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HF 3873

3rd Engrossment - 90th Legislature (2017 - 2018) Posted on 05/24/2018 12:27pm

KEY: stricken = removed, old language.
underscored = added, new language.

Bill Text Versions

Engrossments
Introduction Posted on 03/21/2018
1st Engrossment Posted on 04/09/2018
2nd Engrossment Posted on 04/18/2018
3rd Engrossment Posted on 05/24/2018

Current Version - 3rd Engrossment

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A bill for an act
relating to workers' compensation; adopting recommendations of the Workers'
Compensation Advisory Council; modifying workers' compensation provisions;
modifying hospital outpatient fee schedules; modifying billing, payment, and
dispute resolution; defining ambulatory surgical center payments; modifying
covered benefits; amending Minnesota Statutes 2016, sections 175A.05; 176.011,
subdivision 15; 176.101, subdivisions 2, 2a, 4; 176.102, subdivision 11; 176.136,
subdivision 1b; 176.231, subdivision 9; 176.83, subdivision 5; Minnesota Statutes
2017 Supplement, section 15A.083, subdivision 7; Laws 2017, chapter 94, article
1, section 6; proposing coding for new law in Minnesota Statutes, chapter 176.

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

ARTICLE 1

WORKERS' COMPENSATION GENERAL

Section 1.

Minnesota Statutes 2017 Supplement, section 15A.083, subdivision 7, is
amended to read:


Subd. 7.

Workers' Compensation Court of Appeals and compensation judges.

Salaries of judges of the Workers' Compensation Court of Appeals are deleted text begin98.52deleted text endnew text begin 105new text end percent
of the salary for deleted text begindistrict courtdeleted text endnew text begin workers' compensationnew text end judgesnew text begin of the Office of Administrative
Hearings
new text end. The salary of the chief judge of the Workers' Compensation Court of Appeals is
deleted text begin 98.52deleted text endnew text begin 107new text end percent of the salary for deleted text begina chief district court judgedeleted text endnew text begin workers' compensation judges
of the Office of Administrative Hearings
new text end. Salaries of compensation judges are 98.52 percent
of the salary of district court judges.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective June 1, 2018.
new text end

Sec. 2.

Minnesota Statutes 2016, section 175A.05, is amended to read:


175A.05 QUORUM.

new text begin Subdivision 1. new text end

new text begin Judges' quorum. new text end

A majority of the judges of the Workers' Compensation
Court of Appeals shall constitute a quorum for the exercise of the powers conferred and the
duties imposed on the Workers' Compensation Court of Appeals except that all appeals
shall be heard by no more than a panel of three of the five judges unless the case appealed
is determined to be of exceptional importance by the chief judge prior to assignment of the
case to a panel, or by a three-fifths vote of the judges prior to assignment of the case to a
panel or after the case has been considered by the panel but prior to the service and filing
of the decision.

new text begin Subd. 2. new text end

new text begin Vacancy. new text end

A vacancy shall not impair the ability of the remaining judges of the
Workers' Compensation Court of Appeals to exercise all the powers and perform all of the
duties of the Workers' Compensation Court of Appeals.

new text begin Subd. 3. new text end

new text begin Retired judges. new text end

new text begin Where the number of Workers' Compensation Court of Appeals
judges available to hear a case is insufficient to constitute a quorum, the chief judge of the
Workers' Compensation Court of Appeals may, with the retired judge's consent, assign a
judge who is retired from the Workers' Compensation Court of Appeals or the Office of
Administrative Hearings to hear any case properly assigned to a judge of the Workers'
Compensation Court of Appeals. The retired judge assigned to the case may act on it with
the full powers of the judge of the Workers' Compensation Court of Appeals. A retired
judge performing this service shall receive pay and expenses in the amount and manner
provided by law for judges serving on the court, less the amount of retirement pay the judge
is receiving under chapter 352 or 490.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective June 1, 2018.
new text end

Sec. 3.

Minnesota Statutes 2016, section 176.231, subdivision 9, is amended to read:


Subd. 9.

Uses deleted text beginwhichdeleted text endnew text begin thatnew text end may be made of reports.

new text begin(a) new text endReports filed with the
commissioner under this section may be used in hearings held under this chapter, and for
the purpose of state investigations and for statistics. These reports are available to the
Department of Revenue for use in enforcing Minnesota income tax and property tax refund
laws, and the information shall be protected as provided in chapter 270B.

new text begin (b) new text endThe division or Office of Administrative Hearings or Workers' Compensation Court
of Appeals may permit the examination of its file by the employer, insurer, employee, or
dependent of a deceased employee or any person who furnishes deleted text beginwrittendeleted text endnew text begin signednew text end authorization
to do so from the employer, insurer, employee, or dependent of a deceased employee.
Reports filed under this section and other information the commissioner has regarding
injuries or deaths shall be made available to the Workers' Compensation Reinsurance
Association for use by the association in carrying out its responsibilities under chapter 79.

new text begin (c) The division may provide the worker identification number assigned under section
176.275, subdivision 1, without a signed authorization required under paragraph (b) to an:
new text end

new text begin (1) attorney who represents one of the persons described in paragraph (b);
new text end

new text begin (2) attorney who represents an intervenor or potential intervenor under section 176.361;
new text end

new text begin (3) intervenor; or
new text end

new text begin (4) employee's assigned qualified rehabilitation consultant under section 176.102.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective June 1, 2018.
new text end

Sec. 4.

new text begin [176.2611] COORDINATION OF THE OFFICE OF ADMINISTRATIVE
HEARINGS' CASE MANAGEMENT SYSTEM AND THE WORKERS'
COMPENSATION IMAGING SYSTEM.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the definitions in this
subdivision apply unless otherwise specified.
new text end

new text begin (b) "Commissioner" means the commissioner of labor and industry.
new text end

new text begin (c) "Department" means the Department of Labor and Industry.
new text end

new text begin (d) "Document" includes all data, whether in electronic or paper format, that is filed
with or issued by the office or department related to a claim-specific dispute resolution
proceeding under this section.
new text end

new text begin (e) "Office" means the Office of Administrative Hearings.
new text end

new text begin Subd. 2. new text end

new text begin Applicability. new text end

new text begin This section governs filing requirements pending completion
of the workers' compensation modernization program and access to documents and data in
the office's case management system, the workers' compensation Informix imaging system,
and the system that will be developed as a result of the workers' compensation modernization
program. This section prevails over any conflicting provision in this chapter, Laws 1998,
chapter 366, or corresponding rules.
new text end

new text begin Subd. 3. new text end

new text begin Documents that must be filed with the office. new text end

new text begin Except as provided in
subdivision 4 and section 176.421, all documents that require action by the office under
this chapter must be filed, electronically or in paper format, with the office as required by
the chief administrative law judge. Filing a document that initiates or is filed in preparation
for a proceeding at the office satisfies any requirement under this chapter that the document
must be filed with the commissioner.
new text end

new text begin Subd. 4. new text end

new text begin Documents that must be filed with the commissioner. new text end

new text begin (a) The following
documents must be filed directly with the commissioner in the format and manner prescribed
by the commissioner:
new text end

