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69th Legislature 2025 SB 295.1
- 1 - Authorized Print Version – SB 295
1 SENATE BILL NO. 295
2 INTRODUCED BY A. OLSEN
3
4 A BILL FOR AN ACT ENTITLED: “AN ACT RESTORING THE RIGHT FOR AN INJURED WORKER TO
5 DESIGNATE A TREATING PHYSICIAN FOR WORKERS' COMPENSATION PURPOSES; REVISING
6 REFERENCES TO MANAGED CARE OR PREFERRED PROVIDER ORGANIZATIONS USED AS A
7 TREATING PHYSICIAN; AMENDING SECTIONS 39-71-1101, 39-71-1102, AND 39-71-1103, MCA; AND
8 PROVIDING AN EFFECTIVE DATE.”
9
10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:
11
12Section 1. Section 39-71-1101, MCA, is amended to read:
13 "39-71-1101. Choice of health care provider by worker -- insurer designation or approval of
14treating physician or referral to managed care or preferred provider organization -- payment terms --
15definition. (1) (a) Prior to the insurer's designation or approval of a treating physician as provided in subsection
16 (2) or a referral to a managed care organization or preferred provider organization as provided in subsection
17 (8), a A worker may choose a person who is listed treating physician as defined in 39-71-116(42) for initial
18 treatment and, after the initial treatment and diagnosis, may designate that person or another person meeting
19 the criteria set forth in 39-71-116 as a treating physician. Subject to subsection (2), if the person listed under
20 39-71-116(42) chosen by the worker agrees to comply with the requirements of subsection (2), that person is
21 the treating physician.
22 (b) The insurer may verify that the designated person agrees to carry out the responsibilities in
23 subsection (2).
24 (2) Any time after acceptance of liability by an insurer, the insurer may designate or approve a
25 treating physician who agrees to assume the responsibilities of the treating physician. The designated or
26 approved treating physician:
27 (a) is responsible for coordinating the worker's receipt of medical services as provided in 39-71-
28 704;
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69th Legislature 2025 SB 295.1
- 2 - Authorized Print Version – SB 295
1 (b) shall provide timely determinations required under this chapter, including but not limited to
2 maximum medical healing, physical restrictions, return to work, and approval or disapproval of job analyses,
3 and shall provide documentation;
4 (c) shall provide or arrange for treatment within the utilization and treatment guidelines or obtain
5 prior approval for other treatment; and
6 (d) shall conduct or arrange for timely impairment ratings.
7 (3) A designation of a treating physician must take into account and give due consideration to the
8 type of injury or occupational disease as well as address practical considerations, including the worker's
9 proximity to and the availability of the treating physician.
10 (4) The treating physician may be changed at any time with the consent of the worker and the
11 insurer that has accepted liability for the claim. Refusal to consent to a change in treating physician is subject to
12 mediation.
13 (3)(5) The treating physician may refer the worker to other health care providers for medical services,
14 as provided in 39-71-704, for the treatment of a worker's compensable injury or occupational disease. A health
15 care provider to whom the worker is referred by the designated treating physician is not responsible for
16 coordinating care or providing determinations as required of the treating physician.
17 (4)(6) The treating physician designated or approved by the insurer must be reimbursed at 110% of
18 the department's fee schedule.
19 (5)(7) A health care provider to whom the worker is referred by the treating physician must be
20 reimbursed at 90% of the department's fee schedule.
21 (6)(8) A health care provider providing health care on a compensable claim prior to the designation or
22 approval of the of a treating physician by the insurer must be reimbursed at 100% of the department's fee
23 schedule.
24 (7)(9) Regardless of the date of injury or diagnosis of an occupational disease, the medical fee
25 schedule rates in effect as adopted by the department in 39-71-704 and the percentages referenced in
26 subsections (4) (6) through (6) (8) of this section apply to the medical service on the date on which the medical
27 service was provided.
28 (8)(10) The insurer may direct the injured worker to use a managed care organization or a preferred
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1 provider organization for designation of in designating the treating physician.
