Report Title:

Workes' comp; medical treatment

Description:

Allows employers to establish health care provider networks from which employers would direct their employees for medical treatment.

HOUSE OF REPRESENTATIVES

H.B. NO.

2389

TWENTY-THIRD LEGISLATURE, 2006

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

RELATING TO WORKERS' COMPENSATION.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. The purpose of this Act is to create equity between the rights and benefits afforded to Hawaii's employees and the fiscal needs of Hawaii's employers. This Act seeks to ensure the stability of the State of Hawaii's workers' compensation system and to protect it from experiencing the same crippling hardships faced by other states by establishing medical provider networks from which employers would direct their employees to receive medical treatment.

SECTION 2. Section 386-1, Hawaii Revised Statutes, is amended by adding the definition of "evidence-based medical treatment guidelines" to read as follows:

""Evidence-Based Medical Treatment Guidelines" means evidence-based clinical practice guidelines adopted by the United States Department of Health and Human Services National Guideline Clearinghouse."

SECTION 3. Section 386-21, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

"(b) Whenever medical care is needed, the employer, or its insurance carrier, may require the injured employee to select from an approved employer designated health care provider network to provide medical services for the first one-hundred and twenty calendar days of medical treatment from date of injury, unless the employee, upon the date of employment or 12 months prior to the date of injury, has provided the employer, or its insurance carrier, with the name and address of the employee's family physician, who must be authorized to treat injuries covered by this chapter, from who, they will receive health care treatment in the event of a workers' compensation injury. Further:

(1) In the absence of an employer designated health care provider network or employee designated family physician, the injured employee may select any physician or surgeon who is practicing on the island where the injury was incurred to render such care. If the services of a specialist are indicated, the employee may select any such physician or surgeon practicing in the State. The director may authorize the selection of a specialist practicing outside the State where no comparable medical attendance within the State is available. Upon procuring the services of such physician or surgeon, the injured employee shall give proper notice of the employee's selection to the employer within a reasonable time after the beginning of the treatment. If for any reason during the period when medical care is needed, the employee wishes to change to another physician or surgeon, the employee may do so in accordance with rules prescribed by the director. If the employee is unable to select a physician or surgeon and the emergency nature of the injury requires immediate medical attendance, or if the employee does not desire to select a physician or surgeon and so advises the employer, the employer shall select the physician or surgeon. Such selection, however, shall not deprive the employee of the employee's right of subsequently selecting a physician or surgeon for continuance of needed medical care[.];

(2) Only after one hundred twenty calendar days of treatment for a work injury, may an employee utilizing an employer designated health care network opt to change physicians for any reason;

(3) Fifty per cent of the employer designated health care provider network must contain qualified health care providers who reside on the island where the injured employee resides;

(4) The network shall contain qualified health care providers who are primarily engaged in the treatment of occupational injuries and health care providers primarily engaged in the treatment of nonoccupational injuries. The goal shall be at least twenty-five per cent of physicians primarily engaged in the treatment of nonoccupational injuries. The number of physicians in the health care provider network shall be sufficient to provide treatment for injuries or conditions in a timely manner. The health care provider network shall include an adequate number and type of physicians, or other providers, to treat common injuries experienced by injured employees based on the type of occupation or industry in which the employee is engaged, and the geographic area where the employees are employed;

(5) To the extent feasible, all medical treatment for injuries shall be available to all employees. With respect to availability and accessibility of treatment, the director shall consider the needs of rural areas, specifically those in which health facilities are located at least thirty miles apart;

(6) The employer, or its insurance carrier, shall submit a plan for the health care provider network to the director for approval. The director shall approve the plan if the director determines that the plan meets the requirements of this section;

(7) If the employer, or its insurance carrier, meets the requirements of this section, the director may not withhold approval or disapprove an employer's, or its insurance carrier’s, health care provider network based solely on the selection of providers;

(8) No person other than a qualified health care provider under this chapter, who is competent to evaluate the specific clinical issues involved in the medical treatment services, when these services are within the scope of the health care providers practice, may modify, delay, or deny requests for authorization of medical treatment; and

(9) Qualified health care providers of the employer designated health care provider network must provide treatment utilizing evidence-based medical treatment guidelines approved by the United State Department of Health and Human Services National Guideline Clearinghouse."

SECTION 4. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 5. This Act shall take effect upon its approval.

INTRODUCED BY:

_____________________________

BY REQUEST