new text begin (1) all requests for an administrative conference under section 176.106, regardless of
the amount in dispute;
new text end

new text begin (2) a motion to intervene in an administrative conference that is pending at the department;
new text end

new text begin (3) any other document related to an administrative conference that is pending at the
department;
new text end

new text begin (4) an objection to a penalty assessed by the commissioner or the department;
new text end

new text begin (5) requests for medical and rehabilitation dispute certification under section 176.081,
subdivision 1, paragraph (c), including related documents; and
new text end

new text begin (6) except as provided in this subdivision or subdivision 3, any other document required
to be filed with the commissioner.
new text end

new text begin (b) The filing requirement in paragraph (a), clause (1), makes no changes to the
jurisdictional provisions in section 176.106. A claim petition that contains only medical or
rehabilitation issues, unless primary liability is disputed, is considered to be a request for
an administrative conference and must be filed with the commissioner.
new text end

new text begin (c) The commissioner must refer a timely, unresolved objection to a penalty under
paragraph (a), clause (4), to the office within 60 calendar days.
new text end

new text begin Subd. 5. new text end

new text begin Form revision and access to documents and data. new text end

new text begin (a) The commissioner
must revise dispute resolution forms, in consultation with the chief administrative law judge,
to reflect the filing requirements in this section.
new text end

new text begin (b) For purposes of this subdivision, "complete, read-only electronic access" means the
ability to view all data and document contents, including scheduling information, related
to workers' compensation disputes, except for the following:
new text end

new text begin (1) a confidential mediation statement, including any documents submitted with the
statement for the mediator's review;
new text end

new text begin (2) work product of a compensation judge, mediator, or commissioner that is not issued.
Examples of work product include personal notes of hearings or conferences and draft
decisions;
new text end

new text begin (3) the department's Vocational Rehabilitation Unit's case management system data;
new text end

new text begin (4) the special compensation fund's case management system data; and
new text end

new text begin (5) audit trail information.
new text end

new text begin (c) The office must be provided with continued, complete, read-only electronic access
to the workers' compensation Informix imaging system.
new text end

new text begin (d) The department must be provided with read-only electronic access to the office's
case management system, including the ability to view all data, including scheduling
information, but excluding access into filed documents.
new text end

new text begin (e) The office must send the department all documents that are accepted for filing or
issued by the office. The office must send the documents to the department, electronically
or by courier, within two business days of when the documents are accepted for filing or
issued by the office.
new text end

new text begin (f) The department must place documents that the office sends to the department in the
appropriate imaged file for the employee.
new text end

new text begin (g) The department must send the office copies of the following documents, electronically
or by courier, within two business days of when the documents are filed with or issued by
the department:
new text end

new text begin (1) notices of discontinuance;
new text end

new text begin (2) decisions issued by the department; and
new text end

new text begin (3) mediated agreements.
new text end

new text begin (h) Upon integration of the office's case management system and the department's system
resulting from the workers' compensation modernization program, each agency will be
provided with complete, read-only electronic access to the other agency's system.
new text end

new text begin (i) Each agency's responsible authority pursuant to section 13.02, subdivision 16, is
responsible for its own employees' use and dissemination of the data and documents in the
workers' compensation Informix imaging system, the office's case management system, and
the system developed as a result of the workers' compensation modernization program.
new text end

new text begin Subd. 6. new text end

new text begin Data privacy. new text end

new text begin (a) All documents filed with or issued by the department or the
office under this chapter are private data on individuals and nonpublic data pursuant to
chapter 13, except that the documents are available to the following:
new text end

new text begin (1) the office;
new text end

new text begin (2) the department;
new text end

new text begin (3) the employer;
new text end

new text begin (4) the insurer;
new text end

new text begin (5) the employee;
new text end

new text begin (6) the dependent of a deceased employee;
new text end

new text begin (7) an intervenor in the dispute;
new text end

new text begin (8) the attorney to a party in the dispute;
new text end

new text begin (9) a person who furnishes written authorization from the employer, insurer, employee,
or dependent of a deceased employee; and
new text end

new text begin (10) a person, agency, or other entity allowed access to the documents under this chapter
or other law.
new text end

new text begin (b) The office and department may post notice of scheduled proceedings on the agencies'
Web sites and at their principal places of business in any manner that protects the employee's
identifying information.
new text end

new text begin Subd. 7. new text end

new text begin Workers' Compensation Court of Appeals. new text end

new text begin The Workers' Compensation
Court of Appeals has authority to amend its rules of procedure to reflect electronic filing
with the office under this section for purposes of section 176.421, subdivision 5, and to
allow electronic filing with the court under section 176.285. The court may amend its rules
using the procedure in section 14.389.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective June 1, 2018.
new text end

Sec. 5.

Laws 2017, chapter 94, article 1, section 6, is amended to read:


Sec. 6. WORKERS' COMPENSATION COURT
OF APPEALS

$
1,913,000
$
deleted text begin 1,913,000
deleted text end new text begin 1,946,000
new text end

This appropriation is from the workers'
compensation fund.

ARTICLE 2

HOSPITAL OUTPATIENT FEE SCHEDULE

Section 1.

new text begin [176.1364] WORKERS' COMPENSATION HOSPITAL OUTPATIENT
FEE SCHEDULE.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For the purposes of this section, the terms defined in this
subdivision have the meanings given them.
new text end

new text begin (b) "Addendum A" means the addendum entitled "OPPS APCs for CY 2018," or its
successor, developed by the Centers for Medicare and Medicaid Services (Medicare) for
use in the Medicare Hospital Outpatient Prospective Payment System (OPPS) system under
Code of Federal Regulations, title 42, part 419, as may be amended from time to time.
new text end

new text begin (c) "Addendum B" means the addendum entitled "OPPS Payment by HCPCS Codes for
CY 2018," or its successor, developed by the Centers for Medicare and Medicaid Services
(Medicare) for use in the Medicare Hospital Outpatient Prospective Payment System (OPPS)
system under Code of Federal Regulations, title 42, part 419, as may be amended from time
to time.
new text end

new text begin (d) "HCPCS code" means a numeric or alphanumeric code included in the Centers for
Medicare and Medicaid Services' Healthcare Common Procedure Coding System. A HCPCS
code is used to identify a specific medical service.
new text end

new text begin (e) "Hospital" means a facility that is licensed by the Department of Health under section
144.50.
new text end

new text begin (f) "HOFS" means the workers' compensation hospital outpatient fee schedule established
under subdivision 3.
new text end

new text begin (g) "Insurer" includes workers' compensation insurers and self-insured employers.
new text end

new text begin (h) "Services" includes articles, supplies, procedures, and implantable devices provided
by the hospital with the service. Services are identified by a code described in subdivision
3.
new text end

new text begin Subd. 2. new text end

new text begin Applicability. new text end

new text begin (a) This section only applies to payment of charges for hospital
outpatient services if the charges include a service listed in the workers' compensation
hospital outpatient fee schedule established by the commissioner under subdivision 3. If
the charges do not include a service listed in the HOFS, payment shall be:
new text end

