SF3420 Summary

• Establishes a hospital outpatient fee schedule (HOFS) effective October 1, 2018, based on Medicare OPPS codes with separate conversion factors for critical access hospitals and larger hospitals, with annual adjustments based on Medicare market basket index.

• Creates payment rules for ambulatory surgical centers (ASCs) capping payment at the lesser of usual and customary charges or 320 percent of Medicare ASCPS payment, with provisions for procedures not covered under Medicare ASCPS.

• Implements standardized billing and dispute resolution procedures for hospital outpatient and ASC services, including required use of Medicare coding, prior authorization requirements, one-year filing deadlines for reconsideration requests, and four percent annual interest on disputed payments.

• Modifies workers' compensation benefits including extended temporary partial disability from 225 to 275 weeks, updated permanent partial disability compensation amounts, and presumptive occupational disease status for public safety employees exposed to infectious diseases or diagnosed with post-traumatic stress disorder.

• Requires treatment standards for post-traumatic stress disorder based on American Psychological Association clinical practice guidelines and allows continued temporary partial compensation during approved retraining plans without standard week limitations.