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AN ACT relating to workers compensation. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
ď˘Section 1. KRS 342.020 is amended to read as follows: 3
(1) In addition to all other compensation provided in this chapter, the employer shall 4
pay for the cure and relief from the effects of an injury or occupational disease the 5
medical, surgical, and hospital treatment, including nursing, medical, and surgical 6
supplies and appliances, as may reasonably be required at the time of the injury and 7
thereafter for the length of time set forth in this section, or as may be required for 8
the cure and treatment of an occupational disease. 9
(2) In claims resulting in an award of permanent total disability or resulting from an 10
injury described in subsection (9) of this section, the employer's obligation to pay 11
the benefits specified in this section shall continue for so long as the employee is 12
disabled regardless of the duration of the employee's income benefits. 13
(3) (a) In all permanent partial disability claims not involving an injury described in 14
subsection (9) of this section, the employer's obligation to pay the benefits 15
specified in this section shall continue for seven hundred eighty (780) weeks 16
from the date of injury or date of last exposure. 17
(b) In all permanent partial disability claims not involving an injury described in 18
subsection (9) of this section, the commissioner shall, in writing, advise the 19
employee of the right to file an application for the continuation of benefits as 20
described in this section. This notice shall be made to the employee seven 21
hundred fifty-four (754) weeks from the date of injury or last exposure. 22
(c) An employee shall receive a continuation of benefits as described in this 23
section for additional time beyond the period provided in paragraph (a) of this 24
subsection as long as continued medical treatment is reasonably necessary and 25
related to the work injury or occupational disease if: 26
1. An application is filed within seventy-five (75) days prior to the 27 UNOFFICIAL COPY 25 RS BR 1618
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termination of the seven hundred eighty (780) week period; 1
2. The employee demonstrates that continued medical treatment is 2
reasonably necessary and related to the work injury or occupational 3
disease; and 4
3. An administrative law judge determines and orders that continued 5
benefits are reasonably necessary and related to the work injury or 6
occupational disease for additional time beyond the original seven 7
hundred eighty (780) week period provided in paragraph (a) of this 8
subsection. 9
(d) If the administrative law judge determines that medical benefits are not 10
reasonably necessary or not related to the work injury or occupational disease, 11
or if an employee fails to make proper application for continued benefits 12
within the time period provided in paragraph (c) of this subsection, any future 13
medical treatment shall be deemed to be unrelated to the work injury and the 14
employer's obligation to pay medical benefits shall cease permanently. 15
(4) (a) In the absence of designation of a managed health care system by the 16
employer, the employee may select medical providers to treat his injury or 17
occupational disease. Even if the employer has designated a managed health 18
care system, the injured employee may elect to continue treating with a 19
physician who provided emergency medical care or treatment to the 20
employee. 21
(b) After the carrier accepts the claim as compensable or an administrative law 22
judge makes an initial determination of compensability, whichever occurs 23
first, the employer, insurer, or payment obligor acting on behalf of the 24
employer[,] shall make all payments for services rendered to an employee 25
directly to the provider of the services within thirty (30) days of receipt of a 26
statement for services. The commissioner shall promulgate administrative 27 UNOFFICIAL COPY 25 RS BR 1618
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regulations establishing conditions under which the thirty (30) day period for 1
payment may be tolled. 2
(c) After the injured worker and the medical provider receive notice from the 3
employer, insurer, or payment obligor that the claim has been determined to 4
compensable, or an administrative law judge makes an initial determination 5
of compensability, whichever occurs first, the provider of medical services 6
shall submit the statement for services within forty-five (45) days of the day 7
treatment is initiated and every forty-five (45) days thereafter, if appropriate, 8
as long as medical services are rendered. 9
(d) To be effective under paragraphs (b) and (c) of this subsection, notice 10
regarding compensability of a claim shall provide the injured worker and 11
the medical provider with all necessary information about the manner in 12
which a statement for services is to be submitted. 13
(e) Except as provided in subsection (7) of this section, in no event shall a 14
medical fee exceed the limitations of an adopted medical fee schedule or other 15
limitations contained in KRS 342.035, whichever is lower. The commissioner 16
may promulgate administrative regulations establishing the form and content 17
of a statement for services and procedures by which disputes relative to the 18
necessity, effectiveness, frequency, and cost of services may be resolved. 19
(5) Notwithstanding any provision of the Kentucky Revised Statutes to the contrary, 20
medical services and treatment provided under this chapter shall not be subject to 21
copayments or deductibles. 22
(6) Employers may provide medical services through a managed health care system. 23
The managed health care system shall file with the Department of Workers' Claims 24
a plan for the rendition of health care services for work-related injuries and 25
occupational diseases to be approved by the commissioner pursuant to 26
administrative regulations promulgated by the commissioner. 27 UNOFFICIAL COPY 25 RS BR 1618
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(7) All managed health care systems rendering medical services under this chapter shall 1
include the following features in plans for workers' compensation medical care: 2
(a) Copayments or deductibles shall not be required for medical services rendered 3
in connection with a work-related injury or occupational disease; 4
(b) The employee shall be allowed choice of provider within the plan; 5
(c) The managed health care system shall provide an informal procedure for the 6
expeditious resolution of disputes concerning rendition of medical services; 7
(d) The employee shall be allowed to obtain a second opinion, at the employer's 8
expense, from an outside physician if a managed health care system physician 9
recommends surgery; 10
(e) The employee may obtain medical services from providers outside the 11
managed health care system, at the employer's expense, when treatment is 12
unavailable through the managed health care system; 13
(f) The managed health care system shall establish procedures for utilization 14