new text begin (1) the liability for each service that is included in the workers' compensation relative
value fee schedule as provided in section 176.136, subdivision 1a, and corresponding rules
adopted by the commissioner to implement the relative value fee schedule; or
new text end

new text begin (2) the liability as provided in section 176.136, subdivision 1b, paragraphs (b) and (c),
for each service that is not included in the workers' compensation relative value fee schedule.
new text end

new text begin (b) This section does not apply to outpatient services provided at a hospital that is certified
by Medicare as a critical access hospital. Outpatient services provided by these hospitals
shall be paid as provided in section 176.136, subdivision 1b, paragraph (a).
new text end

new text begin Subd. 3. new text end

new text begin Hospital outpatient fee schedule (HOFS). new text end

new text begin (a) Effective for hospital outpatient
services on or after October 1, 2018, the commissioner shall establish a workers'
compensation hospital outpatient fee schedule (HOFS) to establish the payment for hospital
bills with charges for services with a J1 or J2 status indicator as listed in the status indicator
(SI) column of Addendum B and the comprehensive observation services Ambulatory
Payment Classification (APC) 8011 with a J2 status indicator in Addendum A. The
commissioner shall publish a link to the HOFS in the State Register before October 1, 2018,
and shall maintain the current HOFS on the department's Web site.
new text end

new text begin (b) The amount listed for each of the procedures in the HOFS as described in paragraph
(a) shall be the relative weight for the procedure multiplied by a HOFS conversion factor
that results in the same overall payment for hospital outpatient services under this section
as the actual payments made in the most recent 12-month period available before the effective
date of this section. The commissioner must establish separate conversion factors to achieve
the same overall payment for noncritical access hospitals of 100 or fewer licensed beds and
hospitals with more than 100 licensed beds. The commissioner shall establish the two
conversion factors according to the requirements in clauses (1) to (4) in consultation with
insurer and hospital representatives.
new text end

new text begin (1) The commissioner shall obtain a suitable sample of de-identified data for Minnesota
workers' compensation outpatient cases at Minnesota hospitals for the most recently available
12-month period. The commissioner may obtain de-identified data from any reliable source,
including Minnesota hospitals and insurers, or their representatives. Any data provided to
the commissioner by a hospital, insurer, or their representative under this subdivision is
nonpublic data under section 13.02, subdivision 9.
new text end

new text begin (2) The sample must be divided into a data set for hospitals over 100 licensed beds, and
100 or fewer licensed beds, excluding critical access hospitals.
new text end

new text begin (3) For each data set the commissioner shall:
new text end

new text begin (i) calculate the total amount of the actual payments made in the most recent 12-month
period available before the effective date of this section, adjusted for inflation to July 2018;
and
new text end

new text begin (ii) apply all of the payment provisions in this section to each claim including, as
applicable, payment under the relative value fee schedule or 85 percent of the hospital's
usual and customary charge under section 176.136, subdivisions 1a and 1b, to determine
the total payment amount using the Medicare conversion factor in effect for the OPPS in
effect on July 1, 2018.
new text end

new text begin (4) The commissioner shall calculate the Minnesota conversion factor to equal the
Medicare conversion factor multiplied by the ratio of total payments under clause (3), item
(i), divided by the total payments under clause (3), item (ii).
new text end

new text begin (c) For purposes of this section:
new text end

new text begin (1) the relative weight is the amount in the "relative weight" column in Addendum B
and Addendum A for comprehensive observation services.
new text end

new text begin (2) references to J1, J2, and H status indicators; Addenda A and B; APC 8011; and
HCPCS code G0378 includes any successor status indicators, addenda, APC, or HCPCS
code established by the Centers for Medicare and Medicaid Services.
new text end

new text begin (d) On October 1 of each year, the commissioner shall adjust the HOFS conversion
factors based on the market basket index for inpatient hospital services calculated by
Medicare and published on its Web site. The adjustment on each October 1 shall be a
percentage equal to the value of that index averaged over the four quarters of the most recent
calendar year divided by the value of that index over the four quarters of the prior calendar
year.
new text end

new text begin (e) No later than October 1, 2021, and at least once every three years thereafter, the
commissioner shall update the HOFS established under this subdivision by incorporating
services with a J1 or J2 status indicator, and the corresponding relative weights, listed in
the Addenda A and B most recently available on Medicare's Web site as of the preceding
July 1. If Addenda A and B are not available on Medicare's Web site on the preceding July
1, the HOFS most recently published on the department's Web site remains in effect.
new text end

new text begin (1) Each time the HOFS is updated under this paragraph, the commissioner shall adjust
the conversion factors so that there is no difference between the overall payment under the
new HOFS and the overall payment under the HOFS most recently in effect, for services
in both HOFSs.
new text end

new text begin (2) The conversion factor adjustments under this paragraph shall be made separately for
each hospital category in paragraph (b).
new text end

new text begin (3) The conversion factor adjustments under this paragraph must be made before making
any additional adjustment under paragraph (d).
new text end

new text begin (f) The commissioner shall give notice in the State Register of the adjusted conversion
factor in paragraph (d) no later than October 1 annually. The commissioner shall give notice
in the State Register of an updated HOFS under paragraph (e) no later than October 1 of
the year in which the HOFS becomes effective. The notice must include a link to the HOFS
published on the department's Web site. The notices, the updated fee schedules, and the
adjusted conversion factors are not rules subject to chapter 14, but have the force and effect
of law as of the effective date published in the State Register.
new text end

new text begin Subd. 4. new text end

new text begin Payment under the hospital outpatient fee schedule. new text end

new text begin (a) Services in the
HOFS, and other hospital outpatient services provided with or as part of service in the
HOFS, are paid according to paragraphs (b) and (c).
new text end

new text begin (b) If a hospital bill includes a charge for one or more services with a J1 status indicator,
payment shall be as provided in this paragraph.
new text end

new text begin (1) If the bill includes a charge for only one service with only a J1 status indicator,
payment shall be the amount listed in the HOFS for that service, regardless of the amount
charged by the hospital.
new text end

new text begin (2) If the bill includes charges for more than one service with a J1 status indicator, the
service with the highest listed fee in the HOFS shall be paid at 100 percent of the listed fee.
Each additional service listed in the hospital outpatient fee shall be paid at 50 percent of
the listed fee. Payment under this clause shall be based on the applicable percentage of the
listed fee, regardless of the amount charged by the hospital.
new text end

new text begin (3) If the bill includes an additional charge for a service that does not have a J1 status
indicator listed in the HOFS, no separate payment is made for the additional service. Payment
for the additional service, including any service with a J2 status indicator, is packaged into
and is not paid separately from the payment amount listed in the HOFS for the service with
the J1 status indicator. Implantable devices are paid separately only as provided in subdivision
5.
new text end

new text begin (4) The insurer must not deny payment for any additional service packaged into payment
for a service listed in the HOFS on the basis that the additional service was not reasonably
required or causally related to an admitted work injury.
new text end

new text begin (c) If a hospital bill includes one or more charges for services with a J2 status indicator,
and does not include any charges for services with a J1 status indicator, payment shall be
as provided in this paragraph.
new text end

