HOUSE FILE 340

BY  ISENHART

A BILL FOR

An Act relating to the state’s workers’ compensation laws by modifying alternate care procedures for medical treatment, creating registries of physicians who treat and evaluate work-related injuries, providing for the retention of a medical director, creating a state workplace injury care providers registry fund, establishing a workers’ compensation advisory board, providing for and appropriating fees, and including effective date provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

   Section 1.  Section 85.27, subsection 4, Code 2011, is amended by striking the subsection and inserting in lieu thereof the following:
   4.
  a.  For purposes of this section, the employer is obligated to furnish reasonable services and supplies to treat an injured employee and has the right to predesignate the initial provider of medical care. Upon receiving notification of an injury, the employer is also obligated to provide the injured employee with written information on the state’s workers’ compensation laws, including the rights and responsibilities of the employee and the employer and to document in writing that the employee received the information in a timely manner. The commissioner shall provide, by administrative rule, the format, content, and procedure for the predesignation of the initial provider of medical care by the employer and the provision of this information to the injured employee.
   (1)  The employer shall promptly provide medical care for the injury and may predesignate a licensed physician to treat the injury and any condition the physician believes is causally related to the injury. If the employer has not predesignated a licensed physician to treat the injury and any condition causally related to the injury, the employee may designate a licensed physician of the employee’s choosing to provide that treatment.
   (2)  The employer may predesignate a physician listed in the state registry of workplace injury care providers, as provided in section 85.73, to treat the injury and any condition causally related to the injury.
   (3)  The physician predesignated by the employer or designated by the employee shall be authorized by the employer to treat the injury at the employer’s expense in any manner deemed appropriate by the physician, without a requirement of preapproval for such referrals by the employer, by an agent or representative of the employer, or the employer’s insurer.
   (4)  The physician predesignated by the employer or designated by the employee shall be authorized to make referrals to other physicians, therapists, or health care providers of specialized services at the employer’s expense without a requirement of preapproval for such referrals by the employer, an agent or representative of the employer, or the employer’s insurer.
   b.  The physician predesignated by the employer or designated by the employee to treat the injured employee shall provide ongoing written documentation of the physician’s opinions, treatment recommendations, and care plan to the employee. Such documentation shall indicate whether or not the physician’s opinions, treatment recommendations, and care plan are in accord with the most recent edition of either the official disability guidelines and treatment guidelines in workers’ compensation published by the work loss data institute or the American college of occupational and environmental medicine practice guidelines published by the American college of occupational and environmental medicine, and if so, shall cite the appropriate guidelines.
   c.
  (1)  If an employee receives treatment for an injury from a physician predesignated by the employer and prior to an evaluation of permanent disability by that predesignated physician, the injured employee may be examined by and obtain a second opinion, treatment recommendations, or a care plan from another licensed physician of the employee’s choosing. The employee may request and the employer shall pay the reasonable costs associated with this examination, including reimbursement for transportation expenses incurred by the employee for the examination. The employee shall notify the physician predesignated by the employer that the employee is consulting with another physician of the employee’s choosing.
   (2)  If an employee receives treatment for an injury from a physician designated by the employee, the employer is not responsible for the costs of obtaining a second opinion, treatment recommendations, or a care plan from an additional licensed physician of the employee’s choosing.
   d.  If the employer or employee has reason to be dissatisfied with the care of a treating physician predesignated or designated by the other party or with any referral made by that physician, the employer and employee may mutually agree upon alternate care.
   e.  If the employer and employee cannot agree on alternate care, either the employer or employee may notify an insurance claims specialist within the division of workers’ compensation, who shall, within five working days schedule a conference between the employer and employee by any reasonable manner available to review the basis for dissatisfaction and provide an advisory opinion to resolve the medical care dispute.
   f.  If, following the conference with the insurance claims specialist, the employer and employee cannot agree on such alternate care, the workers’ compensation commissioner may, upon application and reasonable proof of the necessity therefor, allow and order alternate care.
