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_005.html

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Sen. Christine Radogno

Filed: 5/17/2017

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AMENDMENT TO SENATE BILL 12
AMENDMENT NO. ______. Amend Senate Bill 12 on page 10, line
15, after "pursuant", by inserting "to"; and
on page 10, by replacing lines 23 and 24 with the following:
"changing Sections 1, 8, 8.1b, 8.2, 8.2a, 14, 19, 25.5, and
29.2 as follows:"; and
by replacing line 4 on page 17 through line 13 on page 19 with
the following:
"In determining whether an employee is required to travel
for the performance of job duties, the following factors shall
be considered: whether the employer had knowledge that the
employee may be required to travel to perform the job; whether
the employer furnished any mode of transportation to or from
the employee; whether the employee received, or the employer
paid or agreed to pay, any remuneration or reimbursement for
costs or expenses of any form of travel; whether the employer

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in any way directed the course or method of travel; whether the
employer in any way assisted the employee in making any travel
arrangements; whether the employer furnished lodging or in any
way reimbursed the employee for lodging; and whether the
employer received any benefit from the employee traveling.";
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
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

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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
by the last independent accident."; and
on page 58, by replacing lines 2 through 22 with the following:
"(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 shall, by a
preponderance of credible evidence, consider the following
additional factors to determine disability: (i) the occupation
of the injured employee; (ii) the age of the employee at the

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time of the injury; (iii) the employee's future earning
capacity; and (iv) evidence of disability at maximum medical
improvement corroborated by 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. 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.
(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

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physician must be explained in a written order."; and
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."; and
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.

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"Health care services" means those CPT and DRG codes
for procedures, treatments, products, services or supplies
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.

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(2) The Commission shall establish and maintain fee
schedules for procedures, treatments, products, services,
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

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Stark Counties;
(vi) Champaign, Piatt, and Ford Counties;
(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).

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(B) Within 30 days after the Commission makes the
determinations required by subdivision (3)(A) of this
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% of 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) 85% 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

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than or equal to 428.57%, then the workers'
compensation maximum fee for that CPT or DRG code
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 300%
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

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to exactly half of the most recent annual increase in the
Consumer Price Index-U.
(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

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Advisory Board to assist with this determination. If the
Commission grants the petition, the Commission shall
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."; and
by deleting lines 25 and 26 of page 64 and all of page 65; 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:

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"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
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

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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
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 122, line 6, after "pursuant", by inserting "to"; and
by replacing line 23 on page 131 through line 13 on page 132

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with the following:
"(5) The growth of total paid indemnity benefits by
temporary total disability, scheduled and non-scheduled
permanent partial disability, and total disability.
(6) Illinois' rank, relative to other states, for:
(i) the maximum and minimum temporary total
disability benefit levels;
(ii) the maximum and minimum scheduled and
non-scheduled permanent partial disability benefit
levels;
(iii) the maximum and minimum total disability
benefit levels; and
(iv) the maximum and minimum death benefit levels.
(7) The aggregate growth of medical benefit payouts by
non-hospital providers and hospitals."; and
on page 134, by replacing lines 14 through 17 with the
following:
"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.".