new text begin (1) Except for services packaged into an observation service as provided in clause (4),
payment for each service with a J2 status indicator shall be the amount listed in the HOFS,
regardless of the amount charged by the hospital.
new text end

new text begin (2) If a service without a HCPCS code is billed with a service with a J2 status indicator,
payment is packaged into the payment for the J2 service.
new text end

new text begin (3) Payment for drugs with a HCPCS code is separate from payment for the service with
the J2 code as provided in this clause.
new text end

new text begin (i) If the drug is delivered by injection or infusion, payment for the drug is packaged
into payment for the injection or infusion service.
new text end

new text begin (ii) If the drug is not delivered by injection or infusion, payment for the drug is paid at
the Medicare Average Sales Price (ASP) of the drug on the day the drug is dispensed. No
later than October 1, 2018, and October 1 of each subsequent year, the commissioner must
publish on the department's Web site a link to the ASP most recently available as of the
preceding July 1. If no ASP is available, the most recently posted ASP linked on the
department's Web site remains in effect.
new text end

new text begin (4) If a bill includes eight or more units of service with the HCPCS code G0378
(observation services, per hour), and there is a physician's or dentist's order for observation,
payment shall be the amount listed in the HOFS for the comprehensive observation services
Ambulatory Payment Classification 8011, regardless of the amount charged by the hospital.
All other services billed by the hospital, including other services with a J2 status indicator,
are packaged into the payment amount and are not paid separately from the payment amount
listed in the fee schedule for HCPCS code G0378.
new text end

new text begin (5) For any other service on the same bill as the service with a J2 status indicator, payment
shall be as provided in subdivision 2, paragraph (a).
new text end

new text begin Subd. 5. new text end

new text begin Implantable devices. new text end

new text begin The maximum fee for any service in the HOFS includes
payment for all implantable devices, even if the Medicare OPPS would otherwise allow
separate payment for the implantable device. However, separate payment in the amount of
85 percent of the hospital's usual and customary charge for an implantable device is allowed
if the implantable device:
new text end

new text begin (1) has an H status indicator in Addendum B;
new text end

new text begin (2) is properly charged on a bill with a service with a J1 status indicator in the HOFS;
and
new text end

new text begin (3) is properly billed with another HCPCS code, if required by Medicare's OPPS system.
new text end

new text begin The commissioner shall update the HOFS each October 1 to include any HCPCS codes that
are payable under this section according to the Addendum B most recently available on the
preceding July 1.
new text end

new text begin Subd. 6. new text end

new text begin Study. new text end

new text begin (a) The commissioner shall conduct a study analyzing the percentage
of claims with a service in the HOFS that were paid timely and the percentage of claims
paid accurately. The commissioner must report the results of the study and recommendations
to the Workers' Compensation Advisory Council and chairs and ranking minority members
of the house of representatives and senate committees with jurisdiction over workers'
compensation by January 15, 2021.
new text end

new text begin (b) Based on the results of the study, the WCAC shall consider whether there is a
minimum 80 percent compliance in timeliness and accuracy of payments, and additional
statutory amendments, including but not limited to:
new text end

new text begin (1) a maximum ten percent reduction in payments under the HOFS; and
new text end

new text begin (2) an increase in indemnity benefits to injured workers.
new text end

new text begin Subd. 7. new text end

new text begin Rulemaking. new text end

new text begin The commissioner may adopt or amend rules, using the authority
in section 14.386, paragraph (a), to implement this section. The rules are not subject to
expiration under section 14.386, paragraph (b).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for hospital outpatient services provided
on or after October 1, 2018.
new text end

ARTICLE 3

OUTPATIENT BILLING, PAYMENT, AND DISPUTE RESOLUTION

Section 1.

Minnesota Statutes 2016, section 176.136, subdivision 1b, is amended to read:


Subd. 1b.

Limitation of liability.

(a) The liability of the employer for treatment, articles,
and supplies provided to an employee while an inpatient or outpatient at a Critical Access
Hospital certified by the Centers for Medicare and Medicaid Servicesdeleted text begin, or while an outpatient
at a hospital with 100 or fewer licensed beds,
deleted text end shall be the hospital's usual and customary
charge, unless the charge is determined by the commissioner or a compensation judge to
be unreasonably excessive.

(b) The liability of the employer for the treatment, articles, and supplies that are not
limited by paragraph (a), subdivision 1adeleted text begin,deleted text endnew text begin ornew text end 1c, deleted text beginordeleted text end section 176.1362new text begin, 176.1363, or 176.1364,new text end
shall be limited to 85 percent of the provider's usual and customary charge, or 85 percent
of the prevailing charges for similar treatment, articles, and supplies furnished to an injured
person when paid for by the injured person, whichever is lowernew text begin, except as provided in
paragraph (e)
new text end. On this basis, the commissioner or compensation judge may determine the
reasonable value of all treatment, services, and supplies, and the liability of the employer
is limited to that amount. The commissioner may by rule establish the reasonable value of
a service, article, or supply in lieu of the 85 percent limitation in this paragraph. A prevailing
charge established under Minnesota Rules, part 5221.0500, subpart 2, must be based on no
more than two years of billing data immediately preceding the date of the service.

(c) The limitation of liability for charges provided by paragraph (b) does not apply to a
nursing home that participates in the medical assistance program and whose rates are
established by the commissioner of human services.

(d) An employer's liability for treatment, articles, and supplies provided under this chapter
by a health care provider located outside of Minnesota is limited to the payment that the
health care provider would receive if the treatment, article, or supply were paid under the
workers' compensation law of the jurisdiction in which the treatment was provided.

new text begin (e) The limitation of the employer's liability based on 85 percent of prevailing charge
does not apply to charges by an ambulatory surgical center as defined in section 176.1363,
subdivision 1, paragraph (b), or a hospital as defined in section 176.1364, subdivision 1,
paragraph (e).
new text end

new text begin (f) For purposes of this chapter, "inpatient" means a patient that has been admitted to a
hospital by an order from a physician or dentist. If there is no inpatient admission order,
the patient is deemed an outpatient. The hospital must provide documentation of an inpatient
order upon the request of the employer.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for treatment, articles, and supplies
provided on or after October 1, 2018.
new text end

Sec. 2.

