WC Alert: Proposed Workers’ Compensation Medical Fee Schedule Changes Accepted by Maine WCB

Maine Workers' Comp Alert

The Maine Workers’ Compensation Board (WCB) must conduct a review of its medical fee schedule every three years. In the process, it must, pursuant to 39-A M.R.S.A. § 209-A(5), consider: (A) The private third-party payor average payment rates obtained from the Maine Health Data Organization; (B) Any material administrative burden imposed on providers by the nature of the workers’ compensation system; and (C) the goal of maintaining broad access for employees to all individual health care practitioners and health care facilities in the state. The following are some key recommendations:

  1. Professional anesthesia fees: Increases the anesthesia conversion factor from the current $50.00 to $60.00.
  2. All other professional fees: Keeps the professional conversion factor at $60.00.
  3. Durable medical equipment, prosthetics, orthotics, and supplies fees: Increases the maximum reimbursement for durable medical equipment, prosthetics, orthotics, and supplies from the current 125% of Medicare to 135% of Medicare.
  4. Inpatient acute care hospital facility fees: Increases the inpatient base rate from the current $9,217.18 to $11,121.68.
  5. Inpatient critical access hospital facility fees: Increases the inpatient base rate from the current $9,763.86 to $11,788.98, which is 106% of the acute care hospital base rate.
  6. Outpatient acute care hospital facility fees: Increases the outpatient base rate from the current $143.59 to $150.05. This is the current base rate adjusted by Medicare’s outpatient inflation factor for 2017 and 2018.
  7. Outpatient critical access hospital facility fees: Increases the outpatient base rate from the current $166.50 to $174.50.
  8. Ambulatory surgery center facility fees: Increases the current fee of $78.53 to $113.59.

The Medical fee schedule recommendations were considered by the WCB at its meeting on August 27 and accepted. They will now be sent to the Governor’s Office for review. If they are returned without issue, the rule-making process will begin, with hearings. This includes re-submission to the Governor’s Office if substantially amended, with review by the Attorney General’s Office and Secretary of State. It is expected that the process will be completed before the start of the new year.