Report Title:

Worker's Compensation Medical Fee Structure

 

Description:

Changes the medical fee structure for workers' compensation. Establishes the Medical Fee Schedule Advisory Council. (HB308 HD1)

 

HOUSE OF REPRESENTATIVES

H.B. NO.

308

TWENTY-FIRST LEGISLATURE, 2001

H.D. 1

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

relating to workers' compensation medical fees.

 

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

SECTION 1. Chapter 386, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designed and to read as Follows:

"§386-___ Medical fee schedule advisory council. (a) There is established within the department of labor and industrial relations the medical fee schedule advisory council, or "council", for the purpose of assisting and advising the director in adjusting the medical fee schedule as provided in section 386-21, and other matters concerning the medical fee schedule and medical services.

(b) The council shall be composed of nine voting members and four nonvoting members as follows:

(1) Four shall be voting members appointed by the governor pursuant to section 26-34 representing health care providers of authorized medical services, including physicians, chiropractors or physical therapists;

(2) Two shall be voting members appointed by the governor pursuant to section 26-34 representing the business community, including representation from small business;

(3) One shall be a voting member appointed by the governor pursuant to section 26-34 representing the insurance industry;

(4) The director of labor and industrial relations or the director's representative shall be an ex-officio voting member;

(5) One shall be a voting member appointed by the governor pursuant to section 26-34 representing the community at large; and

(6) Four nonvoting members appointed by the governor that represent each of the four counties and the general public.

(c) The powers and duties of the council shall include:

(1) Reviewing annual modifications to the Medicare Resource Based Relative Value Scale and recommending to the director adjustments that should be made to provide adequate rates and fees that ensure at all times that the standard of services and care intended by this chapter are available to injured employees; and

(2) Advising the director on any other matters relating to the medical fee schedule the council may find appropriate to maintain the standard of services for compensable injuries under this chapter, and may take into consideration in making such determination the charges made in the State for similar treatment of injuries that are not compensable under this chapter.

(d) Members of the council shall serve without compensation but shall be entitled to reimbursement for necessary expenses, including travel expenses, while attending meetings and while in the discharge of duties and responsibilities of the council. The terms of each non ex-officio member shall be for four years, provided that half the appointees from each represented group shall be for only two years in order to stagger the terms."

SECTION 2. Section 386-21, Hawaii Revised Statutes, is amended by amending subsection (c) to read as follows:

"(c) The liability of the employer for medical care, services, and supplies shall be limited to the charges computed as set forth in this section. The director shall make determinations of the charges and adopt fee schedules based upon those determinations. Effective January 1, [1997,], 2020, and for each succeeding calendar year thereafter, the charges shall not exceed [one hundred ten] _______ per cent of fees prescribed in the Medicare Resource Based Relative Value Scale system applicable to Hawaii as prepared by the United States Department of Health and Human Services, except as provided in this subsection. The rates or fees provided for in this section shall be adequate to ensure at all times the standard of services and care intended by this chapter to injured employees.

If the director determines that an allowance under the Medicare program is not reasonable, or if a medical treatment, accommodation, product, or service existing as of June 29, 1995, is not covered under the Medicare program, the director may, at any time, establish an additional fee schedule or schedules not exceeding the prevalent charge for fees for services actually received by providers of health care services to cover charges for that treatment, accommodation, product, or service. If no prevalent charge for a fee for service has been established for a given service or procedure, the director shall adopt a reasonable rate that shall be the same for all providers of health care services to be paid for that service or procedure.

The director shall update the schedules required by this section every three years or annually, as required. The updates shall be based upon:

(1) Future charges or additions prescribed in the Medicare Resource Based Relative Value Scale system applicable to Hawaii as prepared by the United States Department of Health and Human Services; or

(2) A statistically valid survey by the director of prevalent charges for fees for services actually received by providers of health care services or based upon the information provided to the director by the appropriate state agency having access to prevalent charges for medical fee information.

When a dispute exists between an insurer or self-insured employer and a medical service provider regarding the amount of a fee for medical services, the director may resolve the dispute in a summary manner as the director may prescribe; provided that a provider shall not charge more than the provider's private patient charge for the service rendered."

SECTION 3. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 4. This Act shall take effect January 1, 2020.