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 follow-
ing 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’ Com-
pensation Medical Benefits to study and develop a de-
tailed 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.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Commission on Inte-
gration of Workers’ Compensation Act of 1994’’.
SEC. 2. DEFINITIONS.
In this Act:
(1) The term ‘‘Commission’’ means the Com-
mission on Integration of Workers’ Compensation
Medical Benefits established under section 3(a).
(2) The term ‘‘health insurance plan’’ means
any insurance plan providing coverage for medical
care (within the meaning of section 213(d)(1)(c) of
the Internal Revenue Code of 1986), and includes
any plan or program of the Federal Government
providing such coverage.
(3) The term ‘‘State’’ includes the District of
Columbia, Puerto Rico, the Virgin Islands, Guam,
American Samoa, and the Northern Mariana Is-
lands.
(4) The term ‘‘workers’ compensation medical
benefits’’ means, with respect to an individual en-
rolled in a health insurance plan who is an employee
subject to the workers’ compensation laws of a
State, the comprehensive medical benefits for work-
related injuries and illnesses provided for under such
laws with respect to such an employee.
(5) The term ‘‘workers’ compensation carrier’’
means an insurance company that underwrites work-
ers’ compensation medical benefits with respect to
one or more employers and includes an employer or
fund that is financially at risk for the provision of
workers’ compensation medical benefits.
SEC. 3. COMMISSION ON INTEGRATION OF WORKERS’ COM-
PENSATION MEDICAL BENEFITS.
(a) ESTABLISHMENT.—There is hereby created a
Commission on Integration of Workers’ Compensation
Medical Benefits.
(b) COMPOSITION.—
(1) IN GENERAL.—The Commission shall con-
sist of the Director of the National Institute for Oc-
cupational Safety and Health (or the Director’s des-
ignee) and 14 members appointed jointly by the Sec-
retary of Health and Human Services and the Sec-
retary of Labor. Appointed members of the Commis-
sion shall include the following:
(A) One or more individuals representing
State workers’ compensation commissioners.
(B) One or more individuals representing
State workers’ compensation funds.
(C) One or more individuals representing
organized labor.
(D) One or more members representing
employers (other than workers’ compensation
insurance carriers).
(E) One or more members representing
workers’ compensation insurance carriers.
(F) One or more members of the medical
profession having expertise in occupational
health.
(G) One or more educators or researchers
having expertise in the field of occupational
health.
(H) One or more members of the legal pro-
fession who regularly represent workers’ com-
pensation claimants.
(2) ROLE OF CONGRESS.—Of the members of
the Commission appointed under paragraph (1)—
(A) 3 shall be appointed from among indi-
viduals recommended by the Speaker of the
House of Representatives;
(B) 3 shall be appointed from among indi-
viduals recommended by the Minority Leader of
the House of Representatives;
(C) 3 shall be appointed from among indi-
viduals recommended by the Majority Leader of
the Senate; and
(D) 3 shall be appointed from among indi-
viduals recommended by the Majority Leader of
the Senate.
(3) NO
COMPENSATION
EXCEPT
TRAVEL
EX-
PENSES.—Members of the Commission shall serve
without compensation, but the Secretaries shall pro-
vide that each member shall receive travel expenses,
including per diem in lieu of subsistence, in accord-
ance with sections 5702 and 5703 of title 5, United
States Code.
(4) QUORUM.—Eight members of the Commis-
sion shall constitute a quorum.
(c) DUTIES.—
(1) IN GENERAL.—The Commission shall study
and develop a detailed plan for implementing the
transfer of financial responsibility for workers’ com-
pensation medical benefits to health insurance plans
and make a recommendation as to whether such a
transfer should be effected.
(2) IMPLEMENTATION
ISSUES
TO
BE
AD-
DRESSED.—In the development of a plan under
paragraph (1), the Commission shall consider poten-
tial barriers to integration including the following:
(A) Whether and how to maintain financial
incentives for employers to prevent work-related
illness and injury and to reduce workers’ com-
pensation costs.
(B) Modifications of requirements for
workers’ compensation carrier and health insur-
ance plan reserves, including any associated
transition issues relating to the modification of
such requirements.
(C) The ability of health insurance plans
to set capitated payment rates for workers’
compensation costs, including the lack of avail-
ability of data for use by plans in setting such
rates.
(D) Coverage for benefits (including cost-
sharing) not typically included in health insur-
ance plans that are covered under State work-
ers’ compensation laws.
(E) Variation among States in eligibility
for medical and rehabilitation benefits, and the
scope of such benefits, compensable under State
workers’ compensation laws.
(F) The ability to move the financial re-
sponsibility for workers’ compensation medical
benefits from an experience-rated system to a
community-rated system.
(G) The need to provide appropriate incen-
tives to encourage health insurance plans, pro-
viders of health cares services, and employers to
return injured employees to work as soon as
possible.
(H) The effect of an integrated system on
the ability to preserve adequate case manage-
ment of workers’ compensation cases.
(I) The impact of an injured worker’s
choice of provider on the costs of medical care,
losses in wages and benefits, and quality of
care.
(3) EVALUATION ISSUES TO BE ADDRESSED.—
In making its recommendation under paragraph (1),
the Commission shall consider both the potential
benefits and potential disadvantages of such a trans-
fer, including the likely impact on—
(A) the quality of medical care delivered to
workers injured or made ill on the job;
(B) the incentives for employers to main-
tain safe workplaces; and
(C) workers’ compensation indemnity bene-
fit costs, medical costs and the overall cost of
the workers’ compensation system.
(d) STAFF SUPPORT.—The Secretaries shall provide
staff support for the Commission.
(e) REPORT.—The Commission shall submit a report
on its work to the President and to the Congress by not
later than 1 year after the date of the enactment of this
Act. The report shall include the plan developed and its
recommendation under subsection (c)(1).
(f) TERMINATION.—The Commission shall terminate
90 days after the date of submission of its report under
subsection (e).
(g) AUTHORIZATION
OF APPROPRIATIONS.—There
are authorized to be appropriated such sums as may be
necessary to carry out this section.
SEC. 4. IMPLEMENTATION OF RECOMMENDATIONS.
Unless Congress provides otherwise, if the report sub-
mitted by the Commission to the President under section
3(e) recommends the integration of financial responsibility
for all medical benefits in health insurance plans, the Sec-
retary of Labor and the Secretary of Health and Human
Services shall promulgate regulations to carry out such in-
tegration.
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