HOUSE OF REPRESENTATIVES

H.B. NO.

152

TWENTY-SEVENTH LEGISLATURE, 2013

H.D. 1

STATE OF HAWAII

S.D. 2

 

Proposed

 

 

 

A BILL FOR AN ACT

 

 

RELATING TO WORKERS' COMPENSATION MEDICAL FEE SCHEDULES.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 


     SECTION 1.  The auditor shall conduct a study relating to the workers' compensation system fee schedule in the State that includes:

     (1)  An evaluation of whether the current rates are sufficient to provide workers' compensation patients with access to physicians in the State who are willing to treat them, including:

          (A)  A comparison of the average rates on Oahu and the neighbor islands;

          (B)  The number of physicians who treat workers' compensation patients on Oahu and the neighbor islands; and

          (C)  Additional costs, if any, that physicians who treat workers' compensation patients incur in terms of filing claims, record keeping, reporting, and compliance requirements;

     (2)  The fiscal impacts of increasing the fee schedule from one hundred ten per cent to one hundred thirty per cent of the medicare resource based relative value scale applicable to Hawaii, including:

         (A)  The effect of the fee increase on access to medical services;

          (B)  The effect of the fee increase on services and providers on Oahu; and

          (C)  The effect of the fee increase on services and providers on the neighbor islands;

     (3)  A comparison of state-federal rate schedules, including:

         (A)  Data collection on current prevalent charges used by various divisions;

         (B)  A ranked listing of the codes billed in workers' compensation cases; and

         (C)  A comparison of codes and fees in the State's fee schedule and the federal fee schedule used for the State, including:

              (i)  The percentage of codes that overlap between the state and federal schedules;

             (ii)  A comparison of the reimbursement rates for codes shared in both schedules;

            (iii)  A comparison of the reimbursement rates for codes not shared;

              (iv)  A percentage of the codes in the federal schedule and on what basis they are being charged; and

              (v)  An inquiry into claims that codes not appearing in the United States Office of Workers' Compensation Programs' fee schedule are paid as billed and the basis on which these codes are being charged;

     (4)  A statistical assessment of independent medical examinations conducted in the State and the fees for those examinations, including the:

         (A)  Prevalence of independent medical examinations, including how often they are requested;

         (B)  Number of independent medical examinations that are found in favor of the employer, by number and percentage;

         (C)  Number of independent medical examinations that are found in favor of the employee, by number and percentage;

         (D)  Trends or differences between Oahu and the neighbor islands;

         (E)  Number of physicians who currently perform independent medical examinations on Oahu and the neighbor islands;

         (F)  Average wait time to have an independent medical examination scheduled and completed on Oahu and the neighbor islands; and

         (G)  Appropriateness of fees paid under applicable fee schedules;

     (5)  A determination of patterns of abuse, if any, among the following:

          (A)  Insurers:  Relating to denying claims; restricting treatment options; and funneling workers to particular physicians and care providers;

          (B)  Employers:  Relating to providing insufficient or no coverage; failing to provide workers with workers' compensation information and rights; and denial of claims;

          (C)  Injured workers:  Relating to submitting false claims and preexisting conditions; and

          (D)  Physicians:  Relating to findings by physicians that appear to be more often favorable to the employer or employee; appropriateness of treatment provided; and possible over-reliance on prescribing narcotics; and

     (6)  A determination of whether and how often the director of labor and industrial relations has established an additional fee schedule not exceeding the prevalent charge for fees for services actually received by providers of health care services to cover charges for a specific treatment, accommodation, product, or service pursuant to the director's authority under section 386-21, Hawaii Revised Statutes.

     SECTION 2.  The auditor shall submit a report of the findings and recommendations, including any proposed legislation, to the legislature not later than twenty days prior to the convening of the regular session of 2014.

     SECTION 3.  This Act shall take effect upon its approval.



 

Report Title:

Workers' Compensation; Medical Fee Schedules

 

Description:

Requires the auditor to conduct a study on various aspects of the workers' compensation medical fee schedules and system in the State, including the sufficiency of current rates to provide access to the State's physicians that are willing to serve workers' compensation patients and fiscal impacts of increasing fee schedules.  (SD2 PROPOSED)

 

 

 

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