Connecticut Seal

General Assembly

 

Raised Bill No. 61

February Session, 2014

 

LCO No. 357

 

*00357_______LAB*

Referred to Committee on LABOR AND PUBLIC EMPLOYEES

 

Introduced by:

 

(LAB)

 

AN ACT CONCERNING WORKERS' COMPENSATION AND LIABILITY FOR HOSPITAL SERVICES.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Section 31-294d of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2014):

(a) (1) The employer, as soon as the employer has knowledge of an injury, shall provide a competent physician or surgeon to attend the injured employee and, in addition, shall furnish any medical and surgical aid or hospital and nursing service, including medical rehabilitation services and prescription drugs, as the physician or surgeon deems reasonable or necessary. The employer, any insurer acting on behalf of the employer, or any other entity acting on behalf of the employer or insurer shall be responsible for paying the cost of such prescription drugs directly to the provider.

(2) If the injured employee is a local or state police officer, state marshal, judicial marshal, correction officer, emergency medical technician, paramedic, ambulance driver, firefighter, or active member of a volunteer fire company or fire department engaged in volunteer duties, who has been exposed in the line of duty to blood or bodily fluids that may carry blood-borne disease, the medical and surgical aid or hospital and nursing service provided by the employer shall include any relevant diagnostic and prophylactic procedure for and treatment of any blood-borne disease.

(b) The employee shall select the physician or surgeon from an approved list of physicians and surgeons prepared by the chairman of the Workers' Compensation Commission. If the employee is unable to make the selection, the employer shall do so, subject to ratification by the employee or [his] the employee's next of kin. If the employer has a full-time staff physician or if a physician is available on call, the initial treatment required immediately following the injury may be rendered by that physician, but the employee may thereafter select his or her own physician as provided by this chapter for any further treatment without prior approval of the commissioner.

(c) The commissioner may, without hearing, at the request of the employer or the injured employee, when good reason exists, or on [his] the commissioner's own motion, authorize or direct a change of physician or surgeon or hospital or nursing service provided pursuant to subsection (a) of this section.

(d) (1) The pecuniary liability of the employer for the medical and surgical service required by this section shall be limited to the charges that prevail in the same community or similar communities for similar treatment of injured persons of a like standard of living when the similar treatment is paid for by the injured person. [The] Prior to July 1, 2016, or prior to the date the chairman of the Workers' Compensation Commission establishes a fee schedule setting the liability of employers for hospital service pursuant to subsection (e) of this section, whichever is earlier, if the employer and hospital have not otherwise negotiated to determine the liability of the employer for hospital services required by this section, the liability of the employer for hospital service shall be (A) the [amount it actually costs] operating costs incurred by the hospital to render the service, [as determined by the commissioner] plus (B) the weighted state-wide average of uncompensated care costs, both of which may be calculated using the ratios reported in the Twelve Months Actual Filing for the most recent fiscal year prepared by such hospital pursuant to section 19a-676, which is presumed to be reasonable and correct as applied to the hospital's pricemaster filed pursuant to section 19a-681, except in the case of state humane institutions, where the liability of the employer shall be the per capita cost as determined by the Comptroller under the provisions of section 17b-223. All disputes concerning liability for hospital services in workers' compensation cases shall be filed not later than one year from the date that the employer remits the payment or notifies the hospital of such employer's dispute and shall be settled by the commissioner in accordance with this chapter.

(2) On and after July 1, 2016, or on and after the date the chairman of the Workers' Compensation Commission establishes a fee schedule setting the liability of employers for hospital services pursuant to subsection (e) of this section, whichever is earlier, unless the employer and the hospital otherwise agree, the liability of the employer for hospital service shall be limited to the annual fee schedule published by the Workers' Compensation Commission pursuant to subsection (e) of this section.

(e) Notwithstanding section 19a-646, the chairman of the Workers' Compensation Commission shall consult with employers and their insurance carriers, union representatives, hospitals and third-party reimbursement organizations to establish, not later than July 1, 2016, and publish annually thereafter, a fee schedule setting the liability of employers for hospital services required under this section.

[(e)] (f) If the employer fails to promptly provide a physician or surgeon or any medical and surgical aid or hospital and nursing service as required by this section, the injured employee may obtain a physician or surgeon, selected from the approved list prepared by the chairman, or such medical and surgical aid or hospital and nursing service at the expense of the employer.

Sec. 2. Section 31-294h of the general statutes is repealed. (Effective October 1, 2014)

This act shall take effect as follows and shall amend the following sections:

Section 1

July 1, 2014

31-294d

Sec. 2

October 1, 2014

Repealer section

Statement of Purpose:

To make certain changes regarding employer liability for hospital services.

[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]