   (1)  The employee is responsible to make the application for alternate care and to provide reasonable proof for the necessity of alternate care if all of the following actions occurred:
   (a)  The employer provided written information about the state’s workers’ compensation laws as provided in paragraph “a”.
   (b)  The employer predesignated a treating physician listed on the state registry of workplace injury care providers as provided in paragraph “a”, subparagraph (2).
   (c)  The treating physician predesignated by the employer provided written documentation of the physician’s opinions, treatment recommendations, and care plan to the employee along with a citation to appropriate treatment guidelines as provided in paragraph “b”.
   (2)  The employer is responsible to make the application for alternate care and to provide reasonable proof for the necessity of alternate care if any of the actions specified in subparagraph (1) did not occur or if the employee designated the treating physician to treat the injury.
   (3)  The commissioner shall not be bound by the advisory opinion of the insurance claims specialist. Upon application, the workers’ compensation commissioner shall conduct a hearing in any reasonable manner to effectuate a prompt resolution of the alternate care dispute. The commissioner shall issue a decision within ten working days of receipt of an application for alternate care.
   (4)  The employer or its insurer is liable for the costs of all medical care provided by a physician predesignated by the employer or designated by the employee pursuant to paragraph “a”, subparagraph (1), or from referrals from the predesignated or designated physician, and shall hold the employee harmless for the cost of care by the predesignated or designated care providers.
   (5)  In an emergency, the employee may choose the employee’s care at the employer’s expense, provided the employer or the employer’s agent cannot be immediately contacted to indicate who the employer has predesignated as a treating physician.
   (6)  The employer shall notify an injured employee of the employee’s ability to contest the employer’s choice of the predesignated treating physician or other provider of medical care as part of the information given to the employee as required under paragraph “a”.
   g.
  (1)  The employer has the right to request an employee to submit, as often as is reasonable and at a reasonable time and place, to an examination by a licensed physician chosen by the employer for any purpose relevant to the employer’s duties to provide benefits to the employee under this chapter, or chapters 85A, 85B, and 86. If the employer makes such a request to an employee in writing and offers to advance or reimburse the employee’s transportation expenses incurred in traveling to and from the place of the examination, the employee shall submit to the examination.
   (2)  Each time that an employee is requested to and submits to an examination requested by the employer as provided in subparagraph (1), the employee has the right to be examined by a licensed physician chosen by the employee for any purpose relevant to the employer’s duties to provide benefits to the employee as described in subparagraph (1).
   (3)  Each time that an employer obtains an evaluation of an employee’s permanent disability by a physician chosen by the employer, if the injured employee believes that the evaluation of the extent of the employee’s permanent disability is too low, the employee may obtain a subsequent examination and evaluation of the employee’s permanent disability by a physician of the employee’s choice. The physician chosen by the employee has the right to confer with and obtain sufficient medical history of the employee from the physician who examined the employee on behalf of the employer to make a proper evaluation of the employee’s permanent disability.
   (4)  The employer shall promptly pay the costs of any examination obtained pursuant to this paragraph “g”, or if necessary to obtain the examination, advance the costs of the examination, and pay the employee’s reasonably necessary transportation expenses incurred in traveling to and from the place of any examination and shall hold the employee harmless for the cost of all examinations and medical care provided pursuant to this paragraph“g” as well as the employee’s reasonably necessary transportation expenses.
   Sec. 2.  NEW SECTION.  85.73  State workplace injury care providers—— registry—— fees.
   1.  The workers’ compensation commissioner shall establish and maintain a registry of physicians licensed in the state that offer or provide treatment of work-related injuries.
   2.  The commissioner shall, by administrative rule, establish requirements for a physician to be listed on the registry and establish a registration fee.
   3.  This section shall not be construed to require a physician to be listed on the registry in order to offer or provide treatment of work-related injuries.
   4.  This section shall not be construed to prohibit an employer from predesignating or an employee from designating a physician to provide treatment of a work-related injury who is not listed on the registry.
