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2015 SESSION

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HB 1820 Workers' compensation; pecuniary liability of the employer for medical services, report.

Introduced by: Peter F. Farrell | all patrons    ...    notes | add to my profiles | history

SUMMARY AS PASSED:

Workers' compensation; payment for medical services. Requires the Virginia Workers' Compensation Commission to determine the number and geographic area of communities across the Commonwealth. The measure also requires the Commission to convene a work group of stakeholder representatives of employers, health care service providers, claimants, and insurers to advise and assist the Commission in (i) reviewing, analyzing, and comparing information contained within and reports on all possible databases containing workers' compensation or health care data for medical services rendered in Virginia; (ii) reviewing, analyzing, and comparing information contained within and reports on how similar databases are used for the establishment of the pecuniary liability of the employer in other states; and (iii) making findings or recommendations as to how the databases reviewed and the contents thereof may serve to enhance or replace Virginia's current mechanisms for establishing the pecuniary liability of the employer for medical services provided to an injured employee.

SUMMARY AS PASSED HOUSE:

Workers' compensation; payment for medical services. Requires the Virginia Workers' Compensation Commission to establish the prevailing community rate for medical, surgical, or hospital services in communities at an amount that is representative of the charge for the same services charged by providers in the community where the services are provided in the Commonwealth. The Commission is directed to obtain a representative sample of charges for such services by providers in a community. If the sample size of data of charges is sufficient to serve as the basis for statistically significant results, the Commission shall establish the prevailing community rate for the service at the middle value of such mean, median, and mode of the charges for the same services. The Commission is required annually to adjust each prevailing community rate to reflect the rate of increase in the medical care component of the Consumer Price Index for All Urban Consumers (CPI-U). The Commission may further adjust each prevailing community rate in consideration of access to health care, the need to control costs, or factors. The measure will expire on July 1, 2018.

SUMMARY AS INTRODUCED:

Workers' compensation; payment for medical services. Limits an employer's liability for medical, surgical, and hospital service required under the Virginia Workers' Compensation Act to the amount that is generally paid to the provider for similar treatment when the provider is paid for the treatment by or on behalf of an individual receiving such treatment when not ordered by the Workers' Compensation Commission. That amount shall be the average amount reported to have been paid for the treatment based on paid claims data for covered benefits collected by the Virginia All-Payer Claims Database in the most recent year for which such paid claims data is available, plus 20 percent. However, if paid claims data is not available through the Virginia All-Payer Claims Database for the treatment, the amount shall be established by the Workers' Compensation Commission based on evidence produced by the provider or other interested party, including payments made by health insurers and other third-party payors. Currently, the employer's liability is such charges as prevail in the same community for similar treatment paid for by the injured person.