new text begin [176.1365] OUTPATIENT BILLING, PAYMENT, AND DISPUTE
RESOLUTION.
new text end

new text begin Subdivision 1. new text end

new text begin Scope. new text end

new text begin This section applies to billing, payment, and dispute resolution
for services provided by an ambulatory surgical center (ASC) under section 176.1363 and
hospital outpatient services under section 176.1364. For purposes of this section, "insurer"
includes self-insured employer and "services" is as defined in section 176.1364.
new text end

new text begin Subd. 2. new text end

new text begin Outpatient billing, coding, and prior notification. new text end

new text begin (a) Ambulatory surgical
centers and hospitals must bill workers' compensation insurers for services governed by
sections 176.1363 and 176.1364 using the same codes, formats, and details that are required
for billing the Medicare program, including coding consistent with the American Medical
Association Current Procedural Terminology coding system and Medicare's Ambulatory
Surgical Center Payment System, Outpatient Prospective Payment System, Outpatient Code
Editor, Healthcare Current Procedural Terminology Coding System, and the National Correct
Coding Initiative Policy Manual for Medicare Services and associated Web page and tables.
new text end

new text begin (b) All charges for ASC or hospital outpatient fee schedule services governed by sections
176.1363 and 176.1364 must be submitted to the insurer on the appropriate electronic
transaction required by section 176.135, subdivisions 7 and 7a. ASCs must submit charges
on the electronic 837P form. ASCs must not separately bill for the services and items
included in the ASC facility fee under Code of Federal Regulations, title 42, section
416.164(a). Minnesota Rules, part 5221.4033, subpart 1a, does not apply to ASCs under
this section, but does apply to hospital outpatient facility fees to the extent they are not
covered by the hospital outpatient fee schedule under section 176.1364.
new text end

new text begin (c) Hospitals, ASCs, and insurers must comply with the prior notification and approval
or authorization requirements specified in Minnesota Rules, part 5221.6050, subpart 9. Prior
notification may be provided by either the hospital, ASC, or the surgeon. For purposes of
prior notification under Minnesota Rules, part 5221.6050, subpart 9, "inpatient" has the
meaning as provided under section 176.136, subdivision 1b, paragraph (d).
new text end

new text begin (d) ASC or hospital bills must be submitted to insurers as required by section 176.135,
subdivisions 7 and 7a, and within the time period required by section 62Q.75, subdivision
3. Insurers must respond to the initial bill as provided in section 176.135, subdivisions 6
and 7a. Copies of any records or reports relating to the items for which payment is sought
are separately payable as provided in section 176.135, subdivision 7, paragraph (a).
new text end

new text begin Subd. 3. new text end

new text begin ASC or hospital request for reconsideration; insurer response; time frames.
new text end

new text begin (a) Following receipt of the insurer's explanation of review (EOR) or explanation of benefits
(EOB), the ASC or hospital may request reconsideration of a payment denial or reduction.
The ASC or hospital must submit its request for reconsideration in writing to the insurer
within one year of the date of the EOR or EOB.
new text end

new text begin (b) The insurer must issue a written response to the ASC or hospital's request for
reconsideration within 30 days, as provided in section 176.135, subdivision 6. The written
response must address the issues raised by the request for reconsideration and not simply
reiterate the information on the EOR or EOB.
new text end

new text begin Subd. 4. new text end

new text begin Insurer request for reimbursement of overpayment; time frame. new text end

new text begin If the
payer determines it has overpaid an ASC or hospital's charges based on workers'
compensation statutes and rules, the payer must submit its request for reimbursement in
writing to the ASC or hospital within one year of the date of the payment.
new text end

new text begin Subd. 5. new text end

new text begin Medical requests for administrative conference; time frame to file. new text end

new text begin (a) An
ASC, hospital, or insurer must notify the provider or payer, as applicable, of its intent to
file a medical request for an administrative conference under section 176.106 at least 20
days before filing one with the department. The insurer, or the ASC or hospital if permitted
by section 176.136, subdivision 2, must file the medical request for an administrative
conference no later than the latest of:
new text end

new text begin (1) one year after the date of the initial EOR or EOB if the ASC or hospital does not
request a reconsideration of a payment denial or reduction under subdivision 3;
new text end

new text begin (2) one year after the date of the insurer's response to the ASC or hospital's request for
reconsideration under subdivision 3; or
new text end

new text begin (3) one year after the insurer's request for reimbursement of an overpayment from an
ASC or hospital under subdivision 4.
new text end

new text begin (b) Paragraph (a) does not prohibit an employee from filing a medical request for
assistance or claim petition for the payment denied or reduced by the insurer. However, the
ASC or hospital may not bill the employee for the denied or reduced payment when
prohibited by this chapter.
new text end

new text begin Subd. 6. new text end

new text begin Interest. new text end

new text begin (a) An insurer must pay the ASC or hospital interest at an annual rate
of four percent if it is determined that the insurer is liable for additional ASC or hospital
charges following a denial of payment. Interest is payable by the insurer on the additional
amount owed from the date payment was due.
new text end

new text begin (b) An ASC or hospital must pay the insurer interest at an annual rate of four percent if
it is determined that the hospital owes the insurer reimbursement following the insurer's
request for reimbursement of an overpayment. Interest is payable by the ASC or hospital
on the amount of the overpayment from the date the overpayment was made.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for services provided on or after October
1, 2018.
new text end

ARTICLE 4

AMBULATORY SURGICAL CENTERS

Section 1.

new text begin [176.1363] AMBULATORY SURGICAL CENTER PAYMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For the purpose of this section, the terms defined in this
subdivision have the meanings given them.
new text end

new text begin (b) "Ambulatory surgical center" or "ASC" means a facility that is: (1) certified as an
ASC by the Centers for Medicare and Medicaid Services; or (2) licensed by the Department
of Health as a freestanding outpatient surgical center and not owned by a hospital.
new text end

new text begin (c) "Conversion factor" means the Medicare ambulatory surgical center payment system
(ASCPS) conversion factor used for ASCs that meet the Medicare quality reporting
requirements, whether or not the ASC submitting the bill has met the quality reporting
requirements.
new text end

new text begin (d) "Covered surgical procedures and ancillary services" means the procedures listed in
ASCPS, addendum AA, and the ancillary services integral to covered surgical procedures
listed in ASCPS, addendum BB.
new text end

new text begin (e) "Insurer" includes workers' compensation insurers and self-insured employers.
new text end

new text begin (f) "Ambulatory surgical center payment system" or "ASCPS" means the system
developed by the Centers for Medicare and Medicaid Services for payment of surgical
services provided by federally certified ASCs as specified in:
new text end

new text begin (1) Code of Federal Regulations, title 42, part 416, including without limitation the
geographic adjustment for the ASC and the multiple surgical procedure reduction rule;
new text end

new text begin (2) annual revisions to Code of Federal Regulations, title 42, part 416, as published in
the Federal Register;
new text end

new text begin (3) the corresponding addendum AA (final ASC covered surgical procedures), addendum
BB (final covered ancillary services integral to covered surgical procedures), addendum
DD1 (final ASC payment indicators), and any successor or replacement addenda; and
new text end

new text begin (4) the Medicare claims processing manual.
new text end

new text begin (g) "Medicare ASCPS payment" means the Medicare ASCPS payment used for ASCs
that meet the Medicare quality reporting requirements, whether or not the ASC submitting
the bill has met the Medicare quality reporting requirements.
new text end

new text begin Subd. 2. new text end

new text begin Payment for covered surgical procedures and ancillary services based on
Medicare ASCPS.
new text end

new text begin (a) Except as provided in subdivisions 3 and 4, the payment to the ASC
for covered surgical procedures and ancillary services shall be the lesser of:
new text end

new text begin (1) the ASC's usual and customary charge for all services, supplies, and implantable
devices provided; or
new text end

new text begin (2) the Medicare ASCPS payment, times a multiplier of 320 percent.
new text end

