[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4609 Introduced in House (IH)]

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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Commission on Integration of 
Workers' Compensation Act of 1994''.

SEC. 2. DEFINITIONS.

    In this Act:
            (1) The term ``Commission'' means the Commission 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 Islands.
            (4) The term ``workers' compensation medical benefits'' 
        means, with respect to an individual enrolled 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 workers' 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' COMPENSATION 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 consist of the 
        Director of the National Institute for Occupational Safety and 
        Health (or the Director's designee) and 14 members appointed 
        jointly by the Secretary of Health and Human Services and the 
        Secretary of Labor. Appointed members of the Commission 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 profession who 
                regularly represent workers' compensation claimants.
            (2) Role of congress.--Of the members of the Commission 
        appointed under paragraph (1)--
                    (A) 3 shall be appointed from among individuals 
                recommended by the Speaker of the House of 
                Representatives;
                    (B) 3 shall be appointed from among individuals 
                recommended by the Minority Leader of the House of 
                Representatives;
                    (C) 3 shall be appointed from among individuals 
                recommended by the Majority Leader of the Senate; and
                    (D) 3 shall be appointed from among individuals 
                recommended by the Majority Leader of the Senate.
            (3) No compensation except travel expenses.--Members of the 
        Commission shall serve without compensation, but the 
        Secretaries shall provide that each member shall receive travel 
        expenses, including per diem in lieu of subsistence, in 
        accordance with sections 5702 and 5703 of title 5, United 
        States Code.
            (4) Quorum.--Eight members of the Commission 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' compensation medical benefits to 
        health insurance plans and make a recommendation as to whether 
        such a transfer should be effected.
            (2) Implementation issues to be addressed.--In the 
        development of a plan under paragraph (1), the Commission shall 
        consider potential 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' compensation 
                costs.
                    (B) Modifications of requirements for workers' 
                compensation carrier and health insurance 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 availability of data for 
                use by plans in setting such rates.
                    (D) Coverage for benefits (including cost-sharing) 
                not typically included in health insurance plans that 
                are covered under State workers' 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 
                responsibility for workers' compensation medical 
                benefits from an experience-rated system to a 
                community-rated system.
                    (G) The need to provide appropriate incentives to 
                encourage health insurance plans, providers 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 management 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 transfer, 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 maintain safe 
                workplaces; and
                    (C) workers' compensation indemnity benefit 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 submitted 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 Secretary of Labor and the Secretary of 
Health and Human Services shall promulgate regulations to carry out 
such integration.

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