SB-0693, As Passed House, June 11, 2014

 

 

 

 

 

 

 

 

 

 

 

 

HOUSE SUBSTITUTE FOR

 

SENATE BILL NO. 693

 

 

 

 

 

 

 

 

 

 

 

 

     A bill to amend 1969 PA 317, entitled

 

"Worker's disability compensation act of 1969,"

 

by amending section 315 (MCL 418.315), as amended by 2011 PA 266.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 315. (1) The employer shall furnish, or cause to be

 

furnished, to an employee who receives a personal injury arising

 

out of and in the course of employment, reasonable medical,

 

surgical, and hospital services and medicines, or other attendance

 

or treatment recognized by the laws of this state as legal, when

 

they are needed. However, an employer is not required to reimburse

 

or cause to be reimbursed charges for an optometric service unless

 

that service was included in the definition of practice of

 

optometry under section 17401 of the public health code, 1978 PA

 

368, MCL 333.17401, as of May 20, 1992 or for a chiropractic

 

service unless that service was included in the definition of

 

practice of chiropractic under section 16401 of the public health

 

code, 1978 PA 368, MCL 333.16401, as of January 1, 2009. An

 

employer is not required to reimburse or cause to be reimbursed

 

charges for services performed by a profession that was not

 

licensed or registered by the laws of this state on or before

 

January 1, 1998, but that becomes licensed, registered, or

 

otherwise recognized by the laws of this state after January 1,

 

1998. An employer is not required to reimburse or cause to be

 

reimbursed charges for a physical therapy service unless that

 

service was provided by a licensed physical therapist or physical

 

therapist assistant under the supervision of a licensed physical

 

therapist pursuant to a prescription from a health care

 

professional who holds a license issued under part 166, 170, 175,

 

or 180 of the public health code, 1978 PA 368, MCL 333.16601 to

 

333.16648, 333.17001 to 333.17084, 333.17501 to 333.17556, and

 

333.18001 to 333.18058, or the equivalent license issued by another

 

state. Attendant or nursing care shall not be ordered in excess of

 

56 hours per week if the care is to be provided by the employee's

 

spouse, brother, sister, child, parent, or any combination of these

 

persons. After 28 days from the inception of medical care as

 

provided in this section, the employee may treat with a physician

 

of his or her own choice by giving to the employer the name of the

 

physician and his or her intention to treat with the physician. The

 

employer or the employer's carrier may file a petition objecting to

 

the named physician selected by the employee and setting forth

 

reasons for the objection. If the employer or carrier can show

 

cause why the employee should not continue treatment with the named

 

physician of the employee's choice, after notice to all parties and

 

a prompt hearing by a worker's compensation magistrate, the

 

worker's compensation magistrate may order that the employee

 

discontinue treatment with the named physician or pay for the

 

treatment received from the physician from the date the order is

 

mailed. The employer shall also supply to the injured employee

 

dental service, crutches, artificial limbs, eyes, teeth,

 

eyeglasses, hearing apparatus, and other appliances necessary to

 

cure, so far as reasonably possible, and relieve from the effects

 

of the injury. If the employer fails, neglects, or refuses so to

 

do, the employee shall be reimbursed for the reasonable expense

 

paid by the employee, or payment may be made in behalf of the

 

employee to persons to whom the unpaid expenses may be owing, by

 

order of the worker's compensation magistrate. The worker's

 

compensation magistrate may prorate attorney fees at the contingent

 

fee rate paid by the employee.

 

     (2) Except as otherwise provided in subsection (1), all fees

 

and other charges for any treatment or attendance, service,

 

devices, apparatus, or medicine under subsection (1), are subject

 

to rules promulgated by the workers' compensation agency pursuant

 

to the administrative procedures act of 1969, 1969 PA 306, MCL

 

24.201 to 24.328. The rules promulgated shall establish schedules

 

of maximum charges for the treatment or attendance, service,

 

devices, apparatus, or medicine, which schedule shall be annually

 

revised. A health facility or health care provider shall be paid

 

either its usual and customary charge for the treatment or

 

attendance, service, devices, apparatus, or medicine, or the

 

maximum charge established under the rules, whichever is less.

 

     (3) The director of the workers' compensation agency shall

 

provide for an advisory committee to aid and assist in establishing

 

the schedules of maximum charges under subsection (2) for charges

 

or fees that are payable under this section. The advisory committee

 

shall be appointed by and serve at the pleasure of the director.

 

     (4) If a carrier determines that a health facility or health

 

care provider has made any excessive charges or required

 

unjustified treatment, hospitalization, or visits, the health

 

facility or health care provider shall not receive payment under

 

this chapter from the carrier for the excessive fees or unjustified

 

treatment, hospitalization, or visits, and is liable to return to

 

the carrier the fees or charges already collected. The workers'

 

compensation agency may review the records and medical bills of a

 

health facility or health care provider determined by a carrier to

 

not be in compliance with the schedule of charges or to be

 

requiring unjustified treatment, hospitalization, or office visits.

 

     (5) As used in this section, "utilization review" means the

 

initial evaluation by a carrier of the appropriateness in terms of

 

both the level and the quality of health care and health services

 

provided an injured employee, based on medically accepted

 

standards. A utilization review shall be accomplished by a carrier

 

pursuant to a system established by the workers' compensation

 

agency that identifies the utilization of health care and health

 

services above the usual range of utilization for the health care

 

and health services based on medically accepted standards and

 

provides for acquiring necessary records, medical bills, and other

 

information concerning the health care or health services.

 

     (6) By accepting payment under this chapter, a health facility

 

or health care provider shall be is considered to have consented to

 

submitting agreed to submit necessary records and other information

 

concerning health care or health services provided for utilization

 

review pursuant to this section. The health facilities and health

 

care providers shall be are considered to have agreed to comply

 

with any decision of the workers' compensation agency pursuant to

 

subsection (7). A health facility or health care provider that

 

submits false or misleading records or other information to a

 

carrier or the workers' compensation agency is guilty of a

 

misdemeanor punishable by a fine of not more than $1,000.00 or by

 

imprisonment for not more than 1 year, or both.

 

     (7) If it is determined by a carrier determines that a health

 

facility or health care provider improperly overutilized or

 

otherwise rendered or ordered inappropriate health care or health

 

services, or that the cost of the health care or health services

 

was inappropriate, the health facility or health care provider may

 

appeal the determination to the workers' compensation agency

 

regarding that determination pursuant to procedures provided for

 

under the system of utilization review.

 

     (8) The workers' compensation agency shall establish criteria

 

or standards established for the for utilization review shall be

 

established by rules promulgated by the workers' compensation

 

agency. by rule. A carrier that complies with the criteria or

 

standards as determined by the workers' compensation agency shall

 

be certified by the department.

 

     (9) If a health facility or health care provider provides

 

health care or a health service that is not usually associated

 

with, is longer in duration in time than, is more frequent than, or

 

extends over a greater number of days than that health care or

 

service usually does with requires for the diagnosis or condition

 

for which the patient is being treated, the carrier may require the

 

health facility or health care provider may be required by the

 

carrier to explain the necessity or indication for the reasons why

 

that care or service in writing.

 

     Enacting section 1. This amendatory act does not take effect

 

unless Senate Bill No. 690 of the 97th Legislature is enacted into

 

law.