Bill Amendment: IL SB0012 | 2017-2018 | 100th General Assembly

NOTE: For additional amemendments please see the Bill Drafting List

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Bill Title: WORKERS' COMP-VARIOUS

Status: 2019-01-09 - Session Sine Die [SB0012 Detail]

Download: Illinois-2017-SB0012-Senate_Amendment_003.html

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Sen. Christine Radogno

Filed: 3/1/2017

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AMENDMENT TO SENATE BILL 12
AMENDMENT NO. ______. Amend Senate Bill 12 on page 10, line
23, by deleting "1,"; and
on page 10, line 23, by deleting "8.7,"; and
on page 10, line 24, by changing "14.3" to "29.3"; and
by deleting all of pages 11 through 18; and
on page 19, by deleting lines 1 through 15; and
on page 26, by replacing lines 1 and 2 with the following:
"lasts more than 5 scheduled 3 working days for the claimant,
weekly compensation as hereinafter provided shall be paid
beginning on the 6th 4th day"; and
on page 29, line 20, by changing "$755.22" to "$775.18"; and

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on page 45, by replacing lines 16 and 17 with the following:
"fingers, leg, foot, or any toes, or loss under Section 8(d)2
due to accidental injuries to the same part of the spine, such
loss or partial loss of any such member or loss under Section
8(d)2 due to accidental injuries to the same part of the spine
shall be deducted from any award made"; and
on page 45, line 20, by replacing "eye" with "eye or loss under
Section 8(d)2 due to accidental injuries to the same part of
the spine"; and
on page 45, line 22, by inserting immediately following the
period the following:
"For purposes of this subdivision (e)17 only, "same part of the
spine" means: (1) cervical spine and thoracic spine from
vertebra C1 through T12 and (2) lumbar and sacral spine and
coccyx from vertebra L1 through S5."; and
on page 46, by replacing lines 6 through 21 with the following:
"members, and in a subsequent independent accident loses
another or suffers the permanent and complete loss of the use
of any one of such members the employer for whom the injured
employee is working at the time of the last independent
accident is liable to pay compensation only for the loss or
permanent and complete loss of the use of the member occasioned

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by the last independent accident."; and
by replacing lines 15 through 25 of page 57 and lines 1 through
22 of page 58 with the following:
"(a) A physician licensed to practice medicine in all of
its branches preparing a permanent partial disability
impairment report shall report the level of impairment in
writing. The report shall include an evaluation of medically
defined and professionally appropriate measurements of
impairment that include, but are not limited to: loss of range
of motion; loss of strength; measured atrophy of tissue mass
consistent with the injury; and any other measurements that
establish the nature and extent of the impairment. The most
current edition of the American Medical Association's "Guides
to the Evaluation of Permanent Impairment" shall be used by the
physician in determining the level of impairment. A report
under this subsection may be waived by joint written agreement
of the parties.
(b) Where an impairment report pursuant to subsection (a)
exists, it must be considered by the Commission in its
determination of the level of permanent partial disability.
In determining the level of permanent partial disability,
the Commission shall base its determination on the reported
level of impairment pursuant to subsection (a). In addition to
any impairment report submitted, the Commission may, by a
preponderance of credible evidence, use the following

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additional factors to determine disability: (i) the occupation
of the injured employee; (ii) the age of the employee at the
time of the injury; (iii) the employee's future earning
capacity; and (iv) evidence of disability at maximum medical
improvement corroborated by objective findings in the treating
medical records and independent medical exams. In determining
the level of permanent partial disability, the Commission may
base its determination on a report of impairment, after
considering by a preponderance of credible evidence, the
additional factors to determine disability.
(c) A report of impairment prepared pursuant to subsection
(a) is not required for the arbitrator or Commission to approve
a Settlement Contract Lump Sum Petition.
(b) In determining the level of permanent partial
disability, the Commission shall base its determination on the
following factors: (i) the reported level of impairment
pursuant to subsection (a); (ii) the occupation of the injured
employee; (iii) the age of the employee at the time of the
injury; (iv) the employee's future earning capacity; and (v)
evidence of disability corroborated by the treating medical
records. No single enumerated factor shall be the sole
determinant of disability. In determining the level of
disability, the relevance and weight of any factors used in
addition to the level of impairment as reported by the
physician must be explained in a written order."; and

