Relates to the rates of payments for the treatment and care of injured employees

BILL NUMBER:S7455A

Title of bill

An act to amend the workers' compensation law, in relation to the rates of payment for the treatment and care of injured employees; and to amend chapter 592 of the laws of 2006 amending the workers' compensation law relating to the rates of payment for the treatment and care of injured employees, in relation to the effectiveness thereof

Purpose

Chapter 592 of 2006 allowed general hospitals to receive reimbursement for the use if implantable hardware and instrumentation in spinal surgeries for patients eligible under the Workers' Compensation law. The schedule fee (rates) for reimbursement for inpatient hospital services is set by the Commissioner of Health and are case based payments per discharge for each diagnosis-related group (DRG).

As required by statute, the Department of Health provided the Workers' Compensation Board with its new reimbursement rates for inpatient hospi- tal care on January 4,2010. These rates are based on a new methodology adopted by DOH know as All Patients Refined Diagnosis Related Groups (APR-DRG). The new rates were effective for all discharges between December 1,2009 and December 31, 2009. There will be new rates for discharges on or after January 1,2010. These rates will have different AP-DRG codes.

This bill will allow for the continued application of WCL§ 13 (a-l) through March 30, 2011 and will apply to whichever APR-DRG codes are in effect for the specific procedures.

Summary of provisions

Amends subdivision (a-1) of section 13 of the workers' compensation law.

Existing law

Chapter 592 of the laws of 2006, which amended the Workers' Compensation law regarding the reimbursement of general hospitals for the use of implantable hardware and instrumentation in spinal surgeries, was enacted.

Justification

Back injuries are a common problem for injured employees seeking bene- fits from the Workers' Compensation program. For many diagnoses, spinal fusion surgery is the recommended treatment for such individuals and results in superior outcomes. In most cases, the use of spinal Implants is the preferable method of performing spinal fusion surgery and has become the medical standard for care. From a financial standpoint, however, performing fusion surgery with implants involves a higher cost. This higher cost is more than recouped in the savings derived from a shorter hospital stay, more effective rehabilitation and better results. The ability of the patient to return to work sooner presents additional

savings for employers and insurers with an employee out with a Worker's Compensation injury or disability.

Legislative history

New Bill.

Fiscal implications

Undetermined, though savings will be achieved by moving people from Workers' Compensation back into the workforce.

Effective date

This act shall take effect immediately and shall expire March 31, 2011 when upon such date the provisions of this act shall be deemed repealed.