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Regular Session, 2013
SENATE BILL NO. 261 (Substitute of Senate Bill No. 181 by Senator Cortez)
BY SENATOR CORTEZ
WORKERS' COMPENSATION. Provides for the qualifications and duties of the medical
director within the office of workers' compensation. (8/1/13)
AN ACT1
To amend and reenact R.S. 23:1203.1(A) and (F)(5) and to enact R.S. 23:1203.1(P) and (Q),2
relative to workers' compensation; to provide for the medical director; to provide for3
definitions; to provide for the associate medical director; to provide for duties; to4
prohibit conflicts of interest; to provide for medical treatment; and to provide for5
related matters.6
Be it enacted by the Legislature of Louisiana:7
Section 1. R.S. 23:1203.1(A) and (F)(5) are hereby amended and reenacted and R.S.8
23:1203.1(P) and (Q) are hereby enacted to read as follows:9
ยง1203.1. Medical treatment schedule; medical advisory council10
A. For use in this Section, the following terms shall have the following11
meanings, unless clearly indicated otherwise by the context:12
(1) "Associate medical director" means a physician who meets all of the13
following criteria:14
(a) Is licensed to practice medicine in the state of Louisiana.15
(b) Is chosen by the director of the office of workers' compensation16
administration pursuant to Subparagraph (F)(5)(a) of this Section.17 SB NO. 261
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(c) Is a full-time public employee of the office of workers' compensation1
administration and does not engage in the practice of medicine outside the office2
of workers' compensation administration.3
(d) Assists the medical director.4
(1)(2) "Council" means the medical advisory council appointed by the5
director of the office of workers' compensation administration.6
(2)(3) "Director" means the director of the office of workers' compensation7
administration.8
(4) "Medical director" means a physician who meets all of the following9
criteria:10
(a) Is licensed to practice medicine in the state of Louisiana.11
(b) Is chosen by the director of the office of workers' compensation12
administration pursuant to Subparagraph (F)(5)(a) of this Section.13
(c) Is a full-time public employee of the office of workers' compensation14
administration and does not engage in the practice of medicine outside the office15
of workers' compensation administration.16
(3)(5) "Office" means the office of workers' compensation administration of17
the Louisiana Workforce Commission.18
(4)(6) "Schedule" means the medical treatment schedule to be developed by19
the council and promulgated by the office and the director.20
* * *21
F. The director of the office of workers' compensation administration shall22
appoint a medical advisory council, which shall be selected in accordance with the23
following:24
* * *25
(5)(a) The director shall have the authority to contract with or employ a26
medical director or an associate medical director and with consultants to assist the27
director and the medical advisory council in the establishment and promulgation of28
the schedule.29 SB NO. 261
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(b) The associate medical director shall have the authority to act in the1
place of the medical director regarding disputed cases filed pursuant to2
Subsection J of this Section in any of the following circumstances:3
(i) The medical director has a conflict of interest.4
(ii) The volume of disputed cases is determined by the director to be5
voluminous and the assistance of the associate medical director is necessary.6
(iii) The disputed case is outside the expertise of the medical director.7
(iv) The medical director is unable to perform his duties.8
(c) The director shall promulgate rules and regulations to prohibit9
potential conflicts of interest by the medical director or the associate medical10
director.11
* * *12
P. Nothing in this Section shall be construed to deny the injured13
employee medically necessary evaluation management visits with injured14
employee's treating physician so long as all of the following are met:15
(1) The medical treatment schedule requires documentation of16
functional improvement to continue prescribed treatment.17
(2) The number of evaluation management visits is not greater than18
twelve visits per annum.19
Q. Notwithstanding any other provision to the contrary, should the20
payor refuse to authorize the number of physical therapy treatments prescribed21
by the treating physician, the payor shall authorize an evaluation management22
visit, pursuant to Subsection P of this Section, following the last authorized23
physical therapy treatment in order to determine if the patient is improving as24
a result of the physical therapy treatments authorized and if more physical25
therapy treatments are medically necessary.26 SB NO. 261
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The original instrument was prepared by Carla S. Roberts. The following
digest, which does not constitute a part of the legislative instrument, was
prepared by Cathy R. Wells.
DIGEST
Cortez (SB 261)
Present law provides that the director of the office of workers' compensation shall have the
authority to contract with a medical director.
Proposed law retains present law but clarifies that the medical director may be contracted
or employed.
Proposed law retains present law but provides that the director of the office of workers'
compensation shall have the authority to contract with or employ an associate medical
director.
Proposed law defines "medical director" to mean a physician who meets all of the following
criteria:
(1)Is licensed to practice medicine in the state of La.
(2)Is chosen by the director of the office of workers' compensation as is provided in
present law.
(3)Is a full-time public employee of the office of workers' compensation and does not
engage in the practice of medicine outside the office of workers' compensation.
(4)Assists the medical director.
Proposed law defines "associate medical director" to mean a physician who meets all of the
following criteria:
(1)Is licensed to practice medicine in the state of La.
(2)Is chosen by the director of the office of workers' compensation.
(3)Is a full-time public employee of the office of workers' compensation and does not
engage in the practice of medicine outside the office of workers' compensation.
(4)Assists the medical director.
Proposed law provides that the associate medical director shall have the authority to act in
the place of the medical director regarding disputed cases in any of the following
circumstances:
(1) The medical director has a conflict of interest.
(2) The volume of disputed cases is determined by the director to be voluminous.
(3) The disputed case is outside the expertise of the medical director.
(4) The medical director is unable to perform his duties.
Proposed law provides that the director shall promulgate rules and regulations to prohibit
potential conflicts of interest by the medical director or the associate medical director. SB NO. 261
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
Present law provides that medical treatment owed to the injured employee shall be done in
accordance with the medical treatment schedule.
Proposed law retains present law but provides that the injured employee is entitled to
medically necessary evaluation management visits with injured employee's treating
physician so long as all of the following are met:
(1)The medical treatment schedule requires documentation of functional improvement
to continue prescribed treatment.
(2)The number of evaluation management visits is not greater than 12 visits per year.
Proposed law retains present law but provides that, should the payor refuse to authorize the
number of physical therapy treatments prescribed by the treating physician, the payor shall
authorize an evaluation management visit following the last authorized physical therapy
treatment in order to determine if the patient is improving as a result of the physical therapy
treatments authorized and if more physical therapy treatments are medically necessary.
Effective August 1, 2013.
(Amends R.S. 23:1203.1(A) and (F)(5); adds R.S. 23:1203.1(P) and (Q))
Summary of Amendments Adopted by Senate
Senate Floor Amendments to engrossed bill
1. Provides an additional circumstance for associate medical director to act in
the place of the medical director regarding disputed cases, specifically if the
medical director is unable to perform his duties.
2. Provides that injured employee is entitled to evaluation management visits
if such treatment is medically necessary.