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on page 61, by inserting after line 7 the following:
The provisions of this subsection (a), other than this
sentence, are inoperative after August 31, 2017.
on page 64, by inserting after line 18 the following:
The provisions of this subsection (a-1), other than this
sentence, are inoperative after August 31, 2017.
(a-1.5) The following provisions apply to procedures,
treatments, services, products, and supplies covered under
this Act and rendered or to be rendered on or after September
1, 2017:
(1) In this Section:
"CPT code" means each Current Procedural Terminology
code, for each geographic region specified in subsection
(b) of this Section, included on the most recent medical
fee schedule established by the Commission pursuant to this
Section.
"DRG code" means each current diagnosis related group
code, for each geographic region specified in subsection
(b) of this Section, included on the most recent medical
fee schedule established by the Commission pursuant to this
Section.
"Geozip" means a three-digit zip code based on data
similarities, geographical similarities, and frequencies.
"Health care services" means those CPT and DRG codes
for procedures, treatments, products, services or supplies

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for hospital inpatient, hospital outpatient, emergency
room, ambulatory surgical treatment centers, accredited
ambulatory surgical treatment facilities, and professional
services. It does not include codes classified as
healthcare common procedure coding systems or dental.
"Medicare maximum fee" means, for each CPT and DRG
code, the current maximum fee for that CPT or DRG code
allowed to be charged by the Centers for Medicare and
Medicaid Services for Medicare patients in that geographic
region. The Medicare maximum fee shall be the greater of
(i) the current maximum fee allowed to be charged by the
Centers for Medicare and Medicaid Services for Medicare
patients in the geographic region or (ii) the maximum fee
charged by the Centers for Medicare and Medicaid Services
for Medicare patients in the geographic region on January
1, 2017.
"Medicare percentage amount" means, for each CPT and
DRG code, the workers' compensation maximum fee as a
percentage of the Medicare maximum fee.
"Workers' compensation maximum fee" means, for each
CPT and DRG code, the current maximum fee allowed to be
charged under the medical fee schedule established by the
Commission for that CPT or DRG code in that geographic
region.
(2) The Commission shall establish and maintain fee
schedules for procedures, treatments, products, services,

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or supplies for hospital inpatient, hospital outpatient,
emergency room, ambulatory surgical treatment centers,
accredited ambulatory surgical treatment facilities,
prescriptions filled and dispensed outside of a licensed
pharmacy, dental services, and professional services.
These fee schedule amounts shall be grouped into geographic
regions in the following manner:
(A) Four regions for non-hospital fee schedule
amounts shall be utilized:
(i) Cook County;
(ii) DuPage, Kane, Lake, and Will Counties;
(iii) Bond, Calhoun, Clinton, Jersey,
Macoupin, Madison, Monroe, Montgomery, Randolph,
St. Clair, and Washington Counties; and
(iv) All other counties of the State.
(B) Fourteen regions for hospital fee schedule
amounts shall be utilized:
(i) Cook, DuPage, Will, Kane, McHenry, DeKalb,
Kendall, and Grundy Counties;
(ii) Kankakee County;
(iii) Madison, St. Clair, Macoupin, Clinton,
Monroe, Jersey, Bond, and Calhoun Counties;
(iv) Winnebago and Boone Counties;
(v) Peoria, Tazewell, Woodford, Marshall, and
Stark Counties;
(vi) Champaign, Piatt, and Ford Counties;

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(vii) Rock Island, Henry, and Mercer Counties;
(viii) Sangamon and Menard Counties;
(ix) McLean County;
(x) Lake County;
(xi) Macon County;
(xii) Vermilion County;
(xiii) Alexander County; and
(xiv) All other counties of the State.
If a geozip overlaps into one or more of the regions
set forth in this Section, then the Commission shall
average or repeat the charges and fees in a geozip in order
to designate charges and fees for each region.
(3) The initial workers' compensation maximum fee for
each CPT and DRG code as of September 1, 2017 shall be
determined as follows:
(A) Within 45 days after the effective date of this
amendatory Act of the 100th General Assembly, the
Commission shall determine the Medicare percentage
amount for each CPT and DRG code using the most recent
data available.
CPT or DRG codes which have a value, but are not
covered expenses under Medicare, are still compensable
under the medical fee schedule according to the rate
described in Section (B).
(B) Within 30 days after the Commission makes the
determinations required by subdivision (3)(A) of this

