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5741S.02C
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SENATE COMMITTEE SUBSTITUTE
FOR
SENATE BILL NO. 1052
AN ACT
To repeal sections 287.140 and 287.210, RSMo, and to
enact in lieu thereof three new sections relating to
establishing a fee schedule for services performed
pursuant to the workers' compensation law, with
penalty provisions.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 287.140 and 287.210, RSMo, are
repealed and three new sections enacted in lieu thereof, to be
known as sections 287.140, 287.142, and 287.210, to read as
follows:
287.140. 1. In addition to all other compensation
paid to the employee under this section, the employee shall
receive and the employer shall provide such medical,
surgical, chiropractic, and hospital treatment, including
nursing, custodial, ambulance and medicines, as may
reasonably be required after the injury or disability, to
cure and relieve from the effects of the injury. If the
employee desires, he shall have the right to select his own
physician, surgeon, or other such requirement at his own
expense. Where the requirements are furnished by a public
hospital or other institution, payment therefor shall be
made to the proper authorities. Regardless of whether the
health care provider is selected by the employer or is
selected by the employee at the employee's expense, the
health care provider shall have the affirmative duty to
communicate fully with the employee regarding the nature of
the employee's injury and recommended treatment exclusive of
any evaluation for a permanent disability rating. Failure
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to perform such duty to communicate shall constitute a
disciplinary violation by the provider subject to the
provisions of chapter 620. When an employee is required to
submit to medical examinations or necessary medical
treatment at a place outside of the local or metropolitan
area from the employee's principal place of employment, the
employer or its insurer shall advance or reimburse the
employee for all necessary and reasonable expenses; except
that an injured employee who resides outside the state of
Missouri and who is employed by an employer located in
Missouri shall have the option of selecting the location of
services provided in this section either at a location
within one hundred miles of the injured employee's
residence, place of injury or place of hire by the
employer. The choice of provider within the location
selected shall continue to be made by the employer. In case
of a medical examination if a dispute arises as to what
expenses shall be paid by the employer, the matter shall be
presented to the legal advisor, the administrative law judge
or the commission, who shall set the sum to be paid and same
shall be paid by the employer prior to the medical
examination. In no event, however, shall the employer or
its insurer be required to pay transportation costs for a
greater distance than two hundred fifty miles each way from
place of treatment.
2. If it be shown to the division or the commission
that the requirements are being furnished in such manner
that there is reasonable ground for believing that the life,
health, or recovery of the employee is endangered thereby,
the division or the commission may order a change in the
physician, surgeon, hospital or other requirement.
3. [All fees and charges under this chapter shall be
fair and reasonable, shall be subject to regulation by the
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division or the commission, or the board of rehabilitation
in rehabilitation cases.] A health care provider shall not
charge a fee for treatment and care which is governed by the
provisions of this chapter greater than [the usual and
customary fee the provider receives for the same treatment
or service when the payor for such treatment or service is a
private individual or a private health insurance carrier]
that set forth in the medical fee schedule promulgated by
the workers' compensation fee schedule commission pursuant
to section 287.142. The division or the commission, or the
board of rehabilitation in rehabilitation cases, shall also
have jurisdiction to hear and determine all disputes as to
such charges. A health care provider is bound by the
determination upon the reasonableness of health care bills.
4. The division shall, by regulation, establish
methods to resolve disputes concerning the reasonableness of
medical charges, services, or aids. This regulation shall
govern resolution of disputes between employers and medical
providers over fees charged, whether or not paid, and shall
be in lieu of any other administrative procedure under this
chapter. The employee shall not be a party to a dispute
over medical charges, nor shall the employee's recovery in
any way be jeopardized because of such dispute. Any
application for payment of additional reimbursement, as such
term is used in 8 CSR 50- 2.030, as amended, shall be filed
not later than:
(1) Two years from the date the first notice of
dispute of the medical charge was received by the health
care provider if such services were rendered before July 1,
2013; and
(2) One year from the date the first notice of dispute
of the medical charge was received by the health care
provider if such services were rendered after July 1, 2013.
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Notice shall be presumed to occur no later than five
business days after transmission by certified United States
mail.
