PA 07-31—sSB 1378

Labor and Public Employees Committee

Insurance and Real Estate Committee

AN ACT CONCERNING THE WORKERS' COMPENSATION MEDICAL PRACTITIONERS' FEE SCHEDULE AND TIME FOR FILING A WORKERS' COMPENSATION APPEAL

SUMMARY: This act requires the Workers' Compensation Commission chairman, by April 1, 2008, to develop, implement, and annually update a new medical practitioners' fee schedule using values from the Medicare resource-based relative value scale (RBRVS). The Medicare RBRVS conversion must be revenue neutral to the workers' compensation system. The fee schedule is used as a basis for physician and other practitioner fees for services provided under the Workers' Compensation Act. The chairman must also implement coding guidelines that conform to the federal Centers for Medicare and Medicaid Services' Correct Coding Initiative.

For services rendered under workers' compensation in cases where there is no established Medicare RBRVS, the act authorizes the chairman to make necessary adjustments to the fee schedule.

The act expands the list of people who can receive fees for service to include “other persons. ” By law, approved physicians, surgeons, podiatrists, optometrists, and dentists can receive fees under workers' compensation, but, in practice, other medical professionals also receive fees.

The act also delays the start of the 20-day deadline to file an appeal of a workers' compensation award or order to the Compensation Review Board in situations when a ruling is pending on a subsequently filed motion. Under the act, the 20-day period to file an appeal with the board begins when a compensation commissioner rules on the motion. Under prior law, the 20-day period began when a commissioner issued an award or order, regardless of any subsequent motions.

EFFECTIVE DATE: October 1, 2007

BACKGROUND

Medicare Resource-Based Relative Value Scale (RBRVS)

This scale ranks medical services according to the relative costs of resources needed to produce the services. Medicare uses three components to calculate resource costs (and therefore the relative value) of each medical service: (1) physician (or other provider) work, 55%; (2) practice expense, 42%; and (3) liability insurance, 3%. The total relative value of a particular medical service is multiplied by a conversion factor to determine the Medicare fee. The RBRVS method is familiar to and accepted by all physician practices because Medicare is the nation's largest medical services payer.

OLR Tracking: JM: SS: PF: RO