Ensures that uninterrupted medical care is provided to an injured employee, even if the injured employee's employer denies further treatment, until the director of labor and industrial relations renders a final decision on the matter. (HB1867 CD1)

A BILL FOR AN ACT

SECTION 1. The legislature finds that needless disruption of medical care services is a recurring problem in workers' compensation-related cases in the state and a serious impediment to the cost-effective treatment and recovery of injured workers.

The legislature also finds that the purpose of section 386-21, Hawaii Revised Statutes, is to:

The purpose of this Act is to ensure that uninterrupted medical care is provided to an injured worker, even if the injured employee's employer denies further treatment, until the director of labor and industrial relations renders a final decision on the matter.

SECTION 2. Section 386-21, Hawaii Revised Statutes, is amended by amending subsection (c) to read as follows:

"(c) The liability of the employer for medical care, services, and 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] 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 director [may], at any time, may 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:

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.

When a dispute exists between an injured employee and the employer or the employer's insurer regarding whether medical services should be continued, the injured employee shall continue to receive the medical services prescribed under the treatment plan last approved by the medical service provider until the director issues a decision on whether the injured employee's medical treatment should be continued. If the director determines that medical services pursuant to the treatment plan should be or should have been discontinued, the director shall designate the date after which medical services for that treatment plan are denied. The employer or the employer's insurer may recover from the claimant's personal health care provider or other appropriate occupation or non-occupational insurer all the sums paid for medical services from that treatment plan rendered after the date designated by the director. Under no circumstances shall the claimant be charged for the disallowed services."

SECTION 3. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 4. This Act shall take effect on July 1, 2006.