ENROLLED
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are additions.
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.
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 R.S. 23:1203.1.1.16
(2) "Council" means the medical advisory council appointed by the director17
of the office of workers' compensation administration.18
(2) (3) "Director" means the director of the office of workers' compensation19
administration.20
(4) "Medical director" means a physician who is licensed to practice21
medicine in the state of Louisiana and has been chosen by the director of the office22
of workers' compensation administration pursuant to R.S. 23:1203.1.1.23 ENROLLEDHB NO. 450
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(3) (5) "Office" means the office of workers' compensation administration1
of the Louisiana Workforce Commission.2
(4) (6) "Schedule" means the medical treatment schedule to be developed by3
the council and promulgated by the office and the director.4
* * *5
J.(1) After a medical provider has submitted to the payor the request for6
authorization and the information required by the Louisiana Administrative Code,7
Title 40, Chapter 27, the payor shall notify the medical provider of their action on8
the request within five business days of receipt of the request. If any dispute arises9
after January 1, 2011, as to whether the recommended care, services, or treatment is10
in accordance with the medical treatment schedule, or whether a variance from the11
medical treatment schedule is reasonably required as contemplated in Subsection I12
of this Section, any aggrieved party shall file, within fifteen calendar days, an appeal13
with the office of workers' compensation administration medical director or associate14
medical director on a form promulgated by the director. The medical director or15
associate medical director shall render a decision as soon as is practicable, but in no16
event, not more than thirty calendar days from the date of filing.17
(2) If either party, the medical director, or associate medical director believes18
that a potential conflict of interest exists, they shall communicate in writing such19
information to the director, who shall make a determination as to whether a conflict20
exists within two business days. The director shall notify in writing the patient, the21
physician, and, if applicable, the attorney of his decision within two business days.22
K. After the issuance of the decision by the medical director or associate23
medical director of the office, any party who disagrees with the medical director's24
decision, may then appeal by filing a "Disputed Claim for Compensation", which is25
LWC Form 1008. The decision of the medical director may be overturned when it26
is shown, by clear and convincing evidence, the decision of the medical director or27
associate medical director was not in accordance with the provisions of this Section.28
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M.(1) With regard to all treatment not covered by the medical treatment1
schedule promulgated in accordance with this Section, all medical care, services, and2
treatment shall be in accordance with Subsection D of this Section.3
(2) Notwithstanding any other provision of this Chapter, all treatment not4
specified in the medical treatment schedule and not found in Subsection D of this5
Section shall be due by the employer when it is demonstrated to the medical director,6
in accordance with the principles of Subsection C of this Section, that a7
preponderance of the scientific medical evidence supports approval of the treatment8
that is not covered.9
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§1203.1.1. Medical director and associate medical director11
A. The director shall hire a medical director and an associate medical12
director to render decisions on disputed cases filed pursuant to R.S. 23:1203.1(J).13
B. The medical director and associate medical director shall be full-time14
public employees of the office of workers' compensation administration and shall not15
engage in the practice of medicine outside the office.16
SPEAKER OF THE HOUSE OF REPRESENTATI VES
PRESIDENT OF THE SENATE
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED: