Workers' compensation; fee schedules for medical services. (SB631)

Introduced By

Sen. Frank Wagner (R-Virginia Beach)

Progress

Introduced
Passed Committee
Passed House
Passed Senate
Signed by Governor
Became Law

Description

Workers' compensation; fee schedules for medical services. Directs the Workers' Compensation Commission (the Commission) to adopt regulations establishing fee schedules setting the maximum pecuniary liability of the employer for medical services provided to an injured person pursuant to the Virginia Workers' Compensation Act, in the absence of a contract under which the provider has agreed to accept a specified amount for the medical service. The regulations implementing the fee schedules shall become effective on January 1, 2018. The initial fee schedules will set amounts based on a reimbursement objective, which is the average of all amounts paid to providers in the same category of providers for the medical service in the same medical community. The Commission is required to retain a firm to assist it in establishing the initial fee schedules. The firm will recommend a methodology that will provide statistically valid estimates of the reimbursement objective for fee scheduled medical services within the medical communities. Reimbursements for medical services provided to treat traumatic injuries and serious burns are excluded from the fee schedules and liability for their treatment costs will be based, absent a contract, on 80 percent of the provider's charges. However, the required reimbursement will be 100 percent of the provider's charges if the employer unsuccessfully contests the compensability of the claim. The Commission is required to review and revise the fee schedules in the year after they become effective and biennially thereafter. The liability of the employer for certain medical services not included in a fee schedule will be set by the Commission. A stop-loss feature allows hospitals to receive payments or reimbursements that exceed the fee schedule amount for certain claims when the total charges exceed a charge outlier threshold, which initially is 150 percent of the maximum fee for the service set forth in the applicable fee schedule. Providers are prohibited from using a different charge master or schedule of fees for any medical service provided for workers' compensation patients than the provider uses for health care services provided to patients who are not claimants. The measure requires the Commission, when determining whether the employee's attorney's work with regard to a contested claim resulted in an award of benefits that inure to the benefit of a third-party insurance carrier or health care provider, and in determining the reasonableness of the amount of any fee awarded to an attorney, to consider only the amount paid by the employer or insurance carrier to the third-party insurance carrier or health care provider for medical services rendered to the employee through a certain date and not to consider additional amounts previously paid to a health care provider or reimbursed to a third-party insurance carrier. The Commission shall have an independent, peer-reviewed study conducted every two years. The regulations setting fee schedules are exempt from the Administrative Process Act if the Commission utilizes a regulatory advisory panel to assist in the development of such regulations and provides an opportunity for public comment on the regulations prior to adoption. The measure prohibits certain practices involving the use by third parties of contracts whereby a provider agrees to accept payment of less than the fee scheduled amount, including restricting the sale, lease, or other dissemination of information regarding the payment amounts or terms of a provider contract without the express written consent and prior notification of all parties to the provider contract and prohibiting an employer from shopping for the lowest discount for a specific provider among the provider contracts held in multiple PPO networks. The regulatory advisory panel is directed to make recommendations to the Commission prior to July 1, 2017, on workers' compensation issues relating to (i) pharmaceutical costs not previously included in the fee schedules; (ii) durable medical equipment costs not previously included in the fee schedules; (iii) certain awards of attorney fees; (iv) peer review of medical costs; (v) prior authorization for medical services; and (vi) other issues that the Commission assigns to it. The existing peer review provisions are repealed. The measure has an emergency clause. Amends § 2.2-4006, § 65.2-605, § 65.2-714, of the Code of Virginia. Read the Bill »

Outcome

Bill Has Passed

History

DateAction
01/15/2016Presented and ordered printed with emergency clause 16103646D
01/15/2016Referred to Committee on Commerce and Labor
02/01/2016Reported from Commerce and Labor with amendments (15-Y 0-N) (see vote tally)
02/03/2016Constitutional reading dispensed (40-Y 0-N) (see vote tally)
02/04/2016Read second time
02/04/2016Reading of amendments waived
02/04/2016Committee amendments agreed to
02/04/2016Engrossed by Senate as amended SB631E
02/04/2016Printed as engrossed 16103646D-E
02/05/2016Read third time and passed Senate (39-Y 0-N) (see vote tally)
02/11/2016Placed on Calendar
02/11/2016Read first time
02/11/2016Referred to Committee on Commerce and Labor
02/11/2016Impact statement from DPB (SB631E)
02/18/2016Reported from Commerce and Labor with amendments (21-Y 0-N) (see vote tally)
02/19/2016Read second time
02/22/2016Read third time
02/22/2016Committee amendments agreed to
02/22/2016Engrossed by House as amended
02/22/2016Passed House with amendments BLOCK VOTE (100-Y 0-N)
02/22/2016VOTE: BLOCK VOTE PASSAGE (100-Y 0-N) (see vote tally)
02/24/2016House amendments agreed to by Senate (39-Y 0-N) (see vote tally)
02/25/2016Enrolled
02/25/2016Bill text as passed Senate and House (SB631ER)
02/25/2016Impact statement from DPB (SB631ER)
02/25/2016Signed by Speaker
02/26/2016Signed by President
02/29/2016Enrolled Bill Communicated to Governor on 2/29/16
02/29/2016G Governor's Action Deadline Midnight, March 7, 2016
03/07/2016G Approved by Governor-Chapter 290 (effective 3/7/16)

Video

This bill was discussed on the floor of the General Assembly. Below is all of the video that we have of that discussion, 1 clip in all, totaling 1 minute.

Transcript

This is a transcript of the video clips in which this bill is discussed.



Sen. Bill Stanley (R-Moneta): REDUNDANCY WHERE WE STATED THE WORD THE CIRCUIT COURT IN THE AIM AREA MORE THAN ONCE. WHAT WE HAVE IS JUST GRAMMATICAL CLEANING UP OF THE EXISTING CODE. I WOULD RENEW MY MOTION TO CONCUR WITH THE HOUSE

Del. Bill Howell (R-Fredericksburg): SENATOR, THE QUESTION IS AMENDMENTS. SHALL THE SENATE CONCUR WITH THE HOUSE AMENDMENTS. ALL IN FAVOR OF THE MOTION WILL. ARE THE SENATORS READY TO VOTE? HAVE ALL THE SENATORS VOTED? DO ANY SENATORS DESIRE TO CH ANGE THEIR VOTE? THE CLERK WILL CLOSE THE ROLL.

[Unknown]: AYES 40, NOS 0. AYES 40, NOS 0. THE SENATE CONCURS WITH THE HOUSE AMENDMENTS. SENATE BILL 631 PASSED THE HOUSE WITH AMENDMENTS. THE SENIOR SENATOR FROM VIRGINIA BEACH, SENATOR WAGNER.

Sen. Frank Wagner (R-Virginia Beach): MR. PRESIDENT, I MOVE THAT WE CONCUR WITH THE HOUSE AMENDMENTS AND SPEAKING TO THAT.

[Unknown]: THE SENATOR HAS THE FLOOR.

Sen. Frank Wagner (R-Virginia Beach): SENATE BILL 631 DEALS WITH THE ISSUE OF FEE SCHEDULES FOR WORK MEN'S COMP CLAIMS SO THERE IS A DEGREE OF CERTAINTY IN TERMS OF HOW MUCH INJURIES ARE TO BE COMPENSATED FOR. A PANEL SETS UP THE FEE SCHEDULE AND DEVELOPS THE REGULATION AND THE HOUSE AMENDMENT REMOVES THE ONE INDIVIDUAL THAT WOULD BE AN EMPLOYER REPRESENTED BY A THIRD-PARTY INSURED WHICH REALLY