Report Title:

Workers' Compensation; Medical Fee Schedule

 

Description:

Bases medical fees beginning 1/1/01 and each year thereafter on rules of department of labor and industrial relations, as adjusted to reflect increases or decreases in the Consumer Price Index for Honolulu, computed annually; requires DLIR director to review rules every 3 years for adequacy.

 

THE SENATE

S.B. NO.

52

TWENTY-FIRST LEGISLATURE, 2001

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

relating to workers' compensation.

 

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

SECTION 1. Section 386-21, Hawaii Revised Statutes, is amended to by amending subsection (c) read as follows:

"(c) The liability of the employer for medical care, medical services, and medical 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, 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] Effective January 1, 2001, and for each succeeding year thereafter, the charges shall be limited to the amounts determined by the director, adjusted to reflect increases or decreases in the Consumer Price Index for the Honolulu region for the preceding twelve months ending June 30 of the immediately preceding year, as prepared by the Bureau of Labor Statistics of the United States Department of Labor. Adjustments shall be computed annually and rounded to the next 10 cents. The director shall conduct a public hearing under section 91-3 to revise the rules, if necessary, no later than December 1, 2002, and every three years thereafter, to ensure that the charges are reasonable for medical care, medical services, and medical supplies, taking into consideration similar charges that are not subject to this chapter. The director may, at any time, as provided in this subsection, 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.] medical care, medical supplies, services, and medical supplies not provided for in the rules.

The liability of the employer shall not exceed the amount set forth in the fee schedules under this subsection, except upon conditions as provided by rules."

SECTION 2. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

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

INTRODUCED BY:

_____________________________