Bill Text 28th Legislature
- Session Laws
00 Enrolled 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.
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
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
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
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
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
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.
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