SENATE BILL REPORT

SB 6226

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

Brief Summary of First Substitute Bill

Requires a self-insured employer to provide electronic copies of medical records for an independent medical exam (IME), and, if not possible, paper copies at least ten business days before the scheduled exam.
Provides that the director of the Department of Labor and Industries (L&I), in consultation with interested parties, must develop access to telemedicine for IMEs and reimburse IME physicians for services in a manner that is similar to the policies developed for commercial health insurance plans and Medicaid managed care.
Requires the worker’s consent to conduct IME by telemedicine.
Requires that any IME using telemedicine must be conducted in Washington State by a Washington State licensed medical provider for the first five years following the effective date.

Background: Whenever the director of L&I or the self-insurer deems it necessary in order to resolve any medical issue, a worker must submit to examination by a physician or physicians selected by the director. L&I or the self-insurer must provide the physician performing an examination with all relevant medical records from the worker's claim file. The director, in the director's discretion, may charge the cost of such examination or examinations to the self-insurer or to the medical aid fund. The cost of the examination must include payment to the worker of reasonable expenses.

Summary of Bill (First Substitute): The self-insured employer must ensure that all relevant medical records of the injured worker scheduled for an IME are provided as electronic medical records to the IME physician or physicians, and, if electronic medical records are not possible, paper records must be delivered to the IME physician or physicians at least ten business days before the scheduled exam. If the IME is scheduled to occur before ten business days or if a medical record only becomes available to the employer during the ten business days, then the paper records must be delivered to the IME physician as soon as possible before the exam occurs.

The director of L&I must develop access to telemedicine for IMEs and reimburse IME physicians for services in a manner that is similar to the policies developed for commercial health insurance plans and Medicaid managed care. An IME may be conducted with the use of telemedicine with the worker's consent. Any IME using telemedicine must be conducted in Washington State by a Washington State licensed medical provider for the first five years following the effective date.

EFFECT OF CHANGES MADE BY LABOR & COMMERCE COMMITTEE (First Substitute):

Provides that if the IME is scheduled to occur before ten business days or if a medical record only becomes available to the employer during the ten business days, then the paper records must be delivered to the independent medical exam physician as soon as possible before the exam occurs.
Requires the worker’s consent to conduct IME by telemedicine.
Provides that for the first five years following the effective date, any IME using telemedicine must be conducted in Washington State by a Washington State licensed medical provider.
Requires L&I to consult with interested parties in any rule-making related to telemedicine for IMEs.

Staff Summary of Public Testimony on Proposed Substitute: The committee recommended a different version of the bill than what was heard. PRO: The bill is brought because of complaints that are pretty routinely lodged with the ombudsman for workers of self-insured employers about the lack of access to timely medical records and to IME panel exams, sometimes involving travel and some pain and difficulty for injured workers to get to them. The bill would require timely medical records and allow telemedicine, which may be more convenient and less costly.

OTHER: We do not have a lot of issues on electronic records, but sometimes there are exceptions to the rule. There may be an IME sent within the ten days or a paper record that comes in during that ten-day period. We have language that may correct that issue. We are a little skeptical about how telemedicine may work in the IME context. We pledge to be involved in the development of it. Hopefully it would distinguish between where telemedicine makes sense in the IME context or where it may not, for example in litigation or rating impairments.

We agree that anything you can do for more electronic records is good. L&I has done a very good job on their electronic claims management. There are possibly some exceptions that we need to figure out. Telemedicine is not always appropriate in all instances for IMEs. We suggest that telemedicine for IMEs be the worker's option. For example, when the worker does not want to travel. When you have telemedicine being conducted in-state, there may be a worker who is now living in another state and they might want telemedicine.