SB-0693, As Passed Senate, May 20, 2014

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 as provided in section 17820 of the public health

code, 1978 PA 368, MCL 333.17820. 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.