Bill Text: IA HF2113 | 2017-2018 | 87th General Assembly | Introduced
Bill Title: A bill for an act relating to the state’s workers’ compensation laws by modifying alternate care procedures for medical treatment, creating registries of physicians who treat and evaluate work-related injuries, providing for the retention of a medical director, creating a state workplace injury care providers registry fund, establishing a workers’ compensation advisory council, providing for and appropriating fees, and including effective date provisions.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Introduced - Dead) 2018-01-25 - Subcommittee: Wheeler, Hunter and Watts. H.J. 155. [HF2113 Detail]
Download: Iowa-2017-HF2113-Introduced.html
House File 2113 - Introduced HOUSE FILE BY ISENHART A BILL FOR 1 An Act relating to the state's workers' compensation laws 2 by modifying alternate care procedures for medical 3 treatment, creating registries of physicians who treat 4 and evaluate work=related injuries, providing for the 5 retention of a medical director, creating a state workplace 6 injury care providers registry fund, establishing a 7 workers' compensation advisory council, providing for and 8 appropriating fees, and including effective date provisions. 9 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: TLSB 5932YH (2) 87 asf/rj PAG LIN 1 1 Section 1. Section 85.27, subsection 4, Code 2018, is 1 2 amended by striking the subsection and inserting in lieu 1 3 thereof the following: 1 4 4. a. For purposes of this section, the employer is 1 5 obligated to furnish reasonable services and supplies to 1 6 treat an injured employee and has the right to predesignate 1 7 the initial provider of medical care. Upon receiving 1 8 notification of an injury, the employer is also obligated 1 9 to provide the injured employee with written information on 1 10 the state's workers' compensation laws, including the rights 1 11 and responsibilities of the employee and the employer and to 1 12 document in writing that the employee received the information 1 13 in a timely manner. The commissioner shall provide, by 1 14 administrative rule, the format, content, and procedure for the 1 15 predesignation of the initial provider of medical care by the 1 16 employer and the provision of this information to the injured 1 17 employee. 1 18 (1) The employer shall promptly provide medical care for 1 19 the injury and may predesignate a licensed physician to treat 1 20 the injury and any condition the physician believes is causally 1 21 related to the injury. If the employer has not predesignated 1 22 a licensed physician to treat the injury and any condition 1 23 causally related to the injury, the employee may designate a 1 24 licensed physician of the employee's choosing to provide that 1 25 treatment. 1 26 (2) The employer may predesignate a physician listed in the 1 27 state registry of workplace injury care providers, as provided 1 28 in section 85.73, to treat the injury and any condition 1 29 causally related to the injury. 1 30 (3) The physician predesignated by the employer or 1 31 designated by the employee shall be authorized by the employer 1 32 to treat the injury at the employer's expense in any manner 1 33 deemed appropriate by the physician, without a requirement of 1 34 preapproval for such referrals by the employer, an agent or 1 35 representative of the employer, or the employer's insurer. 2 1 (4) The physician predesignated by the employer or 2 2 designated by the employee shall be authorized to make 2 3 referrals to other physicians, therapists, or health care 2 4 providers of specialized services at the employer's expense 2 5 without a requirement of preapproval for such referrals by the 2 6 employer, an agent or representative of the employer, or the 2 7 employer's insurer. 2 8 b. The physician predesignated by the employer or designated 2 9 by the employee to treat the injured employee shall provide 2 10 ongoing written documentation of the physician's opinions, 2 11 treatment recommendations, and care plan to the employee. Such 2 12 documentation shall indicate whether or not the physician's 2 13 opinions, treatment recommendations, and care plan are in 2 14 accord with the most recent edition of either the official 2 15 disability guidelines and treatment guidelines in workers' 2 16 compensation published by the work loss data institute or the 2 17 American college of occupational and environmental medicine 2 18 practice guidelines published by the American college of 2 19 occupational and environmental medicine, and if so, shall cite 2 20 the appropriate guidelines. 