UT
Utah Senate Bill SB0190

Utah 2025 Regular Session

Utah Senate Bill SB0190 Compare Versions

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1-Enrolled Copy S.B. 190
1+02-05 09:02 S.B. 190
22 1
33 Workers' Compensation Modifications
44 2025 GENERAL SESSION
55 STATE OF UTAH
66 Chief Sponsor: Scott D. Sandall
7-House Sponsor: James A. Dunnigan
7+House Sponsor:
88 2
99
1010 3
1111 LONG TITLE
1212 4
1313 General Description:
1414 5
1515 This bill amends the Workers' Compensation Act.
1616 6
1717 Highlighted Provisions:
1818 7
1919 This bill:
2020 8
2121 ▸ defines terms;
2222 9
2323 ▸ expands the Labor Commission's authority to disclosures by health care providers;
2424 10
2525 ▸ expands the Labor Commission's authority over fees for health care providers;
2626 11
2727 ▸ expands the prohibition of balance billing for workers' compensation claims to health care
2828 12
2929 providers; and
3030 13
3131 ▸ makes technical changes.
3232 14
3333 Money Appropriated in this Bill:
3434 15
3535 None
3636 16
3737 Other Special Clauses:
3838 17
3939 None
4040 18
4141 Utah Code Sections Affected:
4242 19
4343 AMENDS:
4444 20
4545 34A-2-407, as last amended by Laws of Utah 2021, Chapter 64
4646 21
4747
4848 22
4949 Be it enacted by the Legislature of the state of Utah:
5050 23
5151 Section 1. Section 34A-2-407 is amended to read:
5252 24
5353 34A-2-407 . Reporting of industrial injuries -- Regulation of health care
5454 25
5555 providers.
5656 26
5757 (1) As used in this section[, "physician" is as defined in Section 34A-2-111.] :
5858 27
59-(a) "Balance billing" means charging an individual, on whose behalf a workers' S.B. 190 Enrolled Copy
59+(a) "Balance billing" means charging an individual, on whose behalf a workers'
6060 28
6161 compensation insurance carrier or self-insured employer is obligated to pay covered
6262 29
6363 medical services under this chapter or Chapter 3, Utah Occupational Disease Act, the
6464 30
6565 amount calculated by subtracting the amount the workers' compensation insurance
66+ S.B. 190 S.B. 190 02-05 09:02
6667 31
6768 carrier or self-insured employer reimburses the health care provider for covered
6869 32
6970 medical services from the amount the health care provider charges for the covered
7071 33
7172 medical services.
7273 34
7374 (b) "Covered medical services" means medical services provided by a health care
7475 35
7576 provider that are covered by workers' compensation medical benefits under this
7677 36
7778 chapter or Chapter 3, Utah Occupational Disease Act.
7879 37
7980 (c) "Health care provider" means the same as that term is defined in Section 34A-2-111.
8081 38
8182 (d) "Hospital" means the same as that term is defined in Section 26B-2-219.
8283 39
8384 (e) "Physician" means the same as that term is defined in Section 34A-2-111.
8485 40
8586 (f) "Self-insured employer" means the same as that term is defined in Section
8687 41
8788 34A-2-201.5.
8889 42
8990 (2)(a) An employee sustaining an injury arising out of and in the course of employment
9091 43
9192 shall provide notification to the employee's employer promptly of the injury.
9293 44
9394 (b) If the employee is unable to provide the notification required by Subsection (2)(a),
9495 45
9596 the following may provide notification of the injury to the employee's employer:
9697 46
9798 (i) the employee's next of kin; or
9899 47
99100 (ii) the employee's attorney.
100101 48
101102 (c) [An employee claiming benefits under this chapter or Chapter 3, Utah Occupational
102103 49
103104 Disease Act, shall comply with rules adopted by the commission regarding disclosure
104105 50
105106 of medical records of the employee medically relevant to the industrial accident or
106107 51
107108 occupational disease claim.] An employee claiming benefits under this chapter, or
108109 52
109110 Chapter 3, Utah Occupational Disease Act, shall comply with the commission's
110111 53
111112 requirements for disclosure of medical records for a work-related injury claim.
112113 54
113114 (3)(a) An employee is barred for any claim of benefits arising from an injury if the
114115 55
115116 employee fails to notify within the time period described in Subsection (3)(b):
116117 56
117118 (i) the employee's employer in accordance with Subsection (2); or
118119 57
119120 (ii) the division.
