Bill Text: OR SB533 | 2013 | Regular Session | Enrolled

---

Bill Title: Relating to the authority of certain medical service providers to provide services to injured workers.

Spectrum: Committee Bill

Status: (Passed) 2013-05-24 - Effective date, January 1, 2014. [SB533 Detail]

Download: Oregon-2013-SB533-Enrolled.html

---

     77th OREGON LEGISLATIVE ASSEMBLY--2013 Regular Session

                            Enrolled

                         Senate Bill 533

Sponsored by COMMITTEE ON BUSINESS AND TRANSPORTATION

                     CHAPTER ................

                             AN ACT

Relating to the authority of certain medical service providers to
  provide services to injured workers; amending ORS 656.245 and
  656.260.

Be It Enacted by the People of the State of Oregon:

  SECTION 1. ORS 656.245 is amended to read:
  656.245. (1)(a) For every compensable injury, the insurer or
the self-insured employer shall cause to be provided medical
services for conditions caused in material part by the injury for
such period as the nature of the injury or the process of the
recovery requires, subject to the limitations in ORS 656.225,
including such medical services as may be required after a
determination of permanent disability. In addition, for
consequential and combined conditions described in ORS 656.005
(7), the insurer or the self-insured employer shall cause to be
provided only those medical services directed to medical
conditions caused in major part by the injury.
  (b) Compensable medical services shall include medical,
surgical, hospital, nursing, ambulances and other related
services, and drugs, medicine, crutches and prosthetic
appliances, braces and supports and where necessary, physical
restorative services. A pharmacist or dispensing physician shall
dispense generic drugs to the worker in accordance with ORS
689.515. The duty to provide such medical services continues for
the life of the worker.
  (c) Notwithstanding any other provision of this chapter,
medical services after the worker's condition is medically
stationary are not compensable except for the following:
  (A) Services provided to a worker who has been determined to be
permanently and totally disabled.
  (B) Prescription medications.
  (C) Services necessary to administer prescription medication or
monitor the administration of prescription medication.
  (D) Prosthetic devices, braces and supports.
  (E) Services necessary to monitor the status, replacement or
repair of prosthetic devices, braces and supports.
  (F) Services provided pursuant to an accepted claim for
aggravation under ORS 656.273.
  (G) Services provided pursuant to an order issued under ORS
656.278.
  (H) Services that are necessary to diagnose the worker's
condition.

Enrolled Senate Bill 533 (SB 533-A)                        Page 1

  (I) Life-preserving modalities similar to insulin therapy,
dialysis and transfusions.
  (J) With the approval of the insurer or self-insured employer,
palliative care that the worker's attending physician referred to
in ORS 656.005 (12)(b)(A) prescribes and that is necessary to
enable the worker to continue current employment or a vocational
training program. If the insurer or self-insured employer does
not approve, the attending physician or the worker may request
approval from the Director of the Department of Consumer and
Business Services for such treatment. The director may order a
medical review by a physician or panel of physicians pursuant to
ORS 656.327 (3) to aid in the review of such treatment. The
decision of the director is subject to review under ORS 656.704.
  (K) With the approval of the director, curative care arising
from a generally recognized, nonexperimental advance in medical
science since the worker's claim was closed that is highly likely
to improve the worker's condition and that is otherwise justified
by the circumstances of the claim. The decision of the director
is subject to review under ORS 656.704.
  (L) Curative care provided to a worker to stabilize a temporary
and acute waxing and waning of symptoms of the worker's
condition.
  (d) When the medically stationary date in a disabling claim is
established by the insurer or self-insured employer and is not
based on the findings of the attending physician, the insurer or
self-insured employer is responsible for reimbursement to
affected medical service providers for otherwise compensable
services rendered until the insurer or self-insured employer
provides written notice to the attending physician of the
worker's medically stationary status.
  (e) Except for services provided under a managed care contract,
out-of-pocket expense reimbursement to receive care from the
attending physician or nurse practitioner authorized to provide
compensable medical services under this section shall not exceed
the amount required to seek care from an appropriate nurse
practitioner or attending physician of the same specialty who is
in a medical community geographically closer to the worker's
home.  For the purposes of this paragraph, all physicians and
nurse practitioners within a metropolitan area are considered to
be part of the same medical community.
  (2)(a) The worker may choose an attending doctor, physician or
nurse practitioner within the State of Oregon. The worker may
choose the initial attending physician or nurse practitioner and
may subsequently change attending physician or nurse practitioner
two times without approval from the director. If the worker
thereafter selects another attending physician or nurse
practitioner, the insurer or self-insured employer may require
the director's approval of the selection. The decision of the
director is subject to review under ORS 656.704. The worker also
may choose an attending doctor or physician in another country or
in any state or territory or possession of the United States with
the prior approval of the insurer or self-insured employer.
  (b) A medical service provider who is not a member of a managed
care organization is subject to the following provisions:
  (A) A medical service provider who is not qualified to be an
attending physician may provide compensable medical service to an
injured worker for a period of 30 days from the date of the first
visit on the initial claim or for 12 visits, whichever first
occurs, without the authorization of an attending physician.
Thereafter, medical service provided to an injured worker without

