Full Text of SB0012 100th General Assembly
SB0012sam004 100TH GENERAL ASSEMBLY | Sen. Kwame Raoul Filed: 5/10/2017
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| 1 | | AMENDMENT TO SENATE BILL 12
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 12 on page 10, by | 3 | | replacing lines 23 and 24 with the following: | 4 | | "changing Sections 8, 8.2, 8.2a, 14, 19, 25.5, and 29.2 as | 5 | | follows:"; and | 6 | | by deleting all of pages 11 through 18; and
| 7 | | on page 19, by deleting lines 1 through 15; and
| 8 | | on page 26, by replacing lines 1 and 2 with the following:
| 9 | | "lasts more
than 5 scheduled 3 working days for the claimant , | 10 | | weekly compensation as hereinafter provided shall
be paid | 11 | | beginning on the 6th 4th day"; and | 12 | | on page 29, line 20, by changing " $755.22 " to " $775.18 "; and | 13 | | by deleting lines 16 through 26 of page 33 and lines 1 through |
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| 1 | | 9 of page 34; and
| 2 | | on page 45, by replacing lines 16 and 17 with the following:
| 3 | | "fingers, leg, foot , or any toes, or loss under Section 8(d)2 | 4 | | due to accidental injuries to the same part of the spine, such | 5 | | loss or partial loss of any such member or loss under Section | 6 | | 8(d)2 due to accidental injuries to the same part of the spine | 7 | | shall be deducted from any award made"; and | 8 | | on page 45, line 20, by replacing "eye" with "eye or loss under | 9 | | Section 8(d)2 due to accidental injuries to the same part of | 10 | | the spine "; and | 11 | | on page 45, line 22, by inserting immediately following the | 12 | | period the following: | 13 | | " For purposes of this subdivision (e)17 only, "same part of the | 14 | | spine" means: (1) cervical spine and thoracic spine from | 15 | | vertebra C1 through T12 and (2) lumbar and sacral spine and | 16 | | coccyx from vertebra L1 through S5. "; and | 17 | | on page 46, by replacing lines 6 through 21 with the following: | 18 | | "members, and in a subsequent independent accident loses | 19 | | another or suffers the permanent and complete loss of the use | 20 | | of any one of such members the employer for whom the injured | 21 | | employee is working at the time of the last independent | 22 | | accident is liable to pay compensation only for the loss or |
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| 1 | | permanent and complete loss of the use of the member occasioned | 2 | | by the last independent accident."; and
| 3 | | by deleting lines 10 through 25 of page 57 and lines 1 through | 4 | | 23 of page 58; and
| 5 | | on page 61, by inserting after line 7 the following: | 6 | | " The provisions of this subsection (a), other than this | 7 | | sentence, are inoperative after August 31, 2017. "; and | 8 | | on page 64, by inserting after line 18 the following: | 9 | | " The provisions of this subsection (a-1), other than this | 10 | | sentence, are inoperative after August 31, 2017. "; and | 11 | | (a-1.5) The following provisions apply to procedures, | 12 | | treatments, services, products, and supplies covered under | 13 | | this Act and rendered or to be rendered on or after September | 14 | | 1, 2017: | 15 | | (1) In this Section: | 16 | | "CPT code" means each Current Procedural Terminology | 17 | | code, for each geographic region specified in subsection | 18 | | (b) of this Section, included on the most recent medical | 19 | | fee schedule established by the Commission pursuant to this | 20 | | Section. | 21 | | "DRG code" means each current diagnosis related group | 22 | | code, for each geographic region specified in subsection | 23 | | (b) of this Section, included on the most recent medical |
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| 1 | | fee schedule established by the Commission pursuant to this | 2 | | Section. | 3 | | "Geozip" means a three-digit zip code based on data | 4 | | similarities, geographical similarities, and frequencies. | 5 | | "Health care services" means those CPT and DRG codes | 6 | | for procedures, treatments, products, services or supplies | 7 | | for hospital inpatient, hospital outpatient, emergency | 8 | | room, ambulatory surgical treatment centers, accredited | 9 | | ambulatory surgical treatment facilities, and professional | 10 | | services. It does not include codes classified as | 11 | | healthcare common procedure coding systems or dental. | 12 | | "Medicare maximum fee" means, for each CPT and DRG | 13 | | code, the current maximum fee for that CPT or