HB 316: "An Act relating to workers' compensation fees for medical treatment and services; relating to workers' compensation regulations; and providing for an effective date."
00 HOUSE BILL NO. 316 01 "An Act relating to workers' compensation fees for medical treatment and services; 02 relating to workers' compensation regulations; and providing for an effective date." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. AS 23.30.097(a) is amended to read: 05 (a) All fees and other charges for medical treatment or service are subject to 06 regulation by the board consistent with this section. A fee or other charge for medical 07 treatment or service rendered in the state may not exceed the lowest of 08 (1) the usual, customary, and reasonable fees for the treatment or 09 service in the community in which it is rendered, for treatment or service provided on 10 or after December 31, 2010, not to exceed the fees or other charges as specified in the 11 [A] fee schedules [SCHEDULE] established by the board and adopted by reference in 12 regulation; the fee schedules [SCHEDULE] must include [BE BASED ON 13 STATISTICALLY CREDIBLE DATA, INCLUDING CHARGES FOR THE MOST 14 RECENT CATEGORY I, II, AND III MEDICAL SERVICES MAINTAINED BY
01 THE AMERICAN MEDICAL ASSOCIATION AND THE HEALTH CARE 02 PROCEDURE CODING SYSTEM FOR MEDICAL SUPPLIES, INJECTIONS, 03 EMERGENCY TRANSPORTATION, AND OTHER MEDICALLY RELATED 04 SERVICES, AND MUST RESULT IN A SCHEDULE THAT] 05 (A) a physician fee schedule based on the federal Centers 06 for Medicare and Medicaid Services' resource-based relative value scale; 07 [REFLECTS THE COST IN THE GEOGRAPHICAL AREA WHERE 08 SERVICES ARE PROVIDED; AND] 09 (B) an outpatient and ambulatory surgical center fee 10 schedule based on the federal Centers for Medicare and Medicaid 11 Services' ambulatory payment classification; and 12 (C) an inpatient hospital fee schedule based on the federal 13 Centers for Medicare and Medicaid Services' Medicare severity diagnosis 14 related group [IS AT THE 90TH PERCENTILE]; 15 (2) the fee or charge for the treatment or service when provided to the 16 general public; or 17 (3) the fee or charge for the treatment or service negotiated by the 18 provider and the employer under (c) of this section. 19 * Sec. 2. AS 23.30.097(a), as amended by sec. 1 of this Act, is amended to read: 20 (a) All fees and other charges for medical treatment or service are subject to 21 regulation by the board consistent with this section. A fee or other charge for medical 22 treatment or service [RENDERED IN THE STATE] may not exceed the lowest of 23 (1) the usual, customary, and reasonable fees for the treatment or 24 service in the community in which it is rendered, for treatment or service provided on 25 or after December 31, 2010, not to exceed the fees or other charges as specified in a 26 [THE] fee schedule [SCHEDULES] established by the board and adopted by 27 reference in regulation; the fee schedule [SCHEDULES] must be based on 28 statistically credible data, including charges for the most recent category I, II, 29 and III medical services maintained by the American Medical Association and 30 the Health Care Procedure Coding System for medical supplies, injections, 31 emergency transportation, and other medically related services, and must result
01 in a schedule that [INCLUDE] 02 (A) reflects the cost in the geographical area where services 03 are provided; and [A PHYSICIAN FEE SCHEDULE BASED ON THE 04 FEDERAL CENTERS FOR MEDICARE AND MEDICAID SERVICES' 05 RESOURCE-BASED RELATIVE VALUE SCALE;] 06 (B) is at the 90th percentile [AN OUTPATIENT AND 07 AMBULATORY SURGICAL CENTER FEE SCHEDULE BASED ON THE 08 FEDERAL CENTERS FOR MEDICARE AND MEDICAID SERVICES' 09 AMBULATORY PAYMENT CLASSIFICATION; AND 10 (C) AN INPATIENT HOSPITAL FEE SCHEDULE BASED 11 ON THE FEDERAL CENTERS FOR MEDICARE AND MEDICAID 12 SERVICES' MEDICARE SEVERITY DIAGNOSIS RELATED GROUP]; 13 (2) the fee or charge for the treatment or service when provided to the 14 general public; or 15 (3) the fee or charge for the treatment or service negotiated by the 16 provider and the employer under (c) of this section. 17 * Sec. 3. AS 23.30.097 is amended by adding new subsections to read: 18 (h) The board shall annually 19 (1) renew and adjust fees on the fee schedules established by the board 20 under (a)(1) of this section by a conversion factor established by the board and 21 adopted by reference in regulation; and 22 (2) evaluate and revise by regulation the conversion factors and rates 23 specified in (1) of this subsection. 24 (i) A fee or other charge for medical treatment or service rendered in another 25 state may not exceed the lowest of 26 (1) the fee or charge for a treatment or service set by the workers' 27 compensation statutes of the state where the service is rendered; or 28 (2) the fees specified in a fee schedule under (a)(1) of this section. 29 (j) A fee or other charge for air ambulance services rendered under this 30 chapter shall be reimbursed at a rate established by the board and adopted by reference 31 in regulation.
01 (k) A fee or other charge for durable medical equipment not otherwise 02 included in a covered medical procedure under this section may not exceed the amount 03 of the manufacturer's invoice, plus a markup specified by the board and adopted by 04 reference in regulation. 05 (l) Reimbursement for prescription drugs under this chapter may not exceed 06 the amount of the manufacturer's invoice, plus a dispensing fee and markup specified 07 by the board and adopted by reference in regulation. 08 (m) A prescription drug dispensed by a physician under this chapter shall 09 include in a bill or invoice the code for the drug from the national drug code directory 10 published by the United States Food and Drug Administration. 11 * Sec. 4. AS 23.30 is amended by adding a new section to article 2 to read: 12 Sec. 23.30.098. Regulations. In adopting or amending regulations under this 13 chapter, the department may incorporate future amended versions of a document or 14 reference material incorporated by reference, if the document or reference material is 15 one of the following: 16 (1) Current Procedural Terminology Codes, produced by the American 17 Medical Association; 18 (2) Healthcare Common Procedure Coding System, produced by the 19 American Medical Association; 20 (3) International Classification of Diseases, published by the American 21 Medical Association; 22 (4) Relative Value Guide, produced by the American Society of 23 Anesthesiologists; 24 (5) Diagnostic and Statistical Manual of Mental Disorders, produced 25 by the American Psychiatric Association; 26 (6) Current Dental Terminology, published by the American Dental 27 Association; 28 (7) Resource-Based Relative Value Scale, produced by the federal 29 Centers for Medicare and Medicaid Services; 30 (8) Ambulatory Payment Classifications, produced by the federal 31 Centers for Medicare and Medicaid Services; or
01 (9) Medicare Severity Diagnosis Related Groups, produced by the 02 federal Centers for Medicare and Medicaid Services. 03 * Sec. 5. AS 23.30.097(h), 23.30.097(i), 23.30.097(j), 23.30.097(k), 23.30.097(l), 04 23.30.097(m), and 23.30.098 are repealed January 1, 2019. 05 * Sec. 6. Section 1 of this Act and AS 23.30.097(j) - (m), added by sec. 3 of this Act, take 06 effect January 1, 2015. 07 * Sec. 7. Section 2 of this Act takes effect January 1, 2019. 08 * Sec. 8. Except as provided in secs. 6 and 7 of this Act, this Act takes effect July 1, 2014.