HF 1319

as introduced - 88th Legislature (2013 - 2014) Posted on 03/06/2013 03:08pm

A bill for an act
relating to workers' compensation; modifying conversion factors for chiropractic
services; prohibiting steering practices; amending Minnesota Statutes 2012,
sections 176.135, subdivision 1; 176.136, subdivision 1a.

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

Section 1.

Minnesota Statutes 2012, section 176.135, subdivision 1, is amended to read:

Subdivision 1.

Medical, psychological, chiropractic, podiatric, surgical, hospital.

(a) The employer shall furnish any medical, psychological, chiropractic, podiatric, surgical
and hospital treatment, including nursing, medicines, medical, chiropractic, podiatric, and
surgical supplies, crutches and apparatus, including artificial members, or, at the option of
the employee, if the employer has not filed notice as hereinafter provided, Christian Science
treatment in lieu of medical treatment, chiropractic medicine and medical supplies, as may
reasonably be required at the time of the injury and any time thereafter to cure and relieve
from the effects of the injury. This treatment shall include treatments necessary to physical
rehabilitation. new text begin The employer must not discourage or in any way influence a patient's
decision to pursue chiropractic treatment in lieu of medical treatment or to obtain an MRI.
new text end

(b) The employer shall pay for the reasonable value of nursing services provided by
a member of the employee's family in cases of permanent total disability.

(c) Exposure to rabies is an injury and an employer shall furnish preventative
treatment to employees exposed to rabies.

(d) The employer shall furnish replacement or repair for artificial members, glasses
or spectacles, artificial eyes, podiatric orthotics, dental bridge work, dentures or artificial
teeth, hearing aids, canes, crutches, or wheel chairs damaged by reason of an injury arising
out of and in the course of the employment. For the purpose of this paragraph, "injury"
includes damage wholly or in part to an artificial member. In case of the employer's
inability or refusal seasonably to provide the items required to be provided under this
paragraph, the employer is liable for the reasonable expense incurred by or on behalf of
the employee in providing the same, including costs of copies of any medical records or
medical reports that are in existence, obtained from health care providers, and that directly
relate to the items for which payment is sought under this chapter, limited to the charges
allowed by subdivision 7, and attorney fees incurred by the employee.

(e) Both the commissioner and the compensation judges have authority to make
determinations under this section in accordance with sections 176.106 and 176.305.

(f) An employer may require that the treatment and supplies required to be provided
by an employer by this section be received in whole or in part from a managed care plan
certified under section 176.1351 except as otherwise provided by that section.

(g) An employer may designate a pharmacy or network of pharmacies that
employees must use to obtain outpatient prescription and nonprescription medications. An
employee is not required to obtain outpatient medications at a designated pharmacy unless
the pharmacy is located within 15 miles of the employee's place of residence.

(h) Notwithstanding any fees established by rule adopted under section 176.136, an
employer may contract for the cost of medication provided to employees.

Sec. 2.

Minnesota Statutes 2012, section 176.136, subdivision 1a, is amended to read:

Subd. 1a.

Relative value fee schedule.

(a) The liability of an employer for services
included in the medical fee schedule is limited to the maximum fee allowed by the
schedule in effect on the date of the medical service, or the provider's actual fee, whichever
is lower. The commissioner shall adopt permanent rules regulating fees allowable for
medical, chiropractic, podiatric, surgical, and other health care provider treatment or
service, including those provided to hospital outpatients, by implementing a relative value
fee schedule. The commissioner may adopt by reference, according to the procedures in
paragraph (h), clause (2), the relative value fee schedule tables adopted for the federal
Medicare program. The relative value fee schedule must contain reasonable classifications
including, but not limited to, classifications that differentiate among health care provider
disciplines. The conversion factors for the original relative value fee schedule must
reasonably reflect a 15 percent overall reduction from the medical fee schedule most
recently in effect. The reduction need not be applied equally to all treatment or services,
but must represent a gross 15 percent reduction.

