Bill
Number: S.B. 1407
Fann
Floor Amendment
Reference
to: printed bill
Amendment
drafted by: Leg Council
FLOOR
AMENDMENT EXPLANATION
1. Adds conditions for the
state, political subdivisions and self-insurance pools consisting of public
entities (employer) directing medical care for workers' compensation claims.
2. Requires an employer
directing care to establish a list of providers consisting of at least three
occupational health physicians within 25 miles of an urban employee's workplace
and 50 miles of a rural employee's workplace.
3. Allows rural employees
to receive care in the nearest urban metropolitan area where the needed medical
services can be provided.
4. Requires the physicians
to be specialized in treating workplace illnesses and injuries and board
certified or board eligible in their area of practice.
5. Requires the list of
providers to be:
a) available to workers at
all times:
b) provided to an employee
within one business day of request;
c) updated every 90 days;
and
d) posted on the
Industrial Commission (ICA) website.
6. Requires the employer,
upon notification of an injury, to:
a) provide for the worker
to be treated within 3 days;
b) deliver the list of
providers within 24 hours; and
c) provide the worker a
list of their rights within 24 hours.
7. Allows an injured
worker to receive emergency care without restrictions as to where and when the
emergency care is provided.
8. Allows a worker to
choose any physician from the list of providers if the employer has not
provided for treatment within 3 days or the worker is not satisfied with the
initial treating physician.
9. Allows a worker, whose
request for an alternating physician is denied by the employer, to:
a) appeal to the ICA;
b) seek treatment from any
provider on or off the list; and
c) receive compensation
for treatment if the worker prevails on appeal.
10. Allows a worker to use
their own physician if none of the physicians on the list are available within
proximity to the worker.
11. Expedites appeals
process for public safety employees.
12. Requires the ICA
Chairman to convene a public panel to make recommendations regarding
physicians, service areas and appeals processes.
13. Requires the panel to
consist of:
a) the ICA Chairman;
b) one member who
represents peace officers;
c) one member who
represents firefighters;
d) one member who
represents cities or towns;
e) one member who
represents counties;
f) one member who has
experience with insured entities that direct medical care;
g) two members who have
expertise in adjudicating workers' compensation claims for injured workers in
the public sector; and
h) two members who
represent school districts.
14. Delays implementation
of directed care to December 1, 2017.
15. Requires the ICA, upon
notification of an injury, to email a claim form to the employee or mail a copy
if the email is unknown.
16. Requires a working
member of an LLC, who owns less than 50 percent of the membership interest in
the LLC, to opt-in to workers' compensation coverage.
Page
4, between lines 37 and 38, insert:
"(q) A working member of a limited
liability company who owns less than fifty percent of the membership interest
in the limited liability company."
Reletter
to conform
Line
38, strike "less"
Line
39, strike "than twenty‑five" insert
"fifty"; after "percent"
insert "or more"
Page
6, strike lines 28 through 45
Page
7, strike lines 1 through 21, insert:
"Sec. 2. Title
23, chapter 6, article 3, Arizona Revised Statutes, is amended by adding
section 23-955, to read:
START_STATUTE23-955. Public
safety employees; request or stipulation for expedited hearing; notice; waiver
of change of administrative law judge
A. If a public safety
employee or the public safety employee's authorized agent files a request for a
hearing in connection with the public safety employee's medical benefits or a change
of physician request under section 23‑1074 that alleges, by affidavit,
that immediate and irreparable injury, loss or damage will result if the
hearing is not held before the time frames prescribed by this article or if the
claim involves a public safety employee and all interested parties, in person
or by the interested parties' authorized agents, stipulate in the request for a
hearing that the hearing should be held before the time frames prescribed by
this article, the commission shall:
1. Immediately notify
the parties if the request for an expedited hearing is granted and, if the
request is granted, of a hearing date that is not more than fifteen days after
the date of the notice.
2. If the parties
stipulate to the expedited hearing, immediately notify the parties of a hearing
date that is not more than fifteen days after the date of the notice.
3. Require the
administrative law judge to issue a determination on the matter and make an
award, if any, within five days after the hearing is complete.
B. An interested party
or the interested party's authorized agent who is granted an expedited hearing
pursuant to this section waives the interested party's right to a change of
administrative law judge and may not file a notice of or affidavit for a change
of administrative law judge pursuant to section 23‑941, subsection I or
J."END_STATUTE
Page
8, strike lines 29 through 45
Strike
pages 9 through 11
Page
12, strike lines 1 and 2
Renumber
to conform
Strike
lines 40 and 41, insert:
"C. If
the commission receives a notification of the injury form, the commission shall send e‑mail a claim form to the employee. If
the employee's e‑mail address is not available, the commission shall mail
the claim form to the address provided on the notification of injury form."
