Rep. Norm Thurston — Voting Record

Bill

Number

S.B. 64 Second Substitute (2018GS)

Sponsor

Sen. Mayne, K.

Final action

Governor Signed 3/19/2018

Outcome

Became law — signed by Gov. Gary R. Herbert

Summary

What it does

• This bill:
• modifies the membership of the workers' compensation advisory council;
• amends a required report to the Business and Labor Interim Committee;
• authorizes the Labor Commission to use funds from the Industrial Accident Restricted Account for specific purposes;
• addresses the rate at which certain workers' compensation carriers and self-insured employers must reimburse a hospital for covered medical services; and
• makes technical and conforming changes.

Every vote on this bill

Bill text

WORKERS' COMPENSATION HEALTH CARE AMENDMENTS
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Karen Mayne
House Sponsor: 
James A. Dunnigan
LONG TITLE
General Description:
This bill amends provisions of the Workers' Compensation Act related to health care
providers.
Highlighted Provisions:
This bill:
▸ modifies the membership of the workers' compensation advisory council;
▸ amends a required report to the Business and Labor Interim Committee;
▸ authorizes the Labor Commission to use funds from the Industrial Accident
Restricted Account for specific purposes;
▸ addresses the rate at which certain workers' compensation carriers and self-insured
employers must reimburse a hospital for covered medical services; and
▸ makes technical and conforming changes.
Money Appropriated in this Bill:
None
Other Special Clauses:
None
Utah Code Sections Affected:
AMENDS:
34A-2-107
, as last amended by Laws of Utah 2017, Chapters 18 and 363
34A-2-407
, as last amended by Laws of Utah 2016, Chapter 242
34A-2-705
, as last amended by Laws of Utah 2011, Chapter 328
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 
34A-2-107
 is amended to read:
34A-2-107.
Appointment of workers' compensation advisory council --
Composition -- Terms of members -- Duties -- Compensation.
(1) The commissioner shall appoint a workers' compensation advisory council
composed of:
(a) the following voting members:
(i) five employer representatives; and
(ii) five employee representatives; and
(b) the following nonvoting members:
(i) a representative of the workers' compensation insurance carrier that provides
workers' compensation insurance under Section 
31A-22-1001
;
(ii) a representative of a workers' compensation insurance carrier different from the
workers' compensation insurance carrier listed in Subsection (1)(b)(i);
(iii) a representative of health care providers;
(iv) the Utah insurance commissioner or the insurance commissioner's designee; [
and
]
(v) the commissioner or the commissioner's designee[
.
]
; and
(vi) a representative of hospitals.
(2) Employers and employees shall consider nominating members of groups who
historically may have been excluded from the council, such as women, minorities, and
individuals with disabilities.
(3) (a) Except as required by Subsection (3)(b), as terms of current council members
expire, the commissioner shall appoint each new member or reappointed member to a two-year
term beginning July 1 and ending June 30.
(b) Notwithstanding the requirements of Subsection (3)(a), the commissioner shall, at
the time of appointment or reappointment, adjust the length of terms to ensure that the terms of
council members are staggered so that approximately half of the council is appointed every two
years.
(4) (a) When a vacancy occurs in the membership for any reason, the replacement shall
be appointed for the unexpired term.
(b) The commissioner shall terminate the term of a council member who ceases to be
representative as designated by the member's original appointment.
(5) The council shall confer at least quarterly for the purpose of advising the
commission, the division, and the Legislature on:
(a) the Utah workers' compensation and occupational disease laws;
(b) the administration of the laws described in Subsection (5)(a); and
(c) rules related to the laws described in Subsection (5)(a).
(6) Regarding workers' compensation, rehabilitation, and reemployment of employees
who acquire a disability because of an industrial injury or occupational disease the council
shall:
(a) offer advice on issues requested by:
(i) the commission;
(ii) the division; and
(iii) the Legislature; and
(b) make recommendations to:
(i) the commission; and
(ii) the division.
[
(7) The council shall study how hospital costs may be reduced for purposes of medical
benefits for workers' compensation. By no later than November 30, 2017, the council shall
submit, in accordance with Section 
68-3-14
, a written report to the Business and Labor Interim
Committee containing the council's recommendations.
]
(7) (a) The council shall:
(i) study how to reduce hospital costs for purposes of medical benefits for workers'
