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28th Legislature(2013-2014)

Bill Text 28th Legislature


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.                                                 
03                           _______________                                                                               
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                                     
01       regulation.                                                                                                       
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                                
05       regulation.                                                                                                       
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                                         
12       Administration.                                                                                                   
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                                          
05       Anesthesiologists;                                                                                                
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                                       
09       Association;                                                                                                      
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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