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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(A), (J), (K), and (M) and to enact R.S. 23:1203.1.1,2
relative to the workers' compensation medical treatment schedule; to provide with3
respect to the medical advisory council; to provide with respect to the medical4
director; to provide for an associate medical director; to provide with respect to his5
qualifications; to provide definitions; to provide for supporting scientific evidence6
for treatment; and to provide for related matters.7
Be it enacted by the Legislature of Louisiana:8
Section 1. R.S. 23:1203.1(A), (J), (K), and (M) are hereby amended and reenacted9
and R.S. 23:1203.1.1 is hereby enacted to read as follows:10
§1203.1. Medical Definitions; medical treatment schedule; medical advisory council11
A. For use in this Section, the following terms shall have the following12
meanings, unless clearly indicated otherwise by the context:13
(1) "Associate medical director" means a physician who is licensed to14
practice medicine in the state of Louisiana and has been chosen by the director of the15
office of workers' compensation administration pursuant to Subparagraph (F)(5)(a)16
of this Section.17
(2) "Council" means the medical advisory council appointed by the director18
of the office of workers' compensation administration.19 HLS 13RS-1033 REENGROSSED
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(2) (3) "Director" means the director of the office of workers' compensation1
administration.2
(4) "Medical director" means a physician who is licensed to practice3
medicine in the state of Louisiana and has been chosen by the director of the office4
of workers' compensation administration pursuant to Subparagraph (F)(5)(a) of this5
Section.6
(3) (5) "Office" means the office of workers' compensation administration7
of the Louisiana Workforce Commission.8
(4) (6) "Schedule" means the medical treatment schedule to be developed by9
the council and promulgated by the office and the director.10
* * *11
J.(1) After a medical provider has submitted to the payor the request for12
authorization and the information required by the Louisiana Administrative Code,13
Title 40, Chapter 27, the payor shall notify the medical provider of their action on14
the request within five business days of receipt of the request. If any dispute arises15
after January 1, 2011, as to whether the recommended care, services, or treatment is16
in accordance with the medical treatment schedule, or whether a variance from the17
medical treatment schedule is reasonably required as contemplated in Subsection I18
of this Section, any aggrieved party shall file, within fifteen calendar days, an appeal19
with the office of workers' compensation administration medical director or associate20
medical director on a form promulgated by the director. The medical director or21
associate medical director shall render a decision as soon as is practicable, but in no22
event, not more than thirty calendar days from the date of filing.23
(2) If either party, the medical director, or associate medical director believes24
that a potential conflict of interest exists, they shall communicate in writing such25
information to the director, who shall make a determination as to whether a conflict26
exists within forty-eight hours. The director shall notify in writing the patient, the27
physician, and, if applicable, the attorney of his decision within forty-eight hours.28 HLS 13RS-1033 REENGROSSED
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K. After the issuance of the decision by the medical director or associate1
medical director of the office, any party who disagrees with the medical director's2
decision, may then appeal by filing a "Disputed Claim for Compensation", which is3
LWC Form 1008. The decision of the medical director may be overturned when it4
is shown, by clear and convincing evidence, the decision of the medical director or5
associate medical director was not in accordance with the provisions of this Section.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 medical director,13
in accordance with the principles of Subsection C of this Section, that a14
preponderance of the scientific medical evidence supports approval of the treatment15
that is not covered.16
* * *17
§1203.1.1. Medical director and associate medical director18
A. The director shall hire a medical director and an associate medical19
director to render decisions on disputed cases filed pursuant to R.S. 23:1203.1(J).20
B. The medical director and associate medical director shall be full-time21
public employees of the office of workers' compensation administration and shall not22
engage in the practice of medicine outside the office.23 HLS 13RS-1033 REENGROSSED
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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 for an associate medical director and for procedure for medical
treatment not specifically addressed 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 authorizes the director to hire an associate medical director and provides for
his qualifications.
Proposed law defines associate medical director and medical director.
Proposed law provides that if a conflict of interest exists among any party to the suit, the
director or the associate medical director, that the conflict shall be communicated, in writing,
to the director, who shall make a determination within 48 hours on whether a conflict exists.
Proposed law requires that in the event of a conflict of interest, the director shall notify the
patient, the physician, and if represented, the attorney, within 48 hours.
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 HLS 13RS-1033 REENGROSSED
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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(A), (J), (K), and (M); Adds R.S. 23:1203.1.1)
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.
House Floor Amendments to the engrossed bill.
1. Allowed the director to hire an associate medical director.
2. Defined "associate medical director" and "medical director".
3. Provided for the qualifications of the medical director and associate medical
director.
4. Deleted the provisions relative to the director's ability to contract with other
medical directors.
5. Provided that if a conflict of interest exists among any party to the suit, the
director or the associate medical director, that the conflict shall be
communicated, in writing, to the director, who shall make a determination within
48 hours on whether a conflict exists.
6. Required that in the event of a conflict of interest, the director shall notify the
patient, the physician, and if represented, the attorney, within 48 hours.