DRG code | 14 | | allowed to be charged by the Centers for Medicare and | 15 | | Medicaid Services for Medicare patients in that geographic | 16 | | region. The Medicare maximum fee shall be the greater of | 17 | | (i) the current maximum fee allowed to be charged by the | 18 | | Centers for Medicare and Medicaid Services for Medicare | 19 | | patients in the geographic region or (ii) the maximum fee | 20 | | charged by the Centers for Medicare and Medicaid Services | 21 | | for Medicare patients in the geographic region on January | 22 | | 1, 2017. | 23 | | "Medicare percentage amount" means, for each CPT and | 24 | | DRG code, the workers' compensation maximum fee as a | 25 | | percentage of the Medicare maximum fee. | 26 | | "Workers' compensation maximum fee" means, for each |
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| 1 | | CPT and DRG code, the current maximum fee allowed to be | 2 | | charged under the medical fee schedule established by the | 3 | | Commission for that CPT or DRG code in that geographic | 4 | | region. | 5 | | (2) The Commission shall establish and maintain fee | 6 | | schedules for procedures, treatments, products, services, | 7 | | or supplies for hospital inpatient, hospital outpatient, | 8 | | emergency room, ambulatory surgical treatment centers, | 9 | | accredited ambulatory surgical treatment facilities, | 10 | | prescriptions filled and dispensed outside of a licensed | 11 | | pharmacy, dental services, and professional services. | 12 | | These fee schedule amounts shall be grouped into geographic | 13 | | regions in the following manner: | 14 | | (A) Four regions for non-hospital fee schedule | 15 | | amounts shall be utilized: | 16 | | (i) Cook County; | 17 | | (ii) DuPage, Kane, Lake, and Will Counties; | 18 | | (iii) Bond, Calhoun, Clinton, Jersey, | 19 | | Macoupin, Madison, Monroe, Montgomery, Randolph, | 20 | | St. Clair, and Washington Counties; and | 21 | | (iv) All other counties of the State. | 22 | | (B) Fourteen regions for hospital fee schedule | 23 | | amounts shall be utilized: | 24 | | (i) Cook, DuPage, Will, Kane, McHenry, DeKalb, | 25 | | Kendall, and Grundy Counties; | 26 | | (ii) Kankakee County; |
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| 1 | | (iii) Madison, St. Clair, Macoupin, Clinton, | 2 | | Monroe, Jersey, Bond, and Calhoun Counties; | 3 | | (iv) Winnebago and Boone Counties; | 4 | | (v) Peoria, Tazewell, Woodford, Marshall, and | 5 | | Stark Counties; | 6 | | (vi) Champaign, Piatt, and Ford Counties; | 7 | | (vii) Rock Island, Henry, and Mercer Counties; | 8 | | (viii) Sangamon and Menard Counties; | 9 | | (ix) McLean County; | 10 | | (x) Lake County; | 11 | | (xi) Macon County; | 12 | | (xii) Vermilion County; | 13 | | (xiii) Alexander County; and | 14 | | (xiv) All other counties of the State. | 15 | | If a geozip overlaps into one or more of the regions | 16 | | set forth in this Section, then the Commission shall | 17 | | average or repeat the charges and fees in a geozip in order | 18 | | to designate charges and fees for each region. | 19 | | (3) The initial workers' compensation maximum fee for | 20 | | each CPT and DRG code as of September 1, 2017 shall be | 21 | | determined as follows: | 22 | | (A) Within 45 days after the effective date of this | 23 | | amendatory Act of the 100th General Assembly, the | 24 | | Commission shall determine the Medicare percentage | 25 | | amount for each CPT and DRG code using the most recent | 26 | | data available. |
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| 1 | | CPT or DRG codes which have a value, but are not | 2 | | covered expenses under Medicare, are still compensable | 3 | | under the medical fee schedule according to the rate | 4 | | described in Section (B). | 5 | | (B) Within 30 days after the Commission makes the | 6 | | determinations required by subdivision (3)(A) of this | 7 | | subsection (a-1.5), the Commission shall determine an | 8 | | adjustment to be made to the workers' compensation | 9 | | maximum fee for each CPT and DRG code as follows: | 10 | | (i) If the Medicare percentage amount for that | 11 | | CPT or DRG code is equal to or less than 125%, then | 12 | | the workers' compensation maximum fee for that CPT | 13 | | or DRG code shall be adjusted so that it equals | 14 | | 125% the most recent Medicare maximum fee for that | 15 | | CPT or DRG code. | 16 | | (ii) If the Medicare percentage amount for | 17 | | that CPT or DRG code is greater than 125% but less | 18 | | than 150%, then the workers' compensation maximum | 19 | | fee for that CPT or DRG code shall not be adjusted. | 20 | | (iii) If the Medicare percentage amount for | 21 | | that CPT or DRG code is greater than 150% but less | 22 | | than or equal to 225%, then the workers' | 23 | | compensation maximum fee for that CPT or DRG code | 24 | | shall be adjusted so that it equals the greater of | 25 | | (I) 150% of the most recent Medicare maximum fee | 26 | | for that CPT or DRG code or (II) 85% of the most |
