No. 42567 (Amendment): Section R612-300-4. General Method for Computing Medical Fees

(Amendment)

DAR File No.: 42567
Filed: 02/08/2018 09:04:36 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this rule change is to correct a typographical error in the rule text. The anesthesiology conversion factors were approved by the Workers' Compensation Advisory Council at $62 not the $65 as stated in the current rule text.

Summary of the rule or change:

The purpose of this rule change is to correct a typographical error in the rule text. The anesthesiology conversion factors were approved by the Workers' Compensation Advisory Council at $62 not the $65 as stated in the current rule text.

Statutory or constitutional authorization for this rule:

• Section 34A-2-201
• Section 34A-1-104

Anticipated cost or savings to:

the state budget:

There would be a savings of $3 per unit of anesthesiology charged in workers' compensation cases.

local governments:

There would be a savings of $3 per unit of anesthesiology charged in workers' compensation cases.

small businesses:

There would be a savings of $3 per unit of anesthesiology charged in workers' compensation cases.

persons other than small businesses, businesses, or local governmental entities:

There would be a savings of $3 per unit of anesthesiology charged in workers' compensation cases.

Compliance costs for affected persons:

There would be a savings of $3 per unit of anesthesiology charged in workers' compensation cases.

Comments by the department head on the fiscal impact the rule may have on businesses:

There would be a savings of $3 per unit of anesthesiology charged in workers' compensation cases.

Jaceson Maughan, Commissioner

The full text of this rule may be inspected, during regular business hours, at the Office of Administrative Rules, or at:

Labor Commission
Industrial Accidents
HEBER M WELLS BLDG
160 E 300 S
SALT LAKE CITY, UT 84111-2316

Direct questions regarding this rule to:

• Ron Dressler at the above address, by phone at 801-530-6841, by FAX at 801-530-6804, or by Internet E-mail at [e-mail]
• Christopher Hill at the above address, by phone at 801-530-6113, by FAX at 801-530-6390, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

04/02/2018

This rule may become effective on:

04/09/2018

Authorized by:

Jaceson Maughan, Commissioner

RULE TEXT

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs

FY 2018

FY 2019

FY 2020

State Government

$0

$0

$0

Local Government

$0

$0

$0

Small Businesses

$0

$0

$0

Non-Small Businesses

$0

$0

$0

Other Person

$0

$0

$0

Total Fiscal Costs:

$0

$0

$0

Fiscal Benefits

State Government

$0

$0

$0

Local Government

$0

$0

$0

Small Businesses

$0

$0

$0

Non-Small Businesses

$0

$0

$0

Other Persons

$0

$0

$0

Total Fiscal Benefits:

$0

$0

$0

Net Fiscal Benefits:

$0

$0

$0

*This table only includes fiscal impacts that could be measured. If there are inestimable fiscal impacts, they will not be included in this table. Inestimable impacts for State Government, Local Government, Small Businesses and Other Persons are described above. Inestimable impacts for Non-Small Businesses are described below.

 

Appendix 2: Regulatory Impact to Non-Small Businesses

 

There are a total of 8 Utah companies that provide workers compensation insurance (NAICS Code 525190). We are unable to estimate the benefit to them from this rule, because the number of workers' compensation claims that will require anesthesia are unknown. However, if anesthesia is needed a savings of $3 per unit used will be seen with the passage of this rule. It is possible that these 8 businesses will pass the savings on to their policy holders through a reduction in premiums.

This rule will also affect providers of workers' compensation benefits that are not Utah businesses. It is possible that these non-Utah businesses will also pass the savings onto their Utah business policy holders through a reduction in premiums. All businesses in Utah with employees are required to carry workers compensation insurance and could therefore see an indirect savings from this rule. The Labor Commission is unable to estimate the benefit to Utah Businesses.

Utah Labor Commissioner, Jaceson R. Maughan has reviewed and approved this fiscal analysis.

 

R612. Labor Commission, Industrial Accidents.

R612-300. Workers' Compensation Rules - Medical Care.

R612-300-4. General Method For Computing Medical Fees.

A. Adoption of "CPT" and "RBRVS." The Labor Commission hereby adopts and by this reference incorporates:

"Optum 2017 The Essential RBRVS, 2017 1st Quarter Update," designated as RBRC17/U1787 and U1787R ("RBRVS" hereafter).

B. Medical fees calculated according to the RBRVS relative value unit assigned to each CPT code. Unless some other provision of these rules specifies a different method, the RBRVS is to be used in conjunction with the "conversion factors" established in subsection C. of this rule to calculate payments for medical care provided to injured workers.

C. Conversion Factors. Fees for medical care of injured workers shall be computed by determining the relative value unit ("RVU") assigned by the RBRVS to a CPT code and then multiplying that RVU by the following conversion factors for specific medical specialties:

1. Anesthesiology (1 unit per 15 minutes of anesthesia): $6[5]2.00;

2. Medicine (Evaluation and Medicine Codes 99201 - 99204 and 99211-99214): $50.00;

3. Pathology and Laboratory: $56.00;

4. Radiology: $58.00;

5. Restorative Services: $50.00;

6. Surgery (all 20000 codes, codes 49505 thru 49525, and all 60000 codes): $65.00;

7. Other Surgery: $43.00.

D. Fees for Medical care not addressed by CPT/RBRVS, or requiring unusual treatment.

1. The payor and medical provider may establish and agree to a reasonable fee for medical care of an injured worker if:

a. neither the CPT/RBRVS or any other provision of these rules address the medical care in question; or

b. application of CPT/RBRVS or other provisions of these rules would result in an inadequate fee due to extraordinary difficulty of treatment.

2. If the medical provider and payor cannot agree to a reasonable fee in such cases, the provider can request a hearing before the Commission's Adjudication Division to establish a reasonable fee.

 

KEY: workers' compensation, fees, medical practitioners, nurse practitioners

Date of Enactment or Last Substantive Amendment: December 22, 2016

Authorizing, and Implemented or Interpreted Law: 34A-1-104; 34A-2-201

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