   Sec. 3.  NEW SECTION.  85.74  Independent medical evaluations —— provider—— registry—— fees.
   1.  The commissioner shall establish and maintain a separate registry of licensed physicians trained to perform independent medical evaluations and to issue impairment ratings of injured employees.
   2.  The commissioner shall establish, by administrative rule, minimum training requirements for a physician to be listed on the registry and establish a registration fee.
   3.  The commissioner shall also provide by administrative rule that a physician must be listed on the registry in order to perform independent medical evaluations and issue impairment ratings of injured employees in this state. The commissioner may prohibit an employer or employee from using an independent medical evaluation or an impairment rating of an injured employee from a physician who is not listed on the registry as evidence at a hearing to determine benefits under Iowa’s workers’ compensation laws.
   Sec. 4.  NEW SECTION.  85.75  Fees appropriated.
   All fees collected pursuant to sections 85.73 and 85.74 shall be credited to the state workplace injury care providers registry fund created in section 85.77 and are appropriated to the division to be used to carry out the provisions of sections 85.73, 85.74, 85.76, and 85.78, including but not limited to establishing and maintaining the registries described in sections 85.73 and 85.74, retaining a medical director as set forth in section 85.76, and providing for the expenses of the workers’ compensation advisory board created in section 85.78.
   Sec. 5.  NEW SECTION.  85.76  Medical director.
   The workers’ compensation commissioner may retain the services of a medical director to assist the division of workers’ compensation in advancing occupational health in Iowa and to advise the commissioner on how to successfully apply and administer the state’s workers’ compensation laws, including assessments of the use of evidence-based care in treating work-related injuries.
   Sec. 6.  NEW SECTION.  85.77  State workplace injury care providers registry fund.
   1.  A state workplace injury care providers registry fund is created in the state treasury as a separate fund under the control of the division of workers’ compensation. All moneys appropriated or transferred to the fund shall be credited to the fund. All moneys deposited or paid into the fund shall only be appropriated to the workers’ compensation commissioner to be used for the purposes set forth in sections 85.73, 85.74, 85.75, and 85.76.
   2.  Notwithstanding section 8.33, any balance in the fund on June 30 of each fiscal year shall not revert to the general fund of the state, but shall be available for purposes of sections 85.73, 85.74, 85.75, 85.76, and 85.78 in subsequent fiscal years. Notwithstanding section 12C.7, interest earnings on moneys in the fund shall be credited to the fund.
   Sec. 7.  NEW SECTION.  85.78  Workers’ compensation advisory board.
   1.  A workers’ compensation advisory board is established within the division of workers’ compensation. The board shall be composed of the following persons:
   a.  Two members appointed by the governor and subject to confirmation by the senate pursuant to section 2.32, one representing employers, and one representing organized labor.
   b.  Two members appointed jointly by the president and the minority leader of the senate, one representing employers, and one representing organized labor.
   c.  Two members appointed jointly by the speaker and the minority leader of the house of representatives, one representing employers and one representing organized labor.
   2.  The members shall serve six-year terms beginning and ending as provided in section 69.19. However, the initial members shall be appointed to serve for less than six years to ensure members serve staggered terms. A member is eligible for reappointment. A vacancy on the board shall be filled for the unexpired portion of the regular term in the same manner as regular appointments are made.
   3.  One representative of employers and one of organized labor shall be elected as co-chairpersons by the board and shall serve for two-year staggered terms. However, one of the initial co-chairpersons shall be elected to serve for a three-year term to ensure that the co-chairpersons serve staggered terms.
   4.  Four members constitute a quorum. The affirmative vote of a majority of the voting members present as well as the approval of at least two employer representatives and two labor representatives is necessary for any substantive action to be taken by the board. The majority shall not include any member who has a conflict of interest and a statement by a member that the member has a conflict of interest is conclusive for this purpose. A vacancy in the membership does not impair the duties of the board.
   5.  The board shall meet on a regular basis and at the call of the co-chairpersons or upon the written request to the co-chairpersons of two or more members.