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| 1 | | recent workers' compensation maximum amount for | 2 | | that CPT or DRG code. | 3 | | (iv) If the Medicare percentage amount for | 4 | | that CPT or DRG code is greater than 225% but less | 5 | | than or equal to 428.57%, then the workers' | 6 | | compensation maximum fee for that CPT or DRG code | 7 | | shall be adjusted so that it equals the greater of | 8 | | (I) 191.25% of the most recent Medicare maximum fee | 9 | | for that CPT or DRG code or (II) 70% of the most | 10 | | recent workers' compensation maximum amount for | 11 | | that CPT or DRG code. | 12 | | (v) If the Medicare percentage amount for that | 13 | | CPT or DRG code is greater than 428.57%, then the | 14 | | workers' compensation maximum fee for that CPT or | 15 | | DRG code shall be adjusted so that it equals 300% | 16 | | of the most recent Medicare maximum fee for that | 17 | | CPT or DRG code. | 18 | | The Commission shall promptly publish the | 19 | | adjustments determined pursuant to this subdivision | 20 | | (3)(B) on its website. | 21 | | (C) The initial workers' compensation maximum fee | 22 | | for each CPT and DRG code as of September 1, 2017 shall | 23 | | be equal to the workers' compensation maximum fee for | 24 | | that code as determined and adjusted pursuant to | 25 | | subdivision (3)(B) of this subsection, subject to any | 26 | | further adjustments pursuant to subdivision (5) of |
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| 1 | | this subsection. | 2 | | (4) The Commission, as of September 1, 2018 and | 3 | | September 1 of each year thereafter, shall adjust the | 4 | | workers' compensation maximum fee for each CPT or DRG code | 5 | | to exactly half of the most recent annual increase in the | 6 | | Consumer Price Index-U. | 7 | | (5) A person who believes that the workers' | 8 | | compensation maximum fee for a CPT or DRG code, as | 9 | | otherwise determined pursuant to this subsection, creates | 10 | | or would create upon implementation a significant | 11 | | limitation on access to quality health care in either a | 12 | | specific field of health care services or a specific | 13 | | geographic limitation on access to health care may petition | 14 | | the Commission to modify the workers' compensation maximum | 15 | | fee for that CPT or DRG code so as to not create that | 16 | | significant limitation. | 17 | | The petitioner bears the burden of demonstrating, by a | 18 | | preponderance of the credible evidence, that the workers' | 19 | | compensation maximum fee that would otherwise apply would | 20 | | create a significant limitation on access to quality health | 21 | | care in either a specific field of health care services or | 22 | | a specific geographic limitation on access to health care. | 23 | | Petitions shall be made publicly available. Such credible | 24 | | evidence shall include empirical data demonstrating a | 25 | | significant limitation on access to quality health care. | 26 | | Other interested persons may file comments or responses to |
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| 1 | | a petition within 30 days of the filing of a petition. | 2 | | The Commission shall take final action on each petition | 3 | | within 180 days of filing. The Commission may, but is not | 4 | | required to, seek the recommendation of the Medical Fee | 5 | | Advisory Board to assist with this determination. If the | 6 | | Commission grants the petition, the Commission shall | 7 | | further increase the workers' compensation maximum fee for | 8 | | that CPT or DRG code by the amount minimally necessary to | 9 | | avoid creating a significant limitation on access to | 10 | | quality health care in either a specific field of health | 11 | | care services or a specific geographic limitation on access | 12 | | to health care. The increased workers' compensation | 13 | | maximum fee shall take effect upon entry of the | 14 | | Commission's final action. "; and | 15 | | on page 64, line 24, by inserting after the period the | 16 | | following: | 17 | | " The provisions of this subsection (a-2), other than this | 18 | | sentence, are inoperative after August 31, 2017. "; and | 19 | | by deleting lines 25 and 26 of page 64 and all of page 65; and