Enrolled Senate Bill 533 (SB 533-A)                        Page 2

the written authorization of an attending physician is not
compensable.
  (B) A medical service provider who is not an attending
physician cannot authorize the payment of temporary disability
compensation. However, an emergency room physician who is not
authorized to serve as an attending physician under ORS 656.005
(12)(c) may authorize temporary disability benefits for a maximum
of 14 days. A medical service provider qualified to serve as an
attending physician under ORS 656.005 (12)(b)(B) may authorize
the payment of temporary disability compensation for a period not
to exceed 30 days from the date of the first visit on the initial
claim.
  (C) Except as otherwise provided in this chapter, only a
physician qualified to serve as an attending physician under ORS
656.005 (12)(b)(A) or (B)(i) who is serving as the attending
physician at the time of claim closure may make findings
regarding the worker's impairment for the purpose of evaluating
the worker's disability.
  (D) Notwithstanding subparagraphs (A) and (B) of this
paragraph, a nurse practitioner licensed under ORS 678.375 to
678.390:
  (i) May provide compensable medical services for   { - 90 - }
 { +  180 + } days from the date of the first visit on the
 { + initial + } claim;
  (ii) May authorize the payment of temporary disability benefits
for a period not to exceed   { - 60 - }   { + 180 + } days from
the date of the first visit on the initial claim; and
  (iii) When an injured worker treating with a nurse practitioner
authorized to provide compensable services under this section
becomes medically stationary within the   { - 90-day - }
 { + 180-day + } period in which the nurse practitioner is
authorized to treat the injured worker, shall refer the injured
worker to a physician qualified to be an attending physician as
defined in ORS 656.005 for the purpose of making findings
regarding the worker's impairment for the purpose of evaluating
the worker's disability.  If a worker returns to the nurse
practitioner after initial claim closure for evaluation of a
possible worsening of the worker's condition, the nurse
practitioner shall refer the worker to an attending physician and
the insurer shall compensate the nurse practitioner for the
examination performed.
  (3) Notwithstanding any other provision of this chapter, the
director, by rule, upon the advice of the committee created by
ORS 656.794 and upon the advice of the professional licensing
boards of practitioners affected by the rule, may exclude from
compensability any medical treatment the director finds to be
unscientific, unproven, outmoded or experimental. The decision of
the director is subject to review under ORS 656.704.
  (4) Notwithstanding subsection (2)(a) of this section, when a
self-insured employer or the insurer of an employer contracts
with a managed care organization certified pursuant to ORS
656.260 for medical services required by this chapter to be
provided to injured workers:
  (a) Those workers who are subject to the contract shall receive
medical services in the manner prescribed in the contract.
Workers subject to the contract include those who are receiving
medical treatment for an accepted compensable injury or
occupational disease, regardless of the date of injury or
medically stationary status, on or after the effective date of
the contract. If the managed care organization determines that