new text begin (i) The amount payable under this clause includes payment for all implantable devices,
even if the Medicare ASCPS would otherwise allow separate payment for the implantable
device.
new text end

new text begin (ii) The 320 percent described in this clause must be adjusted if, on July 1, 2019, or any
subsequent July 1, the conversion factor is less than 98 percent of the conversion factor in
effect on the previous July 1. When this occurs, the multiplier must be 320 percent times
98 percent divided by the percentage that the current Medicare conversion factor bears to
the Medicare conversion factor in effect on the prior July 1. In subsequent years, the
multiplier is 320 percent, unless the Medicare ASCPS conversion factor declines by more
than two percent.
new text end

new text begin (b) Payment under this section is effective for covered surgical procedures and ancillary
services provided by an ASC on or after October 1, 2018, through September 30, 2019, and
shall be based on the addenda AA, BB, and DD1 most recently available on the Centers for
Medicare and Medicaid Services Web site as of July 1, 2018, and the corresponding rules
and Medicare claims processing manual described in subdivision 1, paragraph (f).
new text end

new text begin (1) Payment for covered surgical procedures and ancillary services provided by an ASC
on or after each subsequent October 1 shall be based on the addenda AA, BB, and DD1
most recently available on the Centers for Medicare and Medicaid Services Web site as of
the preceding July 1 and the corresponding rules and Medicare claims processing manual.
new text end

new text begin (2) If the Centers for Medicare and Medicaid Services has not updated addendum AA,
BB, or DD1 on its Web site since the commissioner's previous notice under paragraph (c),
the addenda identified in the notice published by the commissioner in paragraph (c) and the
corresponding rules and Medicare claims processing manual shall remain in effect.
new text end

new text begin (3) Addenda AA, BB, and DD1 under this subdivision includes successor or replacement
addenda.
new text end

new text begin (c) The commissioner shall annually give notice in the State Register of any adjustment
to the multiplier under paragraph (a), clause (2), and of the applicable addenda in paragraph
(b) no later than October 1. The notice must identify and include a link to the applicable
addenda. The notices and any adjustment to the multiplier are not rules subject to chapter
14, but have the force and effect of law as of the effective date published in the State Register.
new text end

new text begin Subd. 3. new text end

new text begin Payment for compensable surgical services not covered under ASCPS. new text end

new text begin (a)
If a surgical procedure provided by an ASC is compensable under this chapter but is not
listed in addendum AA or BB of the Medicare ASCPS, payment must be 75 percent of the
ASC's usual and customary charge for the procedure with the highest charge. Payment for
each subsequent surgical procedure not listed in addendum AA or BB must be paid at 50
percent of the ASC's usual and customary charge.
new text end

new text begin (b) Payment must be 75 percent of the ASC's usual and customary charge for a surgical
procedure or ancillary service if the procedure or service is listed in Medicare ASCPS
addendum AA or BB and: (1) the payment indicator provides it is paid at a reasonable cost;
(2) the payment indicator provides it is contractor priced; or (3) a payment rate is not
otherwise provided.
new text end

new text begin Subd. 4. new text end

new text begin Study. new text end

new text begin The commissioner shall conduct a study analyzing the impact of the
reforms, including timeliness and accuracy of payment under this section, and recommend
further changes if needed. The commissioner must report the results of the study to the
Workers' Compensation Advisory Council and the chairs and ranking minority members
of the legislative committees with jurisdiction over workers' compensation by January 15,
2021.
new text end

new text begin Subd. 5. new text end

new text begin Rulemaking. new text end

new text begin The commissioner may adopt or amend rules using the authority
in section 14.386, paragraph (a), to implement this section and the Medicare ASCPS for
workers' compensation. The rules are not subject to expiration under section 14.386,
paragraph (b).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for procedures and services provided by
an ASC on or after October 1, 2018, except subdivision 5 is effective the day following
final enactment.
new text end

ARTICLE 5

WORKERS' COMPENSATION BENEFITS

Section 1.

Minnesota Statutes 2016, section 176.011, subdivision 15, is amended to read:


Subd. 15.

Occupational disease.

(a) "Occupational disease" means a mental impairment
as defined in paragraph (d) or physical disease arising out of and in the course of employment
peculiar to the occupation in which the employee is engaged and due to causes in excess of
the hazards ordinary of employment and shall include undulant fever. Physical stimulus
resulting in mental injury and mental stimulus resulting in physical injury shall remain
compensable. Mental impairment is not considered a disease if it results from a disciplinary
action, work evaluation, job transfer, layoff, demotion, promotion, termination, retirement,
or similar action taken in good faith by the employer. Ordinary diseases of life to which the
general public is equally exposed outside of employment are not compensable, except where
the diseases follow as an incident of an occupational disease, or where the exposure peculiar
to the occupation makes the disease an occupational disease hazard. A disease arises out of
the employment only if there be a direct causal connection between the conditions under
which the work is performed and if the occupational disease follows as a natural incident
of the work as a result of the exposure occasioned by the nature of the employment. An
employer is not liable for compensation for any occupational disease which cannot be traced
to the employment as a direct and proximate cause and is not recognized as a hazard
characteristic of and peculiar to the trade, occupation, process, or employment or which
results from a hazard to which the worker would have been equally exposed outside of the
employment.

(b) If immediately preceding the date of disablement or death, an employee was employed
on active duty with an organized fire or police department of any municipality, as a member
of the Minnesota State Patrol, conservation officer service, state crime bureau, as a forest
officer by the Department of Natural Resources, state correctional officer, or sheriff or
full-time deputy sheriff of any county, and the disease is that of myocarditis, coronary
sclerosis, pneumonia or its sequel, and at the time of employment such employee was given
a thorough physical examination by a licensed doctor of medicine, and a written report
thereof has been made and filed with such organized fire or police department, with the
Minnesota State Patrol, conservation officer service, state crime bureau, Department of
Natural Resources, Department of Corrections, or sheriff's department of any county, which
examination and report negatived any evidence of myocarditis, coronary sclerosis, pneumonia
or its sequel, the disease is presumptively an occupational disease and shall be presumed
to have been due to the nature of employment. If immediately preceding the date of
disablement or death, any individual who by nature of their position provides emergency
medical care, or an employee who was employed as a licensed police officer under section
626.84, subdivision 1; firefighter; paramedic; state correctional officer; emergency medical
technician; or licensed nurse providing emergency medical care; and who contracts an
infectious or communicable disease to which the employee was exposed in the course of
employment outside of a hospital, then the disease is presumptively an occupational disease
and shall be presumed to have been due to the nature of employment and the presumption
may be rebutted by substantial factors brought by the employer or insurer. Any substantial
factors which shall be used to rebut this presumption and which are known to the employer
or insurer at the time of the denial of liability shall be communicated to the employee on
the denial of liability.

(c) A firefighter on active duty with an organized fire department who is unable to
perform duties in the department by reason of a disabling cancer of a type caused by exposure
to heat, radiation, or a known or suspected carcinogen, as defined by the International
Agency for Research on Cancer, and the carcinogen is reasonably linked to the disabling
cancer, is presumed to have an occupational disease under paragraph (a). If a firefighter
who enters the service after August 1, 1988, is examined by a physician prior to being hired
and the examination discloses the existence of a cancer of a type described in this paragraph,
the firefighter is not entitled to the presumption unless a subsequent medical determination
is made that the firefighter no longer has the cancer.

