Bill Text: AZ HB2367 | 2012 | Fiftieth Legislature 2nd Regular | Introduced
Bill Title: Workers' compensation; health care organizations
Spectrum: Partisan Bill (Republican 1-0)
Status: (Failed) 2012-02-06 - House BI Committee action: Discussed and Held [HB2367 Detail]
Download: Arizona-2012-HB2367-Introduced.html
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REFERENCE TITLE: workers' compensation; health care organizations |
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State of Arizona House of Representatives Fiftieth Legislature Second Regular Session 2012
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HB 2367 |
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Introduced by Representative Fann
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AN ACT
Amending section 23-1070, Arizona Revised Statutes; amending Title 23, chapter 6, article 9, Arizona Revised Statutes, by adding sections 23-1070.02 and 23-1070.03; relating to workers' compensation.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 23-1070, Arizona Revised Statutes, is amended to read:
23-1070. Medical, surgical and hospital benefits provided by employer; pilot program
A. An employer, other than this state or a political subdivision of this state, who secures compensation to his employees in the manner provided in section 23‑961, subsection A, paragraph 1 or 2, or section 11-952.02, subsection B alone or jointly with other employers, in lieu of making premium payments for medical, surgical and hospital benefits, may provide such benefits to injured employees and may collect one‑half of the cost thereof from his employees, not to exceed one dollar per month from any employee, which may be deducted from the wages of the employee.
B. An employer electing to provide such benefits shall notify his insurance carrier and the commission of the election and render a detailed statement of the arrangements made therefor to the commission.
C. An employer who maintains a hospital for his employees or who contracts with a physician for the hospital care of injured employees, on or before January 30 each year, shall make a verified written report to the commission for the preceding year showing the total amount of hospital fees collected and showing separately the amount contributed by the employees and the amount contributed by the employers. The report shall also contain an itemized account of the expenditures, investments or other disposition of the fees, and a statement showing the balance remaining.
D. An employer who fails to notify his insurance carrier and the commission of his election to provide such benefits, or who maintains a hospital or contracts for hospital service as provided in subsection C of this section, and fails to make the financial report required therein, is liable for such benefits as provided in section 23‑1062.
E. If the medical, surgical or hospital aid or treatment being furnished by an employer is such that there is reasonable ground to believe that the health, life or recovery of any employee is endangered or impaired thereby, the commission, upon application of the employee or upon its own motion, may order a change of physicians or other conditions. If the employer fails to comply with the order promptly, the injured employee may elect to have medical, surgical or hospital aid or treatment provided by or through the special fund established by section 23‑1065. In that event the claim of the injured employee against the employer shall be assigned to the special fund for the benefit thereof, and the special fund shall furnish to the insured employee medical, surgical or hospital aid or treatment as provided in this chapter.
F. Notwithstanding subsection A of this section, a pilot program is established to allow a city with a population of more than one hundred fifty thousand persons and a self-insured county insurance pool to provide medical, surgical and hospital benefits pursuant to this section. The purpose of the pilot program is to determine whether public sector entities that are self‑insured can, through a directed care and medical management program, contain costs and improve health care and return to work results for injured employees. The industrial commission shall select the qualified city. The entities participating in the pilot program shall consult with the industrial commission on the protocol for assessment and reporting and shall submit all baseline data to the commission before the pilot program can begin. No earlier than January 1, 2012 and not later than January 1, 2013, the pilot program participants may begin providing medical, surgical and hospital benefits pursuant to this section on approval by the industrial commission. This subsection does not exempt pilot program participants from any other requirements for procurement of a medical network to direct care. The pilot program participants shall report in accordance with the protocol for assessment and reporting, with a final report two years after the start of the pilot program. The pilot program ends and pilot program participants may not provide medical, surgical and hospital benefits pursuant to this section from and after December 31, 2014.
Sec. 2. Title 23, chapter 6, article 9, Arizona Revised Statutes, is amended by adding sections 23-1070.02 and 23-1070.03, to read:
23-1070.02. Workers' compensation health care organizations; care for injured workers; definitions
A. An employer or, if insured, the insurer may form or contract with a workers' compensation health care organization to provide medically necessary medical, surgical or hospital benefits for employees who are injured by an accident arising out of and in the course of employment. The services shall not require a deductible, copayment or any other form of financial contribution from the employee.
B. An employee shall receive all medical, surgical or hospital benefits from a provider who is under contract with the workers' compensation health care organization with which the employer has a contract pursuant to subsection a of this section unless the employer authorizes the providing of the benefits by the provider. On notification to the employer by the employee or the employee's physician, an employee may change treating physicians or other providers of medical, surgical or hospital benefits within the list of providers that are participating in the workers' compensation health care organization.
C. Any workers' compensation health care organization must include an adequate number and type of physicians, or other providers, to treat common injuries that are experienced by injured employees and must provide medical treatment that is readily available to all injured employees.
D. When medical treatment is provided through a network, an employer shall notify all employees that the employer or, if insured, the insurer has contracted with a workers' compensation health care organizations. The notice shall be given within ten days of the effective date of the contract and subsequently to all new hires. The notice shall clearly state that pursuant to this section all medical care shall be provided by physicians and facilities within the network, there are no deductibles or copayments required from the employee when securing treatment for an injury or illness arising out of and in the course of employment and enrollment is not necessary to receive treatment. The notice shall also contain the following:
1. A list of contract providers and facilities.
2. A toll free telephone number that employees can call to receive answers to questions regarding medical care if the employee is injured.
3. A website with a list of contract providers and facilities that employees can access if the employee is injured.
4. An explanation of employee rights if the employee does not receive adequate medical care or does not receive care on a timely basis. This explanation shall include the process for requesting a change of physician within the workers' compensation health care organization, and any rights that the employee may have before the commission to review the employee's medical treatment.
E. An employer or, if insured, the insurer and a workers' compensation health care organization may contract for reimbursement rates that are different from the rates in the schedule of fees that is adopted and revised under section 23-908.
F. For the purposes of this section:
1. "Employer" means this state, a political subdivision of this state, an insurance carrier or an employer who secures compensation for employees under section 23-961, subsection A, paragraph 2.
2. "Workers' compensation health care organization" means a preferred provider organization, a physician or hospital network, an indemnity health insurer, hospital and medical service plans, dental plans or a health care service organization.
23-1070.03. Change of medical, surgical and hospital benefits; employer authorization; commission order
A. An employee may not change medical providers from those provided within the workers' compensation health care organization to a provider outside the organization without written authorization of the employer or insurance carrier.
B. If the employer or, if insured, the insurer refuses to authorize a change of medical provider from those provided within the workers' compensation health care organization to a provider outside the organization, the employee may request the commission to order such a change. The commission may order the change of providers only if it determines that the health, life or recovery of the employee is retarded, endangered or impaired.
Sec. 3. Effective date
This act is effective from and after December 31, 2012.