Enrolled Senate Bill 533 (SB 533-A)                        Page 3

the change in provider would be medically detrimental to the
worker, the worker shall not become subject to the contract until
the worker is found to be medically stationary, the worker
changes physicians or nurse practitioners, or the managed care
organization determines that the change in provider is no longer
medically detrimental, whichever event first occurs. A worker
becomes subject to the contract upon the worker's receipt of
actual notice of the worker's enrollment in the managed care
organization, or upon the third day after the notice was sent by
regular mail by the insurer or self-insured employer, whichever
event first occurs. A worker shall not be subject to a contract
after it expires or terminates without renewal. A worker may
continue to treat with the attending physician or nurse
practitioner authorized to provide compensable medical services
under this section under an expired or terminated managed care
organization contract if the physician or nurse practitioner
agrees to comply with the rules, terms and conditions regarding
services performed under any subsequent managed care organization
contract to which the worker is subject. A worker shall not be
subject to a contract if the worker's primary residence is more
than 100 miles outside the managed care organization's certified
geographical area. Each such contract must comply with the
certification standards provided in ORS 656.260. However, a
worker may receive immediate emergency medical treatment that is
compensable from a medical service provider who is not a member
of the managed care organization. Insurers or self-insured
employers who contract with a managed care organization for
medical services shall give notice to the workers of eligible
medical service providers and such other information regarding
the contract and manner of receiving medical services as the
director may prescribe. Notwithstanding any provision of law or
rule to the contrary, a worker of a noncomplying employer is
considered to be subject to a contract between the State Accident
Insurance Fund Corporation as a processing agent or the assigned
claims agent and a managed care organization.
  (b)(A) For initial or aggravation claims filed after June 7,
1995, the insurer or self-insured employer may require an injured
worker, on a case-by-case basis, immediately to receive medical
services from the managed care organization.
  (B) If the insurer or self-insured employer gives notice that
the worker is required to receive treatment from the managed care
organization, the insurer or self-insured employer must guarantee
that any reasonable and necessary services so received, that are
not otherwise covered by health insurance, will be paid as
provided in ORS 656.248, even if the claim is denied, until the
worker receives actual notice of the denial or until three days
after the denial is mailed, whichever event first occurs. The
worker may elect to receive care from a primary care physician or
nurse practitioner authorized to provide compensable medical
services under this section who agrees to the conditions of ORS
656.260 (4)(g). However, guarantee of payment is not required by
the insurer or self-insured employer if this election is made.
  (C) If the insurer or self-insured employer does not give
notice that the worker is required to receive treatment from the
managed care organization, the insurer or self-insured employer
is under no obligation to pay for services received by the worker
unless the claim is later accepted.
  (D) If the claim is denied, the worker may receive medical
services after the date of denial from sources other than the
managed care organization until the denial is reversed.