2 (9)(11) After the insurer directs a worker to a managed care organization, or a preferred provider
3 organization, or an individual qualified under 39-71-116 within either type of organization as a treating
4 physician, a health care provider who otherwise qualifies as a treating physician but who is not a member of a
5 the designated managed care organization or the designated preferred provider organization may not provide
6 treatment at rates paid to treating physicians unless authorized by the insurer.
7 (10)(12)After the date that a worker subject to the provisions of subsection (9) (11) receives individual
8 written notice of a referral, the worker must, unless otherwise authorized by the insurer, receive medical
9 services from the organization designated by the insurer, in accordance with 39-71-1102 and 39-71-1104. The
10 designated treating physician in the organization then becomes the worker's treating physician. The insurer is
11 not liable for medical services obtained otherwise outside the recommendations by the managed care
12 organization or the preferred provider organization, except that a worker may receive immediate emergency
13 medical treatment for a compensable injury from a health care provider who is not a member of a managed
14 care organization or a preferred provider organization.
15 (11)(13)Posting of managed care requirements in the workplace on bulletin boards, in personnel
16 policies, in company manuals, or by other general or broadcast means does not constitute individual written
17 notice. To constitute individual written notice under this section, information regarding referral to a managed
18 care organization or a preferred provider organization must be provided to the worker in written form by mail or
19 in person after the date of injury or occupational disease."
20
21Section 2. Section 39-71-1102, MCA, is amended to read:
22 "39-71-1102. Preferred provider organizations -- establishment -- limitations. (1) In order to To
23 promote cost containment of medical care provided for in 39-71-704, development of preferred provider
24 organizations by insurers is encouraged. Insurers may establish arrangements with suppliers of soft and
25 durable medical goods and health care providers in addition to or in conjunction with managed care
26 organizations. Workers' compensation insurers may contract with other entities to use the other entities'
27 preferred provider organizations. After the date that an injured worker is given an individual written notice by the
28 insurer of a preferred provider, the insurer is not liable for charges from nonpreferred providers, unless the
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1 injured worker is in need of emergency medical treatment. If the injured worker requires immediate emergency
2 medical treatment for a compensable injury or occupational disease, the insurer shall pay for the emergency
3 medical treatment at 100% of the department's fee schedule even if the emergency medical treatment is from a
4 health care provider outside the preferred provider organization.
5 (2) Posting of preferred provider requirements in the workplace on bulletin boards, in personnel
6 policies, in company manuals, or by other general or broadcast means does not constitute individual written
7 notice. To constitute individual written notice under this section, information regarding referral to preferred
8 providers must be provided to the injured worker in written form by mail or in person after the date of injury or
9 occupational disease."
10
11Section 3. Section 39-71-1103, MCA, is amended to read:
12 "39-71-1103. Workers' compensation managed care. (1) A managed care system is a program
13 organized to serve the medical needs of injured workers in an efficient and cost-effective manner by managing
14 the delivery of medical services for a defined population of injured workers, pursuant to 39-71-1101, through
15 appropriate health care professionals. (1) (a) Designation of a treating physician who is part of a managed care
16 organization is the same as designating any member of that managed care organization as a treating physician
17 if the member is otherwise qualified as a treating physician.
18 (b) If, after designation by an insurer of a treating physician in a managed care organization, an
19 injured worker requires immediate emergency medical treatment for a compensable injury or occupational
20 disease, the insurer shall pay for the emergency medical treatment at 100% of the department's fee schedule
21 even if the emergency medical treatment is from a health care provider outside the managed care organization.
22 (2) The department shall develop criteria pursuant to 39-71-1105 for certification of managed care
23 organizations. The department may adopt rules for certification of managed care organizations.
24 (3) Insurers may contract with certified managed care organizations for medical services for injured
25 workers. A worker who is subject to managed care may choose from managed care organizations in the
26 worker's community that have a contract with the insurer responsible for the worker's medical services."
27
28 NEW SECTION. Section 4. Effective date. [This act] is effective July 1, 2025.
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