Advocacy in Action | TeamHealth's Legislative Action Center

Workers' Compensation Fee Schedule- TMA Legislation

TMA's Workers Compensation legislation is scheduled to be heard this week in House Employee Affairs Subcommittee. The original bill had been slapped with a $1.5 million fiscal note, however, with amendatory language that has been developed, the fiscal note has been revised to show minimal impact to the State.

The state-mandated Workers' Compensation Medical Fee Schedule which took effect in 2005 capped reimbursement for medical services. It was anticipated that insurance payments could be less than the fee schedule if negotiated between the provider and payor. Such negotiations have not routinely taken place, yet payors are using contracts which existed prior to the implementation of the fee schedule to reimburse physician providers at discounted rates from the Medical Fee Schedule.

This legislation stipulates that, effective 1/1/08, MFS rates will be paid unless a discount, negotiated directly between the payor and provider, has been agreed upon. It provides employers and payors time to work out specific agreements. It would prohibit a discount worked out for one employer group to be applied without the provider's knowledge and consent to other employer groups.