Enrolled Senate Bill 533 (SB 533-A)                        Page 4

Reasonable and necessary medical services received from sources
other than the managed care organization after the date of claim
denial must be paid as provided in ORS 656.248 by the insurer or
self-insured employer if the claim is finally determined to be
compensable.
  (5) { + (a) + } A nurse practitioner licensed under ORS 678.375
to 678.390 who is not a member of the managed care organization
 { - , - }  is authorized to provide the same level of services
as a primary care physician as established by ORS 656.260 (4)
 { - , - }  if   { - at the time the worker is enrolled in the
managed care organization, - }  the nurse practitioner maintains
the worker's medical records and with whom the worker has a
documented history of treatment, if that nurse practitioner
agrees to refer the worker to the managed care organization for
any specialized treatment, including physical therapy, to be
furnished by another provider that the worker may require and if
that nurse practitioner agrees to comply with all the rules,
terms and conditions regarding services performed by the managed
care organization.
   { +  (b) A nurse practitioner authorized to provide medical
services to a worker enrolled in the managed care organization
may provide medical treatment to the worker if the treatment is
determined to be medically appropriate according to the service
utilization review process of the managed care organization and
may authorize temporary disability payments as provided in
subsection (2)(b)(D) of this section. However, the managed care
organization may authorize the nurse practitioner to provide
medical services and authorize temporary disability payments
beyond the periods established in subsection (2)(b)(D) of this
section. + }
  (6) Subject to the provisions of ORS 656.704, if a claim for
medical services is disapproved, the injured worker, insurer or
self-insured employer may request administrative review by the
director pursuant to ORS 656.260 or 656.327.
  SECTION 2. ORS 656.260 is amended to read:
  656.260. (1) Any health care provider or group of medical
service providers may make written application to the Director of
the Department of Consumer and Business Services to become
certified to provide managed care to injured workers for injuries
and diseases compensable under this chapter. However, nothing in
this section authorizes an organization that is formed, owned or
operated by an insurer or employer other than a health care
provider to become certified to provide managed care.
  (2) Each application for certification shall be accompanied by
a reasonable fee prescribed by the director. A certificate is
valid for such period as the director may prescribe unless sooner
revoked or suspended.
  (3) Application for certification shall be made in such form
and manner and shall set forth such information regarding the
proposed plan for providing services as the director may
prescribe. The information shall include, but not be limited to:
  (a) A list of the names of all individuals who will provide
services under the managed care plan, together with appropriate
evidence of compliance with any licensing or certification
requirements for that individual to practice in this state.
  (b) A description of the times, places and manner of providing
services under the plan.
  (c) A description of the times, places and manner of providing
other related optional services the applicants wish to provide.

Enrolled Senate Bill 533 (SB 533-A)                        Page 5

  (d) Satisfactory evidence of ability to comply with any
financial requirements to insure delivery of service in
accordance with the plan which the director may prescribe.
  (4) The director shall certify a health care provider or group
of medical service providers to provide managed care under a plan
if the director finds that the plan:
  (a) Proposes to provide medical and health care services
required by this chapter in a manner that:
  (A) Meets quality, continuity and other treatment standards
adopted by the health care provider or group of medical service
providers in accordance with processes approved by the director;
and
  (B) Is timely, effective and convenient for the worker.
  (b) Subject to any other provision of law, does not
discriminate against or exclude from participation in the plan
any category of medical service providers and includes an
adequate number of each category of medical service providers to
give workers adequate flexibility to choose medical service
providers from among those individuals who provide services under
the plan.  However, nothing in the requirements of this paragraph
shall affect the provisions of ORS 441.055 relating to the
granting of medical staff privileges.
  (c) Provides appropriate financial incentives to reduce service
costs and utilization without sacrificing the quality of service.
  (d) Provides adequate methods of peer review, service
utilization review, quality assurance, contract review and
dispute resolution to ensure appropriate treatment or to prevent
inappropriate or excessive treatment, to exclude from
participation in the plan those individuals who violate these
treatment standards and to provide for the resolution of such
medical disputes as the director considers appropriate. A
majority of the members of each peer review, quality assurance,
service utilization and contract review committee shall be
physicians licensed to practice medicine by the Oregon Medical
Board. As used in this paragraph:
  (A) 'Peer review' means evaluation or review of the performance
of colleagues by a panel with similar types and degrees of
expertise. Peer review requires participation of at least three
physicians prior to final determination.
  (B) 'Service utilization review' means evaluation and
determination of the reasonableness, necessity and
appropriateness of a worker's use of medical care resources and
the provision of any needed assistance to clinician or member, or
both, to ensure appropriate use of resources. 'Service
utilization review ' includes prior authorization, concurrent
review, retrospective review, discharge planning and case
management activities.
  (C) 'Quality assurance' means activities to safeguard or
improve the quality of medical care by assessing the quality of
care or service and taking action to improve it.
  (D) 'Dispute resolution' includes the resolution of disputes
arising under peer review, service utilization review and quality
assurance activities between insurers, self-insured employers,
workers and medical and health care service providers, as
required under the certified plan.
  (E) 'Contract review' means the methods and processes whereby
the managed care organization monitors and enforces its contracts
with participating providers for matters other than matters
enumerated in subparagraphs (A), (B) and (C) of this paragraph.

