SB 665

This bill makes various changes to the worker's compensation law, as

administered by the Department of Workforce Development and the Division of

Hearings and Appeals in the Department of Administration.

Payment of benefits; other payments

Health service fee schedule

This bill requires DWD, by January 1, 2019, to establish a schedule of the

maximum fees that a health care provider may charge an employer or insurer for

health services provided to an injured employee who claims worker's compensation

benefits. Under the bill, DWD must, when that schedule is established, notify the

Legislative Reference Bureau, and the LRB must publish that notice in the

Wisconsin Administrative Register. The reasonableness of the health service fee

dispute resolution process under current law does not apply to health services

provided on or after the date of the notice. The liability of an employer or insurer for

a health service included in the fee schedule is then limited to the lesser of the

maximum fee allowed under the schedule or the health care provider's actual fee for

that health service as of the date on which the health service was provided.

The bill requires DWD to establish the maximum fees by using a formula that

compares the cost for group health plans and self-insured plans with the cost under

the federal Medicare program for health services included in the schedule. DWD

must first determine the average negotiated price for insured and self-insured group

health plans for each health service included in the schedule. Records related to the

collection of that information are not subject to disclosure under the public records

law. DWD must then determine the payment made under the federal Medicare

program for each health service included in the schedule, and then determine the

average variance in prices under the group health and self-insured plans and under

the federal Medicare program for each health care service included in the schedule.

The bill then requires DWD to increase the prices under the federal Medicare

program by the average variation in prices. Finally, DWD must increase the cost of

each health service by 2.5 percent for administrative costs or by an alternative

percentage not to exceed 10 percent if DWD determines, based on information

provided by health care providers before the schedule initially takes effect, that the

2.5 percent increase is insufficient to pay for the administrative costs of treating

worker's compensation patients.

The bill requires DWD to adjust those maximum fees annually by the change

in the consumer price index for medical care services and, no less often than every

ten years, to redetermine the average negotiated prices for group health plans and

self-insured plans and payments under the federal Medicare program for the

services included in the schedule and revise the maximum fees based on those

redetermined amounts.

Additional payments for permanent partial disability