   6.  The members are entitled to receive a per diem allowance and actual expense reimbursement as specified in section 7E.6.
   7.  The purpose of the board is to assist the workers’ compensation commissioner in the successful administration of the division of workers’ compensation and to make recommendations to the governor and the general assembly regarding workplace safety and improvements to the state’s workers’ compensation system.
   8.  The responsibilities of the board are as follows:
   a.  Monitor and support the successful implementation of the state’s workers’ compensation laws.
   b.  Identify problems and recommend solutions and improvements with respect to the effectiveness of the state’s workers’ compensation system, to the division of workers’ compensation and to the governor and the general assembly.
   c.  Assist the workers’ compensation commissioner in developing and implementing a program to train and certify claims adjusters for practice in Iowa.
   d.  Work with all stakeholders, including the medical director retained pursuant to section 85.76, to develop and promote a system of high-performance, transparent, accountable, and evidence-based health care for the treatment and prevention of workplace injuries.
   e.  Make recommendations to and receive recommendations from the nonprofit Iowa workers’ compensation advisory committee regarding topics for stakeholder and public education with respect to the application of workers’ compensation law and successful workers’ compensation programs and strategies, as well as the prevention of workplace injuries.
   Sec. 8.  EFFECTIVE DATE.  The following provision or provisions of this Act take effect July 1, 2012:
   1.  Section1 of this Act amending section 85.27.
   2.  Section3 of this Act enacting section 85.74.
   Sec. 9.  EFFECTIVE DATE.  The following provision or provisions of this Act take effect January 1, 2012:
   1.  Section2 of this Act enacting section 86.73.
   2.  Section4 of this Act enacting section 85.75.
   3.  Section5 of this Act enacting section 85.76.
   4.  Section6 of this Act enacting section 85.77.
   5.  Section7 of this Act enacting section 85.78.
EXPLANATION
   This bill relates to the state’s workers’ compensation laws by modifying alternate care procedures for medical treatment, creating registries of physicians who treat and evaluate work-related injuries, providing for the retention of a medical director, creating a state workplace injury care providers registry fund, establishing a workers’ compensation advisory board, providing for fees, and providing effective dates.
   ALTERNATE CARE. Code section 85.27(4), concerning the provision of medical services, requires an employer to provide written information about the state’s workers’ compensation laws to an employee upon receiving notification that the employee has suffered a work-related injury. The employer has the right to predesignate a licensed physician to treat the injury and make necessary referrals and may predesignate a physician listed on the state registry of workplace injury care providers. If the employer does not predesignate a treating physician, the employee may designate a physician of the employee’s choosing to provide the treatment.
   The physician predesignated by the employer or designated by the employee is required to provide ongoing written documentation of the physician’s opinions, treatment recommendations, and care plan to the employee along with information about whether the opinions, recommendations, and care plan are in accord with either the official disability guidelines and treatment guidelines in workers’ compensation published by the work loss data institute or the American college of occupational and environmental medicine practice guidelines (ACOEM), and if so, citation to the appropriate guidelines. The employee has the right to request and obtain a second opinion from another licensed physician of the employee’s choosing at the employer’s expense.
   If the employer or employee is dissatisfied with the care of a treating physician predesignated or designated by the other party or with any referral made by that physician, the employer and employee may mutually agree to alternate care. If they cannot agree on alternate care, either party may notify an insurance claims specialist within the division of workers’ compensation, who shall, within five working days, schedule a conference between the parties to review the basis for dissatisfaction and provide an advisory opinion to resolve the dispute. If the parties still cannot agree on alternate care after this conference, the workers’ compensation commissioner may, upon application and reasonable proof of the necessity, allow and order alternate care.
   The employee is responsible to make the application for alternate care and to provide such reasonable proof to the commissioner if the employer provided written information about the state’s workers’ compensation laws at the time of notification of the employee’s injury, and predesignated a treating physician listed on the state registry of workplace injury care providers, and if the treating physician predesignated by the employer provided written documentation to the employee of the physician’s opinions, treatment recommendations, and care plan along with citation to the appropriate treatment guidelines.