compensation;
(ii) study hospital billing and payment trends in the state;
(iii) study hospital fee schedules used in other states; and
(iv) collect information from third-party hospital bill review companies in the state or
region, to identify an average reimbursement rate that represents the approximate rate at which
a workers' compensation insurance carrier or self-insured employer should expect to reimburse
a hospital for billed hospital fees for covered medical services in the state.
(b) In accordance with Section 
68-3-14
, the council shall submit a written report to the
Business and Labor Interim Committee no later than September 1, 2019, 2020, and 2021. Each
written report shall include:
(i) recommendations on how to reduce hospital costs for purposes of medical benefits
for workers' compensation;
(ii) aggregate data on hospital billing and payment trends in the state;
(iii) the results of the council's study of hospital fee schedules from other states; and
(iv) the approximate rate at which a workers' compensation insurance carrier or
self-insured employer should expect to reimburse a hospital for billed hospital fees for covered
medical services, calculated in accordance with Subsection (7)(a)(iv).
(c) For each report described in Subsection (7)(b), the commission may contract with a
third-party expert to assist with the council's duties described in Subsections (7)(a) and (b).
(8) The commissioner or the commissioner's designee shall serve as the chair of the
council and call the necessary meetings.
(9) The commission shall provide staff support to the council.
(10) A member may not receive compensation or benefits for the member's service, but
may receive per diem and travel expenses in accordance with:
(a) Section 
63A-3-106
;
(b) Section 
63A-3-107
; and
(c) rules made by the Division of Finance pursuant to Sections 
63A-3-106
 and
63A-3-107
.
Section 2. Section 
34A-2-407
 is amended to read:
34A-2-407.
Reporting of industrial injuries -- Regulation of health care
providers.
(1) As used in this section, "physician" is as defined in Section 
34A-2-111
.
(2) (a) An employee sustaining an injury arising out of and in the course of
employment shall provide notification to the employee's employer promptly of the injury.
(b) If the employee is unable to provide the notification required by Subsection (2)(a),
the following may provide notification of the injury to the employee's employer:
(i) the employee's next of kin; or
(ii) the employee's attorney.
(c) An employee claiming benefits under this chapter or Chapter 3, Utah Occupational
Disease Act, shall comply with rules adopted by the commission regarding disclosure of
medical records of the employee medically relevant to the industrial accident or occupational
disease claim.
(3) (a) An employee is barred for any claim of benefits arising from an injury if the
employee fails to notify within the time period described in Subsection (3)(b):
(i) the employee's employer in accordance with Subsection (2); or
(ii) the division.
(b) The notice required by Subsection (3)(a) shall be made within:
(i) 180 days of the day on which the injury occurs; or
(ii) in the case of an occupational hearing loss, the time period specified in Section
34A-2-506
.
(4) The following constitute notification of injury required by Subsection (2):
(a) an employer's report filed with:
(i) the division; or
(ii) the employer's workers' compensation insurance carrier;
(b) a physician's injury report filed with:
(i) the division;
(ii) the employer; or
(iii) the employer's workers' compensation insurance carrier;
(c) a workers' compensation insurance carrier's report filed with the division; or
(d) the payment of any medical or disability benefits by:
(i) the employer; or
(ii) the employer's workers' compensation insurance carrier.
(5) (a) An employer and the employer's workers' compensation insurance carrier, if
any, shall file a report in accordance with the rules made under Subsection (5)(b) of a:
(i) work-related fatality; or
(ii) work-related injury resulting in:
(A) medical treatment;
(B) loss of consciousness;
(C) loss of work;
(D) restriction of work; or
(E) transfer to another job.
(b) An employer or the employer's workers' compensation insurance carrier, if any,
shall file a report required by Subsection (5)(a), and any subsequent reports of a previously
reported injury as may be required by the commission, within the time limits and in the manner
established by rule by the commission made after consultation with the workers' compensation
advisory council and in accordance with Title 63G, Chapter 3, Utah Administrative
Rulemaking Act. A rule made under this Subsection (5)(b) shall:
(i) be reasonable; and
(ii) take into consideration the practicality and cost of complying with the rule.
(c) A report is not required to be filed under this Subsection (5) for a minor injury, such
