Enrolled HB 316: Relating to workers' compensation fees for medical treatment and services; relating to workers' compensation regulations; and providing for an effective date.
00Enrolled HB 316 01 Relating to workers' compensation fees for medical treatment and services; relating to 02 workers' compensation regulations; and providing for an effective date. 03 _______________ 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 medical services review 12 committee [BOARD] and adopted by the board [REFERENCE] in regulation; the fee 13 schedules [SCHEDULE] must include [BE BASED ON STATISTICALLY 14 CREDIBLE DATA, INCLUDING CHARGES FOR THE MOST RECENT
01 CATEGORY I, II, AND III MEDICAL SERVICES MAINTAINED BY THE 02 AMERICAN MEDICAL ASSOCIATION AND THE HEALTH CARE 03 PROCEDURE CODING SYSTEM FOR MEDICAL SUPPLIES, INJECTIONS, 04 EMERGENCY TRANSPORTATION, AND OTHER MEDICALLY RELATED 05 SERVICES, AND MUST RESULT IN A SCHEDULE THAT] 06 (A) a physician fee schedule based on the federal Centers 07 for Medicare and Medicaid Services' resource-based relative value scale; 08 [REFLECTS THE COST IN THE GEOGRAPHICAL AREA WHERE 09 SERVICES ARE PROVIDED; AND] 10 (B) an outpatient and ambulatory surgical center fee 11 schedule based on the federal Centers for Medicare and Medicaid 12 Services' ambulatory payment classification; and 13 (C) an inpatient hospital fee schedule based on the federal 14 Centers for Medicare and Medicaid Services' Medicare severity diagnosis 15 related group [IS AT THE 90TH PERCENTILE]; 16 (2) the fee or charge for the treatment or service when provided to the 17 general public; or 18 (3) the fee or charge for the treatment or service negotiated by the 19 provider and the employer under (c) of this section. 20 * Sec. 2. AS 23.30.097 is amended by adding new subsections to read: 21 (h) The board shall annually renew and adjust fees on the fee schedules 22 established by the medical services review committee under (a)(1) of this section by a 23 conversion factor established by the medical services review committee and adopted 24 by the board in regulation. 25 (i) A fee or other charge for medical treatment or service rendered in another 26 state may not exceed the lowest of 27 (1) the fee or charge for a treatment or service set by the workers' 28 compensation statutes of the state where the service is rendered; or 29 (2) the fees specified in a fee schedule under (a)(1) of this section. 30 (j) A fee or other charge for air ambulance services rendered under this 31 chapter shall be reimbursed at a rate established by the board and adopted in
01 regulation. 02 (k) A fee or other charge for durable medical equipment not otherwise 03 included in a covered medical procedure under this section may not exceed the amount 04 of the manufacturer's invoice, plus a markup specified by the board and adopted in 05 regulation. 06 (l) Reimbursement for prescription drugs under this chapter may not exceed 07 the amount of the original manufacturer's invoice, plus a dispensing fee and markup 08 specified by the board and adopted in regulation. 09 (m) A prescription drug dispensed by a physician under this chapter shall 10 include in a bill or invoice the original manufacturer's code for the drug from the 11 national drug code directory published by the United States Food and Drug 12 Administration. 13 (n) A fee or other charge for medical treatment or service provided by a 14 hospital licensed by the Department of Health and Social Services to operate as a 15 critical access hospital is exempt from the fee schedules established under (a)(1) of 16 this section. 17 (o) The board may adjust the fee schedules established under (a)(1) of this 18 section to reflect the cost in the geographical area where the services are provided. 19 (p) The medical services review committee shall formulate a conversion factor 20 and submit the conversion factor to the commissioner of labor and workforce 21 development. If the commissioner does not approve the conversion factor, the medical 22 services review committee shall revise the conversion factor and submit the revised 23 conversion factor to the commissioner for approval. 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. AS 23.30.395 is amended by adding a new paragraph to read: 17 (42) "medical services review committee" means the committee 18 established under AS 23.30.095(j). 19 * Sec. 5. Section 1 of this Act and AS 23.30.097(j) - (p), added by sec. 2 of this Act, take 20 effect July 1, 2015. 21 * Sec. 6. Except as provided in sec. 5 of this Act, this Act takes effect July 1, 2014.