   The employer is responsible for making the application for alternate care and providing reasonable proof if the employer and predesignated treating physician did not act as described above or if the employee designated the treating physician to treat the work injury.
   The commissioner is not bound by the advisory opinion of the claims specialist and must conduct a hearing and issue a decision within 10 days of receipt of an application for alternate care.
   The employer has the right to request an employee to submit, as often as is reasonable and at a reasonable time and place to an examination by a licensed physician chosen by the employer for any purpose relevant to the employer’s duties to provide benefits to the employee under the state’s workers’ compensation laws and at the employer’s expense. If the employer makes the request in writing and pays all expenses, including transportation, the employee shall submit to the examination. Each time that the employer obtains an evaluation of an employee’s permanent disability by a physician chosen by the employer, if the employee believes that the evaluation of disability is too low, the employee may obtain a subsequent examination and evaluation by a physician of the employee’s choosing at the employer’s expense, including transportation expenses to and from the place of the examination.
   PROVIDER REGISTRIES —— FEES —— MEDICAL DIRECTOR. New Code section 85.73 requires the workers’ compensation commissioner to establish and maintain a registry of licensed physicians that offer or provide treatment of work-related injuries. The commissioner shall, by administrative rule, establish requirements for a physician to be listed on the registry and establish a registration fee. The provision shall not be construed to require a physician to be listed on the registry in order to offer or provide treatment of work-related injuries or to prohibit an employer or employee from predesignating or designating a physician to provide treatment who is not listed on the registry.
   New Code section 85.74 requires the commissioner to establish and maintain a separate registry of licensed physicians trained to perform independent medical evaluations and to issue impairment ratings of injured employees. The commissioner shall establish, by administrative rule, minimum training requirements for a physician to be listed on the registry and establish a fee. A physician must be listed on the registry in order to perform independent medical evaluations and issue impairment ratings of injured employees in this state. The commissioner may prohibit an employer or employee from using an independent medical evaluation or impairment rating of an injured employee from a physician who is not listed on the registry as evidence at a hearing to determine benefits under Iowa’s workers’ compensation laws.
   New Code section 85.76 authorizes the commissioner to retain the services of a medical director to assist the division of workers’ compensation in advancing the field of occupational health in Iowa and to advise the commissioner on how to successfully apply and administer the state’s workers’ compensation laws.
   STATE WORKPLACE INJURY CARE PROVIDERS REGISTRY FUND. All registration fees collected pursuant to new Code sections 85.73 and 85.74 shall be credited to the state workplace injury care providers registry fund created in new Code section 85.77 and are appropriated to the division of workers’ compensation by new Code section 85.75 to carry out the provisions of new Code sections 85.73, 85.74, 85.75, and 85.76 including establishing and maintaining the two physician registries, retaining a medical director, and for the expenses of the workers’ compensation advisory board created in new Code section 85.78.
   WORKERS’ COMPENSATION ADVISORY BOARD. New Code section 85.78 establishes a workers’ compensation advisory board within the division of workers’ compensation that is composed of six members, three representing employers and three representing organized labor. The governor appoints two of the members, the president and the minority leader of the senate jointly appoint two members, and the speaker and the minority leader of the house of representatives jointly appoint two members. The members serve six-year staggered terms. The purpose of the board is to assist the workers’ compensation commissioner in the successful administration of the division of workers’ compensation and to make recommendations to the governor and the general assembly regarding workplace safety and improvements to the state’s workers’ compensation system.
   EFFECTIVE DATES. The sections of the bill creating the provider registry for treatment of work injuries, the provider registry fund, the position of medical director, and the advisory board, and appropriating fees, take effect January 1, 2012. The sections of the bill pertaining to alternate care procedures and required registration of physicians performing independent medical evaluations and impairment ratings take effect July 1, 2012.