as a cut or scratch that requires first aid treatment only, unless:
(i) a treating physician files a report with the division in accordance with Subsection
(9); or
(ii) a treating physician is required to file a report with the division in accordance with
Subsection (9).
(6) An employer and its workers' compensation insurance carrier, if any, required to
file a report under Subsection (5) shall provide the employee with:
(a) a copy of the report submitted to the division; and
(b) a statement, as prepared by the division, of the employee's rights and
responsibilities related to the industrial injury.
(7) An employer shall maintain a record in a manner prescribed by the commission by
rule of all:
(a) work-related fatalities; or
(b) work-related injuries resulting in:
(i) medical treatment;
(ii) loss of consciousness;
(iii) loss of work;
(iv) restriction of work; or
(v) transfer to another job.
(8) (a) Except as provided in Subsection (8)(b), an employer or a workers'
compensation insurance carrier who refuses or neglects to make a report, maintain a record, or
file a report as required by this section is subject to a civil assessment:
(i) imposed by the division, subject to the requirements of Title 63G, Chapter 4,
Administrative Procedures Act; and
(ii) that may not exceed $500.
(b) An employer or workers' compensation insurance carrier is not subject to the civil
assessment under this Subsection (8) if:
(i) the employer or workers' compensation insurance carrier submits a report later than
required by this section; and
(ii) the division finds that the employer or workers' compensation insurance carrier has
shown good cause for submitting a report later than required by this section.
(c) (i) A civil assessment collected under this Subsection (8) shall be deposited into the
Uninsured Employers' Fund created in Section 
34A-2-704
 to be used for a purpose specified in
Section 
34A-2-704
.
(ii) The administrator of the Uninsured Employers' Fund shall collect money required
to be deposited into the Uninsured Employers' Fund under this Subsection (8)(c) in accordance
with Section 
34A-2-704
.
(9) (a) A physician attending an injured employee shall comply with rules established
by the commission regarding:
(i) fees for physician's services;
(ii) disclosure of medical records of the employee medically relevant to the employee's
industrial accident or occupational disease claim;
(iii) reports to the division regarding:
(A) the condition and treatment of an injured employee; or
(B) any other matter concerning industrial cases that the physician is treating; and
(iv) rules made under Section 
34A-2-407.5
.
(b) A physician who is associated with, employed by, or bills through a hospital is
subject to Subsection (9)(a).
(c) A hospital providing services for an injured employee is not subject to the
requirements of Subsection (9)(a) except for rules made by the commission that are described
in Subsection (9)(a)(ii) or (iii) or Section 
34A-2-407.5
.
(d) The commission's schedule of fees may reasonably differentiate remuneration to be
paid to providers of health services based on:
(i) the severity of the employee's condition;
(ii) the nature of the treatment necessary; and
(iii) the facilities or equipment specially required to deliver that treatment.
(e) This Subsection (9) does not prohibit a contract with a provider of health services
relating to the pricing of goods and services.
(10) A copy of the initial report filed under Subsection (9)(a)(iii) shall be furnished to:
(a) the division;
(b) the employee; and
(c) (i) the employer; or
(ii) the employer's workers' compensation insurance carrier.
(11) (a) As used in this Subsection (11):
(i) "Balance billing" means charging a person, on whose behalf a workers'
compensation insurance carrier or self-insured employer is obligated to pay medical benefits
under this chapter or Chapter 3, Utah Occupational Disease Act, for the difference between
what the workers' compensation insurance carrier or self-insured employer reimburses the
hospital for covered medical services and what the hospital charges for those covered medical
services.
(ii) "Covered medical services" means medical services provided by a hospital that are
covered by workers' compensation medical benefits under this chapter or Chapter 3, Utah
Occupational Disease Act.
(iii) "Health benefit plan" means the same as that term is defined in Section
31A-22-619.6
.
(iv) "Self-insured employer" means the same as that term is defined in Section
34A-2-201.5
.
(b) Subject to Subsection (11)(d), a workers' compensation insurance carrier or
self-insured employer may contract, either in writing or by mutual oral agreement, with a
hospital to establish reimbursement rates.
(c) Subject to Subsection (11)(d), for the time period beginning on May [
10, 2016
] 
8,
, and ending on July 1, [
] 