Enrolled Senate Bill 533 (SB 533-A)                        Page 6

  (e) Provides a program involving cooperative efforts by the
workers, the employer and the managed care organizations to
promote workplace health and safety consultative and other
services and early return to work for injured workers.
  (f) Provides a timely and accurate method of reporting to the
director necessary information regarding medical and health care
service cost and utilization to enable the director to determine
the effectiveness of the plan.
    { - (g) Authorizes workers to receive compensable medical
treatment from a primary care physician who is not a member of
the managed care organization, but who maintains the worker's
medical records and with whom the worker has a documented history
of treatment, if that primary care physician agrees to refer the
worker to the managed care organization for any specialized
treatment, including physical therapy, to be furnished by another
provider that the worker may require and if that primary care
physician agrees to comply with all the rules, terms and
conditions regarding services performed by the managed care
organization. Nothing in this paragraph is intended to limit the
worker's right to change primary care physicians prior to the
filing of a workers' compensation claim. As used in this
paragraph, 'primary care physician' means a physician who is
qualified to be an attending physician referred to in ORS 656.005
(12)(b)(A) and who is a family practitioner, a general
practitioner or an internal medicine practitioner. - }
   { +  (g)(A) Authorizes workers to receive compensable medical
treatment from a primary care physician or chiropractic physician
who is not a member of the managed care organization, but who
maintains the worker's medical records and is a physician with
whom the worker has a documented history of treatment, if:
  (i) The primary care physician or chiropractic physician agrees
to refer the worker to the managed care organization for any
specialized treatment, including physical therapy, to be
furnished by another provider that the worker may require;
  (ii) The primary care physician or chiropractic physician
agrees to comply with all the rules, terms and conditions
regarding services performed by the managed care organization;
and
  (iii) The treatment is determined to be medically appropriate
according to the service utilization review process of the
managed care organization.
  (B) Nothing in this paragraph is intended to limit the worker's
right to change primary care physicians or chiropractic
physicians prior to the filing of a workers' compensation claim.
  (C) A chiropractic physician authorized to provide compensable
medical treatment under this paragraph may provide services and
authorize temporary disability compensation as provided in ORS
656.005 (12)(b)(B) and 656.245 (2)(b). However, the managed care
organization may authorize chiropractic physicians to provide
medical services and authorize temporary disability payments
beyond the periods established in ORS 656.005 (12)(b)(B) and ORS
656.245 (2)(b).
  (D) As used in this paragraph, 'primary care physician ' means
a physician who is qualified to be an attending physician
referred to in ORS 656.005 (12)(b)(A) and who is a family
practitioner, a general practitioner or an internal medicine
practitioner. + }
  (h) Provides a written explanation for denial of participation
in the managed care organization plan to any licensed health care

