Loading chat...
IN SB0278
Bill
Status
1/4/2018
Primary Sponsor
Philip Boots
Click for details
AI Summary
Senate Bill 278 Summary
-
Caps employer/insurance carrier liability for medical services provided by medical service facilities at 200% of the facility's Medicare reimbursement rate when no amount has been negotiated.
-
Applies to services covered under worker's compensation and occupational disease compensation provided by hospitals, hospital-based health facilities, and medical centers after July 1, 2018.
-
Allows negotiated rates between medical service facilities and employers, insurance carriers, billing review services, or direct provider networks to supersede the 200% Medicare-based cap.
-
Requires billing review services to use community-based billing data, update standards semiannually, and base reimbursement rates on the 80th percentile of provider charges for non-facility medical service providers.
-
Establishes civil penalties of $100-$1,000 for billing review services that fail to comply with pecuniary liability standards.
Legislative Description
Medical service facility pecuniary liability. Provides that, if another amount is not negotiated, the pecuniary liability of an employer or the employer's insurance carrier for a specific service or product covered under worker's compensation or occupational diseases compensation and provided by a medical service facility is not more than 200% of the amount that would be paid to the medical service facility on the same date for the same service or product under the medical service facility's Medicare reimbursement rate.
Last Action
First reading: referred to Committee on Pensions and Labor
1/4/2018