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subsection (a-1.5), the Commission shall determine an
adjustment to be made to the workers' compensation
maximum fee for each CPT and DRG code as follows:
(i) If the Medicare percentage amount for that
CPT or DRG code is equal to or less than 125%, then
the workers' compensation maximum fee for that CPT
or DRG code shall be adjusted so that it equals
125% the most recent Medicare maximum fee for that
CPT or DRG code.
(ii) If the Medicare percentage amount for
that CPT or DRG code is greater than 125% but less
than 150%, then the workers' compensation maximum
fee for that CPT or DRG code shall not be adjusted.
(iii) If the Medicare percentage amount for
that CPT or DRG code is greater than 150% but less
than or equal to 225%, then the workers'
compensation maximum fee for that CPT or DRG code
shall be adjusted so that it equals the greater of
(I) 150% of the most recent Medicare maximum fee
for that CPT or DRG code or (II) 80% of the most
recent workers' compensation maximum amount for
that CPT or DRG code.
(iv) If the Medicare percentage amount for
that CPT or DRG code is greater than 225% but less
than or equal to 428.57%, then the workers'
compensation maximum fee for that CPT or DRG code

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shall be adjusted so that it equals the greater of
(I) 191.25% of the most recent Medicare maximum fee
for that CPT or DRG code or (II) 70% of the most
recent workers' compensation maximum amount for
that CPT or DRG code.
(v) If the Medicare percentage amount for that
CPT or DRG code is greater than 428.57%, then the
workers' compensation maximum fee for that CPT or
DRG code shall be adjusted so that it equals 275%
of the most recent Medicare maximum fee for that
CPT or DRG code.
The Commission shall promptly publish the
adjustments determined pursuant to this subdivision
(3)(B) on its website.
(C) The initial workers' compensation maximum fee
for each CPT and DRG code as of September 1, 2017 shall
be equal to the workers' compensation maximum fee for
that code as determined and adjusted pursuant to
subdivision (3)(B) of this subsection, subject to any
further adjustments pursuant to subdivision (5) of
this subsection.
(4) The Commission, as of September 1, 2018 and
September 1 of each year thereafter, shall adjust the
workers' compensation maximum fee for each CPT or DRG code
to exactly half of the most recent annual increase in the
Consumer Price Index-U.

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(5) A person who believes that the workers'
compensation maximum fee for a CPT or DRG code, as
otherwise determined pursuant to this subsection, creates
or would create upon implementation a significant
limitation on access to quality health care in either a
specific field of health care services or a specific
geographic limitation on access to health care may petition
the Commission to modify the workers' compensation maximum
fee for that CPT or DRG code so as to not create that
significant limitation.
The petitioner bears the burden of demonstrating, by a
preponderance of the credible evidence, that the workers'
compensation maximum fee that would otherwise apply would
create a significant limitation on access to quality health
care in either a specific field of health care services or
a specific geographic limitation on access to health care.
Petitions shall be made publicly available. Such credible
evidence shall include empirical data demonstrating a
significant limitation on access to quality health care.
Other interested persons may file comments or responses to
a petition within 30 days of the filing of a petition.
The Commission shall take final action on each petition
within 180 days of filing. The Commission may, but is not
required to, seek the recommendation of the Medical Fee
Advisory Board to assist with this determination. If the
Commission grants the petition, the Commission shall

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further increase the workers' compensation maximum fee for
that CPT or DRG code by the amount minimally necessary to
avoid creating a significant limitation on access to
quality health care in either a specific field of health
care services or a specific geographic limitation on access
to health care. The increased workers' compensation
maximum fee shall take effect upon entry of the
Commission's final action."; and
on page 64, line 24, by inserting after the period the
following:
The provisions of this subsection (a-2), other than this
sentence, are inoperative after August 31, 2017.
by deleting lines 25 and 26 of page 64 and all of page 65; and
on page 66, by replacing lines 1 through 15 with the following:
"(a-3) Prescriptions, other than custom compound
medications, filled and dispensed outside of a licensed
pharmacy shall be subject to a fee schedule that shall not
exceed the Average Wholesale Price (AWP) plus a dispensing fee
of $4.18. AWP or its equivalent as registered by the National
Drug Code shall be set forth for that drug on that date as
published in Medi-Span. Custom compound medications are
governed by subsection (a-4).
(a-4) As used in this Section:

