I

103D CONGRESS

2D SESSION H. R. 4609

To establish a Commission on Integration of Workers’ Compensation Medical

Benefits to study and develop a detailed plan for implementing the

transfer of financial responsibility for workers’ compensation medical

benefits to health insurers, and to provide for the implementation of

the plan.

IN THE HOUSE OF REPRESENTATIVES

JUNE 21, 1994

Mr. FAZIO (for himself and Mr. MILLER of California) introduced the following bill; which was referred jointly to the Committees on Education and

Labor, Energy and Commerce, Ways and Means, Armed Services, Post

Office and Civil Service, Natural Resources, and Veterans’ Affairs

A BILL

To establish a Commission on Integration of Workers’ Compensation Medical Benefits to study and develop a detailed plan for implementing the transfer of financial

responsibility for workers’ compensation medical benefits

to health insurers, and to provide for the implementation

of the plan.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Commission on Inte5 gration of Workers’ Compensation Act of 1994’’.
2

•HR 4609 IH

1 SEC. 2. DEFINITIONS.

2 In this Act:

3 (1) The term ‘‘Commission’’ means the Com4 mission on Integration of Workers’ Compensation

5 Medical Benefits established under section 3(a).

6 (2) The term ‘‘health insurance plan’’ means

7 any insurance plan providing coverage for medical

8 care (within the meaning of section 213(d)(1)(c) of

9 the Internal Revenue Code of 1986), and includes

10 any plan or program of the Federal Government

11 providing such coverage.

12 (3) The term ‘‘State’’ includes the District of

13 Columbia, Puerto Rico, the Virgin Islands, Guam,

14 American Samoa, and the Northern Mariana Is15 lands.

16 (4) The term ‘‘workers’ compensation medical

17 benefits’’ means, with respect to an individual en18 rolled in a health insurance plan who is an employee

19 subject to the workers’ compensation laws of a

20 State, the comprehensive medical benefits for work21 related injuries and illnesses provided for under such

22 laws with respect to such an employee.

23 (5) The term ‘‘workers’ compensation carrier’’

24 means an insurance company that underwrites work25 ers’ compensation medical benefits with respect to

26 one or more employers and includes an employer or
3

•HR 4609 IH

1 fund that is financially at risk for the provision of

2 workers’ compensation medical benefits.

3 SEC. 3. COMMISSION ON INTEGRATION OF WORKERS’ COM4 PENSATION MEDICAL BENEFITS.

5 (a) ESTABLISHMENT.—There is hereby created a

6 Commission on Integration of Workers’ Compensation

7 Medical Benefits.

8 (b) COMPOSITION.—

9 (1) IN GENERAL.—The Commission shall con10 sist of the Director of the National Institute for Oc11 cupational Safety and Health (or the Director’s des12 ignee) and 14 members appointed jointly by the Sec13 retary of Health and Human Services and the Sec14 retary of Labor. Appointed members of the Commis15 sion shall include the following:

16 (A) One or more individuals representing

17 State workers’ compensation commissioners.

18 (B) One or more individuals representing

19 State workers’ compensation funds.

20 (C) One or more individuals representing

21 organized labor.

22 (D) One or more members representing

23 employers (other than workers’ compensation

24 insurance carriers).
4

•HR 4609 IH

1 (E) One or more members representing

2 workers’ compensation insurance carriers.

3 (F) One or more members of the medical

4 profession having expertise in occupational

5 health.

6 (G) One or more educators or researchers

7 having expertise in the field of occupational

8 health.

9 (H) One or more members of the legal pro10 fession who regularly represent workers’ com11 pensation claimants.

