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Regular Session, 2013
HOUSE BILL NO. 450
BY REPRESENTATIVE IVEY
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
WORKERS COMPENSATI ON: Provides with respect to the medical treatment schedule
AN ACT1
To amend and reenact R.S. 23:1203.1(J) and (M), relative to the workers' compensation2
medical treatment schedule; to provide with respect to the medical advisory council;3
to provide with respect to the medical director; to provide for supporting scientific4
evidence for treatment; and to provide for related matters.5
Be it enacted by the Legislature of Louisiana:6
Section 1. R.S. 23:1203.1(J) and (M) are hereby amended and reenacted to read as7
follows:8
ยง1203.1. Medical treatment schedule; medical advisory council9
* * *10
J.(1) After a medical provider has submitted to the payor the request for11
authorization and the information required by the Louisiana Administrative Code,12
Title 40, Chapter 27, the payor shall notify the medical provider of their action on13
the request within five business days of receipt of the request. If any dispute arises14
after January 1, 2011, as to whether the recommended care, services, or treatment is15
in accordance with the medical treatment schedule, or whether a variance from the16
medical treatment schedule is reasonably required as contemplated in Subsection I17
of this Section, any aggrieved party shall file, within fifteen calendar days, an appeal18
with the office of workers' compensation administration medical director on a form19
promulgated by the director. The medical director shall render a decision as soon as20 HLS 13RS-1033 ENGROSSED
HB NO. 450
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is practicable, but in no event, not more than thirty calendar days from the date of1
filing.2
(2) Should a conflict of interest exist involving any medical director and any3
party to an appeal, the office of workers' compensation administration shall contract4
with other medical directors who shall render a decision as soon as practicable, but5
no longer than thirty calendar days from the date of filing.6
* * *7
M.(1) With regard to all treatment not covered by the medical treatment8
schedule promulgated in accordance with this Section, all medical care, services, and9
treatment shall be in accordance with Subsection D of this Section.10
(2) Notwithstanding any other provision of this Chapter, all treatment not11
specified in the medical treatment schedule and not found in Subsection D of this12
Section, shall be due by the employer when it is demonstrated to the medical13
director, by a preponderance of the scientific medical evidence, and in accordance14
with Subsection C of this Section, that supports approval of the treatment that is not15
covered.16
* * *17
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
Ivey HB No. 450
Abstract: Provides alternatives for cases in which there exist conflicts with the medical
director or cases in which the recommended treatment is not outlined specifically in
the medical treatment guidelines.
Present law provides procedure for submitting claims for workers' compensation
reimbursement.
Present law (R.S. 23:1203.1(J)) provides that if a dispute arises regarding medical care, the
aggrieved party shall file an appeal with the office of workers' compensation administration
(OWCA) medical director.
Proposed law retains present law but provides that if a conflict exists between any medical
director and any party to the appeal, OWCA shall contract with other medical directors. HLS 13RS-1033 ENGROSSED
HB NO. 450
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Proposed law requires that in the event of a conflict described in proposed law, the alternate
medical director(s) shall render a decision within 30 calendar days.
Present law (R.S. 23:1203.1(M)) provides that all medical treatment not covered by the
medical treatment schedule shall be in accordance with present law (R.S. 23:1203.1(D)).
Present law (R.S. 23:1203.1(D)) provides that medical treatment guidelines shall be based
on the following criteria:
(1)Rely on specified, comprehensive, and ongoing systematic medical literature review.
(2)Contain published criteria for rating studies and for determining the overall strength
of the medical evidence, including the size of the sample, whether the authors and
researchers had any financial interest in the product or service being studied, the
design of the study and identification of any bias, and the statistical significance of
the study.
(3)Are current and the most recent version produced, which shall mean that documented
evidence can be produced or verified that the guideline was developed, reviewed, or
revised within the previous five years.
(4)Are interdisciplinary and address the frequency, duration, intensity, and
appropriateness of treatment procedures and modalities for all disciplines commonly
performing treatment of employment-related injuries and diseases.
(5)Are, by statute or rule, adopted by any other state regarding medical treatment for
workers' compensation injuries, diseases, or conditions.
Proposed law retains present law and further provides that in instances in which a treatment
is not covered by the medical treatment schedule, the employer is liable to pay when it has
been demonstrated by a preponderance of scientific evidence to the medical director, in
accordance with present law (R.S. 23:1203.1(C), that the treatment is appropriate.
(Amends R.S. 23:1203.1(J) and (M))
Summary of Amendments Adopted by House
Committee Amendments Proposed by House Committee on Labor and Industrial
Relations to the original bill.
1. Provided that if there is a conflict of interest between any party to the appeal and
any medical director, that OWCA shall contract with other medical directors.
2. Provided that when treatment is not covered by the medical treatment schedule,
payment is due by the employer when the employee can demonstrate to the
medical director, by preponderance of the scientific evidence, and in accordance
with present law, which provides for best available external clinical evidence
from systematic research, that treatment is appropriate.