2 21 c. (1) If an employee receives treatment for an injury 2 22 from a physician predesignated by the employer and prior to 2 23 an evaluation of permanent disability by that predesignated 2 24 physician, the injured employee may be examined by and obtain a 2 25 second opinion, treatment recommendations, or a care plan from 2 26 another licensed physician of the employee's choosing. The 2 27 employee may request and the employer shall pay the reasonable 2 28 costs associated with this examination, including reimbursement 2 29 for transportation expenses incurred by the employee for 2 30 the examination. The employee shall notify the physician 2 31 predesignated by the employer that the employee is consulting 2 32 with another physician of the employee's choosing. 2 33 (2) If an employee receives treatment for an injury from 2 34 a physician designated by the employee, the employer is not 2 35 responsible for the costs of obtaining a second opinion, 3 1 treatment recommendations, or a care plan from an additional 3 2 licensed physician of the employee's choosing. 3 3 d. If the employer or employee has reason to be dissatisfied 3 4 with the care of a treating physician predesignated or 3 5 designated by the other party or with any referral made by that 3 6 physician, the employer and employee may mutually agree upon 3 7 alternate care. 3 8 e. If the employer and employee cannot agree on alternate 3 9 care, either the employer or employee may notify an insurance 3 10 claims specialist within the division of workers' compensation, 3 11 who shall, within five working days schedule a conference 3 12 between the employer and employee by any reasonable manner 3 13 available to review the basis for dissatisfaction and provide 3 14 an advisory opinion to resolve the medical care dispute. 3 15 f. If, following the conference with the insurance claims 3 16 specialist, the employer and employee cannot agree on such 3 17 alternate care, the workers' compensation commissioner, upon 3 18 application and reasonable proof of the necessity therefor, may 3 19 allow and order alternate care. 3 20 (1) The employee is responsible to make the application 3 21 for alternate care and to provide reasonable proof for the 3 22 necessity of alternate care if all of the following actions 3 23 occurred: 3 24 (a) The employer provided written information about the 3 25 state's workers' compensation laws as provided in paragraph 3 26 "a". 3 27 (b) The employer predesignated a treating physician listed 3 28 on the state registry of workplace injury care providers as 3 29 provided in paragraph "a", subparagraph (2). 3 30 (c) The treating physician predesignated by the employer 3 31 provided written documentation of the physician's opinions, 3 32 treatment recommendations, and care plan to the employee along 3 33 with a citation to appropriate treatment guidelines as provided 3 34 in paragraph "b". 3 35 (2) The employer is responsible to make the application 4 1 for alternate care and to provide reasonable proof for the 4 2 necessity of alternate care if any of the actions specified in 4 3 subparagraph (1) did not occur or if the employee designated 4 4 the treating physician to treat the injury. 4 5 (3) The commissioner shall not be bound by the advisory 4 6 opinion of the insurance claims specialist. Upon application, 4 7 the workers' compensation commissioner shall conduct a hearing 4 8 in any reasonable manner to effectuate a prompt resolution of 4 9 the alternate care dispute. The commissioner shall issue a 4 10 decision within ten working days of receipt of an application 4 11 for alternate care. 4 12 (4) The employer or its insurer is liable for the costs of 4 13 all medical care provided by a physician predesignated by the 4 14 employer or designated by the employee pursuant to paragraph 4 15 "a", subparagraph (1), or from referrals from the predesignated 4 16 or designated physician, and shall hold the employee harmless 4 17 for the cost of care by the predesignated or designated care 4 18 providers. 4 19 (5) In an emergency, the employee may choose the employee's 4 20 care at the employer's expense, provided the employer or the 4 21 employer's agent cannot be immediately contacted to indicate 4 22 who the employer has predesignated as a treating physician. 4 23 (6) The employer shall notify an injured employee of the 4 24 employee's ability to contest the employer's choice of the 4 25 predesignated treating physician or other provider of medical 4 26 care as part of the information given to the employee as 4 27 required under paragraph "a". 4 28 g. (1) The employer has the right to request an employee 4 29 to submit, as often as is reasonable and at a reasonable time 4 30 and place, to an examination by a licensed physician chosen 4 31 by the employer for any purpose relevant to the employer's 4 32 duties to provide benefits to the employee under this chapter, 4 33 or chapters 85A, 85B, and 86. If the employer makes such a 4 34 request to an employee in writing and offers to advance or 4 35 reimburse the employee's transportation expenses incurred 5 1 in traveling to and from the place of the examination, the 5 2 employee shall submit to the examination. 