Enrolled Senate Bill 533 (SB 533-A)                        Page 7

provider that has been denied participation in the managed care
organization plan.
  (i) Does not prohibit the injured worker's attending physician
from advocating for medical services and temporary disability
benefits for the injured worker that are supported by the medical
record.
  (j) Complies with any other requirement the director determines
is necessary to provide quality medical services and health care
to injured workers.
   { +  (5)(a) Notwithstanding ORS 656.245 (5) and subsection
(4)(g) of this section, a managed care organization may deny or
terminate the authorization of a primary care physician or
chiropractic physician to serve as an attending physician under
subsection (4)(g) of this section or of a nurse practitioner to
provide medical services as provided in ORS 656.245 (5) if the
physician or nurse practitioner, within two years prior to the
worker's enrollment in the plan:
  (A) Has been terminated from serving as an attending physician
or nurse practitioner for a worker enrolled in the plan for
failure to meet the requirements of subsection (4)(g) of this
section or of ORS 656.245 (5); or
  (B) Has failed to satisfy the credentialing standards for
participating in the managed care organization.
  (b) The director shall adopt by rule reporting standards for
managed care organizations to report denials and terminations of
the authorization of primary care physicians, chiropractic
physicians and nurse practitioners who are not members of the
managed care organization to provide compensable medical
treatment under ORS 656.245 (5) and subsection (4)(g) of this
section. The director shall annually report to the Workers'
Compensation Management-Labor Advisory Committee the information
reported to the director by managed care organizations under this
paragraph. + }
    { - (5) - }   { + (6) + } The director shall refuse to
certify or may revoke or suspend the certification of any health
care provider or group of medical service providers to provide
managed care if the director finds that:
  (a) The plan for providing medical or health care services
fails to meet the requirements of this section.
  (b) Service under the plan is not being provided in accordance
with the terms of a certified plan.
    { - (6) - }   { + (7) + } Any issue concerning the provision
of medical services to injured workers subject to a managed care
contract and service utilization review, quality assurance,
dispute resolution, contract review and peer review activities as
well as authorization of medical services to be provided by other
than an attending physician pursuant to ORS 656.245 (2)(b) shall
be subject to review by the director or the director's designated
representatives. The decision of the director is subject to
review under ORS 656.704. Data generated by or received in
connection with these activities, including written reports,
notes or records of any such activities, or of any review
thereof, shall be confidential, and shall not be disclosed except
as considered necessary by the director in the administration of
this chapter.  The director may report professional misconduct to
an appropriate licensing board.
    { - (7) - }  { +  (8) + } No data generated by service
utilization review, quality assurance, dispute resolution or peer
review activities and no physician profiles or data used to
create physician profiles pursuant to this section or a review

Enrolled Senate Bill 533 (SB 533-A)                        Page 8

thereof shall be used in any action, suit or proceeding except to
the extent considered necessary by the director in the
administration of this chapter. The confidentiality provisions of
this section shall not apply in any action, suit or proceeding
arising out of or related to a contract between a managed care
organization and a health care provider whose confidentiality is
protected by this section.
    { - (8) - }  { +  (9) + } A person participating in service
utilization review, quality assurance, dispute resolution or peer
review activities pursuant to this section shall not be examined
as to any communication made in the course of such activities or
the findings thereof, nor shall any person be subject to an
action for civil damages for affirmative actions taken or
statements made in good faith.
    { - (9) - }  { +  (10) + } No person who participates in
forming consortiums, collectively negotiating fees or otherwise
solicits or enters into contracts in a good faith effort to
provide medical or health care services according to the
provisions of this section shall be examined or subject to
administrative or civil liability regarding any such
participation except pursuant to the director's active
supervision of such activities and the managed care organization.
Before engaging in such activities, the person shall provide
notice of intent to the director in a form prescribed by the
director.
    { - (10) - }   { + (11) + } The provisions of this section
shall not affect the confidentiality or admission in evidence of
a claimant's medical treatment records.
    { - (11) - }  { +  (12) + } In consultation with the
committees referred to in ORS 656.790 and 656.794, the director
shall adopt such rules as may be necessary to carry out the
provisions of this section.
    { - (12) - }  { +  (13) + } As used in this section, ORS
656.245, 656.248 and 656.327, 'medical service provider' means a
person duly licensed to practice one or more of the healing arts
in any country or in any state or territory or possession of the
United States.
    { - (13) - }  { +  (14) + } Notwithstanding ORS 656.005 (12)
or subsection (4)(b) of this section, a managed care organization
contract may designate any medical service provider or category
of providers as attending physicians.
    { - (14) - }  { +  (15) + } If a worker, insurer,
self-insured employer   { - or - }  { + , + } the attending
physician  { + or an authorized health care provider + } is
dissatisfied with an action of the managed care organization
regarding the provision of medical services pursuant to this
chapter, peer review, service utilization review or quality
assurance activities, that person or entity must first apply to
the director for administrative review of the matter before
requesting a hearing. Such application must be made not later
than the 60th day after the date the managed care organization
has completed and issued its final decision.
    { - (15) - }  { +  (16) + } Upon a request for administrative
review, the director shall create a documentary record sufficient
for judicial review. The director shall complete administrative
review and issue a proposed order within a reasonable time. The
proposed order of the director issued pursuant to this section
shall become final and not subject to further review unless a
written request for a hearing is filed with the director within
30 days of the mailing of the order to all parties.