(d) For the purposes of this chapter, "mental impairment" means a diagnosis of
post-traumatic stress disorder by a licensed psychiatrist or psychologist. For the purposes
of this chapter, "post-traumatic stress disorder" means the condition as described in the most
recently published edition of the Diagnostic and Statistical Manual of Mental Disorders by
the American Psychiatric Association. For purposes of section 79.34, subdivision 2, one or
more compensable mental impairment claims arising out of a single event or occurrence
shall constitute a single loss occurrence.

new text begin (e) If, preceding the date of disablement or death, an employee who was employed on
active duty as: a licensed police officer; a firefighter; a paramedic; an emergency medical
technician; a licensed nurse employed to provide emergency medical services outside of a
medical facility; a public safety dispatcher; an officer employed by the state or a political
subdivision at a corrections, detention, or secure treatment facility; a sheriff or full-time
deputy sheriff of any county; or a member of the Minnesota State Patrol is diagnosed with
a mental impairment as defined in paragraph (d), and had not been diagnosed with the mental
impairment previously, then the mental impairment is presumptively an occupational disease
and shall be presumed to have been due to the nature of employment. This presumption
may be rebutted by substantial factors brought by the employer or insurer. Any substantial
factors that are used to rebut this presumption and that are known to the employer or insurer
at the time of the denial of liability shall be communicated to the employee on the denial
of liability. The mental impairment is not considered an occupational disease if it results
from a disciplinary action, work evaluation, job transfer, layoff, demotion, promotion,
termination, retirement, or similar action taken in good faith by the employer.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for employees with dates of injury on
or after January 1, 2019.
new text end

Sec. 2.

Minnesota Statutes 2016, section 176.101, subdivision 2, is amended to read:


Subd. 2.

Temporary partial disability.

(a) In all cases of temporary partial disability
the compensation shall be 66-2/3 percent of the difference between the weekly wage of the
employee at the time of injury and the wage the employee is able to earn in the employee's
partially disabled condition. This compensation shall be paid during the period of disability
except as provided in this section, payment to be made at the intervals when the wage was
payable, as nearly as may be, and subject to the maximum rate for temporary total
compensation.

(b) Temporary partial compensation may be paid only while the employee is employed,
earning less than the employee's weekly wage at the time of the injury, and the reduced
wage the employee is able to earn in the employee's partially disabled condition is due to
the injury. Except as provided in section 176.102, subdivision 11, paragraphs (b) and (c),
temporary partial compensation may not be paid for more than deleted text begin225deleted text endnew text begin 275new text end weeks, or after 450
weeks after the date of injury, whichever occurs first.

(c) Temporary partial compensation must be reduced to the extent that the wage the
employee is able to earn in the employee's partially disabled condition plus the temporary
partial disability payment otherwise payable under this subdivision exceeds 500 percent of
the statewide average weekly wage.

Sec. 3.

Minnesota Statutes 2016, section 176.101, subdivision 2a, is amended to read:


Subd. 2a.

Permanent partial disability.

(a) Compensation for permanent partial disability
is as provided in this subdivision. Permanent partial disability must be rated as a percentage
of the whole body in accordance with rules adopted by the commissioner under section
176.105. The percentage determined pursuant to the rules must be multiplied by the
corresponding amount in the following table:

Impairment Rating
Amount
(percent)
less than 5.5
$
deleted text begin 75,000
deleted text end new text begin 78,800
new text end
5.5 to less than 10.5
deleted text begin 80,000
deleted text end new text begin 84,000
new text end
10.5 to less than 15.5
deleted text begin 85,000
deleted text end new text begin 89,300
new text end
15.5 to less than 20.5
deleted text begin 90,000
deleted text end new text begin 94,500
new text end
20.5 to less than 25.5
deleted text begin 95,000
deleted text end new text begin 99,800
new text end
25.5 to less than 30.5
deleted text begin 100,000
deleted text end new text begin 105,000
new text end
30.5 to less than 35.5
deleted text begin 110,000
deleted text end new text begin 115,500
new text end
35.5 to less than 40.5
deleted text begin 120,000
deleted text end new text begin 126,000
new text end
40.5 to less than 45.5
deleted text begin 130,000
deleted text end new text begin 136,500
new text end
45.5 to less than 50.5
deleted text begin 140,000
deleted text end new text begin 147,000
new text end
50.5 to less than 55.5
deleted text begin 165,000
deleted text end new text begin 173,300
new text end
55.5 to less than 60.5
deleted text begin 190,000
deleted text end new text begin 199,500
new text end
60.5 to less than 65.5
deleted text begin 215,000
deleted text end new text begin 225,800
new text end
65.5 to less than 70.5
deleted text begin 240,000
deleted text end new text begin 252,000
new text end
70.5 to less than 75.5
deleted text begin 265,000
deleted text end new text begin 278,300
new text end
75.5 to less than 80.5
deleted text begin 315,000
deleted text end new text begin 330,800
new text end
80.5 to less than 85.5
deleted text begin 365,000
deleted text end new text begin 383,300
new text end
85.5 to less than 90.5
deleted text begin 415,000
deleted text end new text begin 435,800
new text end
90.5 to less than 95.5
deleted text begin 465,000
deleted text end new text begin 488,300
new text end
95.5 up to and including 100
deleted text begin 515,000
deleted text end new text begin 540,800
new text end

An employee may not receive compensation for more than a 100 percent disability of
the whole body, even if the employee sustains disability to two or more body parts.

(b) Permanent partial disability is payable upon cessation of temporary total disability
under subdivision 1. If the employee requests payment in a lump sum, then the compensation
must be paid within 30 days. This lump-sum payment may be discounted to the present
value calculated up to a maximum five percent basis. If the employee does not choose to
receive the compensation in a lump sum, then the compensation is payable in installments
at the same intervals and in the same amount as the employee's temporary total disability
rate on the date of injury. Permanent partial disability is not payable while temporary total
compensation is being paid.

Sec. 4.

Minnesota Statutes 2016, section 176.101, subdivision 4, is amended to read:


Subd. 4.

Permanent total disability.

