Tennessee § 50-6-125 - Medical payment committee.

§ 50-6-125. Medical payment committee.

The administrator shall appoint a medical payment committee. The committee shall hear disputes on medical bill payments between providers and insurers and advise the administrator on issues relating to the medical fee schedule and medical care cost containment in the workers' compensation system. Upon hearing disputes on medical bill payments between providers and insurers, the medical payment committee shall have authority to render a decision on the merits of a dispute. If the medical payment committee determines that a provider or insurer has acted in bad faith in refusing to provide payment for a medical bill or refusing to provide reimbursement for overpayment, the medical payment committee, upon a majority vote, shall refer the malfeasant provider or insurer to the bureau for consideration of assessment of a civil penalty of no more than one thousand dollars ($1,000) per occurrence. Any provider or insurer aggrieved by the assessment of a penalty under this subsection (a) shall have the right to seek review of the penalty assessment in the manner provided by § 50-6-118(c). The committee shall be comprised of seven (7) voting members appointed by the administrator as follows: Three (3) members shall be representative of the medical provider industry; Three (3) members shall be representative of the workers' compensation insurance industry; and The medical director shall serve as the final member of the committee but shall not cast a vote unless a vote taken by members results in a tie. In that case, the medical director shall cast the deciding vote. In making appointments, the administrator shall strive to achieve a geographic balance and, in the case of the physician members of the committee, shall assure, to the extent possible, that the membership of the committee reflects the diversity of specialties involved in the medical treatment and management of workers' compensation claimants. Members of the committee shall serve without compensation but, when engaged in the conduct of their official duties as members of the committee, shall be entitled to reimbursement for travel expenses in accordance with uniform regulations promulgated by the department of finance and administration and approved by the attorney general and reporter. Each member appointed shall serve a term of four (4) years and may be reappointed by the administrator. If a member leaves the position prior to the expiration of the term, the administrator shall appoint an individual meeting the qualifications of this section to serve the unexpired portion of the term, and the individual may be reappointed by the administrator upon expiration of the term. This section applies to all disputes of medical bill payments for services provided, pursuant to this chapter, on or after July 1, 2014. Acts 1992, ch. 900, § 9; 1999, ch. 520, § 41; 2004, ch. 962, § 33; 2005, ch. 105, §§ 1, 2; 2013, ch. 289, § 23; 2014, ch. 903, § 4; 2015, ch. 341, § 15. Code Commission Notes. The former second sentence of (c), concerning the terms to be served by members on initial appointment, was deleted as obsolete by the code commission in 2008. Compiler's Notes. The medical payment committee, created by this section, terminates June 30, 2024. See §§ 4-29-112 , 4-29-245 . 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 2013, ch. 289, § 101 provided that any guidelines issued by the medical care and cost containment committee issued at the time the act, which amended this section, becomes law shall remain in effect and not be added to, altered, or amended until or unless the medical advisory committee, created pursuant to § 50-6-135 , or the medical payment committee, created pursuant to § 50-6-125 , issue new guidelines pursuant to the act. Acts 2013, ch. 289, § 103 provided that the act, which amended this section, shall be known and may be cited as the “Workers' Compensation Reform Act of 2013.” Amendments. The 2013 amendment by ch. 289, effective July 1, 2014, rewrote the section which read: “(a) The commissioner shall appoint a medical care and cost containment committee. The committee shall approve regulations pursuant to § 50-6-233(c)(7) before they become effective, assist the commissioner in their implementation, and advise the commissioner, at the commissioner's request, on issues relating to medical care and cost containment in the workers' compensation system.“(b)(1) The committee shall be composed of fifteen (15) voting members appointed by the commissioner as follows:“(A) Three (3) members shall be physicians licensed to practice medicine and surgery under title 63, chapter 6, and shall be appointed from a list of nominees submitted by the Tennessee Medical Association;“(B) Two (2) members shall represent employers and shall be appointed from a list of nominees submitted by the Tennessee Chamber of Commerce and Industry;“(C) One (1) member shall represent employers and shall be appointed from a list of nominees submitted by the Associated Builders and Contractors, Inc.;“(D) Three (3) members shall represent employees and shall be appointed from a list of nominees submitted by the Tennessee AFL-CIO State Labor Council;“(E) Three (3) members shall represent hospitals and shall be appointed from a list of nominees submitted by the Tennessee Hospital Association;“(F) One (1) member shall be a pharmacist and shall be appointed from a list submitted by the Tennessee Pharmacists Association;“(G) One (1) member shall represent the health insurance industry; and“(H) One (1) member shall be a chiropractor and shall be appointed from a list of nominees submitted by the Tennessee Chiropractic Association.“(2) The medical director shall serve as a nonvoting ex officio member of the committee.“(3) An organization that submits a list of nominees shall list at least three (3) nominees for each of the committee positions for which it is requested to submit nominations. If the commissioner finds a list of nominees unsatisfactory, the commissioner shall return the list to the submitting organization. The organization shall submit another list within thirty (30) days. This process shall continue until the commissioner appoints a member. If an organization that is required to submit a list of nominees fails to do so within thirty (30) days of a request for the list by the commissioner, then the commissioner may appoint a member of the commissioner's own choosing.“(4) In making appointments, the commissioner shall strive to achieve a geographic balance and, in the case of the physician members of the committee, shall assure to the extent possible that the membership of the committee reflects the diversity of specialties involved in the medical treatment and management of workers' compensation claimants.“(c) The members of the committee shall be appointed for terms of four (4) years. Each member of the committee shall, upon the expiration of such member's term, be eligible for reappointment and shall serve until a successor is appointed and qualified.“(d) Members of the committee shall serve without compensation but, when engaged in the conduct of their official duties as members of the committee, shall be entitled to reimbursement for travel expenses in accordance with uniform regulations promulgated by the department of finance and administration and approved by the attorney general and reporter.” The 2014 amendment added (e). The 2015 amendment substituted “bureau” for “division” in the fourth sentence in (a)(1). Effective Dates. Acts 2013, ch. 289, § 106. July 1, 2014; provided, that, for purposes of promulgating rules and regulations, making appointments and making necessary provisions for the implementation of the act, the act shall take effect April 29, 2013. Acts 2014, ch. 903, § 14. July 1, 2014. Acts 2015, ch. 341, § 19. May 4, 2015.