, a workers' compensation insurance carrier or
self-insured employer that is reimbursing a hospital [
that has not entered into a contract
described in Subsection (11)(b) shall reimburse the hospital
] for covered medical services [
at
85% of the billed hospital fees for the covered medical services.
] 
shall reimburse the hospital:
(i) in accordance with a contract described in Subsection (11)(b); or
(ii) (A) if the hospital is located in a county of the first, second, or third class, as
classified in Section 
17-50-501
, at 75% of the billed hospital fees for the covered medical
services; or
(B) if the hospital is located in a county of the fourth, fifth, or sixth class, as classified
in Section 
17-50-501
, at 85% of the billed hospital fees for the covered medical services.
(d) A hospital may not engage in balance billing.
(e) Covered services paid under a health benefit plan are subject to coordination of
benefits in accordance with Sections 
31A-22-619.6
 and 
34A-2-213
. 
(12) (a) Subject to appellate review under Section 
34A-1-303
, the commission has
exclusive jurisdiction to hear and determine:
(i) whether goods provided to or services rendered to an employee are compensable
pursuant to this chapter or Chapter 3, Utah Occupational Disease Act, including:
(A) medical, nurse, or hospital services;
(B) medicines; and
(C) artificial means, appliances, or prosthesis;
(ii) except for amounts charged or paid under Subsection (11), the reasonableness of
the amounts charged or paid for a good or service described in Subsection (12)(a)(i); and
(iii) collection issues related to a good or service described in Subsection (12)(a)(i).
(b) Except as provided in Subsection (12)(a), Subsection 
34A-2-211
(6), or Section
34A-2-212
, a person may not maintain a cause of action in any forum within this state other
than the commission for collection or payment for goods or services described in Subsection
(12)(a) that are compensable under this chapter or Chapter 3, Utah Occupational Disease Act.
Section 3. Section 
34A-2-705
 is amended to read:
34A-2-705.
Industrial Accident Restricted Account.
(1) As used in this section:
(a) "Account" means the Industrial Accident Restricted Account created by this
section.
(b) "Advisory council" means the state workers' compensation advisory council created
under Section 
34A-2-107
.
(2) There is created in the General Fund a restricted account known as the "Industrial
Accident Restricted Account."
(3) (a) The account is funded from:
(i) .5% of the premium income remitted to the state treasurer and credited to the
account pursuant to Subsection 
59-9-101
(2)(c)(iv); and
(ii) amounts deposited under Section 
34A-2-1003
.
(b) If the balance in the account exceeds $500,000 at the close of a fiscal year, the
excess shall be transferred to the Uninsured Employers' Fund created under Section 
34A-2-704
.
(4) (a) From money appropriated by the Legislature from the account to the
commission and subject to the requirements of this section, the commission may fund:
(i) the activities of the Division of Industrial Accidents described in Section
34A-1-202
;
(ii) the activities of the Division of Adjudication described in Section 
34A-1-202
;
[
and
]
(iii) the activities of the commission described in Section 
34A-2-1005
[
.
]
; and
(iv) the activities of the commission described in Subsection 
34A-2-107
(7)(c), up to
$50,000 for each of the three reports described in Subsection 
34A-2-107
(7)(b).
(b) The money deposited in the account may not be used for a purpose other than a
purpose described in this Subsection (4), including an administrative cost or another activity of
the commission unrelated to the account.
(5) (a) Each year before the public hearing required by Subsection 
59-9-101
(2)(d)(i),
the commission shall report to the advisory council regarding:
(i) the commission's budget request to the governor for the next fiscal year related to:
(A) the Division of Industrial Accidents; and
(B) the Division of Adjudication;
(ii) the expenditures of the commission for the fiscal year in which the commission is
reporting related to:
(A) the Division of Industrial Accidents; and
(B) the Division of Adjudication;
(iii) revenues generated from the premium assessment under Section 
59-9-101
 on an
admitted insurer writing workers' compensation insurance in this state and on a self-insured
employer under Section 
34A-2-202
; and
(iv) money deposited under Section 
34A-2-1003
.
(b) The commission shall annually report to the governor and the Legislature
regarding:
(i) the use of the money appropriated to the commission under this section;
(ii) revenues generated from the premium assessment under Section 
59-9-101
 on an
admitted insurer writing workers' compensation insurance in this state and on a self-insured
employer under Section 
34A-2-202
; and
(iii) money deposited under Section 
34A-2-1003
.