12 (2) ROLE OF CONGRESS.—Of the members of

13 the Commission appointed under paragraph (1)—

14 (A) 3 shall be appointed from among indi15 viduals recommended by the Speaker of the

16 House of Representatives;

17 (B) 3 shall be appointed from among indi18 viduals recommended by the Minority Leader of

19 the House of Representatives;

20 (C) 3 shall be appointed from among indi21 viduals recommended by the Majority Leader of

22 the Senate; and

23 (D) 3 shall be appointed from among indi24 viduals recommended by the Majority Leader of

25 the Senate.
5

•HR 4609 IH

1 (3) NO COMPENSATION EXCEPT TRAVEL EX2 PENSES.—Members of the Commission shall serve

3 without compensation, but the Secretaries shall pro4 vide that each member shall receive travel expenses,

5 including per diem in lieu of subsistence, in accord6 ance with sections 5702 and 5703 of title 5, United

7 States Code.

8 (4) QUORUM.—Eight members of the Commis9 sion shall constitute a quorum.

10 (c) DUTIES.—

11 (1) IN GENERAL.—The Commission shall study

12 and develop a detailed plan for implementing the

13 transfer of financial responsibility for workers’ com14 pensation medical benefits to health insurance plans

15 and make a recommendation as to whether such a

16 transfer should be effected.

17 (2) IMPLEMENTATION ISSUES TO BE AD18 DRESSED.—In the development of a plan under

19 paragraph (1), the Commission shall consider poten20 tial barriers to integration including the following:

21 (A) Whether and how to maintain financial

22 incentives for employers to prevent work-related

23 illness and injury and to reduce workers’ com24 pensation costs.
6

•HR 4609 IH

1 (B) Modifications of requirements for

2 workers’ compensation carrier and health insur3 ance plan reserves, including any associated

4 transition issues relating to the modification of

5 such requirements.

6 (C) The ability of health insurance plans

7 to set capitated payment rates for workers’

8 compensation costs, including the lack of avail9 ability of data for use by plans in setting such

10 rates.

11 (D) Coverage for benefits (including cost12 sharing) not typically included in health insur13 ance plans that are covered under State work14 ers’ compensation laws.

15 (E) Variation among States in eligibility

16 for medical and rehabilitation benefits, and the

17 scope of such benefits, compensable under State

18 workers’ compensation laws.

19 (F) The ability to move the financial re20 sponsibility for workers’ compensation medical

21 benefits from an experience-rated system to a

22 community-rated system.

23 (G) The need to provide appropriate incen24 tives to encourage health insurance plans, pro25 viders of health cares services, and employers to
7

•HR 4609 IH

1 return injured employees to work as soon as

2 possible.

3 (H) The effect of an integrated system on

4 the ability to preserve adequate case manage5 ment of workers’ compensation cases.

6 (I) The impact of an injured worker’s

7 choice of provider on the costs of medical care,

8 losses in wages and benefits, and quality of

9 care.

10 (3) EVALUATION ISSUES TO BE ADDRESSED.—

11 In making its recommendation under paragraph (1),

12 the Commission shall consider both the potential

13 benefits and potential disadvantages of such a trans14 fer, including the likely impact on—

15 (A) the quality of medical care delivered to

16 workers injured or made ill on the job;

17 (B) the incentives for employers to main18 tain safe workplaces; and

19 (C) workers’ compensation indemnity bene20 fit costs, medical costs and the overall cost of

21 the workers’ compensation system.

22 (d) STAFF SUPPORT.—The Secretaries shall provide

23 staff support for the Commission.

24 (e) REPORT.—The Commission shall submit a report

25 on its work to the President and to the Congress by not
8

•HR 4609 IH

1 later than 1 year after the date of the enactment of this

2 Act. The report shall include the plan developed and its

3 recommendation under subsection (c)(1).

4 (f) TERMINATION.—The Commission shall terminate

5 90 days after the date of submission of its report under

6 subsection (e).

7 (g) AUTHORIZATION OF APPROPRIATIONS.—There

8 are authorized to be appropriated such sums as may be

9 necessary to carry out this section.

10 SEC. 4. IMPLEMENTATION OF RECOMMENDATIONS.

11 Unless Congress provides otherwise, if the report sub12 mitted by the Commission to the President under section

13 3(e) recommends the integration of financial responsibility

14 for all medical benefits in health insurance plans, the Sec15 retary of Labor and the Secretary of Health and Human

16 Services shall promulgate regulations to carry out such in17 tegration.

Æ