Enrolled Senate Bill 533 (SB 533-A)                        Page 9

    { - (16) - }  { +  (17) + } At the contested case hearing,
the order may be modified only if it is not supported by
substantial evidence in the record or reflects an error of law.
No new medical evidence or issues shall be admitted. The dispute
may also be remanded to the managed care organization for further
evidence taking, correction or other necessary action if the
Administrative Law Judge or director determines the record has
been improperly, incompletely or otherwise insufficiently
developed. Decisions by the director regarding medical disputes
are subject to review under ORS 656.704.
    { - (17) - }   { + (18) + } Any person who is dissatisfied
with an action of a managed care organization other than
regarding the provision of medical services pursuant to this
chapter, peer review, service utilization review or quality
assurance activities may request review under ORS 656.704.
    { - (18) - }   { + (19) + } Notwithstanding any other
provision of law, original jurisdiction over contract review
disputes is with the director. The director may resolve the
matter by issuing an order subject to review under ORS 656.704,
or the director may determine that the matter in dispute would be
best addressed in another forum and so inform the parties.
    { - (19) - }   { + (20) + } The director shall conduct such
investigations, audits and other administrative oversight in
regard to managed care as the director deems necessary to carry
out the purposes of this chapter.
    { - (20)(a) - }  { +  (21)(a) + } Except as otherwise
provided in this chapter, only a managed care organization
certified by the director may:
  (A) Restrict the choice of a health care provider or medical
service provider by a worker;
  (B) Restrict the access of a worker to any category of medical
service providers;
  (C) Restrict the ability of a medical service provider to refer
a worker to another provider;
  (D) Require preauthorization or precertification to determine
the necessity of medical services or treatment; or
  (E) Restrict treatment provided to a worker by a medical
service provider to specific treatment guidelines, protocols or
standards.
  (b) The provisions of paragraph (a) of this subsection do not
apply to:
  (A) A medical service provider who refers a worker to another
medical service provider;
  (B) Use of an on-site medical service facility by the employer
to assess the nature or extent of a worker's injury; or
  (C) Treatment provided by a medical service provider or
transportation of a worker in an emergency or trauma situation.
  (c) Except as provided in paragraph (b) of this subsection, if
the director finds that a person has violated a provision of
paragraph (a) of this subsection, the director may impose a
sanction that may include a civil penalty not to exceed $2,000
for each violation.
  (d) If violation of paragraph (a) of this subsection is
repeated or willful, the director may order the person committing
the violation to cease and desist from making any future
communications with injured workers or medical service providers
or from taking any other actions that directly or indirectly
affect the delivery of medical services provided under this
chapter.

Enrolled Senate Bill 533 (SB 533-A)                       Page 10

  (e)(A) Penalties imposed under this subsection are subject to
ORS 656.735 (4) to (6) and 656.740.
  (B) Cease and desist orders issued under this subsection are
subject to ORS 656.740.
                         ----------

Passed by Senate April 2, 2013

    .............................................................
                               Robert Taylor, Secretary of Senate

    .............................................................
                              Peter Courtney, President of Senate

Passed by House May 6, 2013

    .............................................................
                                     Tina Kotek, Speaker of House

Enrolled Senate Bill 533 (SB 533-A)                       Page 11

Received by Governor:

......M.,............., 2013

Approved:

......M.,............., 2013

    .............................................................
                                         John Kitzhaber, Governor

Filed in Office of Secretary of State:

......M.,............., 2013

    .............................................................
                                   Kate Brown, Secretary of State

Enrolled Senate Bill 533 (SB 533-A)                       Page 12