review of medical services to assure that a course of treatment is reasonably 15
necessary; diagnostic procedures are not unnecessarily duplicated; the 16
frequency, scope, and duration of treatment is appropriate; pharmaceuticals 17
are not unnecessarily prescribed; and that ongoing and proposed treatment is 18
not experimental, cost ineffective, or harmful to the employee; and 19
(g) Statements for services shall be audited regularly to assure that charges are 20
not duplicated and do not exceed those authorized in the applicable fee 21
schedules. 22
(h) A schedule of fees for all medical services to be provided under this chapter 23
which shall not be subject to the limitations on medical fees contained in this 24
chapter. 25
(i) Restrictions on provider selection imposed by a managed health care system 26
authorized by this chapter shall not apply to emergency medical care. 27 UNOFFICIAL COPY 25 RS BR 1618
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(8) Except for emergency medical care, medical services rendered pursuant to this 1
chapter shall be under the supervision of a single treating physician or physicians' 2
group having the authority to make referrals, as reasonably necessary, to 3
appropriate facilities and specialists. The employee may change his designated 4
physician one (1) time and thereafter shall show reasonable cause in order to 5
change physicians. 6
(9) When a compensable injury or occupational disease results in the amputation or 7
partial amputation of an arm, hand, leg, or foot, or the loss of hearing, or the 8
enucleation of an eye or loss of teeth, or permanent total or permanent partial 9
paralysis, the employer shall pay for, in addition to the other medical, surgical, and 10
hospital treatment enumerated in subsection (1) and this subsection, a modern 11
artificial member and, where required, proper braces as may reasonably be required 12
at the time of the injury and thereafter during disability. 13
(10) Upon motion of the employer, with sufficient notice to the employee for a response 14
to be filed, if it is shown to the satisfaction of the administrative law judge by 15
affidavits or testimony that, because of the physician selected by the employee to 16
treat the injury or disease, or because of the hospital selected by the employee in 17
which treatment is being rendered, that the employee is not receiving proper 18
medical treatment and the recovery is being substantially affected or delayed; or 19
that the funds for medical expenses are being spent without reasonable benefit to 20
the employee; or that because of the physician selected by the employee or because 21
of the type of medical treatment being received by the employee that the employer 22
will substantially be prejudiced in any compensation proceedings resulting from the 23
employee's injury or disease; then the administrative law judge may allow the 24
employer to select a physician to treat the employee and the hospital or hospitals in 25
which the employee is treated for the injury or disease. No action shall be brought 26
against any employer subject to this chapter by any person to recover damages for 27 UNOFFICIAL COPY 25 RS BR 1618
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malpractice or improper treatment received by any employee from any physician, 1
hospital, or attendant thereof. 2
(11) An employee who reports an injury alleged to be work-related or files an 3
application for adjustment of a claim shall execute a waiver and consent of any 4
physician-patient, psychiatrist-patient, or chiropractor-patient privilege with respect 5
to any condition or complaint reasonably related to the condition for which the 6
employee claims compensation. Notwithstanding any other provision in the 7
Kentucky Revised Statutes, any physician, psychiatrist, chiropractor, podiatrist, 8
hospital, or health care provider shall, within a reasonable time after written request 9
by the employee, employer, workers' compensation insurer, special fund, uninsured 10
employers' fund, or the administrative law judge, provide the requesting party with 11
any information or written material reasonably related to any injury or disease for 12
which the employee claims compensation. 13
(12) When a provider of medical services or treatment, required by this chapter, makes 14
referrals for medical services or treatment by this chapter, to a provider or entity in 15
which the provider making the referral has an investment interest, the referring 16
provider shall disclose that investment interest to the employee, the commissioner, 17
and the employer's insurer or the party responsible for paying for the medical 18
services or treatment, within thirty (30) days from the date the referral was made. 19
(13) (a) Except as provided in paragraphs (b) and (c) of this subsection, the employer, 20
insurer, or payment obligor shall not be liable for urine drug screenings of 21
patients in excess of: 22
1. One (1) per year for a patient considered to be low-risk; 23
2. Two (2) per year for a patient considered to be moderate-risk; and 24
3. Four (4) per year for patients considered to be high-risk; 25
based upon the screening performed by the treating medical provider and 26
other pertinent factors. 27 UNOFFICIAL COPY 25 RS BR 1618
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(b) The employer, insurer, or payment obligor may be liable for urine drug 1
screening at each office visit for patients that have exhibited aberrant behavior 2
documented by multiple lost prescriptions, multiple requests for early refills 3
of prescriptions, multiple providers prescribing or dispensing opioids or 4
opioid substitutes as evidenced by the electronic monitoring system 5
established in KRS 218A.202 or a similar system, unauthorized dosage 6
escalation, or apparent intoxication. 7
(c) The employer, insurer, or payment obligor may request additional urine drug 8
screenings which shall not count toward the maximum number of drug 9
screenings enumerated in paragraph (a) of this subsection. 10
(d) The commissioner shall promulgate administrative regulations related to urine 11
drug screenings as part of the practice parameters or treatment guidelines 12
required under KRS 342.035. 13
(14) (a) As used in this subsection, "practice of pharmacy" has the same meaning as in 14
KRS 315.010. 15
(b) In addition to all other compensation that may be reimbursed to a pharmacist 16
under this chapter, the employer, insurer, or payment obligor shall be liable 17
for the reimbursement of a pharmacist for a service or procedure at a rate not 18
less than that provided to other nonphysician practitioners if the service or 19
procedure: 20
1. Is within the scope of the practice of pharmacy; 21
2. Would otherwise be compensable under this chapter if the service or 22
procedure were provided by a: 23
a. Physician; 24
b. Advanced practice registered nurse; or 25
c. Physician assistant; and 26
3. Is performed by the pharmacist in strict compliance with laws and 27 UNOFFICIAL COPY 25 RS BR 1618
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administrative regulations related to the pharmacist's license. 1