5. No compensation shall be payable for the death or
disability of an employee, if and insofar as the death or
disability may be caused, continued or aggravated by any
unreasonable refusal to submit to any medical or surgical
treatment or operation, the risk of which is, in the opinion
of the division or the commission, inconsiderable in view of
the seriousness of the injury. If the employee dies as a
result of an operation made necessary by the injury, the
death shall be deemed to be caused by the injury.
6. The testimony of any physician or chiropractic
physician who treated the employee shall be admissible in
evidence in any proceedings for compensation under this
chapter, subject to all of the provisions of section 287.210.
7. Every hospital or other person furnishing the
employee with medical aid shall permit its record to be
copied by and shall furnish full information to the division
or the commission, the employer, the employee or his
dependents and any other party to any proceedings for
compensation under this chapter, and certified copies of the
records shall be admissible in evidence in any such
proceedings.
8. The employer may be required by the division or the
commission to furnish an injured employee with artificial
legs, arms, hands, surgical orthopedic joints, or eyes, or
braces, as needed, for life whenever the division or the
commission shall find that the injured employee may be
partially or wholly relieved of the effects of a permanent
injury by the use thereof. The director of the division
shall establish a procedure whereby a claim for compensation
may be reactivated after settlement of such claim is
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completed. The claim shall be reactivated only after the
claimant can show good cause for the reactivation of this
claim and the claim shall be made only for the payment of
medical procedures involving life-threatening surgical
procedures or if the claimant requires the use of a new, or
the modification, alteration or exchange of an existing,
prosthetic device. For the purpose of this subsection,
"life threatening" shall mean a situation or condition
which, if not treated immediately, will likely result in the
death of the injured worker.
9. Nothing in this chapter shall prevent an employee
being provided treatment for his injuries by prayer or
spiritual means if the employer does not object to the
treatment.
10. The employer shall have the right to select the
licensed treating physician, surgeon, chiropractic
physician, or other health care provider; provided, however,
that such physicians, surgeons or other health care
providers shall offer only those services authorized within
the scope of their licenses. For the purpose of this
subsection, subsection 2 of section 287.030 shall not apply.
11. Any physician or other health care provider who
orders, directs or refers a patient for treatment, testing,
therapy or rehabilitation at any institution or facility
shall, at or prior to the time of the referral, disclose in
writing if such health care provider, any of his partners or
his employer has a financial interest in the institution or
facility to which the patient is being referred, to the
following:
(1) The patient;
(2) The employer of the patient with workers'
compensation liability for the injury or disease being
treated;
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(3) The workers' compensation insurer of such
employer; and
(4) The workers' compensation adjusting company for
such insurer.
12. Violation of subsection 11 of this section is a
class A misdemeanor.
13. (1) No hospital, physician or other health care
provider, other than a hospital, physician or health care
provider selected by the employee at his own expense
pursuant to subsection 1 of this section, shall bill or
attempt to collect any fee or any portion of a fee for
services rendered to an employee due to a work-related
injury or report to any credit reporting agency any failure
of the employee to make such payment, when an injury covered
by this chapter has occurred and such hospital, physician or
health care provider has received actual notice given in
writing by the employee, the employer or the employer's
insurer. Actual notice shall be deemed received by the
hospital, physician or health care provider five days after
mailing by certified mail by the employer or insurer to the
hospital, physician or health care provider.
(2) The notice shall include:
(a) The name of the employer;
(b) The name of the insurer, if known;
(c) The name of the employee receiving the services;
(d) The general nature of the injury, if known; and
(e) Where a claim has been filed, the claim number, if
known.
(3) When an injury is found to be noncompensable under
this chapter, the hospital, physician or other health care
provider shall be entitled to pursue the employee for any
unpaid portion of the fee or other charges for authorized
services provided to the employee. Any applicable statute
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of limitations for an action for such fees or other charges
shall be tolled from the time notice is given to the
division by a hospital, physician or other health care
provider pursuant to subdivision (6) of this subsection,
until a determination of noncompensability in regard to the
injury which is the basis of such services is made, or in
the event there is an appeal to the labor and industrial
relations commission, until a decision is rendered by that
commission.
(4) If a hospital, physician or other health care
provider or a debt collector on behalf of such hospital,
physician or other health care provider pursues any action
to collect from an employee after such notice is properly
given, the employee shall have a cause of action against the
hospital, physician or other health care provider for actual
damages sustained plus up to one thousand dollars in
additional damages, costs and reasonable attorney's fees.