Reletter
to conform
Page
15, strike lines 20 through 43
Page
16, strike lines 1 through 13
Renumber
to conform
Page
17, after line 34, insert:
"Sec. 6. Title
23, chapter 6, article 9, Arizona Revised Statutes, is amended by adding
section 23-1074, to read:
START_STATUTE23-1074. Government
employers and self‑insurance pools; directed medical care; requirements;
alternative physicians; intergovernmental agreements; emergency care exception;
definitions
A. Beginning December
1, 2017, except as provided in subsection K of this section, This state, a
political subdivision of this state or a self‑insurance pool consisting
of public entities may direct medical care.
B. If this state, a
political subdivision of this state or a self‑insurance pool consisting
of public entities provides medical benefits in the manner specified in
subsection A of this section, this state, the political subdivision of this
state or the self‑insurance pool consisting of public entities shall:
1. Maintain a list of
providers that complies with all of the following:
(a) Consists
of Providers that are within the service area. Providers on the list shall be
board certified or eligible to be board certified in occupational health.
Providers on the list that are specialists shall be certified in the provider's
area of practice.
(b) Consists
of not less than three providers who are occupational health physicians and who
specialize in treating workplace illnesses and injuries.
(c) Is
available to workers at all times either on request or by posting the list on
its website. If a worker requests the list, this state, the political
subdivision of this state or the self‑insurance pool consisting of public
entities shall provide the list within one business day after receiving the
request.
(d) is
Updated and provided to the commission at least every ninety days. The
commission shall post on the commission's website the list of providers for
this state, each political subdivision of this state and each self-insurance
pool consisting of public entities.
2. Provide an injured
worker with the list of providers and the injured worker's rights under this
chapter within twenty‑four hours after notification of an injury or
illness that requires medical treatment and maintain a record of providing the
information required by this paragraph.
3. Within three days
after notification of an injury or illness that requires medical treatment,
provide for the injured worker to be treated by a physician. If
treatment is not scheduled within three days after the notification of the
injury or illness that requires medical treatment, the injured worker may
choose a physician from the list of providers and shall notify the employer of
the physician chosen.
C. If an injured worker
is not satisfied with the treating physician provided pursuant to subsection B,
paragraph 3 of this section, after the injured worker's initial visit, the
injured worker may choose an alternative treating physician from the list of
providers. To change to an alternative treating physician pursuant to this
subsection, within seven days after the initial visit, the injured worker shall
notify This state, the political subdivision of this state or the self‑insurance
pool consisting of public entities that the injured worker intends to choose an
alternative treating physician. This state, the political subdivision of this
state or the self‑insurance pool consisting of public entities may not
deny the injured worker's choice of alternative treating physician under this
subsection.
D. An injured worker
who chooses an alternative treating physician pursuant to subsection C of this
section shall notify This state, the political subdivision of this state or the
self‑insurance pool consisting of public entities of the alternative
treating physician chosen from the list of providers. If the injured worker
does not notify This state, the political subdivision of this state or the self‑insurance
pool consisting of public entities of the alternative treating physician chosen
within seven days after the date that the injured worker provides the notice of
intent pursuant to subsection C of this section, This state, the political
subdivision of this state or the self‑insurance pool consisting of public
entities may assign the injured worker an alternative treating physician.
E. An injured worker
who is not satisfied with the alternative treating physician chosen or assigned
pursuant to subsection C or D of this section shall obtain written
authorization from This state, the political subdivision of this state or the
self‑insurance pool consisting of public entities to choose a subsequent
alternative treating physician from the list of providers. If the
request to change to an alternative treating physician pursuant to this
subsection is denied, the injured worker may file a request to change to an
alternative treating physician with the commission.
F. For the purposes of
this section, none of the following constitutes the selection of an alternative
treating physician or a subsequent alternative treating physician:
1. A referral made by a
treating physician, including a referral for a second opinion.
2. The selection of a
treating physician because the initial treating physician either:
(a) Dies.
(b) Retires.
(c) Leaves
This state's, the political subdivision's of this state or the self‑insurance
pool's consisting of public entities network.
3. A change of treating
physician is required because of a change of address by the injured worker to a
location outside of the service area.