5 3 (2) Each time that an employee is requested to and submits 5 4 to an examination requested by the employer as provided in 5 5 subparagraph (1), the employee has the right to be examined by 5 6 a licensed physician chosen by the employee for any purpose 5 7 relevant to the employer's duties to provide benefits to the 5 8 employee as described in subparagraph (1). 5 9 (3) Each time that an employer obtains an evaluation of 5 10 an employee's permanent disability by a physician chosen 5 11 by the employer, if the injured employee believes that the 5 12 evaluation of the extent of the employee's permanent disability 5 13 is too low, the employee may obtain a subsequent examination 5 14 and evaluation of the employee's permanent disability by a 5 15 physician of the employee's choice. The physician chosen by 5 16 the employee has the right to confer with and obtain sufficient 5 17 medical history of the employee from the physician who examined 5 18 the employee on behalf of the employer to make a proper 5 19 evaluation of the employee's permanent disability. 5 20 (4) The employer shall promptly pay the costs of any 5 21 examination obtained pursuant to this paragraph "g", or if 5 22 necessary to obtain the examination, advance the costs of 5 23 the examination, and pay the employee's reasonably necessary 5 24 transportation expenses incurred in traveling to and from the 5 25 place of any examination and shall hold the employee harmless 5 26 for the cost of all examinations and medical care provided 5 27 pursuant to this paragraph "g" and the employee's reasonably 5 28 necessary transportation expenses. 5 29 Sec. 2. NEW SECTION. 85.73 State workplace injury care 5 30 providers ==== registry ==== fees. 5 31 1. The workers' compensation commissioner shall establish 5 32 and maintain a registry of physicians licensed in the state 5 33 that offer or provide treatment of work=related injuries. 5 34 2. The commissioner, by administrative rule, shall 5 35 establish requirements for a physician to be listed on the 6 1 registry and establish a registration fee. 6 2 3. This section shall not be construed to require a 6 3 physician to be listed on the registry in order to offer or 6 4 provide treatment of work=related injuries. 6 5 4. This section shall not be construed to prohibit an 6 6 employer from predesignating or an employee from designating a 6 7 physician to provide treatment of a work=related injury who is 6 8 not listed on the registry. 6 9 Sec. 3. NEW SECTION. 85.74 Independent medical evaluations 6 10 ==== provider ==== registry ==== fees. 6 11 1. The commissioner shall establish and maintain a separate 6 12 registry of licensed physicians trained to perform independent 6 13 medical evaluations and to issue impairment ratings of injured 6 14 employees. 6 15 2. The commissioner shall establish, by administrative 6 16 rule, minimum training requirements for a physician to be 6 17 listed on the registry and establish a registration fee. 6 18 3. The commissioner shall also provide by administrative 6 19 rule that a physician must be listed on the registry in order 6 20 to perform independent medical evaluations and issue impairment 6 21 ratings of injured employees in this state. The commissioner 6 22 may prohibit an employer or employee from using an independent 6 23 medical evaluation or an impairment rating of an injured 6 24 employee from a physician who is not listed on the registry 6 25 as evidence at a hearing to determine benefits under Iowa's 6 26 workers' compensation laws. 6 27 Sec. 4. NEW SECTION. 85.75 Fees appropriated. 6 28 All fees collected pursuant to sections 85.73 and 85.74 6 29 shall be credited to the state workplace injury care providers 6 30 registry fund created in section 85.77 and are appropriated to 6 31 the division to be used to carry out the provisions of sections 6 32 85.73, 85.74, 85.76, and 85.78, including but not limited 6 33 to establishing and maintaining the registries described in 6 34 sections 85.73 and 85.74, retaining a medical director as set 6 35 forth in section 85.76, and providing for the expenses of the 7 1 workers' compensation advisory council created in section 7 2 85.78. 7 3 Sec. 5. NEW SECTION. 85.76 Medical director. 7 4 The workers' compensation commissioner may retain the 7 5 services of a medical director to assist the division of 7 6 workers' compensation in advancing occupational health in Iowa 7 7 and to advise the commissioner on how to successfully apply and 7 8 administer the state's workers' compensation laws, including 7 9 assessments of the use of evidence=based care in treating 7 10 work=related injuries. 7 11 Sec. 6. NEW SECTION. 85.77 State workplace injury care 7 12 providers registry fund. 7 13 1. A state workplace injury care providers registry fund 7 14 is created in the state treasury as a separate fund under the 7 15 control of the division of workers' compensation. All moneys 7 16 appropriated or transferred to the fund shall be credited to 7 17 the fund. All moneys deposited or paid into the fund shall 7 18 only be appropriated to the workers' compensation commissioner 7 19 to be used for the purposes set forth in sections 85.73, 85.74, 7 20 85.75, and 85.76. 