(5) If an employer or insurer fails to make payment
for authorized services provided to the employee by a
hospital, physician or other health care provider pursuant
to this chapter, the hospital, physician or other health
care provider may proceed pursuant to subsection 4 of this
section with a dispute against the employer or insurer for
any fees or other charges for services provided.
(6) A hospital, physician or other health care
provider whose services have been authorized in advance by
the employer or insurer may give notice to the division of
any claim for fees or other charges for services provided
for a work-related injury that is covered by this chapter,
with copies of the notice to the employee, employer and the
employer's insurer. Where such notice has been filed, the
administrative law judge may order direct payment from the
proceeds of any settlement or award to the hospital,
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physician or other health care provider for such fees as are
determined by the division. The notice shall be on a form
prescribed by the division.
14. The employer may allow or require an employee to
use any of the employee's accumulated paid leave, personal
leave, or medical or sick leave to attend to medical
treatment, physical rehabilitation, or medical evaluations
during work time. The intent of this subsection is to
specifically supercede and abrogate any case law that
contradicts the express language of this section.
287.142. 1. There is hereby established a "Workers'
Compensation Fee Schedule Commission", organized under the
department of labor and industrial relations, to consist of
nine members in total, five of whom shall be appointed by
the governor, one member of the house of representatives who
whom shall be appointed by the speaker of the house of
representatives, one member of the senate, who shall be
appointed by the president pro tempore of the senate, the
director of the department of labor and industrial
relations, or his or her designee, and the director of the
department of commerce and insurance, or his or her
designee. Of the five gubernatorial appointees, one member
shall have experience as a health care provider, one member
shall have experience representing health care facilities,
one member shall represent insurance carriers, one member
shall represent employees, and one member shall have
expertise in health care economics. Each member appointed
shall serve a three-year term. The governor shall designate
one of the members to be chairman. All members shall serve
without compensation. Any vacancy shall be filled by the
respective appointing authority. The commission may make
such rules, regulations, and bylaws consistent with state
law to effectuate its purposes as it deems necessary.
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2. The workers' compensation fee schedule commission
shall promulgate rules for the purpose of establishing a
medical fee schedule specifying the maximum allowable
amounts to reimburse for any treatment and care rendered to
employees under this chapter. Any rule or portion of a
rule, as that term is defined in section 536.010, that is
created under the authority delegated in this section shall
become effective only if it complies with and is subject to
all of the provisions of chapter 536 and, if applicable,
section 536.028. This section and chapter 536 are
nonseverable and if any of the powers vested with the
general assembly pursuant to chapter 536 to review, to delay
the effective date, or to disapprove and annul a rule are
subsequently held unconstitutional, then the grant of
rulemaking authority and any rule proposed or adopted after
August 28, 2026, shall be invalid and void.
3. The medical fee schedule shall promote health care
cost containment and efficiency, and shall be sufficient to
ensure availability of such reasonably necessary treatment,
care, and attendance to each injured employee to cure and
relieve the employee from the effects of the injury.
4. The workers' compensation fee schedule commission
shall be reconvened not sooner than once every three years
to consider adjustments in the fee schedule.
5. The workers' compensation fee schedule commission
shall produce the initial medical fee schedule not later
than January 1, 2027. The initial medical fee schedule
shall take effect on July 1, 2028.
287.210. 1. After an employee has received an injury
he shall from time to time thereafter during disability
submit to reasonable medical examination at the request of
the employer, the employer's insurer, the commission, the
division, an administrative law judge, or the attorney
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general on behalf of the second injury fund if the employer
has not obtained a medical examination report, the time and
place of which shall be fixed with due regard to the
convenience of the employee and his physical condition and
ability to attend. The employee may have his own physician
present, and if the employee refuses to submit to the
examination, or in any way obstructs it, his right to
compensation shall be forfeited during such period unless in
the opinion of the commission the circumstances justify the
refusal or obstruction.
2. The commission, the division or administrative law
judge shall, when deemed necessary, appoint a duly qualified
impartial physician to examine the injured employee, and any
physician so chosen, if he accepts the appointment, shall
promptly make the examination requested and make a complete
medical report to the commission or the division in such
duplication as to provide all parties with copies thereof.
