House File 274 - Introduced HOUSE FILE 274 BY ISENHART A BILL FOR An Act relating to the state’s workers’ compensation laws 1 by modifying alternate care procedures for medical 2 treatment, creating registries of physicians who treat 3 and evaluate work-related injuries, providing for the 4 retention of a medical director, creating a state workplace 5 injury care providers registry fund, establishing a 6 workers’ compensation advisory council, providing for and 7 appropriating fees, and including effective date provisions. 8 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 9 TLSB 1181HH (3) 85 av/rj

H.F. 274 Section 1. Section 85.27, subsection 4, Code 2013, 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 1181HH (3) 85 av/rj 1/ 14

H.F. 274 (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 1181HH (3) 85 av/rj 2/ 14

H.F. 274 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 1181HH (3) 85 av/rj 3/ 14

H.F. 274 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 1181HH (3) 85 av/rj 4/ 14

H.F. 274 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 this 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 1181HH (3) 85 av/rj 5/ 14

H.F. 274 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 as 24 evidence at a hearing to determine benefits under the state’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 1181HH (3) 85 av/rj 6/ 14

H.F. 274 workers’ compensation advisory council created in section 1 85.78. 2 Sec. 5. NEW SECTION . 85.76 Medical director. 3 The workers’ compensation commissioner may retain the 4 services of a medical director to assist the division of 5 workers’ compensation in advancing occupational health in this 6 state and to advise the commissioner on how to successfully 7 apply and administer the state’s workers’ compensation laws, 8 including assessments of the use of evidence-based care in 9 treating work-related injuries. 10 Sec. 6. NEW SECTION . 85.77 State workplace injury care 11 providers registry fund. 12 1. A state workplace injury care providers registry fund 13 is created in the state treasury as a separate fund under the 14 control of the division of workers’ compensation. All moneys 15 appropriated or transferred to the fund shall be credited to 16 the fund. All moneys deposited or paid into the fund shall 17 only be appropriated to the workers’ compensation commissioner 18 to be used for the purposes set forth in sections 85.73, 85.74, 19 85.75, 85.76, and 85.78. 20 2. Notwithstanding section 8.33, any balance in the fund 21 on June 30 of each fiscal year shall not revert to the general 22 fund of the state, but shall be available for purposes of 23 sections 85.73, 85.74, 85.75, 85.76, and 85.78 in subsequent 24 fiscal years. Notwithstanding section 12C.7, interest earnings 25 on moneys in the fund shall be credited to the fund. 26 Sec. 7. NEW SECTION . 85.78 Workers’ compensation advisory 27 council. 28 1. A workers’ compensation advisory council is established 29 within the division of workers’ compensation. The council 30 shall be composed of the following persons: 31 a. Two members appointed by the governor and subject to 32 confirmation by the senate pursuant to section 2.32, one 33 representing employers, and one representing organized labor. 34 b. Two members appointed jointly by the president and the 35 -7- LSB 1181HH (3) 85 av/rj 7/ 14

H.F. 274 minority leader of the senate, one representing employers, and 1 one representing organized labor. 2 c. Two members appointed jointly by the speaker and 3 the minority leader of the house of representatives, one 4 representing employers and one representing organized labor. 5 2. The members shall serve six-year terms beginning and 6 ending as provided in section 69.19. However, for the initial 7 terms commencing January 1, 2014, one member appointed by 8 the governor, one member representing employers, and one 9 member representing organized labor shall be appointed to 10 serve three-year terms to ensure that members serve staggered 11 terms. A member is eligible for reappointment. A vacancy on 12 the council shall be filled for the unexpired portion of the 13 regular term in the same manner as regular appointments are 14 made. 15 3. One representative of employers and one representative 16 of organized labor shall be elected as co-chairpersons by the 17 council and shall serve for two-year staggered terms. However, 18 one of the initial co-chairpersons shall be elected to serve 19 for a three-year term to ensure that the co-chairpersons serve 20 staggered terms. 21 4. Four members constitute a quorum. The affirmative 22 vote of a majority of the voting members present as well as 23 the approval of at least two employer representatives and two 24 labor representatives is necessary for any substantive action 25 to be taken by the council. The majority shall not include 26 any member who has a conflict of interest and a statement by a 27 member that the member has a conflict of interest is conclusive 28 for this purpose. A vacancy in the membership does not impair 29 the duties of the council. 30 5. The council shall meet on a regular basis and at the 31 call of the co-chairpersons or upon the written request to the 32 co-chairpersons of two or more members. 33 6. The members are entitled to receive a per diem allowance 34 and actual expense reimbursement as specified in section 7E.6. 35 -8- LSB 1181HH (3) 85 av/rj 8/ 14