120121 58
121122 (b) [The ] An employee shall provide the notice required by Subsection (3)(a) [shall be
122123 59
123124 made ]within:
124125 60
125126 (i) 180 days [of] after the day on which the injury occurs; or
126127 61
127128 (ii) in the case of an occupational hearing loss, the time period specified in Section
128-- 2 - Enrolled Copy S.B. 190
129129 62
130130 34A-2-506.
131131 63
132-(4) The following [constitute] constitutes notification of injury from the employee, the
132+(4) The following Ŝ→ [may ] ←Ŝ constitute notification of injury from the employee, the employee's
133133 64
134-employee's next of kin, or the employee's attorney, as required by Subsection (2):
134+next of kin, or the employee's attorney, as required by Subsection (2):
135+- 2 - 02-05 09:02 S.B. 190
135136 65
136137 (a) an employer's report once filed with:
137138 66
138139 (i) the division; or
139140 67
140141 (ii) the employer's workers' compensation insurance carrier;
141142 68
142143 (b) a physician's injury report once filed with:
143144 69
144145 (i) the division;
145146 70
146147 (ii) the employer; or
147148 71
148149 (iii) the employer's workers' compensation insurance carrier;
149150 72
150151 (c) a workers' compensation insurance carrier's report filed with the division; or
151152 73
152153 (d) the payment of any medical or disability benefits by:
153154 74
154155 (i) the employer; or
155156 75
156157 (ii) the employer's workers' compensation insurance carrier.
157158 76
158159 (5)(a) An employer and the employer's workers' compensation insurance carrier, if any,
159160 77
160161 shall file a report in accordance with the rules made under Subsection (5)(b) of a:
161162 78
162163 (i) work-related fatality; or
163164 79
164165 (ii) work-related injury resulting in:
165166 80
166167 (A) medical treatment;
167168 81
168169 (B) loss of consciousness;
169170 82
170171 (C) loss of work;
171172 83
172173 (D) restriction of work; or
173174 84
174175 (E) transfer to another job.
175176 85
176177 (b)(i)(A) [An employer or the employer's workers' compensation insurance
177178 86
178179 carrier, if any, shall file a report required by Subsection (5)(a), and any
179180 87
180181 subsequent reports of a previously reported injury as may be required by the
181182 88
182183 commission, within the time limits and in the manner established by rule by the
183184 89
184185 commission made after consultation with the workers' compensation advisory
185186 90
186187 council and in accordance with Title 63G, Chapter 3, Utah Administrative
187188 91
188189 Rulemaking Act. ] The commission may require additional reports for a
189190 92
190191 previously reported injury by rule made after consulting with the workers'
191192 93
192193 compensation advisory council and in accordance with Title 63G, Chapter 3,
193194 94
194195 Utah Administrative Rulemaking Act.
195196 95
196197 (B) An employer or the employer's workers' compensation insurance carrier, if
197-- 3 - S.B. 190 Enrolled Copy
198198 96
199199 any, shall file the report required by Subsection (5)(a) and any other report of a
200200 97
201201 previously reported injury within the time limits and in the manner the
202202 98
203203 commission establishes.
204+- 3 - S.B. 190 02-05 09:02
204205 99
205206 (ii) A rule made under this Subsection (5)(b) shall:
206207 100
207208 [(i)] (A) be reasonable; and
208209 101
209210 [(ii)] (B) take into consideration the practicality and cost of complying with the
210211 102
211212 rule.
212213 103
213-(c) [A] An employer is not required to file a report [is not required to be filed under this
214+(c) An Ŝ→ [employee] employer ←Ŝ is not required to file a report [is not required to be filed
215+103a
216+under this
214217 104
215218 Subsection (5) ]for a minor injury, such as a cut or scratch that requires first aid
216219 105
217220 treatment only, unless:
218221 106
219222 (i) a treating physician files a report with the division in accordance with Subsection
220223 107
221224 (9); or
222225 108
223226 (ii) a treating physician is required to file a report with the division in accordance
224227 109
225228 with Subsection (9).
226229 110
227230 (6) An employer and [its] the employer's workers' compensation insurance carrier, if any,
228231 111
229232 required to file a report under Subsection (5) shall provide the employee with:
230233 112
231234 (a) a copy of the report submitted to the division; and
232235 113
233236 (b) a statement, as prepared by the division, of the employee's rights and responsibilities
234237 114
235238 related to the industrial injury.
