Connecticut > Workers Compensation
Employer Medical Care Plans Information Packet And Forms - Connecticut
| Employer Medical Care Plans Information Packet And Forms Form. This is a Connecticut form and can be used in Workers Compensation . |
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STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION EMPLOYER MEDICAL CARE PLANS INFORMATION PACKET Enclosed are informational materials on workers' compensation employer medical care plans in the State of Connecticut. Please reference Connecticut General Statute 31-279 and Administrative Regulation 31-27910 as amended to December 02, 1997, for a listing of the information required in a medical care plan application. A checklist has been provided to assist you. Should you have any questions, please contact Marilou O. Lang or Elaine Silver at (860) 493-1500. American LegalNet, Inc. www.FormsWorkFlow.com Please be advised that the statute which grants authority for workers' compensation medical care plans is Connecticut General Statute §31-279, subsections (c) and (d). Public Act 01-85, effective January 1, 2002, amends C.G.S. §31-279 in that it requires a listing of pharmacies to which direct payment must be made. Below please find a copy of C.G.S. §31-279(c)(d) and P.A. 01-85 (section 1). Sec. 31-279. Notice of availability of compensation. Uniform system for determination of degree of physical impairment. Employer-sponsored plan for medical care and treatment. Indemnification of medical advisory panel members. (c) On or after January 1, 1992, any employer or any insurer acting on behalf of an employer, may establish a plan, subject to the approval of the chairman of the Workers' Compensation Commission under subsection (d) of this section, for the provision of medical care which the employer provides for treatment of any injury or illness under this chapter. Each plan shall contain such information as the chairman shall require, including, but not limited to: (1) A listing of all persons who will provide services under the plan, along with appropriate evidence that each person listed has met any licensing, certification or registration requirement necessary for the person to legally provide the service in this state; (2) a designation of the times, places and manners in which the services will be provided; (3) a description of how the quality and quantity of medical care will be managed; and (4) such other provisions as the employer and the employees may agree to, subject to the approval of the chairman. The election by an employee covered by a plan established under this subsection to obtain medical care and treatment from a provider of medical services who is not listed in the plan shall suspend his right to compensation, subject to the order of the commissioner. (d) Each plan established under subsection (c) of this section shall be submitted to the chairman for his approval at least one hundred twenty days before the proposed effective date of the plan and each approved plan, along with any proposed changes therein, shall be resubmitted to the chairman every two years thereafter for reapproval. The chairman shall approve or disapprove such plans on the basis of standards established by the chairman in consultation with a medical advisory panel appointed by the chairman. Such standards shall include, but not be limited to: (1) The ability of the plan to provide all medical and health care services that may be required under this chapter in a manner that is timely, effective and convenient for the employees; (2) the inclusion in the plan of all categories of medical service and of an adequate number of providers of each type of medical service in accessible locations to ensure that employees are given an adequate choice of providers; (3) the provision in the plan for appropriate financial incentives to reduce service costs and utilization without a reduction in the quality of service; (4) the inclusion in the plan of fee screening, peer review, service utilization review and dispute resolution procedures designed to prevent inappropriate or excessive treatment; and (5) the inclusion in the plan of a procedure by which information on medical and health care service costs and utilization will be reported to the chairman in order for him to determine the effectiveness of the plan. Public Act No. 01-85. An Act Requiring Direct Payment of Prescription Medication for Workers' Compensation Claimants. Be it enacted by the Senate and House of Representatives in General Assembly convened: Section 1. Subsection (c) of section 31-279 of the general statutes is repealed and the following is substituted in lieu thereof: (c) [On or after January 1, 1992, any] (1) Any employer or any insurer acting on behalf of an employer, may establish a plan, subject to the approval of the chairman of the Workers' Compensation Commission under subsection (d) of this section, for the provision of medical care [which] that the employer provides for treatment of any injury or illness under this chapter. Each plan shall contain such information as the chairman shall require, including, but not limited to: [(1)] (A) A listing of all persons who will provide services under the plan, along with appropriate evidence that each person listed has met any licensing, certification or registration requirement necessary for the person to legally provide the service in this state; [(2) a] (B) A listing of all pharmacies that will provide services under the plan, to which the employer, any insurer acting on behalf of the employer, or any other entity acting on behalf of the employer or insurer shall make direct payments for any prescription drug prescribed by a physician participating in the plan; (C) A designation of the times, places and manners in which the services will be provided; [(3) a] (D) A description of how the quality and quantity of medical care will be managed; and [(4) such] (E) Such other provisions as the employer and the employees may agree to, subject to the approval of the chairman. (2) The election by an employee covered by a plan established under this subsection to obtain medical care and treatment from a provider of medical services who is not listed in the plan shall suspend [his] the employee's right to compensation, subject to the order of the commissioner. American LegalNet, Inc. www.FormsWorkFlow.com STATE OF CONNECTICUT REGULATION OF WORKERS' COMPENSATION COMMISSION Concerning Filed with the Secretary of the State and effective on December 2, 1997 Medical Care Plans Section 31-279-10 of the Regulations of Connecticut State Agencies are amended to read as follows: (a) All medical care plans submitted pursuant to Section 31-279 of the Connecticut General Statutes by any employer or, on beh
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