H.F. 274 7. The purpose of the council is to assist the workers’ 1 compensation commissioner in the successful administration 2 of the division of workers’ compensation and to make 3 recommendations to the governor and the general assembly 4 regarding workplace safety and improvements to the state’s 5 workers’ compensation system. 6 8. The responsibilities of the council are as follows: 7 a. Monitor and support the successful implementation of the 8 state’s workers’ compensation laws. 9 b. Identify problems and recommend solutions and 10 improvements with respect to the effectiveness of the state’s 11 workers’ compensation system, to the division of workers’ 12 compensation and to the governor and the general assembly. 13 c. Assist the workers’ compensation commissioner in 14 developing and implementing a program to train and certify 15 claims adjusters for practice in this state. 16 d. Work with all stakeholders, including the medical 17 director retained pursuant to section 85.76, to develop and 18 promote a system of high-performance, transparent, accountable, 19 and evidence-based health care for the treatment and prevention 20 of workplace injuries. 21 e. Make recommendations to and receive recommendations from 22 the nonprofit Iowa workers’ compensation advisory committee 23 regarding topics for stakeholder and public education with 24 respect to the application of workers’ compensation law and 25 successful workers’ compensation programs and strategies, as 26 well as the prevention of workplace injuries. 27 Sec. 8. EFFECTIVE DATE. The following provision or 28 provisions of this Act take effect July 1, 2014: 29 1. The section of this Act amending section 85.27. 30 2. The section of this Act enacting section 85.74. 31 Sec. 9. EFFECTIVE DATE. The following provision or 32 provisions of this Act take effect January 1, 2014: 33 1. The section of this Act enacting section 86.73. 34 2. The section of this Act enacting section 85.75. 35 -9- LSB 1181HH (3) 85 av/rj 9/ 14

H.F. 274 3. The section of this Act enacting section 85.76. 1 4. The section of this Act enacting section 85.77. 2 5. The section of this Act enacting section 85.78. 3 EXPLANATION 4 This bill relates to the state’s workers’ compensation laws 5 by modifying alternate care procedures for medical treatment, 6 creating registries of physicians who treat and evaluate 7 work-related injuries, providing for the retention of a medical 8 director, creating a state workplace injury care providers 9 registry fund, establishing a workers’ compensation advisory 10 council, providing for and appropriating fees, and providing 11 effective dates. 12 MEDICAL AND ALTERNATE CARE. Code section 85.27(4), 13 concerning the provision of medical services, requires an 14 employer to provide written information about the state’s 15 workers’ compensation laws to an employee upon receiving 16 notification that the employee has suffered a work-related 17 injury. The employer has the right to predesignate a licensed 18 physician to treat the injury and make necessary referrals and 19 may predesignate a physician listed on the state registry of 20 workplace injury care providers. If the employer does not 21 predesignate a treating physician, the employee may designate a 22 physician of the employee’s choosing to provide the treatment. 23 The physician predesignated by the employer or designated 24 by the employee is required to provide ongoing written 25 documentation of the physician’s opinions, treatment 26 recommendations, and care plan to the employee along with 27 information about whether the opinions, recommendations, and 28 care plan are in accord with either the official disability 29 guidelines and treatment guidelines in workers’ compensation 30 published by the work loss data institute or the American 31 college of occupational and environmental medicine practice 32 guidelines (ACOEM), and if so, citation to the appropriate 33 guidelines. The employee has the right to request and obtain 34 a second opinion from another licensed physician of the 35 -10- LSB 1181HH (3) 85 av/rj 10/ 14

H.F. 274 employee’s choosing at the employer’s expense. 1 If the employer or employee is dissatisfied with the care 2 of a treating physician predesignated or designated by the 3 other party or with any referral made by that physician, the 4 employer and employee may mutually agree to alternate care. If 5 they cannot agree on alternate care, either party may notify 6 an insurance claims specialist within the division of workers’ 7 compensation, who shall, within five working days, schedule 8 a conference between the parties to review the basis for 9 dissatisfaction and provide an advisory opinion to resolve the 10 dispute. If the parties still cannot agree on alternate care 11 after this conference, the workers’ compensation commissioner 12 may, upon application and reasonable proof of the necessity, 13 allow and order alternate care. 14 The employee is responsible to make the application for 15 alternate care and to provide such reasonable proof to the 16 commissioner if the employer provided written information 17 about the state’s workers’ compensation laws at the time of 18 notification of the employee’s injury, and predesignated a 19 treating physician listed on the state registry of workplace 20 injury care providers, and if the treating physician 21 predesignated by the employer provided written documentation 22 to the employee of the physician’s opinions, treatment 23 recommendations, and care plan along with citation to the 24 appropriate treatment guidelines. 25 The employer is responsible for making the application for 26 alternate care and providing reasonable proof if the employer 27 and predesignated treating physician did not act as described 28 above or if the employee designated the treating physician to 29 treat the work injury. 30 The commissioner is not bound by the advisory opinion of 31 the claims specialist and must conduct a hearing and issue 32 a decision within 10 days of receipt of an application for 33 alternate care. 34 The employer has the right to request an employee to submit, 35 -11- LSB 1181HH (3) 85 av/rj 11/ 14

