 recommendations to the governor and the general assembly 35 -8- LSB 1112YH (9) 84 av/rj 8/ 14

H.F. 340 regarding workplace safety and improvements to the state’s 1 workers’ compensation system. 2 8. The responsibilities of the board are as follows: 3 a. Monitor and support the successful implementation of the 4 state’s workers’ compensation laws. 5 b. Identify problems and recommend solutions and 6 improvements with respect to the effectiveness of the state’s 7 workers’ compensation system, to the division of workers’ 8 compensation and to the governor and the general assembly. 9 c. Assist the workers’ compensation commissioner in 10 developing and implementing a program to train and certify 11 claims adjusters for practice in Iowa. 12 d. Work with all stakeholders, including the medical 13 director retained pursuant to section 85.76, to develop and 14 promote a system of high-performance, transparent, accountable, 15 and evidence-based health care for the treatment and prevention 16 of workplace injuries. 17 e. Make recommendations to and receive recommendations from 18 the nonprofit Iowa workers’ compensation advisory committee 19 regarding topics for stakeholder and public education with 20 respect to the application of workers’ compensation law and 21 successful workers’ compensation programs and strategies, as 22 well as the prevention of workplace injuries. 23 Sec. 8. EFFECTIVE DATE. The following provision or 24 provisions of this Act take effect July 1, 2012: 25 1. Section 1 of this Act amending section 85.27. 26 2. Section 3 of this Act enacting section 85.74. 27 Sec. 9. EFFECTIVE DATE. The following provision or 28 provisions of this Act take effect January 1, 2012: 29 1. Section 2 of this Act enacting section 86.73. 30 2. Section 4 of this Act enacting section 85.75. 31 3. Section 5 of this Act enacting section 85.76. 32 4. Section 6 of this Act enacting section 85.77. 33 5. Section 7 of this Act enacting section 85.78. 34 EXPLANATION 35 -9- LSB 1112YH (9) 84 av/rj 9/ 14

H.F. 340 This bill relates to the state’s workers’ compensation laws 1 by 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 a medical 4 director, creating a state workplace injury care providers 5 registry fund, establishing a workers’ compensation advisory 6 board, providing for fees, and providing effective dates. 7 ALTERNATE CARE. Code section 85.27(4), concerning the 8 provision of medical services, requires an employer to provide 9 written information about the state’s workers’ compensation 10 laws to an employee upon receiving notification that the 11 employee has suffered a work-related injury. The employer has 12 the right to predesignate a licensed physician to treat the 13 injury and make necessary referrals and may predesignate a 14 physician listed on the state registry of workplace injury care 15 providers. If the employer does not predesignate a treating 16 physician, the employee may designate a physician of the 17 employee’s choosing to provide the treatment. 18 The physician predesignated by the employer or designated 19 by the employee is required to provide ongoing written 20 documentation of the physician’s opinions, treatment 21 recommendations, and care plan to the employee along with 22 information about whether the opinions, recommendations, and 23 care plan are in accord with either the official disability 24 guidelines and treatment guidelines in workers’ compensation 25 published by the work loss data institute or the American 26 college of occupational and environmental medicine practice 27 guidelines (ACOEM), and if so, citation to the appropriate 28 guidelines. The employee has the right to request and obtain 29 a second opinion from another licensed physician of the 30 employee’s choosing at the employer’s expense. 31 If the employer or employee is dissatisfied with the care 32 of a treating physician predesignated or designated by the 33 other party or with any referral made by that physician, the 34 employer and employee may mutually agree to alternate care. If 35 -10- LSB 1112YH (9) 84 av/rj 10/ 14

H.F. 340 they cannot agree on alternate care, either party may notify 1 an insurance claims specialist within the division of workers’ 2 compensation, who shall, within five working days, schedule 3 a conference between the parties to review the basis for 4 dissatisfaction and provide an advisory opinion to resolve the 5 dispute. If the parties still cannot agree on alternate care 6 after this conference, the workers’ compensation commissioner 7 may, upon application and reasonable proof of the necessity, 8 allow and order alternate care. 9 The employee is responsible to make the application for 10 alternate care and to provide such reasonable proof to the 11 commissioner if the employer provided written information 12 about the state’s workers’ compensation laws at the time of 13 notification of the employee’s injury, and predesignated a 14 treating physician listed on the state registry of workplace 15 injury care providers, and if the treating physician 16 predesignated by the employer provided written documentation 17 to the employee of the physician’s opinions, treatment 18 recommendations, and care plan along with citation to the 19 appropriate treatment guidelines. 20 The employer is responsible for making the application for 21 alternate care and providing reasonable proof if the employer 22 and predesignated treating physician did not act as described 23 above or if the employee designated the treating physician to 24 treat the work injury. 25 The commissioner is not bound by the advisory opinion of 26 the claims specialist and must conduct a hearing and issue 27 a decision within 10 days of receipt of an application for 28 alternate care. 29 The employer has the right to request an employee to submit, 30 as often as is reasonable and at a reasonable time and place 31 to an examination by a licensed physician chosen by the 32 employer for any purpose relevant to the employer’s duties to 33 provide benefits to the employee under the state’s workers’ 34 compensation laws and at the employer’s expense. If the 35 -11- LSB 1112YH (9) 84 av/rj 11/ 14