7 21 2. Notwithstanding section 8.33, any balance in the fund 7 22 on June 30 of each fiscal year shall not revert to the general 7 23 fund of the state, but shall be available for purposes of 7 24 sections 85.73, 85.74, 85.75, 85.76, and 85.78 in subsequent 7 25 fiscal years. Notwithstanding section 12C.7, interest earnings 7 26 on moneys in the fund shall be credited to the fund. 7 27 Sec. 7. NEW SECTION. 85.78 Workers' compensation advisory 7 28 council. 7 29 1. A workers' compensation advisory council is established 7 30 within the division of workers' compensation. The council 7 31 shall be composed of the following persons: 7 32 a. Two members appointed by the governor and subject to 7 33 confirmation by the senate pursuant to section 2.32, one 7 34 representing employers, and one representing organized labor. 7 35 b. Two members appointed jointly by the majority leader and 8 1 the minority leader of the senate, one representing employers, 8 2 and one representing organized labor. 8 3 c. Two members appointed jointly by the speaker and 8 4 the minority leader of the house of representatives, one 8 5 representing employers and one representing organized labor. 8 6 2. The members shall serve six=year terms beginning and 8 7 ending as provided in section 69.19. However, the initial 8 8 members shall be appointed to serve for less than six years to 8 9 ensure members serve staggered terms. A member is eligible for 8 10 reappointment. A vacancy on the council shall be filled for 8 11 the unexpired portion of the regular term in the same manner as 8 12 regular appointments are made. 8 13 3. One representative of employers and one of organized 8 14 labor shall be elected as co=chairpersons by the council and 8 15 shall serve for two=year staggered terms. However, one of 8 16 the initial co=chairpersons shall be elected to serve for 8 17 a three=year term to ensure that the co=chairpersons serve 8 18 staggered terms. 8 19 4. Four members constitute a quorum. The affirmative 8 20 vote of a majority of the voting members present as well as 8 21 the approval of at least two employer representatives and two 8 22 labor representatives is necessary for any substantive action 8 23 to be taken by the council. The majority shall not include 8 24 any member who has a conflict of interest and a statement by a 8 25 member that the member has a conflict of interest is conclusive 8 26 for this purpose. A vacancy in the membership does not impair 8 27 the duties of the council. 8 28 5. The council shall meet on a regular basis and at the 8 29 call of the co=chairpersons or upon the written request to the 8 30 co=chairpersons of two or more members. 8 31 6. The members are entitled to receive a per diem allowance 8 32 and actual expense reimbursement as specified in section 7E.6. 8 33 7. The purpose of the council is to assist the workers' 8 34 compensation commissioner in the successful administration 8 35 of the division of workers' compensation and to make 9 1 recommendations to the governor and the general assembly 9 2 regarding workplace safety and improvements to the state's 9 3 workers' compensation system. 9 4 8. The responsibilities of the council are as follows: 9 5 a. Monitor and support the successful implementation of the 9 6 state's workers' compensation laws. 9 7 b. Identify problems and recommend solutions and 9 8 improvements with respect to the effectiveness of the state's 9 9 workers' compensation system, to the division of workers' 9 10 compensation, and to the governor and the general assembly. 9 11 c. Assist the workers' compensation commissioner in 9 12 developing and implementing a program to train and certify 9 13 claims adjusters for practice in Iowa. 9 14 d. Work with all stakeholders, including the medical 9 15 director retained pursuant to section 85.76, to develop and 9 16 promote a system of high=performance, transparent, accountable, 9 17 and evidence=based health care for the treatment and prevention 9 18 of workplace injuries. 9 19 e. Make recommendations to and receive recommendations from 9 20 the nonprofit Iowa workers' compensation advisory committee 9 21 regarding topics for stakeholder and public education with 9 22 respect to the application of workers' compensation law and 9 23 successful workers' compensation programs and strategies, as 9 24 well as the prevention of workplace injuries. 9 25 Sec. 8. EFFECTIVE DATE. The following provision or 9 26 provisions of this Act take effect July 1, 2019: 9 27 1. The section of this Act amending section 85.27. 9 28 2. The section of this Act enacting section 85.74. 9 29 Sec. 9. EFFECTIVE DATE. The following provision or 9 30 provisions of this Act take effect January 1, 2019: 9 31 1. The section of this Act enacting section 85.73. 