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"Custom compound medication" means a customized medication
prescribed or ordered by a duly licensed prescriber for the
specific patient that is prepared in a pharmacy by a licensed
pharmacist in response to a licensed prescriber's prescription
or order by combining, mixing, or altering of ingredients, but
not reconstituting, to meet the unique needs of an individual
patient. A custom compound medication does not include a drug
reconstituted pursuant to a manufacturer's direction nor does
it include the sole act of tablet splitting or crushing,
capsule opening, or the addition of a flavoring agent to
enhance palatability.
A custom compound medication shall be approved for payment
only if the custom compound medication meets all of the
following standards:
(1) there is no readily available commercially
manufactured therapeutically equivalent product;
(2) no other Food and Drug Administration-approved
alternative drug or combination of readily available drugs
is appropriate for the patient;
(3) the active ingredients of the custom compound
medication each have a National Drug Code (NDC) number, are
components of drugs approved by the Food and Drug
Administration, and the active ingredients in the custom
compound medication are being used to treat conditions for
which the component drugs have been approved for use by the
Food and Drug Administration;

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(4) no component of the custom compound medication has
been withdrawn or removed from the market for safety
reasons; and
(5) the prescriber is able to demonstrate to the payer
that the custom compound medication is reasonable and
necessary.
The Average Wholesale Price (AWP) for the specific amount
of each component, as identified by its National Drug Code
(NDC) from the original labeler, shall be used to determine the
maximum reimbursement of a custom compound medication meeting
the standards of subsection (a-5). A single dispensing fee for
a custom compound medication shall be based on the actual costs
of preparing and dispensing the custom compound medication as
determined by the Commission. The dispensing fee for a custom
compound medication shall be billed with code WC 700-C.
This Section is subject to the other provisions of this Act
including, but not limited to, Section 8.7.
The changes to this Section made by this amendatory Act of
the 100th General Assembly apply to compounding medications
provided on or after the effective date of this amendatory Act
of the 100th General Assembly.
(a-5) Notwithstanding any other provision of this Section,
on or before March 1, 2018 and on or before March 1 of each
subsequent year, the Commission must investigate all
procedures, treatments, and services covered under this Act for
ambulatory surgical treatment centers and accredited

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ambulatory surgical treatment facilities and establish fee
schedule amounts for procedures, treatments, and services for
which fee schedule amounts have not been established. The
Commission must adopt, in a timely and ongoing manner, all
rules necessary to ensure that its responsibilities under this
subsection are carried out.
(a-3) Prescriptions filled and dispensed outside of a
licensed pharmacy shall be subject to a fee schedule that shall
not exceed the Average Wholesale Price (AWP) plus a dispensing
fee of $4.18. AWP or its equivalent as registered by the
National Drug Code shall be set forth for that drug on that
date as published in Medispan."; and
by deleting lines 22 through 25 of page 73, all of pages 74
through 80, and lines 1 through 12 of page 81; and
by deleting lines 18 through 25 of page 86, all of pages 87 and
88, and lines 1 through 7 of page 89; and
by replacing lines 20 through 26 of page 92 and lines 1 through
23 of page 93 with the following:
"Whether the employee is working or not, if the employee is
not receiving or has not received medical, surgical, or
hospital services or other services or compensation as provided
in paragraph (a) of Section 8, or compensation as provided in
paragraph (b) of Section 8, or if the employer has refused or

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failed to respond to a written request for authorization of
medical care and treatment, the employee may at any time
petition for an expedited hearing by an Arbitrator on the issue
of whether or not he or she is entitled to receive payment of
the services or compensation or authorization of medical care.
Provided the employer continues to pay compensation pursuant to
paragraph (b) of Section 8, the employer may at any time
petition for an expedited hearing on the issue of whether or
not the employee is entitled to receive medical, surgical, or
hospital services or other services or compensation as provided
in paragraph (a) of Section 8, whether or not the employee is
entitled to authorization of medical care and treatment, or
compensation as provided in paragraph (b) of Section 8. When an
employer has petitioned for an expedited hearing, the employer
shall continue to pay compensation as provided in paragraph (b)
of Section 8 unless the arbitrator renders a decision that the
employee is not entitled to the benefits that are the subject
of the expedited hearing or unless the employee's treating
physician has released the employee to return to work at his or
her regular job with the employer or the employee actually
returns to work at any other job. If the arbitrator renders a
decision that the employee is not entitled to the benefits or
medical care that is are the subject of the expedited hearing,
a petition for review filed by the employee shall receive the
same priority as if the employee had filed a petition for an
expedited hearing by an Arbitrator. Neither party shall be

