Bill Text: HI SB413 | 2018 | Regular Session | Introduced
Bill Title: Relating To Workers' Compensation.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2018-01-17 - Re-Referred to LBR, WAM. [SB413 Detail]
Download: Hawaii-2018-SB413-Introduced.html
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THE SENATE |
S.B. NO. |
413 |
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TWENTY-NINTH LEGISLATURE, 2017 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
relating to workers' compensation.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that injured workers, generally of average adult age and employed, are dissimilar from the medicare population, mostly an elderly group with chronic degenerative conditions. Injured workers need immediate access to physicians and rehabilitative providers for treatment to appropriately return to work as soon as possible. Access to medical and rehabilitative treatment for injured workers is restricted because few providers accept workers' compensation patients due to burdensome documentation and reporting, slow approval and payment processing, and inadequate fee reimbursements. Access to workers' compensation treatment is especially limited on neighbor islands where there is already a shortage of physicians.
Section 386-21, Hawaii Revised Statutes, requires the director of labor and industrial relations to determine charges that do not exceed one hundred ten per cent of fees prescribed in the Medicare Resource Based Relative Value Scale applicable to Hawaii and allows the director to establish an additional fee schedule under certain circumstances. The state auditor's 2013 "Report on Methodology for the Department of Labor and Industrial Relations' Workers' Compensation Medical Fee Schedule" states that flat medicare fee reimbursement rates since at least 2011 indicate the need for an incentive for doctors. Currently, medicare physician fee reimbursements are about eighty per cent of those paid by private health insurance. These fee reimbursements are projected to drop to forty per cent within twenty years and to twenty-five per cent in seventy-five years. If Congress continues to allow this reimbursement differential, increasingly severe problems with access to physician services are expected.
The legislature further finds that the United States Department of Labor Office of Workers' Compensation Programs (OWCP), a nationwide program for federal workers, protects the interests of workers who are injured or become ill on the job, their families, and their employers by making timely, appropriate, and accurate decisions on claims, providing prompt payment of benefits, and helping injured workers return to gainful work as early as is feasible. The OWCP fee schedule provides the necessary incentive for Hawaii's physicians and rehabilitation providers to treat injured workers and eliminates the need for the department of labor and industrial relations' limited staff and resources to review thousands of fee codes to determine appropriate reimbursement.
The purpose of this Act is to ensure that injured workers receive medical treatment through rates and fees that are adequate for standards of services and care intended for injured employees.
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,] 2018, 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
applicable to Hawaii as prepared by the United States Department of Health and
Human Services, except as provided in this subsection.] correspond to
codes and fees as established in the United States Department of Labor Office
Workers' Compensation Programs fee schedule. 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] United States
Department of Labor Office Workers' Compensation Programs fee schedule for
a medical treatment, accommodation, product, or service existing as of June 29,
1995, is not covered under the [medicare program,] fee schedule,
the director, at any time, may establish an additional fee schedule or
schedules not [exceeding] below 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 which 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[:
(1) Future] future charges or
additions prescribed in the [Medicare Resource Based Relative Value Scale
applicable to Hawaii as prepared by the United States Department of Health and
Human Services; or
(2) A statistically valid survey by the
director of prevalent charges for fees for services actually received by
providers of health care services or based upon the information provided to the
director by the appropriate state agency having access to prevalent charges for
medical fee information.] Office Workers' Compensation Programs fee
schedule as prepared by the United States Department of Labor.
When a dispute exists between an insurer or self-insured employer and a medical services 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 employee and the employer or the employer's insurer regarding the proposed treatment plan or whether medical services should be continued, the employee shall continue to receive essential medical services prescribed by the treating physician necessary to prevent deterioration of the employee's condition or further injury until the director issues a decision on whether the employee's medical treatment should be continued. The director shall make a decision within thirty days of the filing of a dispute. 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 employee's personal health care provider qualified pursuant to section 386-27, or from any other appropriate occupational or non-occupational insurer, all the sums paid for medical services rendered after the date designated by the director. Under no circumstances shall the employee be charged for the disallowed services, unless the services were obtained in violation of section 386-98. The attending physician, employee, employer, or insurance carrier may request in writing that the director review the denial of the treatment plan or the continuation of medical services."
SECTION 3. The department of labor and industrial relations shall analyze the impact of this Act on workers' compensation claimants' access to appropriate treatment and report its findings and recommendations, including any proposed legislation, to the legislature no later than twenty days prior to the convening of the regular session of 2024.
SECTION 4. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2017-2018 and the same sum or so much thereof as may be necessary for fiscal year 2018-2019 for analysis of the impact of this Act on workers' compensation claimants' access to appropriate treatment.
The sums appropriated shall be expended by the department of labor and industrial relations for the purposes of this Act.
SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 6. This Act shall take effect on January 1, 2018, and shall be repealed on December 31, 2024; provided that section 386-21(c), Hawaii Revised Statutes, shall be reenacted in the form in which it read on the day prior to the effective date of this Act.
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INTRODUCED BY: |
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Report Title:
Workers' Compensation; Medical Fee Schedule; Appropriation
Description:
Requires the director of labor and industrial relations to set workers' compensation medical charges that correspond to the United States Department of Labor Office of Workers' Compensation Programs fee schedule instead of the Medicare Resource Based Relative Value Scale applicable to Hawaii. Requires the department of labor and industrial relations to submit a report to the legislature. Makes an appropriation for analysis of the Act's impact on injured worker's access to treatment. Repeals on 12/31/2024.
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
