REPORT TITLE:
Medical Fee Schedule



DESCRIPTION:
Establishes a medical fee schedule advisory council to advise the
director of health on adjusting the medical fee schedule.  (SD1)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        2245
THE SENATE                              S.B. NO.           S.D. 1
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            
                                                             
________________________________________________________________
________________________________________________________________


                   A  BILL  FOR  AN  ACT

RELATING TO MEDICAL FEE SCHEDULES.
 


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

 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 thirteen voting
 
12 members, and no more than ten 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)  Four shall be voting members appointed by the governor
 
18           pursuant to section 26-34 representing the business
 
19           community, including representation from small
 

 
Page 2                                                     2245
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1           business;
 
 2      (3)  Four shall be voting members appointed by the governor
 
 3           to section 26-34 representing the insurance 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)  Not more than ten nonvoting members appointed by the
 
 8           governor that represent the general public and each of
 
 9           the four counties.
 
10      (c)  The powers and duties of the council shall include:
 
11      (1)  Reviewing annual modifications to the Medicare Resource
 
12           Based Relative Value Scale and recommending to the
 
13           director adjustments that should be made to provide
 
14           adequate rates and fees that ensure at all times that
 
15           the standard of services and care intended by this
 
16           chapter are available to injured employees; and
 
17      (2)  Advising the director on any other matters relating to
 
18           the medical fee schedule the council may find
 
19           appropriate to maintain the standard of services for
 
20           compensable injuries under this chapter.
 
21      (d)  Members of the council shall serve without compensation
 
22 but shall be entitled to reimbursement for necessary expenses,
 
23 including travel expenses, while attending meetings and while in
 

 
Page 3                                                     2245
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1 the discharge of duties and responsibilities of the council.  The
 
 2 terms of each nonex-officio member shall be for four years;
 
 3 provided that half of the initial appointees from each
 
 4 represented group shall be for only two years in order to stagger
 
 5 the terms."
 
 6      SECTION 2.  Section 386-21, Hawaii Revised Statutes, is
 
 7 amended by amending subsection (c) to read as follows:
 
 8      "(c)  The liability of the employer for medical care,
 
 9 services, and supplies shall be limited to the charges computed
 
10 as set forth in this section.  The director shall make
 
11 determinations of the charges and adopt fee schedules based upon
 
12 those determinations.  Effective January 1, 1997, and for each
 
13 succeeding calendar year thereafter, the charges shall not exceed
 
14 one hundred ten per cent of fees prescribed in the Medicare
 
15 Resource Based Relative Value Scale system applicable to Hawaii
 
16 as prepared by the United States Department of Health and Human
 
17 Services, except as provided in this subsection.  The rates or
 
18 fees provided for in this section shall be adequate to ensure at
 
19 all times the standard of services and care intended by this
 
20 chapter to injured employees.
 
21      If the director determines that an allowance under the
 
22 medicare program is not reasonable, or if a medical treatment,
 
23 accommodation, product, or service existing as of [June 29,
 

 
Page 4                                                     2245
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1 1995,] June 30, 1999, is not covered under the medicare program,
 
 2 the director [may], on the recommendation of the medical fee
 
 3 schedule advisory council or at any time, may establish an
 
 4 additional fee schedule or schedules not exceeding the prevalent
 
 5 charge for fees for services actually received by providers of
 
 6 health care services to cover charges for that treatment,
 
 7 accommodation, product, or service.  If no prevalent charge for a
 
 8 fee for service has been established for a given service or
 
 9 procedure, the director shall adopt a reasonable rate that shall
 
10 be the same for all providers of health care services to be paid
 
11 for that service or procedure.
 
12      The director shall, with the advice of the council, update
 
13 the schedules required by this section [every three years or]
 
14 annually, or more frequently, as required.  The updates shall be
 
15 based upon:
 
16      (1)  Future charges or additions prescribed in the Medicare
 
17           Resource Based Relative Value Scale system applicable
 
18           to Hawaii as prepared by the United States Department
 
19           of Health and Human Services; or
 
20      (2)  A statistically valid survey by the director of
 
21           prevalent charges for fees for services actually
 
22           received by providers of health care services or based
 
23           upon the information provided to the director by the
 

 
Page 5                                                     2245
                                     S.B. NO.           S.D. 1
                                                        
                                                        

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