50-6-233 - Enforcement power of commissioner Referral of vocational rehabilitation cases Promulgation of rules and regulations to implement chapter. - Tennessee Statutes

50-6-233. Enforcement power of commissioner Referral of vocational rehabilitation cases Promulgation of rules and regulations to implement chapter.

(a)  (1)  There is conferred upon the commissioner the power to enforce the provisions of this chapter that relate to the assurance of payments of the awards under this chapter.

     (2)  The commissioner has the power, subject to the approval of the governor, to employ clerical assistance the commissioner deems necessary and fix the compensation of the person or persons so employed.

     (3)  The commissioner may make rules and regulations not inconsistent with this law for the purpose of discharging the commissioner's duties under the provisions of this chapter.

     (4)  The commissioner may provide forms for the use of employers and other literature that may be necessary and shall furnish to any employee or employer literature and blank forms that the commissioner deems requisite to facilitate or promote the efficient administration of this chapter.

     (5)  In no event shall the division of workers' compensation charge a fee or impose a cost for any necessary or required forms needed to process a workers' compensation claim.

     (6)  The commissioner shall modify Form # C32 to include a location for a health care provider to indicate temporary total disability and the point at which the employee reached maximum medical improvement.

(b)  The commissioner shall cause the division of workers' compensation to refer all feasible cases for vocational rehabilitation to the department of education.

(c)  In addition to the rulemaking authority granted in § 50-6-118, and subsection (a) of this section, the commissioner or the commissioner of commerce and insurance, as appropriate, may promulgate rules and regulations implementing this chapter. The rules and regulations shall be promulgated pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. The commissioner's rules and regulations shall include, but not be limited to, the rules and regulations:

     (1)  Establishing minimum qualifications and training for workers' compensation specialists;

     (2)  Establishing procedures for benefit review conferences including the time within which all conferences must be held and the times within which copies of reports and agreements must be filed with the commissioner. The rules shall prescribe a mechanism by which written notice of all conferences, copies of agreements, and copies of reports shall be provided to the insurer, the employee, the employer, and any party to a claim. The rules shall provide guidelines relating to claims that do not require a benefit review conference;

     (3)  To provide a civil penalty for parties to a claim who fail to attend a properly scheduled and noticed conference;

     (4)  To provide a procedure to withhold payment from a health care provider for over-utilization of medical care or services or for ordering inappropriate medical care or services;

     (5)  To provide an appeal procedure for a health care provider who has had payment withheld for over-utilization of medical care or services;

     (6)  To provide a system of case management to coordinate the medical care services provided to employees claiming benefits under this chapter. The rules and regulations shall establish a threshold of medical expenses and services or other appropriate point over which all cases will be subject to case management;

     (7)  To ensure health care providers' compliance with § 50-6-204(a)(4), and rules and regulations to provide an appeal procedure for a health care provider who has had payment withheld for charging amounts found to be excessive; provided, that no rule promulgated pursuant to this subdivision (c)(7) shall be filed with the secretary of state after approval by the attorney general and reporter, pursuant to §§ 4-5-207 and 4-5-211, unless also approved by the medical care and cost containment committee established by § 50-6-125; and

     (8)  To establish a civil penalty, to be assessed at the discretion of the commissioner, against a provider who has, after proper notification and appropriate time to respond, refused to make repayment to a payor for a payment that exceeds the medical fee schedule after exhausting all appeals. Under no circumstances shall a provider be assessed a civil penalty solely for receiving payment from a payor that exceeds the medical fee schedule.

[Acts 1919, ch. 123, § 46; impl. am. Acts 1923, ch. 7, §§ 2, 50; Shan. Supp., § 3608a196; Code 1932, § 6900; Acts 1941, ch. 90, § 12; C. Supp. 1950, § 6900; Acts 1972, ch. 699, § 5; impl. am. Acts 1980, ch. 534, § 1; T.C.A. (orig. ed.), § 50-1028; Acts 1983, ch. 215, § 3; 1992, ch. 900, § 3; 1999, ch. 242, § 2; 1999, ch. 265, § 3; 1999, ch. 520, § 41, 2006, ch. 687, § 1.]