9 32 2. The section of this Act enacting section 85.75. 9 33 3. The section of this Act enacting section 85.76. 9 34 4. The section of this Act enacting section 85.77. 9 35 5. The section of this Act enacting section 85.78. 10 1 EXPLANATION 10 2 The inclusion of this explanation does not constitute agreement with 10 3 the explanation's substance by the members of the general assembly. 10 4 This bill relates to the state's workers' compensation laws 10 5 by modifying alternate care procedures for medical treatment, 10 6 creating registries of physicians who treat and evaluate 10 7 work=related injuries, providing for the retention of a medical 10 8 director, creating a state workplace injury care providers 10 9 registry fund, establishing a workers' compensation advisory 10 10 council, providing for fees, and providing effective dates. 10 11 ALTERNATE CARE. Amended Code section 85.27(4), concerning 10 12 the provision of medical services, requires an employer 10 13 to provide written information about the state's workers' 10 14 compensation laws to an employee upon receiving notification 10 15 that the employee has suffered a work=related injury. The 10 16 employer has the right to predesignate a licensed physician 10 17 to treat the injury and make necessary referrals and may 10 18 predesignate a physician listed on the state registry of 10 19 workplace injury care providers. If the employer does not 10 20 predesignate a treating physician, the employee may designate a 10 21 physician of the employee's choosing to provide the treatment. 10 22 Currently, an employer has the right to choose care for 10 23 workplace injuries and an employee does not have the right 10 24 to designate a physician to provide treatment for workplace 10 25 injuries, whether or not the employer has predesignated a 10 26 treating physician, except in certain emergency situations. 10 27 The physician predesignated by the employer or designated 10 28 by the employee is required to provide ongoing written 10 29 documentation of the physician's opinions, treatment 10 30 recommendations, and care plan to the employee along with 10 31 information about whether the opinions, recommendations, and 10 32 care plan are in accord with either the official disability 10 33 guidelines and treatment guidelines in workers' compensation 10 34 published by the work loss data institute or the American 10 35 college of occupational and environmental medicine practice 11 1 guidelines (ACOEM), and if so, citation to the appropriate 11 2 guidelines. The employee has the right to request and obtain 11 3 a second opinion from another licensed physician of the 11 4 employee's choosing at the employer's expense. 11 5 If the employer or employee is dissatisfied with the care 11 6 of a treating physician predesignated or designated by the 11 7 other party or with any referral made by that physician, the 11 8 employer and employee may mutually agree to alternate care. If 11 9 they cannot agree on alternate care, either party may notify 11 10 an insurance claims specialist within the division of workers' 11 11 compensation, who shall, within five working days, schedule 11 12 a conference between the parties to review the basis for 11 13 dissatisfaction and provide an advisory opinion to resolve the 11 14 dispute. If the parties still cannot agree on alternate care 11 15 after this conference, the workers' compensation commissioner, 11 16 upon application and reasonable proof of the necessity, may 11 17 allow and order alternate care. 11 18 The employee is responsible to make the application for 11 19 alternate care and to provide such reasonable proof to the 11 20 commissioner if the employer provided written information 11 21 about the state's workers' compensation laws at the time of 11 22 notification of the employee's injury, and predesignated a 11 23 treating physician listed on the state registry of workplace 11 24 injury care providers, and if the treating physician 11 25 predesignated by the employer provided written documentation 11 26 to the employee of the physician's opinions, treatment 11 27 recommendations, and care plan along with citation to the 11 28 appropriate treatment guidelines. 11 29 The employer is responsible for making the application for 11 30 alternate care and providing reasonable proof if the employer 11 31 and predesignated treating physician did not act as described 11 32 above or if the employee designated the treating physician to 11 33 treat the work injury. 