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entitled to an expedited hearing when the employee has returned
to work and the sole issue in dispute amounts to less than 12
weeks of unpaid compensation pursuant to paragraph (b) of
Section 8."; and
on page 113, by replacing lines 7 through 18 with the
following:
"(k) In a case where there has been any unreasonable or
vexatious delay of payment or intentional underpayment of
compensation, or proceedings have been instituted or carried on
by the one liable to pay the compensation, which do not present
a real controversy, but are merely frivolous or for delay, then
the Commission may award compensation additional to that
otherwise payable under this Act equal to 50% of the amount
payable at the time of such award. Failure to pay compensation
in accordance with the provisions of Section 8, paragraph (b)
of this Act, shall be considered unreasonable delay."; and
on page 131, by deleting lines 23 and 24; and
on page 131, line 25, by changing "(6)" to "(5)"; and
on page 132, line 2, by changing "(7)" to "(6)"; and
on page 132, line 12, by changing "(8)" to "(7)"; and

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on page 134, by replacing lines 14 through 17 with the
following:
"(820 ILCS 305/29.3 new)
Sec. 29.3. Workers' Compensation Transparency Task Force.
(a) There is created the Workers' Compensation
Transparency Task Force consisting of the following members:
(1) The Director of Insurance or his or her designee.
(2) The Chairman of the Illinois Workers' Compensation
Commission or his or her designee.
(3) One member of the House of Representatives
appointed by the Speaker of the House of Representatives.
(4) One member of the House of Representatives
appointed by the Minority Leader of the House of
Representatives.
(5) One member of the Senate appointed by the President
of the Senate.
(6) One member of the Senate appointed by the Minority
Leader of the Senate.
(b) The Task Force shall collect and review information and
data on the effects of the changes in workers' compensation law
enacted by the General Assembly. The purpose of the collection
and review of information under this Section is to make as
transparent as possible all information relating to the medical
treatment and benefits paid to injured workers in this State.
(c) In order to enable the Task Force to complete its

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purpose, insurers, advisory organizations, and medical
providers involved in the provision of services to persons
covered under the workers' compensation laws of this State
shall report data and information to the Task Force on an
annual basis.
(d) Insurers and advisory organizations shall report to the
Task Force the information required to be reported under
Section 29.2.
(e) Medical providers shall report workers' compensation
information including, but not limited to, the following:
(1) Gross revenue attributable to workers'
compensation care of injured workers.
(2) Expenses incurred in the medical treatment of
injured workers.
(3) The number of patients treated with respect to
workers' compensation claims.
(4) The time and resources expended on the medical
treatment of injured workers.
(5) Complaints registered with the licensing authority
for medical providers related to the treatment of injured
workers relating to the workers' compensation laws.
(6) Profits made as a result of the medical treatment
provided to injured workers.
(7) Any additional information that is determined by
the Task Force to be necessary for the effective analysis
of the effect of changes in workers' compensation laws.

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(f) The Task Force shall report its findings to the
Governor and General Assembly by March 31 of each year. The
findings in the report shall be based upon the information
reported to the Task Force by December 31 of the year preceding
the date of the report.
(g) The Task Force shall end its collection of information
on December 31, 2021 and issue its final report no later than
March 31, 2022.
(h) A person or entity that fails to comply with the
reporting requirements of this Section is subject to a civil
penalty of $100 per day for each category of information
required to be reported up to a maximum of $10,000. The
Attorney General may bring an action to enforce the penalty
authorized under this subsection. If a person or entity incurs
more than $10,000 in penalties under this subsection, the
license of the person or entity may be suspended.
(i) This Section is repealed on January 1, 2022.
Section 99. Effective date. This Act takes effect upon
becoming law, but this Act does not take effect at all unless
Senate Bills 1, 3, 4, 5, 6, 7, 8, 9, 10, 13, and 16 of the 100th
General Assembly become law.".