Vermont H 163: An act relating to requiring State agencies and departments to have a consumer data policy

Bill Text

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H.163 1
Introduced by Representatives Priestley of Bradford, Carris-Duncan of 2
Whitingham, Duke of Burlington, Marcotte of Coventry, Olson 3
of Starksboro, and White of Bethel 4
Referred to Committee on 5
Date: 6
Subject: Labor; workersʼ compensation; definitions; translation services; 7
preauthorization; penalties 8
Statement of purpose of bill as introduced: This bill proposes to include health 9
insurance benefits in the definition of wages for workers’ compensation 10
claims; to require carriers to pay for translation services; to allow claimants to 11
request medical case management services; and to increase penalties for late 12
payments of workers’ compensation benefits. 13
An act relating to workersʼ compensation 14
It is hereby enacted by the General Assembly of the State of Vermont: 15
Sec. 1. 21 V.S.A § 601 is amended to read: 16
§ 601. DEFINITIONS 17
As used in this chapter: 18
* * * 19

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(13) “Wages” includes bonuses and the market value of health 1
insurance, board, lodging, fuel, and other advantages that can be estimated in 2
money and that the employee receives from the employer as a part of the 3
employee’s remuneration, but does not include any sum paid by the employer 4
to the employee to cover any special expenses entailed on the employee by the 5
nature of the employment. 6
* * * 7
(31) “Medical case management” means the planning and coordination 8
of health care services appropriate to achieve the goal of medical 9
rehabilitation. 10
(A) Medical case management may include medical case assessment, 11
including a personal interview with the injured employee; assistance in 12
developing, implementing, and coordinating a medical care plan with health 13
care providers in consultation with the injured employee and the employees’ 14
family; and an evaluation of treatment results. The goal of medical case 15
management is to provide the injured employee with reasonable treatment 16
options to ensure that the injured employee can make an informed choice. 17
(B) Medical Case Managers shall not provide medical care or adjust 18
claims. 19
(C) An injured employee shall be entitled to medical case 20
management services if reasonably supported. Reasonable support includes a 21

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recommendation made by a health care provider or evidence demonstrating the 1
injured employee’s medical recovery would benefit from the services, or both. 2
Sec. 2 21 V.S.A. § 602 is amended to read: 3
§ 602. PROCESS AND PROCEDURE 4
* * * 5
(d) When an injured employee does not speak English fluently, the 6
employer shall pay for translation services to ensure the injured employee fully 7
understands the employee’s rights and can effectively participate in the 8
employee’s medical recovery and the workers’ compensation claims process. 9
Sec. 3. 21 V.S.A. 640b is amended to read: 10
§ 640b. REQUEST FOR PREAUTHORIZATION TO DETERMINE IF 11
PROPOSED BENEFITS OR SERVICES ARE NECESSARY 12
(a) As used in this section, 13
(1) “benefits” means medical treatment and surgical, medical, and 14
nursing services and supplies, including prescription drugs and durable 15
medical equipment; and 16
(2) “services” means medical case management services. 17
* * * 18
(e) Within 14 days after receiving a request for preauthorization of 19
proposed medical case management services, the insurer shall do one of the 20
following, in writing: 21

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(1) Authorize the services and notify the injured employee, the 1
Department, and the treating provider recommending the services, if 2
applicable. 3
(2) Deny the services because the entire claim is disputed, and the 4
Commissioner has not issued an interim order to pay benefits. The insurer 5
shall notify the injured employee, the Department, and the treating provider 6
recommending the services, if applicable, of the decision to deny benefits. 7
(3) Deny the request if there is not reasonable support for the requested 8
services. The insurer shall notify the injured employee, the Department, and 9
the treating provider recommending the services, if applicable, of the decision 10
to deny benefits. 11
(4) Notify the injured employee, the Department, and the treating 12
provider recommending the services, if applicable, that the insurer has 13
scheduled an examination of the injured employee pursuant to section 655 of 14
this title or ordered a medical record review pursuant to section 655a of this 15
title. Based on the examination or review, the insurer shall notify the injured 16
employee and the Department of the decision within 45 days after a request for 17
preauthorization. The Commissioner may, in the Commissioner’s sole 18
discretion, grant a 10-day extension to the insurer to authorize or deny the 19
services, and such an extension shall not be subjec