236239 115
237240 (7) An employer shall maintain a record in a manner [prescribed by ]the commission
238241 116
239242 provides by rule of all:
240243 117
241244 (a) work-related fatalities; or
242245 118
243246 (b) work-related injuries resulting in:
244247 119
245248 (i) medical treatment;
246249 120
247250 (ii) loss of consciousness;
248251 121
249252 (iii) loss of work;
250253 122
251254 (iv) restriction of work; or
252255 123
253256 (v) transfer to another job.
254257 124
255258 (8)(a) Except as provided in Subsection (8)(b), an employer or a workers' compensation
256259 125
257260 insurance carrier [who] that refuses or neglects to make a report, maintain a record, or
258261 126
259262 file a report as required by this section is subject to a civil assessment:
260263 127
261264 (i) imposed by the division, subject to the requirements of Title 63G, Chapter 4,
262265 128
263266 Administrative Procedures Act; and
264267 129
265268 (ii) that may not exceed $500.
266-- 4 - Enrolled Copy S.B. 190
267269 130
268270 (b) An employer or workers' compensation insurance carrier is not subject to the civil
269271 131
270272 assessment under this Subsection (8) if:
273+- 4 - 02-05 09:02 S.B. 190
271274 132
272275 (i) the employer or workers' compensation insurance carrier submits a report later
273276 133
274277 than required by this section; and
275278 134
276279 (ii) the division finds that the employer or workers' compensation insurance carrier
277280 135
278281 has shown good cause for submitting a report later than required by this section.
279282 136
280283 (c)(i) [A ] The division shall deposit a civil assessment collected under this
281284 137
282285 Subsection (8) [shall be deposited ]into the Uninsured Employers' Fund created in
283286 138
284287 Section 34A-2-704[ to be used for a purpose specified in Section 34A-2-704].
285288 139
286289 (ii) The administrator of the Uninsured Employers' Fund shall [collect] receive and
287290 140
288291 distribute the money [required to be deposited into the Uninsured Employers'
289292 141
290293 Fund under this Subsection (8)(c) in accordance with Section 34A-2-704.] in
291294 142
292295 accordance with Section 34A-2-704.
293296 143
294297 (9)(a) A [physician attending] health care provider treating an injured employee shall
295298 144
296-comply with rules [established by ]the commission establishes in accordance with
299+comply with rules [established by ]the commission establishes Ŝ→ in accordance with
300+144a
301+Title 63G, Chapter 3, Utah Administrative Rulemaking Act, ←Ŝ regarding:
297302 145
298-Title 63G, Chapter 3, Utah Administrative Rulemaking Act, regarding:
303+(i) fees for [physician's] covered medical services Ŝ→ , other than a hospital's covered
304+145a
305+medical services ←Ŝ ;
306+145b
307+ Ŝ→ (ii) fees for a hospital's covered medical services, which, if the
308+145c
309+commission establishes, shall be based on Medicare reimbursement rates; ←Ŝ
299310 146
300-(i) fees for [physician's] covered medical services, other than a hospital's covered
311+{(ii)} (iii) disclosure of medical records of the employee medically relevant to the
301312 147
302-medical services;
313+employee's [industrial accident or occupational disease] work-related injury claim;
303314 148
304-(ii) fees for a hospital's covered medical services, which, if the commission
315+{(iii)} (iv) reports to the division regarding:
305316 149
306-establishes, shall be based on Medicare reimbursement rates;
317+(A) the condition and treatment of an injured employee; or
307318 150
308-[(ii)] (iii) disclosure of medical records of the employee medically relevant to the
319+(B) any other matter concerning employees with industrial cases that the [
309320 151
310-employee's [industrial accident or occupational disease] work-related injury claim;
321+physician ] health care provider is treating; and
311322 152
312-[(iii)] (iv) reports to the division regarding:
323+{(iv)} (v) rules made under Section 34A-2-407.5.
313324 153
314-(A) the condition and treatment of an injured employee; or
325+[(b) A physician who is associated with, employed by, or bills through a hospital is
315326 154
316-(B) any other matter concerning employees with industrial cases that the [
327+subject to Subsection (9)(a).]
317328 155
318-physician ] health care provider is treating; and
329+[(c) A hospital providing services for an injured employee is not subject to the
319330 156
320-[(iv)] (v) rules made under Section 34A-2-407.5.
331+requirements of Subsection (9)(a) except for rules made by the commission that are
321332 157
322-[(b) A physician who is associated with, employed by, or bills through a hospital is
333+described in Subsection (9)(a)(ii) or (iii) or Section 34A-2-407.5.]
323334 158
324-subject to Subsection (9)(a).]
