Bill Text: CA SB896 | 2011-2012 | Regular Session | Amended

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Bill Title: Workers' compensation: spinal surgeries.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2012-01-31 - Returned to Secretary of Senate pursuant to Joint Rule 56. [SB896 Detail]

Download: California-2011-SB896-Amended.html

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BILL NUMBER: SB 896	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 27, 2011

INTRODUCED BY   Senator De León

                        FEBRUARY 18, 2011

   An act to amend Section 5318 of the Labor Code, relating to
workers' compensation.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 896, as amended, De León. Workers' compensation:  spine
  spinal  surgeries.
   Existing law establishes a workers' compensation system,
administered by the Administrative Director of the Division of
Workers' Compensation, to compensate an employee for injuries
sustained in the course of his or her employment. Existing law,
operative only until the administrative director adopts a regulation
specifying separate reimbursement, if any, for implantable medical
hardware or instrumentation for complex spinal surgeries, requires
that implantable medical devices, hardware, and instrumentation for
specified Diagnostic Related Groups (DRGs) be separately reimbursed
in accordance with a prescribed formula.
   This bill would instead require that specified  spine
  spinal  surgeries be reimbursed  to the
performing hospital at the rate of 1.8 times the applicable DRG rate,
with no separate reimbursement for any implantable devices,
hardware, or instrumentation   in accordance with the
prescribed formula, but, unless the case qualifies for outlier
reimbursement, the bill would cap the total payment to the provider
at 2 times the applicable rate  .
   Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 5318 of the Labor Code is amended to read:
   5318.   Spine   Spinal  surgeries with
implantable medical devices, hardware, and instrumentation 
for   as defined by Medical Severity  Diagnostic
Related Groups  (DRGs)   (MSDRGs) 028, 029,
 030, 453, 454, 455,  457,   456, 457, 458,
 459, 460, 471,  473, and 491   472, and
473, or successor MSDRGs, shall be  reimbursed to the
performing hospital at the rate of 1.8 times the applicable DRG rate,
with no separate reimbursement for any implantable devices,
hardware, or instrumentation.   separately reimbursed at
the provider's documented paid cost, plus an additional 10 percent
of the provider's documented paid cost, not to exceed a maximum of
two hundred fifty dollars ($250), plus any sales tax and shipping and
handling charges actually paid. Unless the case qualifies for
outlier reimbursement, total payment to the provider shall not exceed
2 times the applicable MSDRG rate.