Ensures 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.

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 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, 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 injured employer or 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 worker's medical treatment should be continued."

SECTION 3. New statutory material is underscored.

SECTION 4. This Act shall take effect upon its approval.