For permanent total disability, as defined in
subdivision 5, the compensation shall be 66-2/3 percent of the daily wage at the time of the
injury, subject to a maximum weekly compensation equal to the maximum weekly
compensation for a temporary total disability and a minimum weekly compensation equal
to 65 percent of the statewide average weekly wage. This compensation shall be paid during
the permanent total disability of the injured employee but after a total of $25,000 of weekly
compensation has been paid, the amount of the weekly compensation benefits being paid
by the employer shall be reduced by the amount of any disability benefits being paid by
any government disability benefit program if the disability benefits are occasioned by the
same injury or injuries which give rise to payments under this subdivision. This reduction
shall also apply to any old age and survivor insurance benefits. Payments shall be made at
the intervals when the wage was payable, as nearly as may be. In case an employee who is
permanently and totally disabled becomes an inmate of a public institution, no compensation
shall be payable during the period of confinement in the institution, unless there is wholly
dependent on the employee for support some person named in section 176.111, subdivision
1, 2 or 3
, in which case the compensation provided for in section 176.111, during the period
of confinement, shall be paid for the benefit of the dependent person during dependency.
The dependency of this person shall be determined as though the employee were deceased.
Permanent total disability shall cease at age deleted text begin67 because the employee is presumed retired
from the labor market
deleted text endnew text begin 72, except that if an employee is injured after age 67, permanent total
disability benefits shall cease after five years of those benefits have been paid
new text end. deleted text beginThis
presumption is rebuttable by the employee. The subjective statement the employee is not
retired is not sufficient in itself to rebut the presumptive evidence of retirement but may be
considered along with other evidence.
deleted text end

Sec. 5.

Minnesota Statutes 2016, section 176.102, subdivision 11, is amended to read:


Subd. 11.

Retraining; compensation.

(a) Retraining is limited to 156 weeks. An
employee who has been approved for retraining may petition the commissioner or
compensation judge for additional compensation not to exceed 25 percent of the
compensation otherwise payable. If the commissioner or compensation judge determines
that this additional compensation is warranted due to unusual or unique circumstances of
the employee's retraining plan, the commissioner may award additional compensation in
an amount not to exceed the employee's request. This additional compensation shall cease
at any time the commissioner or compensation judge determines the special circumstances
are no longer present.

(b) If the employee is not employed during a retraining plan that has been specifically
approved under this section, temporary total compensation is payable for up to 90 days after
the end of the retraining plan; except that, payment during the 90-day period is subject to
cessation in accordance with section 176.101. If the employee is employed during the
retraining plan but earning less than at the time of injury, temporary partial compensation
is payable at the rate of 66-2/3 percent of the difference between the employee's weekly
wage at the time of injury and the weekly wage the employee is able to earn in the employee's
partially disabled condition, subject to the maximum rate for temporary total compensation.
Temporary partial compensation is not subject to the deleted text begin225-weekdeleted text endnew text begin 275-weeknew text end or 450-week
limitations provided by section 176.101, subdivision 2, during the retraining plan, but is
subject to those limitations before and after the plan.

(c) Any request for retraining shall be filed with the commissioner before 208 weeks of
any combination of temporary total or temporary partial compensation have been paid.
Retraining shall not be available after 208 weeks of any combination of temporary total or
temporary partial compensation benefits have been paid unless the request for the retraining
has been filed with the commissioner prior to the time the 208 weeks of compensation have
been paid.

(d) The employer or insurer must notify the employee in writing of the 208-week
limitation for filing a request for retraining with the commissioner. This notice must be
given before 80 weeks of temporary total disability or temporary partial disability
compensation have been paid, regardless of the number of weeks that have elapsed since
the date of injury. If the notice is not given before the 80 weeks, the period of time within
which to file a request for retraining is extended by the number of days the notice is late,
but in no event may a request be filed later than 225 weeks after any combination of
temporary total disability or temporary partial disability compensation have been paid. The
commissioner may assess a penalty of $25 per day that the notice is late, up to a maximum
penalty of $2,000, against an employer or insurer for failure to provide the notice. The
penalty is payable to the commissioner for deposit in the assigned risk safety account.

Sec. 6.

Minnesota Statutes 2016, section 176.83, subdivision 5, is amended to read:


Subd. 5.

Treatment standards for medical services.

(a) In consultation with the Medical
Services Review Board or the rehabilitation review panel, the commissioner shall adopt
rules establishing standards and procedures for health care provider treatment. The rules
shall apply uniformly to all providers including those providing managed care under section
176.1351. The rules shall be used to determine whether a provider of health care services
and rehabilitation services, including a provider of medical, chiropractic, podiatric, surgical,
hospital, or other services, is performing procedures or providing services at a level or with
a frequency that is excessive, unnecessary, or inappropriate under section 176.135,
subdivision 1
, based upon accepted medical standards for quality health care and accepted
rehabilitation standards.

(b) The rules shall include, but are not limited to, the following:

(1) criteria for diagnosis and treatment of the most common work-related injuries
including, but not limited to, low back injuries and upper extremity repetitive trauma injuries;

(2) criteria for surgical procedures including, but not limited to, diagnosis, prior
conservative treatment, supporting diagnostic imaging and testing, and anticipated outcome
criteria;

(3) criteria for use of appliances, adaptive equipment, and use of health clubs or other
exercise facilities;

(4) criteria for diagnostic imaging procedures;

(5) criteria for inpatient hospitalization;

(6) criteria for treatment of chronic pain; deleted text beginand
deleted text end

(7) criteria for the long-term use of opioids or other scheduled medications to alleviate
intractable pain and improve function, including the use of written contracts between the
injured worker and the health care provider who prescribes the medicationdeleted text begin.deleted text endnew text begin; and
new text end

new text begin (8) criteria for treatment of post-traumatic stress disorder. In developing such treatment
criteria, the commissioner and the Medical Services Review Board shall consider the
guidance set forth in the American Psychological Association's most recently adopted
Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in
Adults. The commissioner shall adopt such rules using the expedited rulemaking process
in section 14.389, including subdivision 5, to commence promptly upon final enactment of
the legislation enacting this clause. Such rules shall apply to employees with all dates of
injury who receive treatment after the commissioner adopts the rules. In consultation with
the Medical Services Review Board, the commissioner shall review and update the rules
governing criteria for treatment of post-traumatic stress disorder each time the American
Psychological Association adopts a significant change to their Clinical Practice Guideline
for the Treatment of PTSD in Adults, using the expedited rulemaking process in section
14.389, including subdivision 5.
new text end

(c) If it is determined by the payer that the level, frequency, or cost of a procedure or
service of a provider is excessive, unnecessary, or inappropriate according to the standards
established by the rules, the provider shall not be paid for the procedure, service, or cost by
an insurer, self-insurer, or group self-insurer, and the provider shall not be reimbursed or
attempt to collect reimbursement for the procedure, service, or cost from any other source,
including the employee, another insurer, the special compensation fund, or any government
program unless the commissioner or compensation judge determines at a hearing or
administrative conference that the level, frequency, or cost was not excessive under the
rules in which case the insurer, self-insurer, or group self-insurer shall make the payment
deemed reasonable.

(d) A rehabilitation provider who is determined by the rehabilitation review panel board,
after hearing, to be consistently performing procedures or providing services at an excessive
level or cost may be prohibited from receiving any further reimbursement for procedures
or services provided under this chapter. A prohibition imposed on a provider under this
subdivision may be grounds for revocation or suspension of the provider's license or
certificate of registration to provide health care or rehabilitation service in Minnesota by
the appropriate licensing or certifying body. The commissioner and Medical Services Review
Board shall review excessive, inappropriate, or unnecessary health care provider treatment
under section 176.103.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective June 1, 2018.
new text end

Sec. 7. new text beginEFFECTIVE DATE.
new text end

new text begin Unless otherwise specified, this article is effective for employees with dates of injury
on or after October 1, 2018.
new text end