G. If none of the
physicians on the list of providers is available to treat the injured worker
within the service area, the injured worker may choose the injured worker's own
physician and shall notify this state, the political subdivision of this state
or the self‑insurance pool consisting of public entities of the physician
chosen.
H. If This state, a
political subdivision of this state or a self‑insurance pool consisting
of public entities denies the claim or terminates treatment, the injured worker
has the right during the appeal process to seek treatment from any
physician. If the injured worker prevails, This state, the political
subdivision of this state or the self‑insurance pool consisting of public
entities shall cover the injured worker's costs of treatment.
I. This state, A
political subdivision of this state or a self‑insurance pool consisting
of public entities may enter into intergovernmental agreements and other
agreements with other political subdivisions to establish or contract with
networks under this section.
J. If the service area
of this state, a political subdivision of this state or a self-insurance pool
consisting of public entities is adjacent to another state, the service area
may be expanded into that other state.
K. In the case of a
medical emergency, an injured worker may seek and receive emergency care
without restrictions as to where the emergency care is provided. An injured
worker who is receiving emergency care for a medical emergency and who is
discharged from the medical facility because the injured worker's injuries or
illness is stabilized but still requires ongoing medical treatment shall notify
this state, the political subdivision of this state or the self‑insurance
pool consisting of public entities within one business day after the injured
worker's discharge that ongoing medical treatment is required. The ongoing
medical treatment shall be provided pursuant to subsection A of this section.
L. In a rural area, if
the nearest physician on the list of providers is more than fifty miles from
the injured worker's residence, the injured worker may file a request with this
state, the political subdivision of this state or the self‑insurance pool
consisting of public entities to receive treatment from a physician who is
closer to the injured worker's residence.
M. For the purposes of
this section:
1. "Emergency
care" means health care services that are provided in a hospital emergency
facility, freestanding emergency medical care facility or comparable emergency
facility to evaluate and stabilize a medical condition of a recent onset and
severity, including severe pain, that would lead a prudent person who has an
average knowledge of medicine and health to believe that the person's
condition, sickness or injury is of a nature that failure to get immediate
medical care could result in any of the following:
(a) Serious
jeopardy To the person's health.
(b) Serious
impairment to bodily functions.
(c) Serious
dysfunction of a bodily organ or part.
(d) Serious
disfigurement.
(e) If
the injured worker is a pregnant woman, serious jeopardy to the health of the
fetus.
2. "Governmental
workplace" means the location in which an employee of this state, a
political subdivision of this state or a member of a self‑insurance pool
consisting of public entities would be presumed by this state, the political
subdivision of this state or the self-insurance pool consisting of public
entities to conduct a majority of the employee's employment duties.
3. "Medical
emergency" means the sudden onset of a medical condition of sufficient
severity, including severe pain, that the absence of immediate medical
attention could reasonably be expected to result in either of the following:
(a) Serious
jeopardy To the person's health.
(b) Serious
impairment to bodily functions.
(c) Serious
dysfunction of a bodily organ or part.
(d) Serious
disfigurement.
(e) If
the injured worker is a pregnant woman, serious jeopardy to the health of the
fetus.
4. "Rural
area" means an area that is located in a county with a population of less
than five hundred thousand persons and that has a population of less than
twenty thousand persons.
5. "Service
area" means the geographic area of twenty‑five miles from the
injured worker's governmental workplace. If the injured worker's governmental
workplace is located in a rural area, the service area may be expanded to a
geographic area of fifty miles and to include the nearest urban metropolitan
area in which the medical services needed can be provided.
Sec. 7. Industrial commission of Arizona; guidelines for directed medical
care; panel; delayed repeal
A. The
chairman of the industrial commission of Arizona shall convene a panel to make
recommendations for implementing section 23‑1074, Arizona Revised
Statutes, as added by this act. The panel shall consist of the following
members:
1. The
chairman of the industrial commission of Arizona.
2. One
member who represents peace officers.
3. One
member who represents firefighters.
4. One
member who represents cities or towns.
5. One
member who represents counties.
6. One
member who has experience with insured or self-insured entities that direct
medical care.
7. Two
members who have expertise in adjudicating workers' compensation claims for
injured workers in the public sector.
8. Two
members who represent school districts.
B. The
panel shall conduct meetings that are open to the public and make
recommendations regarding the following for implementing section 23‑1074,
Arizona Revised Statutes, as added by this act:
1. Selecting
treating physicians who are board certified, board eligible or have equivalent experience
in a related field.
2. Establishing
service areas.
3. Establishing
an appeals process.
C. This
section is repealed from and after December 31, 2017."
Amend title
to conform