11 34 The commissioner is not bound by the advisory opinion of 11 35 the claims specialist and must conduct a hearing and issue 12 1 a decision within 10 days of receipt of an application for 12 2 alternate care. 12 3 The employer has the right to request an employee to submit, 12 4 as often as is reasonable and at a reasonable time and place 12 5 to an examination by a licensed physician chosen by the 12 6 employer for any purpose relevant to the employer's duties to 12 7 provide benefits to the employee under the state's workers' 12 8 compensation laws and at the employer's expense. If the 12 9 employer makes the request in writing and pays all expenses, 12 10 including transportation, the employee shall submit to the 12 11 examination. Each time that the employer obtains an evaluation 12 12 of an employee's permanent disability by a physician chosen by 12 13 the employer, if the employee believes that the evaluation of 12 14 disability is too low, the employee may obtain a subsequent 12 15 examination and evaluation by a physician of the employee's 12 16 choosing at the employer's expense, including transportation 12 17 expenses to and from the place of the examination. 12 18 PROVIDER REGISTRIES ==== FEES ==== MEDICAL DIRECTOR. New Code 12 19 section 85.73 requires the workers' compensation commissioner 12 20 to establish and maintain a registry of licensed physicians 12 21 that offer or provide treatment of work=related injuries. 12 22 The commissioner shall establish, by administrative rule, 12 23 requirements for a physician to be listed on the registry and 12 24 establish a registration fee. The provision shall not be 12 25 construed to require a physician to be listed on the registry 12 26 in order to offer or provide treatment of work=related injuries 12 27 or to prohibit an employer or employee from predesignating or 12 28 designating a physician to provide treatment who is not listed 12 29 on the registry. 12 30 New Code section 85.74 requires the commissioner to 12 31 establish and maintain a separate registry of licensed 12 32 physicians trained to perform independent medical evaluations 12 33 and to issue impairment ratings of injured employees. The 12 34 commissioner shall establish, by administrative rule, minimum 12 35 training requirements for a physician to be listed on the 13 1 registry and establish a fee. A physician must be listed 13 2 on the registry in order to perform independent medical 13 3 evaluations and issue impairment ratings of injured employees 13 4 in this state. The commissioner may prohibit an employer 13 5 or employee from using an independent medical evaluation or 13 6 impairment rating of an injured employee from a physician who 13 7 is not listed on the registry as evidence at a hearing to 13 8 determine benefits under Iowa's workers' compensation laws. 13 9 New Code section 85.76 authorizes the commissioner to 13 10 retain the services of a medical director to assist the 13 11 division of workers' compensation in advancing the field of 13 12 occupational health in Iowa and to advise the commissioner on 13 13 how to successfully apply and administer the state's workers' 13 14 compensation laws. 13 15 STATE WORKPLACE INJURY CARE PROVIDERS REGISTRY FUND. All 13 16 registration fees collected pursuant to new Code sections 85.73 13 17 and 85.74 shall be credited to the state workplace injury care 13 18 providers registry fund created in new Code section 85.77 and 13 19 are appropriated to the division of workers' compensation by 13 20 new Code section 85.75 to carry out the provisions of new Code 13 21 sections 85.73, 85.74, 85.75, and 85.76 including establishing 13 22 and maintaining the two physician registries, retaining 13 23 a medical director, and for the expenses of the workers' 13 24 compensation advisory council created in new Code section 13 25 85.78. 13 26 WORKERS' COMPENSATION ADVISORY COUNCIL. New Code section 13 27 85.78 establishes a workers' compensation advisory council 13 28 within the division of workers' compensation that is composed 13 29 of six members, three representing employers and three 13 30 representing organized labor. The governor appoints two of the 13 31 members, the majority leader and the minority leader of the 13 32 senate jointly appoint two members, and the speaker and the 13 33 minority leader of the house of representatives jointly appoint 13 34 two members. The members serve six=year staggered terms. The 13 35 purpose of the council is to assist the workers' compensation 14 1 commissioner in the successful administration of the division 14 2 of workers' compensation and to make recommendations to the 14 3 governor and the general assembly regarding workplace safety 14 4 and improvements to the state's workers' compensation system. 14 5 EFFECTIVE DATES. The sections of the bill creating the 14 6 provider registry for treatment of work injuries, the provider 14 7 registry fund, the position of medical director, and the 14 8 advisory council, and appropriating fees, take effect January 14 9 1, 2019. The sections of the bill pertaining to alternate care 14 10 procedures and required registration of physicians performing 14 11 independent medical evaluations and impairment ratings take 14 12 effect July 1, 2019. LSB 5932YH (2) 87 asf/rj