(b) Effective October 1, 2005, the commissioner shall remove all scaling factors
from the relative value units and establish four separate conversion factors according to
paragraphs (c) and (d) for each of the following parts of Minnesota Rules:

(1) medical/surgical services in Minnesota Rules, part 5221.4030, as defined in part
5221.0700, subpart 3, item C, subitem (2);

(2) pathology and laboratory services in Minnesota Rules, part 5221.4040, as
defined in part 5221.0700, subpart 3, item C, subitem (3);

(3) physical medicine and rehabilitation services in Minnesota Rules, part
5221.4050, as defined in part 5221.0700, subpart 3, item C, subitem (4); and

(4) chiropractic services in Minnesota Rules, part 5221.4060, as defined in part
5221.0700, subpart 3, item C, subitem (5).

(c) The four conversion factors established under paragraph (b) shall be calculated
so that there is no change in each maximum fee for each service under the current fee
schedule, except as provided in paragraphs (d) and (e).

(d) By deleted text begin October 1, 2006 deleted text end new text begin October 1, 2013 new text end , the conversion factor for chiropractic
services described in paragraph (b), clause (4), shall be increased to equal deleted text begin 72 deleted text end new text begin 100 new text end percent
of the conversion factor for medical/surgical services described in paragraph (b), clause
(1). deleted text begin Beginning October 1, 2005, the increase in chiropractic conversion factor shall be
phased in over two years by approximately equal percentage point increases.
deleted text end

(e) When adjusting the conversion factors in accordance with paragraph (g) on
October 1, 2005, and October 1, 2006, the commissioner may adjust by no less than zero,
all of the conversion factors as necessary to offset any overall increase in payments under
the fee schedule resulting from the increase in the chiropractic conversion factor.

(f) The commissioner shall give notice of the relative value units and conversion
factors established under paragraphs (b), (c), and (d) according to the procedures in section
14.386, paragraph (a). The relative value units and conversion factors established under
paragraphs (b), (c), and (d) are not subject to expiration under section 14.386, paragraph (b).

(g) The conversion factors shall be adjusted as follows:

(1) After permanent rules have been adopted to implement this section, the conversion
factors must be adjusted annually on October 1 by no more than the percentage change
computed under section 176.645, but without the annual cap provided by that section.

(2) Each time the workers' compensation relative value fee schedule tables are
updated under paragraph (h), the commissioner shall adjust the conversion factors so that,
for services in both fee schedules, there is no difference between the overall payment in each
category of service listed in paragraph (b) under the new schedule and the overall payment
for that category under the workers' compensation fee schedule most recently in effect.
This adjustment must be made before making any additional adjustment under clause (1).

(h) The commissioner shall give notice of the adjusted conversion factors and
updates to the relative value fee schedule as follows:

(1) The commissioner shall annually give notice in the State Register of the adjusted
conversion factors and any amendments to rules to implement Medicare relative value
tables incorporated by reference under this subdivision. The notices of the adjusted
conversion factors and amended rules to implement the relative value tables are subject
to the requirements of section 14.386, paragraph (a). The annual adjustments to the
conversion factors and the medical fee schedules adopted under this section, including all
previous fee schedules, are not subject to expiration under section 14.386, paragraph (b).

(2) The commissioner shall periodically, but at least once every three years, update
the workers' compensation relative value tables by incorporating by reference the relative
value tables in the national physician fee schedule relative value file established by the
Centers for Medicare and Medicaid Services. The commissioner shall publish the notices
of the incorporation by reference in the State Register at least 60 days before the tables
are to become effective for purposes of payment under this section. Each notice of
incorporation must state the date the incorporated tables will become effective and must
include information on how the Medicare relative value tables may be obtained. The
published notices of incorporation by reference and the incorporated tables are not rules
subject to section 14.386 or other provisions of chapter 14, but have the force and effect of
law as of the date specified in the notices.