H.F. 340 employer makes the request in writing and pays all expenses, 1 including transportation, the employee shall submit to the 2 examination. Each time that the employer obtains an evaluation 3 of an employee’s permanent disability by a physician chosen by 4 the employer, if the employee believes that the evaluation of 5 disability is too low, the employee may obtain a subsequent 6 examination and evaluation by a physician of the employee’s 7 choosing at the employer’s expense, including transportation 8 expenses to and from the place of the examination. 9 PROVIDER REGISTRIES —— FEES —— MEDICAL DIRECTOR. New Code 10 section 85.73 requires the workers’ compensation commissioner 11 to establish and maintain a registry of licensed physicians 12 that offer or provide treatment of work-related injuries. 13 The commissioner shall, by administrative rule, establish 14 requirements for a physician to be listed on the registry and 15 establish a registration fee. The provision shall not be 16 construed to require a physician to be listed on the registry 17 in order to offer or provide treatment of work-related injuries 18 or to prohibit an employer or employee from predesignating or 19 designating a physician to provide treatment who is not listed 20 on the registry. 21 New Code section 85.74 requires the commissioner to 22 establish and maintain a separate registry of licensed 23 physicians trained to perform independent medical evaluations 24 and to issue impairment ratings of injured employees. The 25 commissioner shall establish, by administrative rule, minimum 26 training requirements for a physician to be listed on the 27 registry and establish a fee. A physician must be listed 28 on the registry in order to perform independent medical 29 evaluations and issue impairment ratings of injured employees 30 in this state. The commissioner may prohibit an employer 31 or employee from using an independent medical evaluation or 32 impairment rating of an injured employee from a physician who 33 is not listed on the registry as evidence at a hearing to 34 determine benefits under Iowa’s workers’ compensation laws. 35 -12- LSB 1112YH (9) 84 av/rj 12/ 14

H.F. 340 New Code section 85.76 authorizes the commissioner to 1 retain the services of a medical director to assist the 2 division of workers’ compensation in advancing the field of 3 occupational health in Iowa and to advise the commissioner on 4 how to successfully apply and administer the state’s workers’ 5 compensation laws. 6 STATE WORKPLACE INJURY CARE PROVIDERS REGISTRY FUND. All 7 registration fees collected pursuant to new Code sections 85.73 8 and 85.74 shall be credited to the state workplace injury care 9 providers registry fund created in new Code section 85.77 and 10 are appropriated to the division of workers’ compensation by 11 new Code section 85.75 to carry out the provisions of new Code 12 sections 85.73, 85.74, 85.75, and 85.76 including establishing 13 and maintaining the two physician registries, retaining 14 a medical director, and for the expenses of the workers’ 15 compensation advisory board created in new Code section 85.78. 16 WORKERS’ COMPENSATION ADVISORY BOARD. New Code section 17 85.78 establishes a workers’ compensation advisory board within 18 the division of workers’ compensation that is composed of six 19 members, three representing employers and three representing 20 organized labor. The governor appoints two of the members, 21 the president and the minority leader of the senate jointly 22 appoint two members, and the speaker and the minority leader 23 of the house of representatives jointly appoint two members. 24 The members serve six-year staggered terms. The purpose of 25 the board is to assist the workers’ compensation commissioner 26 in the successful administration of the division of workers’ 27 compensation and to make recommendations to the governor 28 and the general assembly regarding workplace safety and 29 improvements to the state’s workers’ compensation system. 30 EFFECTIVE DATES. The sections of the bill creating the 31 provider registry for treatment of work injuries, the provider 32 registry fund, the position of medical director, and the 33 advisory board, and appropriating fees, take effect January 1, 34 2012. The sections of the bill pertaining to alternate care 35 -13- LSB 1112YH (9) 84 av/rj 13/ 14