| 20 | | by deleting lines 22 through 25 of page 73, all of pages 74 | 21 | | through 80, and lines 1 through 12 of page 81; and | 22 | | by deleting lines 18 through 25 of page 86, all of pages 87 and |
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| 1 | | 88, and lines 1 through 7 of page 89; and | 2 | | by replacing lines 20 through 26 of page 92 and lines 1 through | 3 | | 23 of page 93 with the following: | 4 | | "Whether the employee is working or not, if the employee is | 5 | | not receiving or has not received medical, surgical, or | 6 | | hospital services or other services or compensation as provided | 7 | | in paragraph (a) of Section 8, or compensation as provided in | 8 | | paragraph (b) of Section 8, or if the employer has refused or | 9 | | failed to respond to a written request for authorization of | 10 | | medical care and treatment, the employee may at any time | 11 | | petition for an expedited hearing by an Arbitrator on the issue | 12 | | of whether or not he or she is entitled to receive payment of | 13 | | the services or compensation or authorization of medical care . | 14 | | Provided the employer continues to pay compensation pursuant to | 15 | | paragraph (b) of Section 8, the employer may at any time | 16 | | petition for an expedited hearing on the issue of whether or | 17 | | not the employee is entitled to receive medical, surgical, or | 18 | | hospital services or other services or compensation as provided | 19 | | in paragraph (a) of Section 8, whether or not the employee is | 20 | | entitled to authorization of medical care and treatment, or | 21 | | compensation as provided in paragraph (b) of Section 8. When an | 22 | | employer has petitioned for an expedited hearing, the employer | 23 | | shall continue to pay compensation as provided in paragraph (b) | 24 | | of Section 8 unless the arbitrator renders a decision that the | 25 | | employee is not entitled to the benefits that are the subject |
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| 1 | | of the expedited hearing or unless the employee's treating | 2 | | physician has released the employee to return to work at his or | 3 | | her regular job with the employer or the employee actually | 4 | | returns to work at any other job. If the arbitrator renders a | 5 | | decision that the employee is not entitled to the benefits or | 6 | | medical care that is are the subject of the expedited hearing, | 7 | | a petition for review filed by the employee shall receive the | 8 | | same priority as if the employee had filed a petition for an | 9 | | expedited hearing by an Arbitrator. Neither party shall be | 10 | | entitled to an expedited hearing when the employee has returned | 11 | | to work and the sole issue in dispute amounts to less than 12 | 12 | | weeks of unpaid compensation pursuant to paragraph (b) of | 13 | | Section 8."; and | 14 | | on page 113, by replacing lines 7 through 18 with the | 15 | | following: | 16 | | "(k) In a case where there has been any unreasonable or | 17 | | vexatious delay
of payment or intentional underpayment of | 18 | | compensation, or proceedings
have been instituted or carried on | 19 | | by the one liable to pay the
compensation, which do not present | 20 | | a real controversy, but are merely
frivolous or for delay, then | 21 | | the Commission may award compensation
additional to that | 22 | | otherwise payable under this Act equal to 50% of the
amount | 23 | | payable at the time of such award. Failure to pay compensation
| 24 | | in accordance with the provisions of Section 8, paragraph (b) | 25 | | of this
Act, shall be considered unreasonable delay."; and
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| 1 | | on page 131, by deleting lines 23 and 24; and
| 2 | | on page 131, line 25, by changing " (6) " to " (5) "; and
| 3 | | on page 132, line 2, by changing " (7) " to " (6) "; and
| 4 | | on page 132, line 12, by changing " (8) " to " (7) "; and | 5 | | on page 134, by replacing lines 14 through 17 with the | 6 | | following: | 7 | | "Section 99. Effective date. This Act takes effect upon | 8 | | becoming law, but this Act does not take effect at all unless | 9 | | Senate Bills 1, 3, 4, 5, 6, 7, 8, 9, 10, 13, and 16 of the 100th | 10 | | General Assembly become law.".
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