REPORT TITLE:
Medical fee schedule


DESCRIPTION:
Changes the current medical fee schedule for workers'
compensation. (HB2134 HD1)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        2134
HOUSE OF REPRESENTATIVES                H.B. NO.           H.D. 1
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            
                                                             
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                   A  BILL  FOR  AN  ACT

RELATING TO MEDICAL FEE SCHEDULES.
 


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

 1      SECTION 1.  Section 386-21, Hawaii Revised Statutes, is
 
 2 amended by amending subsection (c) to read as follows:
 
 3      "(c)  The liability of the employer for medical care,
 
 4 services, and supplies shall be limited to the charges computed
 
 5 as set forth in this section.  The director shall make
 
 6 determinations of the charges and adopt fee schedules based upon
 
 7 those determinations.  Effective January 1, [1997,] 2001, and for
 
 8 each succeeding calendar year thereafter, the charges shall not
 
 9 exceed [one hundred ten] one hundred       per cent of fees
 
10 prescribed in the Medicare Resource Based Relative Value Scale
 
11 system applicable to Hawaii as prepared by the United States
 
12 Department of Health and Human Services, except as provided in
 
13 this subsection.  The rates or fees provided for in this section
 
14 shall be adequate to ensure at all times the standard of services
 
15 and care intended by this chapter to injured employees.
 
16      If the director determines that an allowance under the
 
17 Medicare program is not reasonable, or if a medical treatment,
 
18 accommodation, product, or service existing as of June 29, 1995,
 
19 is not covered under the Medicare program, the director may, at
 

 
Page 2                                                     2134
                                     H.B. NO.           H.D. 1
                                                        
                                                        

 
 1 any time, establish an additional fee schedule or schedules not
 
 2 exceeding the prevalent charge for fees for services actually
 
 3 received by providers of health care services to cover charges
 
 4 for that treatment, accommodation, product, or service.  If no
 
 5 prevalent charge for a fee for service has been established for a
 
 6 given service or procedure, the director shall adopt a reasonable
 
 7 rate that shall be the same for all providers of health care
 
 8 services to be paid for that service or procedure.
 
 9      The director shall update the schedules required by this
 
10 section every three years or annually, as required.  The updates
 
11 shall be based upon:
 
12      (1)  Future charges or additions prescribed in the Medicare
 
13           Resource Based Relative Value Scale system applicable
 
14           to Hawaii as prepared by the United States Department
 
15           of Health and Human Services; or
 
16      (2)  A statistically valid survey by the director of
 
17           prevalent charges for fees for services actually
 
18           received by providers of health care services or based
 
19           upon the information provided to the director by the
 
20           appropriate state agency having access to prevalent
 
21           charges for medical fee information.
 
22      When a dispute exists between an insurer or self-insured
 
23 employer and a medical service provider regarding the amount of a
 

 
Page 3                                                     2134
                                     H.B. NO.           H.D. 1
                                                        
                                                        

 
 1 fee for medical services, the director may resolve the dispute in
 
 2 a summary manner as the director may prescribe; provided that a
 
 3 provider shall not charge more than the provider's private
 
 4 patient charge for the service rendered."
 
 5      SECTION 2.  Statutory material to be repealed is bracketed.
 
 6 New statutory material is underscored.
 
 7      SECTION 3.  This Act shall take effect on January 1, 2001.