Bill Text: HI HB922 | 2014 | Regular Session | Amended
Bill Title: Workers' Compensation Medical Treatment; Decisions Without a Hearing
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Engrossed - Dead) 2013-12-18 - Carried over to 2014 Regular Session. [HB922 Detail]
Download: Hawaii-2014-HB922-Amended.html
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HOUSE OF REPRESENTATIVES |
H.B. NO. |
922 |
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TWENTY-SEVENTH LEGISLATURE, 2013 |
H.D. 2 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO MEDICAL BENEFITS UNDER THE WORKERS' COMPENSATION LAW.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. 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, 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. 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 a medical treatment, accommodation, product, or service existing as of June 29, 1995, is not covered under the medicare program, the director, at any time, may establish an additional fee schedule or schedules not exceeding 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 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.
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] Notwithstanding section 386-86,
the director [shall] may make a decision without a hearing,
upon the mutual consent of both parties, provided that the decision shall be
made 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 2. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 3. This Act shall take effect upon its approval and shall be repealed on June 30, 2015; provided that section 386-21(c), Hawaii Revised Statutes, shall be reenacted in the form in which it read on the day before the effective date of this Act.
Report Title:
Workers' Compensation Medical Treatment; Decisions Without a Hearing
Description:
Allows the Director of Labor and Industrial Relations to make a decision on disputes regarding treatment plans and continued medical services without a hearing, upon the mutual consent of both parties. (HD2)
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
