Bill Text: MI SB0693 | 2013-2014 | 97th Legislature | Introduced
Bill Title: Worker's compensation; benefits; reimbursement for physical therapy services; allow employer to withhold unless patient has a prescription from a licensed health professional. Amends sec. 315 of 1969 PA 317 (MCL 418.315). TIE BAR WITH: SB 0690'13
Spectrum: Moderate Partisan Bill (Republican 7-1)
Status: (Passed) 2014-07-16 - Assigned Pa 0264'14 With Immediate Effect [SB0693 Detail]
Download: Michigan-2013-SB0693-Introduced.html
SENATE BILL No. 693
November 14, 2013, Introduced by Senators HILDENBRAND, MOOLENAAR, PAPPAGEORGE, WARREN, GREEN, MEEKHOF, CASPERSON and BRANDENBURG and referred to the Committee on Insurance.
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 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 professional as that term
is defined in section 17801 of the public health code, 1978 PA 368,
MCL 333.17801. 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.
