CSHB 316(L&C): "An Act relating to workers' compensation fees for medical treatment and services; relating to workers' compensation regulations; and providing for an effective date."
00 CS FOR HOUSE BILL NO. 316(L&C) 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 is amended by adding new subsections to read: 20 (h) The board shall annually 21 (1) renew and adjust fees on the fee schedules established by the board 22 under (a)(1) of this section by a conversion factor established by the board and 23 adopted in regulation; 24 (2) request and consider recommendations from the medical services 25 review committee established under AS 23.30.095(j) on setting the conversion factors 26 and rates specified in (1) of this subsection; and 27 (3) after consulting with the medical services review committee 28 established under AS 23.30.095(j), evaluate and revise by regulation the conversion 29 factors and rates specified in (1) of this subsection. 30 (i) A fee or other charge for medical treatment or service rendered in another 31 state may not exceed the lowest of
01 (1) the fee or charge for a treatment or service set by the workers' 02 compensation statutes of the state where the service is rendered; or 03 (2) the fees specified in a fee schedule under (a)(1) of this section. 04 (j) A fee or other charge for air ambulance services rendered under this 05 chapter shall be reimbursed at a rate established by the board and adopted in 06 regulation. 07 (k) A fee or other charge for durable medical equipment not otherwise 08 included in a covered medical procedure under this section may not exceed the amount 09 of the manufacturer's invoice, plus a markup specified by the board and adopted in 10 regulation. 11 (l) Reimbursement for prescription drugs under this chapter may not exceed 12 the amount of the original manufacturer's invoice, plus a dispensing fee and markup 13 specified by the board and adopted in regulation. 14 (m) A prescription drug dispensed by a physician under this chapter shall 15 include in a bill or invoice the original manufacturer's code for the drug from the 16 national drug code directory published by the United States Food and Drug 17 Administration. 18 (n) A fee or other charge for medical treatment or service provided by a 19 hospital licensed by the Department of Health and Social Services to operate as a 20 critical access hospital is exempt from the fee schedules established under (a)(1) of 21 this section. 22 (o) The board may adjust the fee schedules established under (a)(1) of this 23 section to reflect the cost in the geographical area where the services are provided. 24 * Sec. 3. AS 23.30 is amended by adding a new section to article 2 to read: 25 Sec. 23.30.098. Regulations. Under AS 44.62.245(a)(2), in adopting or 26 amending regulations under this chapter, the department may incorporate future 27 amended versions of a document or reference material incorporated by reference if the 28 document or reference material is one of the following: 29 (1) Current Procedural Terminology Codes, produced by the American 30 Medical Association; 31 (2) Healthcare Common Procedure Coding System, produced by the
01 American Medical Association; 02 (3) International Classification of Diseases, published by the American 03 Medical Association; 04 (4) Relative Value Guide, produced by the American Society of 05 Anesthesiologists; 06 (5) Diagnostic and Statistical Manual of Mental Disorders, produced 07 by the American Psychiatric Association; 08 (6) Current Dental Terminology, published by the American Dental 09 Association; 10 (7) Resource-Based Relative Value Scale, produced by the federal 11 Centers for Medicare and Medicaid Services; 12 (8) Ambulatory Payment Classifications, produced by the federal 13 Centers for Medicare and Medicaid Services; or 14 (9) Medicare Severity Diagnosis Related Groups, produced by the 15 federal Centers for Medicare and Medicaid Services. 16 * Sec. 4. Section 1 of this Act and AS 23.30.097(j) - (o), added by sec. 2 of this Act, take 17 effect July 1, 2015. 18 * Sec. 5. Except as provided in sec. 4 of this Act, this Act takes effect July 1, 2014.