Workers' Compensation

Establishes a medical fee schedule advisory council for workers'
compensation. (HB2290 HD1)

HOUSE OF REPRESENTATIVES                H.B. NO.           H.D.1
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            

                   A  BILL  FOR  AN  ACT



 1      SECTION 1.  Chapter 386, Hawaii Revised Statutes, is amended
 2 by adding a new section to be appropriately designated and to
 3 read as follows:
 4      "386-     Medical fee schedule advisory council.  (a)
 5 There is established within the department of labor and
 6 industrial relations the medical fee schedule advisory council,
 7 or "council", for the purpose of assisting and advising the
 8 director in adjusting the medical fee schedule as provided in
 9 section 386-21, and other matters concerning the medical fee
10 schedule and medical services.
11      (b)  The council shall be composed of nine voting members,
12 and four nonvoting members, as follows:
13      (1)  Four shall be voting members appointed by the governor
14           pursuant to section 26-34 representing health care
15           providers of authorized medical services, including
16           physicians, chiropractors, or physical therapists;
17      (2)  Two shall be voting members appointed by the governor
18           pursuant to section 26-34 representing the business
19           community, including representation from small
20           business;

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 1      (3)  One shall be a voting member appointed by the governor
 2           pursuant to section 26-34 representing the insurance
 3           industry;
 4      (4)  The director of labor and industrial relations or the
 5           director's representative shall be an ex-officio voting
 6           member; and
 7      (5)  One shall be a voting member appointed by the governor
 8           pursuant to section 26-34 representing the community at
 9           large;
10      (6)  Four nonvoting members appointed by the governor that
11           represent the general public and each of the four
12           counties.
13      (c)  The powers and duties of the council shall include:
14      (1)  Reviewing annual modifications to the Medicare Resource
15           Based Relative Value Scale and recommending to the
16           director adjustments that should be made to provide
17           adequate rates and fees that ensure at all times that
18           the standard of services and care intended by this
19           chapter are available to injured employees; and
20      (2)  Advising the director on any other matters relating to
21           the medical fee schedule the council may find
22           appropriate to maintain the standard of services for
23           compensable injuries under this chapter.

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 1      (d)  Members of the council shall serve without compensation
 2 but shall be entitled to reimbursement for necessary expenses,
 3 including travel expenses, while attending meetings and while in
 4 the discharge of duties and responsibilities of the council.  The
 5 terms of each non-ex-officio member shall be for four years;
 6 provided that half of the appointees from each represented group
 7 shall be for only two years in order to stagger the terms."
 8      SECTION 2.  Section 386-21, Hawaii Revised Statutes, is
 9 amended by amending subsection (c) to read as follows:
10      "(c)  The liability of the employer for medical care,
11 services, and supplies shall be limited to the charges computed
12 as set forth in this section.  The director shall make
13 determinations of the charges and adopt fee schedules based upon
14 those determinations.  Effective [January 1, 1997,] July 1, 2000,
15 and for each succeeding [calendar] year thereafter, the charges
16 shall not exceed one hundred [ten] thirty per cent of fees
17 prescribed in the Medicare Resource Based Relative Value Scale
18 system applicable to Hawaii as prepared by the United States
19 Department of Health and Human Services, except as provided in
20 this subsection.  The rates or fees provided for in this section
21 shall be adequate to ensure at all times the standard of services
22 and care intended by this chapter to injured employees.

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                                     H.B. NO.           

 1      If the director determines that an allowance under the
 2 medicare program is not reasonable, or if a medical treatment,
 3 accommodation, product, or service existing as of [June 29,
 4 1995,] June 30, 2000, is not covered under the medicare program,
 5 the director [may], at any time, may establish an additional fee
 6 schedule or schedules not exceeding the prevalent charge for fees
 7 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 the director shall adopt a reasonable rate that shall be the same
12 for all providers of health care services to be paid for that
13 service or procedure.
14      The director shall, with the advice of the council, update
15 the schedules required by this section every three years or
16 annually, as required.  The updates shall be based upon:
17      (1)  Future charges or additions prescribed in the Medicare
18           Resource Based Relative Value Scale system applicable
19           to Hawaii as prepared by the United States Department
20           of Health and Human Services; or
21      (2)  A statistically valid survey by the director of
22           prevalent charges for fees for services actually
23           received by providers of health care services or based

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 1           upon the information provided to the director by the
 2           appropriate state agency having access to prevalent
 3           charges for medical fee information.
 4      When a dispute exists between an insurer or self-insured
 5 employer and a medical service provider regarding the amount of a
 6 fee for medical services, the director may resolve the dispute in
 7 a summary manner as the director may prescribe; provided that a
 8 provider shall not charge more than the provider's private
 9 patient charge for the service rendered."
10      SECTION 3.  Statutory material to be repealed is bracketed.
11 New statutory material is underscored.
12      SECTION 4.  This Act shall take effect on July 1, 2000.