The physician's fee shall be [fair and reasonable, as
provided in] subject to subsection 3 of section 287.140, and
the fee and other reasonable costs of the impartial
examination may be paid as other costs under this chapter.
If all the parties shall have had reasonable access thereto,
the report of the physician shall be admissible in evidence.
3. The testimony of any physician who treated or
examined the injured employee shall be admissible in
evidence in any proceedings for compensation under this
chapter, but only if the medical report of the physician has
been made available to all parties as in this section
provided. Immediately upon receipt of notice from the
division or the commission setting a date for hearing of a
case in which the nature and extent of an employee's
disability is to be determined, the parties or their
attorneys shall arrange, without charge or costs, each to
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the other, for an exchange of all medical reports, including
those made both by treating and examining physician or
physicians, to the end that the parties may be commonly
informed of all medical findings and opinions. The exchange
of medical reports shall be made at least seven days before
the date set for the hearing and failure of any party to
comply may be grounds for asking for and receiving a
continuance, upon proper showing by the party to whom the
medical reports were not furnished. If any party fails or
refuses to furnish the opposing party with the medical
report of the treating or examining physician at least seven
days before such physician's deposition or personal
testimony at the hearing, as in this section provided, upon
the objection of the party who was not provided with the
medical report, the physician shall not be permitted to
testify at that hearing or by medical deposition.
4. Upon request, an administrative law judge, the
division, or the commission shall be provided with a copy of
any medical report.
5. As used in this chapter the terms "physician's
report" and "medical report" mean the report of any
physician made on any printed form authorized by the
division or the commission or any complete medical report.
As used in this chapter the term "complete medical report"
means the report of a physician giving the physician's
qualifications and the patient's history, complaints,
details of the findings of any and all laboratory, X-ray and
all other technical examinations, diagnosis, prognosis,
nature of disability, if any, and an estimate of the
percentage of permanent partial disability, if any. An
element or elements of a complete medical report may be met
by the physician's records.
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6. Upon the request of a party, the physician or
physicians who treated or are treating the injured employee
shall be required to furnish to the parties a rating and
complete medical report on the injured employee, at the
expense of the party selecting the physician, along with a
complete copy of the physician's clinical record including
copies of any records and reports received from other health
care providers.
7. The testimony of a treating or examining physician
may be submitted in evidence on the issues in controversy by
a complete medical report and shall be admissible without
other foundational evidence subject to compliance with the
following procedures. The party intending to submit a
complete medical report in evidence shall give notice at
least sixty days prior to the hearing to all parties and
shall provide reasonable opportunity to all parties to
obtain cross-examination testimony of the physician by
deposition. The notice shall include a copy of the report
and all the clinical and treatment records of the physician
including copies of all records and reports received by the
physician from other health care providers. The party
offering the report must make the physician available for
cross-examination testimony by deposition not later than
seven days before the matter is set for hearing, and each
cross-examiner shall compensate the physician for the
portion of testimony obtained in an amount not to exceed a
rate of reasonable compensation taking into consideration
the specialty practiced by the physician. Cross-examination
testimony shall not bind the cross-examining party. Any
testimony obtained by the offering party shall be at that
party's expense on a proportional basis, including the
deposition fee of the physician. Upon request of any party,
the party offering a complete medical report in evidence
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must also make available copies of X rays or other
diagnostic studies obtained by or relied upon by the
physician. Within ten days after receipt of such notice a
party shall dispute whether a report meets the requirements
of a complete medical report by providing written objections
to the offering party stating the grounds for the dispute,
and at the request of any party, the administrative law
judge shall rule upon such objections upon pretrial hearing
whether the report meets the requirements of a complete
medical report and upon the admissibility of the report or
portions thereof. If no objections are filed the report is
admissible, and any objections thereto are deemed waived.
Nothing herein shall prevent the parties from agreeing to
admit medical reports or records by consent.
8. Certified copies of the proceedings before any
coroner holding an inquest over the body of any employee
receiving an injury in the course of his employment
resulting in death shall be admissible in evidence in any
proceedings for compensation under this chapter, and it
shall be the duty of the coroner to give notice of the
inquest to the employer and the dependents of the deceased
employee, who shall have the right to cross-examine the
witness.
9. The division or the commission may in its
discretion in extraordinary cases order a postmortem
examination and for that purpose may also order a body
exhumed.