335+[(d)] (b) The commission's schedule of fees may reasonably differentiate [remuneration
325336 159
326-[(c) A hospital providing services for an injured employee is not subject to the
337+to be ] compensation paid to health care providers [of health services] for covered
327338 160
328-requirements of Subsection (9)(a) except for rules made by the commission that are
339+medical services based on:
329340 161
330-described in Subsection (9)(a)(ii) or (iii) or Section 34A-2-407.5.]
341+(i) the severity of the employee's condition;
342+- 5 - S.B. 190 02-05 09:02
331343 162
332-[(d)] (b) The commission's schedule of fees may reasonably differentiate [remuneration
344+(ii) the nature of the treatment necessary; and
333345 163
334-to be ] compensation paid to health care providers [of health services] for covered
335-- 5 - S.B. 190 Enrolled Copy
346+(iii) the facilities or equipment specially required to deliver that treatment.
336347 164
337-medical services based on:
348+[(e)] (c) This Subsection (9) does not prohibit a contract with a health care provider of [
338349 165
339-(i) the severity of the employee's condition;
350+health services] covered medical services relating to the pricing of goods and covered
340351 166
341-(ii) the nature of the treatment necessary; and
352+medical services.
342353 167
343-(iii) the facilities or equipment specially required to deliver that treatment.
354+(d) A health care provider may not engage in balance billing.
344355 168
345-[(e)] (c) This Subsection (9) does not prohibit a contract with a health care provider of [
356+(10) A health care provider treating an injured employee shall provide a copy of the initial
346357 169
347-health services] covered medical services relating to the pricing of goods and covered
358+report filed under Subsection [(9)(a)(iii) shall be furnished Ŝ→ (9)(a)(iii) ]
359+169a
360+(9)(a)(iv) ←Ŝ to:
348361 170
349-medical services.
362+(a) the division;
350363 171
351-(d) A health care provider may not engage in balance billing.
364+(b) the employee; and
352365 172
353-(10) A health care provider treating an injured employee shall provide a copy of the initial
366+(c)(i) the employer; or
354367 173
355-report filed under Subsection [(9)(a)(iii) shall be furnished ] (9)(a)(iv) to:
368+(ii) the employer's workers' compensation insurance carrier.
356369 174
357-(a) the division;
370+[(11)(a) As used in this Subsection (11):]
358371 175
359-(b) the employee; and
372+[(i) "Balance billing" means charging a person, on whose behalf a workers'
360373 176
361-(c)(i) the employer; or
374+compensation insurance carrier or self-insured employer is obligated to pay
362375 177
363-(ii) the employer's workers' compensation insurance carrier.
376+medical benefits under this chapter or Chapter 3, Utah Occupational Disease Act,
364377 178
365-[(11)(a) As used in this Subsection (11):]
378+for the difference between what the workers' compensation insurance carrier or
366379 179
367-[(i) "Balance billing" means charging a person, on whose behalf a workers'
380+self-insured employer reimburses the hospital for covered medical services and
368381 180
369-compensation insurance carrier or self-insured employer is obligated to pay
382+what the hospital charges for those covered medical services.]
370383 181
371-medical benefits under this chapter or Chapter 3, Utah Occupational Disease Act,
384+[(ii) "Covered medical services" means medical services provided by a hospital that
372385 182
373-for the difference between what the workers' compensation insurance carrier or
386+are covered by workers' compensation medical benefits under this chapter or
374387 183
375-self-insured employer reimburses the hospital for covered medical services and
388+Chapter 3, Utah Occupational Disease Act.]
376389 184
377-what the hospital charges for those covered medical services.]
390+[(iii) "Self-insured employer" means the same as that term is defined in Section
378391 185
379-[(ii) "Covered medical services" means medical services provided by a hospital that
392+34A-2-201.5.]
380393 186
381-are covered by workers' compensation medical benefits under this chapter or
394+[(b) Subject to Subsection (11)(d), a workers' compensation insurance carrier or
382395 187
383-Chapter 3, Utah Occupational Disease Act.]
396+self-insured employer may contract, either in writing or by mutual oral agreement,
384397 188
385-[(iii) "Self-insured employer" means the same as that term is defined in Section
398+with a hospital to establish reimbursement rates.]
386399 189
387-34A-2-201.5.]
400+[(c) Subject to Subsection (11)(d), for the time period beginning on May 8, 2018, and
388401 190
389-[(b) Subject to Subsection (11)(d), a workers' compensation insurance carrier or
402+ending on July 1, 2021, a workers' compensation insurance carrier or self-insured
390403 191
391-self-insured employer may contract, either in writing or by mutual oral agreement,
404+employer that is reimbursing a hospital for covered medical services shall reimburse
392405 192
393-with a hospital to establish reimbursement rates.]