H.F. 274 as often as is reasonable and at a reasonable time and place 1 to an examination by a licensed physician chosen by the 2 employer for any purpose relevant to the employer’s duties to 3 provide benefits to the employee under the state’s workers’ 4 compensation laws and at the employer’s expense. If the 5 employer makes the request in writing and pays all expenses, 6 including transportation, the employee shall submit to the 7 examination. Each time that the employer obtains an evaluation 8 of an employee’s permanent disability by a physician chosen by 9 the employer, if the employee believes that the evaluation of 10 disability is too low, the employee may obtain a subsequent 11 examination and evaluation by a physician of the employee’s 12 choosing at the employer’s expense, including transportation 13 expenses to and from the place of the examination. 14 PROVIDER REGISTRIES —— FEES —— MEDICAL DIRECTOR. New Code 15 section 85.73 requires the workers’ compensation commissioner 16 to establish and maintain a registry of licensed physicians 17 that offer or provide treatment of work-related injuries. 18 The commissioner shall, by administrative rule, establish 19 requirements for a physician to be listed on the registry and 20 establish a registration fee. The provision shall not be 21 construed to require a physician to be listed on the registry 22 in order to offer or provide treatment of work-related injuries 23 or to prohibit an employer or employee from predesignating or 24 designating a physician to provide treatment who is not listed 25 on the registry. 26 New Code section 85.74 requires the commissioner to 27 establish and maintain a separate registry of licensed 28 physicians trained to perform independent medical evaluations 29 and to issue impairment ratings of injured employees. The 30 commissioner shall establish, by administrative rule, minimum 31 training requirements for a physician to be listed on the 32 registry and establish a fee. A physician must be listed 33 on the registry in order to perform independent medical 34 evaluations and issue impairment ratings of injured employees 35 -12- LSB 1181HH (3) 85 av/rj 12/ 14

H.F. 274 in this state. The commissioner may prohibit an employer 1 or employee from using an independent medical evaluation or 2 impairment rating of an injured employee from a physician who 3 is not listed on the registry as evidence at a hearing to 4 determine benefits under the state’s workers’ compensation 5 laws. 6 New Code section 85.76 authorizes the commissioner to 7 retain the services of a medical director to assist the 8 division of workers’ compensation in advancing the field of 9 occupational health in Iowa and to advise the commissioner on 10 how to successfully apply and administer the state’s workers’ 11 compensation laws. 12 STATE WORKPLACE INJURY CARE PROVIDERS REGISTRY FUND. All 13 registration fees collected pursuant to new Code sections 85.73 14 and 85.74 shall be credited to the state workplace injury care 15 providers registry fund created in new Code section 85.77 and 16 are appropriated to the division of workers’ compensation by 17 new Code section 85.75 to carry out the provisions of new Code 18 sections 85.73, 85.74, 85.75, 85.76, and 85.78, including 19 establishing and maintaining the two physician registries, 20 retaining a medical director, and for the expenses of the 21 workers’ compensation advisory council created in new Code 22 section 85.78. 23 WORKERS’ COMPENSATION ADVISORY COUNCIL. New Code section 24 85.78 establishes a workers’ compensation advisory council 25 within the division of workers’ compensation that is composed 26 of six members, three representing employers and three 27 representing organized labor. The governor appoints two of the 28 members, the president and the minority leader of the senate 29 jointly appoint two members, and the speaker and the minority 30 leader of the house of representatives jointly appoint two 31 members. The members serve six-year staggered terms, except 32 that for the initial terms beginning on January 1, 2014, one 33 member appointed by the governor, one member representing 34 employers, and one member representing organized labor shall 35 -13- LSB 1181HH (3) 85 av/rj 13/ 14

H.F. 274 be appointed for three-year terms to ensure that members serve 1 staggered terms. The purpose of the council is to assist 2 the workers’ compensation commissioner in the successful 3 administration of the division of workers’ compensation and to 4 make recommendations to the governor and the general assembly 5 regarding workplace safety and improvements to the state’s 6 workers’ compensation system. 7 EFFECTIVE DATES. The sections of the bill creating the 8 provider registry for treatment of work injuries, the provider 9 registry fund, the position of medical director, and the 10 advisory council, and appropriating fees, take effect January 11 1, 2014. The sections of the bill pertaining to alternate care 12 procedures and required registration of physicians performing 13 independent medical evaluations and impairment ratings take 14 effect July 1, 2014. 15 -14- LSB 1181HH (3) 85 av/rj 14/ 14