HB1381

SECTION 1. The purpose of this Act is to expedite access to medical services for workers’ compensation claimants by allowing employers the opportunity to provide their employees with an employer-designated health care provider network to provide medical services for the initial 120 days of medical treatment. After the initial 120 days of treatment, the injured employee would then be allowed to “opt out” of the plan and select a physician that is not on the list. If the injured employee prefers not to go to the employer-designated health care provider network for initial treatment, the injured employee shall provide the employer with the name of the injured employee’s family physician, who is authorized to treat industrial injuries and illnesses under this chapter, who will treat the injured employee in the event of an industrial injury.

This Act will allow both employers and employees greater input into the decision making process on the treatment of a workplace injury, as well as to help control the costs of the workers' compensation claim.

SECTION 2. Section 386-21, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

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

(1) In the absence of any employer-designated health care provider network or employee-designated qualified family physician, which shall be furnished upon date of employment or twelve months prior to the date of injury, the injured employee may select any attending physician [~~or surgeon~~] who is practicing on the island where the injury was incurred to render medical care. If the services of a specialist are indicated, the employee may select any such attending 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 attending 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 attending physician [~~or surgeon~~], the employee may do so in accordance with rules prescribed by the director. If the employee is unable to select [a] an attending physician [or surgeon] and the emergency nature of the injury requires immediate medical attendance, or if the employee does not desire to select [a] an attending physician [~~or surgeon~~] and so advises the employer, the employer shall select the attending physician [~~or surgeon~~]. Such selection, however, shall not deprive the employee of the employee's right of subsequently selecting [a] an attending physician [~~or surgeon~~] for continuance of needed medical care.

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

(3) Fifty per cent of the employer-designated health care provider network must be qualified healthcare 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. At least twenty-five per cent of the employer-designated health care provider network must be physicians primarily engaged in the treatment of nonoccupational injuries. The director shall encourage the integration of occupational and nonoccupational providers. The number of physicians in the healthcare 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) Medical treatment for injuries shall be readily available at reasonable times to all employees. To the extent feasible, all medical treatment for injuries shall be readily accessible 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."

SECTION 3. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 4. This Act shall take effect upon its approval.

INTRODUCED BY:

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BY REQUEST

HOUSE OF REPRESENTATIVES	H.B. NO.	1381
TWENTY-FOURTH LEGISLATURE, 2007
STATE OF HAWAII