Tennessee § 50-6-123 - Case management system for coordinating medical care services.

§ 50-6-123. Case management system for coordinating medical care services.

All case managers, including case manager assistants, coordinating the medical care services provided to employees claiming benefits or handling claims of employees claimed under this chapter shall be certified by the bureau pursuant to this section. The administrator shall establish, pursuant to the administrator's rulemaking authority, a system of case management for coordinating the medical care services provided to employees claiming benefits under this chapter; provided, however, it is within the discretion of the administrator to provide or deny case management services to any employee who has suffered a workers' compensation injury. Pursuant to the administrator's rulemaking authority, the administrator may establish: Minimum standards for the professional practice of case managers and case manager assistants; and A procedure for case managers and case manager assistants to obtain certification if required pursuant to this section. Any case manager, case manager assistant, or person or entity that employs a case manager who fails to comply with this section, or rules promulgated pursuant to this section, may be subject, after notice of a violation has been provided, to a penalty of not less than one hundred dollars ($100) nor more than one thousand dollars ($1,000) per violation, at the discretion of the administrator. In addition to any penalty assessed pursuant to this subsection (c), the administrator may also suspend the person's certification as a case manager or case manager assistant if, in the discretion of the administrator, the person has an established pattern of violations of this section. The bureau shall notify any person who has violated this section of such violation and may assess a penalty, suspend the person's certification, or both. The person shall have fifteen (15) calendar days from the date notice was sent to appeal the decision pursuant to the procedures provided for under the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, or to pay the assessed penalty. Nothing in this section shall prevent an employer from establishing its own program of case management that meets the guidelines promulgated by the administrator in rules. Medical care, treatment, therapy, or services provided at the employee's residence pursuant to this chapter shall not be considered home health services as defined in § 68-11-201 when provided pursuant to direction of the employee's attending physician in the following specific circumstances only: By a licensed healthcare provider who routinely provides services to employees at the place of employment, if the services rendered by the provider at the employee's residence are of the same type rendered by the provider at the place of employment; or By a licensed physical therapist, occupational therapist, or speech therapist practicing independently of a home health agency, when the employee's attending physician determines that it is in the best interest of the employee to be treated by the independent therapist because of the therapist's expertise in workplace injuries. Acts 1992, ch. 900, § 7; 1996, ch. 944, § 9; 2001, ch. 148, § 1; 2004, ch. 962, §§ 28, 29; 2013, ch. 282, § 1; 2016, ch. 803, § 1. Compiler's Notes. Acts 1996, ch. 944, which amended this section, is known and may be cited as the “Workers' Compensation Reform Act of 1996.” Acts 2004, ch. 962, § 42 provided that: The general assembly recognizes that significant cost savings will result from the implementation of this bill. It is in the best interest of the citizens of Tennessee that the cost savings be passed to the entities that have paid faithfully workers' compensation premiums in order to ensure the economic well-being of their employees. It is the intent and purpose of the general assembly that workers' compensation premiums be adjusted downward within fifteen (15) months of July 1, 2004, to reflect the cost savings resulting from the provisions of the act. If a workers' compensation policy is subject to renewal during the fifteen (15) month period, adjustments to the policy may be made at that time. It is the intent of the general assembly that the savings of the act shall routinely be reflected in future filings through the advisory prospective loss cost filing system, pursuant to §§ 56-5-106(b) and 50-6-402. Nothing in this section shall be construed as amending or affecting the procedures for filing and approval of rates set forth in title 56, chapter 5. Acts 2016, ch. 803, § 4 provided that the act, which amended this section, shall apply to actions committed on or after January 1, 2017. The text of this section as was effective for injuries occurring, and actions committed, on or after July 1, 2014, but prior to January 1, 2017 is as follows: “(a) The administrator shall establish, pursuant to the administrator's rule and regulation-making authority, a system of case management for coordinating the medical care services provided to employees claiming benefits under this chapter. “(b) Employers may, at their own expense, utilize case management, and, if utilized, the employee shall cooperate with the case management. Case management shall include, but not be limited to: “(1) Developing a treatment plan to provide appropriate medical care services to an injured or disabled employee; “(2) Systematically monitoring the treatment rendered and the medical progress of the injured or disabled employee; “(3) Assessing whether alternate medical care services are appropriate and delivered in a cost-effective manner based on acceptable medical standards; “(4) Ensuring that the injured or disabled employee is following the prescribed medical care plan; and “(5) Formulating a plan for return to work with due regard for the employee's recovery and restrictions and limitations, if any. “(c) The administrator may contract with an independent organization, not owned by or affiliated with any carrier authorized to write workers' compensation insurance in the state, to assist with the administration of this section. “(d) Nothing in this section shall prevent an employer from establishing its own program of case management that meets the guidelines promulgated by the administrator in rules and regulations. “(e) Medical care, treatment, therapy or services provided at the employee's residence pursuant to this chapter, shall not be considered home health services as defined in § 68-11-201 when provided pursuant to direction of the employee's attending physician in the following specific circumstances only: “(1) By a licensed health care provider who routinely provides services to employees at the place of employment, if the services rendered by the provider at the employee's residence are of the same type rendered by the provider at the place of employment; or “(2) By a licensed physical therapist, occupational therapist or speech therapist practicing independently of a home health agency, when the employee's attending physician determines that it is in the best interest of the employee to be treated by the independent therapist because of the therapist's expertise in workplace injuries.” Amendments. The 2013 amendment, effective July 1, 2014, substituted “administrator” for “commissioner” in (a), (c), and (d), and substituted “administrator's” for “commissioner's” in (a). The 2016 amendment, effective January 1, 2017, added (a); redesignated former (a) as present (b) and rewrote the subsection which read: “The administrator shall establish, pursuant to the administrator's rule and regulation-making authority, a system of case management for coordinating the medical care services provided to employees claiming benefits under this chapter.”; deleted former (b) which read: “(b) Employers may, at their own expense, utilize case management, and, if utilized, the employee shall cooperate with the case management. Case management shall include, but not be limited to:“(1) Developing a treatment plan to provide appropriate medical care services to an injured or disabled employee;“(2) Systematically monitoring the treatment rendered and the medical progress of the injured or disabled employee;“(3) Assessing whether alternate medical care services are appropriate and delivered in a cost-effective manner based on acceptable medical standards;“(4) Ensuring that the injured or disabled employee is following the prescribed medical care plan; and“(5) Formulating a plan for return to work with due regard for the employee's recovery and restrictions and limitations, if any.”; rewrote (c) which read: “(c) The administrator may contract with an independent organization, not owned by or affiliated with any carrier authorized to write workers' compensation insurance in the state, to assist with the administration of this section.”; added present (d); redesignated former (d) and (e) to be present (e) and (f), respectively; and substituted “administrator in rules” for “administrator in rules and regulations” at the end of present (e). Effective Dates. Acts 2013, ch. 282, § 10. July 1, 2014. Acts 2016, ch. 803, § 4. January 1, 2017; provided that for purposes of promulgating rules, the act took effect April 14, 2016.