Bill Text: MI SB1379 | 2011-2012 | 96th Legislature | Introduced
Bill Title: Worker's compensation; employers; authority to refuse reimbursement for certain services; eliminate. Amends sec. 315 of 1969 PA 317 (MCL 418.315).
Spectrum: Partisan Bill (Republican 2-0)
Status: (Introduced - Dead) 2012-11-27 - Referred To Committee On Insurance [SB1379 Detail]
Download: Michigan-2011-SB1379-Introduced.html
SENATE BILL No. 1379
November 27, 2012, Introduced by Senators NOFS and JANSEN 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. 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 considered to have consented to
submitting 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 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 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 to the
workers' compensation agency regarding that determination pursuant
to procedures provided for under the system of utilization review.
(8) The criteria or standards established for the utilization
review shall be established by rules promulgated by the workers'
compensation agency. 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 the diagnosis or condition for which the
patient is being treated, the health facility or health care
provider may be required by the carrier to explain the necessity or
indication for the reasons why in writing.
