74th OREGON LEGISLATIVE ASSEMBLY--2007 Regular Session
 
SA to RC to A-Eng. HB 2247
 
LC 786/HB 2247-A2
 
            SENATE AMENDMENTS TO RESOLVE CONFLICTS TO
                   A-ENGROSSED HOUSE BILL 2247
 
                    By COMMITTEE ON COMMERCE
 
                             May 15
 
  On page 1 of the printed A-engrossed bill, line 2, after the
semicolon insert 'creating new provisions;'.
  On page 8, after line 37, insert:
  '  { +  SECTION 2a. + }  { + If House Bill 2756 becomes law,
section 2 of this 2007 Act (amending ORS 656.245) is repealed and
ORS 656.245, as amended by section 4, chapter 811, Oregon Laws
2003, section 4, chapter 26, Oregon Laws 2005, and section 4,
chapter ___, Oregon Laws 2007 (Enrolled House Bill 2756), 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.
  ' (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 { + , + }
 { - or - } 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 and, if
requested, the director shall determine with the advice of one or
more physicians, whether the selection by the worker shall be
approved. 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 injury or
occupational disease or for 12 visits, whichever first occurs,
without the authorization of an attending physician. Thereafter,
medical service provided to an injured worker without 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. 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) 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 days from
the date of the first visit on the claim;
  ' (ii) May authorize the payment of temporary disability
benefits for a period not to exceed 60 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
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
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.
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) Notwithstanding any other provision of this chapter,
the director, by rule, shall authorize nurse practitioners
certified by the Oregon State Board of Nursing who practice in
areas served by Type A or Type B rural hospitals described in ORS
442.470 to authorize the payment of temporary disability
compensation for injured workers for a period not to exceed 30
days from the date of the first visit on the claim. In addition,
the director, by rule, may authorize such practitioners who
practice in areas served by a Type C rural hospital described in
ORS 442.470 to authorize such payment. - }
  '  { +  (5) 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. + }
  ' (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.'.
  On page 27, after line 19, insert:
  '  { +  SECTION 9a. + }  { + If House Bill 2244 becomes law,
section 9 of this 2007 Act (amending ORS 656.726) is
repealed. + } ' .
                         ----------