REPORT TITLE:
Medical fee schedule


DESCRIPTION:
Changes the current medical fee schedule for workers'
compensation from 110 percent of the Medicare system to an amount
calculated according to the annual federal workers' compensation
medical fee schedule for Hawaii.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        2134
HOUSE OF REPRESENTATIVES                H.B. NO.           
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            
                                                             
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                   A  BILL  FOR  AN  ACT

RELATING TO MEDICAL FEE SCHEDULES.
 


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

 1      SECTION 1.  Section 386-21, Hawaii Revised Statutes, is
 
 2 amended by amending subsection (c) to read as follows:
 
 3      "(c)  The liability of the employer for medical care,
 
 4 services, and supplies shall be limited to the charges computed
 
 5 as set forth in this section.  [The director shall make
 
 6 determinations of the charges and adopt fee schedules based upon
 
 7 those determinations.]  Effective January 1, [1997,] 2001, and
 
 8 for each succeeding calendar year thereafter, the charges shall
 
 9 [not exceed one hundred ten per cent of fees prescribed in the
 
10 Medicare Resource Based Relative Value Scale system applicable to
 
11 Hawaii as prepared by the United States Department of Health and
 
12 Human Services,] be calculated according to the annual federal
 
13 workers' compensation medical fee schedule for Hawaii, except as
 
14 provided in this subsection.  The rates or fees provided for in
 
15 this section shall be adequate to ensure at all times the
 
16 standard of services and care intended by this chapter to injured
 
17 employees.
 
18      If the director determines that an allowance under the
 
19 [Medicare program] federal workers' compensation medical fee
 

 
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                                     H.B. NO.           
                                                        
                                                        

 
 1 schedule for Hawaii is not reasonable, or if a medical treatment,
 
 2 accommodation, product, or service existing as of [June 29,
 
 3 1995,] January 1, 2001, is not covered under the [Medicare
 
 4 program,] federal workers' compensation medical fee schedule for
 
 5 Hawaii, the director may, at any time, establish an additional
 
 6 fee schedule or schedules not exceeding the prevalent charge for
 
 7 fees for services actually received by providers of health care
 
 8 services to cover charges for that treatment, accommodation,
 
 9 product, or service.  If no prevalent charge for a fee for
 
10 service has been established for a given service or procedure[,]
 
11 under the federal workers' compensation medical fee schedule for
 
12 Hawaii, the director shall adopt a reasonable rate that shall be
 
13 the same for all providers of health care services to be paid for
 
14 that service or procedure.
 
15      The director shall update the schedules required by this
 
16 section [every three years or annually, as required.] annually by
 
17 rule adopted under chapter 91.  The updates shall be based upon[:
 
18      (1)  Future charges or additions prescribed in the Medicare
 
19           Resource Based Relative Value Scale system applicable
 
20           to Hawaii as prepared by the United States Department
 
21           of Health and Human Services; or
 
22      (2)  A statistically valid survey by the director of
 
23           prevalent charges for fees for services actually
 

 
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                                     H.B. NO.           
                                                        
                                                        

 
 1           received by providers of health care services or based
 
 2           upon the information provided to the director by the
 
 3           appropriate state agency having access to prevalent
 
 4           charges for medical fee information.] the federal
 
 5           workers' compensation medical fee schedule for Hawaii.
 
 6      When a dispute exists between an insurer or self-insured
 
 7 employer and a medical service provider regarding the amount of a
 
 8 fee for medical services, the director may resolve the dispute in
 
 9 a summary manner as the director may prescribe; provided that a
 
10 provider shall not charge more than the provider's private
 
11 patient charge for the service rendered."
 
12      SECTION 2.  Statutory material to be repealed is bracketed.
 
13 New statutory material is underscored.
 
14      SECTION 3.  This Act shall take effect on January 1, 2001.
 
15 
 
16                           INTRODUCED BY:_________________________