406+the hospital:]
394407 193
395-[(c) Subject to Subsection (11)(d), for the time period beginning on May 8, 2018, and
408+[(i) in accordance with a contract described in Subsection (11)(b); or]
396409 194
397-ending on July 1, 2021, a workers' compensation insurance carrier or self-insured
410+[(ii)(A) if the hospital is located in a county of the first, second, or third class, as
411+- 6 - 02-05 09:02 S.B. 190
398412 195
399-employer that is reimbursing a hospital for covered medical services shall reimburse
413+classified in Section 17-50-501, at 75% of the billed hospital fees for the
400414 196
401-the hospital:]
415+covered medical services; or]
402416 197
403-[(i) in accordance with a contract described in Subsection (11)(b); or]
404-- 6 - Enrolled Copy S.B. 190
417+[(B) if the hospital is located in a county of the fourth, fifth, or sixth class, as
405418 198
406-[(ii)(A) if the hospital is located in a county of the first, second, or third class, as
419+classified in Section 17-50-501, at 85% of the billed hospital fees for the
407420 199
408-classified in Section 17-50-501, at 75% of the billed hospital fees for the
421+covered medical services.]
409422 200
410-covered medical services; or]
423+[(d) A hospital may not engage in balance billing. ]
411424 201
412-[(B) if the hospital is located in a county of the fourth, fifth, or sixth class, as
425+[(12)] (11)(a) Subject to appellate review under Section 34A-1-303, the commission has
413426 202
414-classified in Section 17-50-501, at 85% of the billed hospital fees for the
427+exclusive jurisdiction to hear and determine:
415428 203
416-covered medical services.]
429+(i) whether goods [provided to ]or services [rendered ] provided to an employee are
417430 204
418-[(d) A hospital may not engage in balance billing. ]
431+compensable [pursuant to] under this chapter or Chapter 3, Utah Occupational
419432 205
420-[(12)] (11)(a) Subject to appellate review under Section 34A-1-303, the commission has
433+Disease Act, including:
421434 206
422-exclusive jurisdiction to hear and determine:
435+(A) [medical, nurse, or hospital ] covered medical services;
423436 207
424-(i) whether goods [provided to ]or services [rendered ] provided to an employee are
437+(B) medicines; and
425438 208
426-compensable [pursuant to] under this chapter or Chapter 3, Utah Occupational
439+(C) artificial means, appliances, or prosthesis;
427440 209
428-Disease Act, including:
441+(ii) except for amounts charged or paid under Subsection [(11)] (9)(c), the
429442 210
430-(A) [medical, nurse, or hospital ] covered medical services;
443+reasonableness of the amounts charged or paid for a good or service described in
431444 211
432-(B) medicines; and
445+Subsection [(12)(a)(i)] (11)(a)(i); and
433446 212
434-(C) artificial means, appliances, or prosthesis;
447+(iii) collection issues related to a good or service described in Subsection[ (12)(a)(i)]
435448 213
436-(ii) except for amounts charged or paid under Subsection [(11)] (9)(c), the
449+(11)(a)(i).
437450 214
438-reasonableness of the amounts charged or paid for a good or service described in
451+(b) Except as provided in Subsection [(12)(a)] (11)(a), Subsection 34A-2-211(6), or
439452 215
440-Subsection [(12)(a)(i)] (11)(a)(i); and
453+Section 34A-2-212, a person may not maintain a cause of action in any forum within
441454 216
442-(iii) collection issues related to a good or service described in Subsection [(12)(a)(i)]
455+this state other than the commission for collection or payment for goods or covered
443456 217
444-(11)(a)(i).
457+medical services described in Subsection [(12)(a)] (11)(a) that are compensable under
445458 218
446-(b) Except as provided in Subsection [(12)(a)] (11)(a), Subsection 34A-2-211(6), or
459+this chapter or Chapter 3, Utah Occupational Disease Act.
447460 219
448-Section 34A-2-212, a person may not maintain a cause of action in any forum within
461+Section 2. Effective Date.
449462 220
450-this state other than the commission for collection or payment for goods or covered
451-221
452-medical services described in Subsection [(12)(a)] (11)(a) that are compensable under
453-222
454-this chapter or Chapter 3, Utah Occupational Disease Act.
455-223
456-Section 2. Effective Date.
457-224
458463 This bill takes effect on May 7, 2025.
459464 - 7 -