Fee Schedules

New Hampshire Works to Rein in WC Medical Fees

An amended bill would impose reductions on medical fees for three years, giving the state an opportunity to consider the need for a fee schedule based on Medicare rates.
By: | April 3, 2015

A medical fee schedule based on Medicare rates may not be in the offing in New Hampshire after all. A proposal to that effect has been amended and is being studied by members of a state Senate committee.

The amended version of Senate Bill 3 would impose reductions on medical fees for the next three years. During that time, a specially created commission would determine whether a fee schedule would also be needed.

“After considering the work of the governor’s commission to recommend reforms to reduce workers’ compensation medical costs, the workers’ compensation advisory council, and analysis by the insurance department, the general court has determined that overall workers’ compensation costs in New Hampshire are among the highest in the country and further, that medical costs under workers’ compensation are high in comparison to workers’ compensation medical costs in the region and countrywide, and to health care costs in New Hampshire,” the amendment reads. Therefore, “the general court hereby develops a process to reduce these costs.”

The proposal would limit the payment for medical services to “the lower of 85 percent of the charge in place as of December 31, 2014 or any payment rates established under an existing contract between a provider and workers’ compensation payer,” the proposal says. The baseline for payments established “shall remain in effect for a period of three years … with no adjustment for inflation during the first two years.”

The rates could be increased in the third year by an increase in the consumer price index for medical care if it exceeds 3.5 percent. Otherwise, the baseline payments would remain unchanged.

During the three years, officials would determine the savings achieved annually. The savings experienced by insurers are to be passed on to policyholders as rate reductions.

Meanwhile, a commission would be established to review and report on issues concerning medical payments in the workers’ comp system. It would consist of the labor commissioner or designee, the insurance commissioner or designee, three health care providers, three business representatives, and three representatives of labor.

“The commission shall review the reports issued by the labor commissioner, after consultation with the insurance commissioner … to evaluate the savings being obtained, shall study issues relating to workers’ compensation medical payments, and make recommendations for proposed legislation in support of the purpose of this paragraph,” the bill states. “The commission shall evaluate whether a fixed fee medical payment schedule is necessary to further reduce workers’ compensation medical costs and make a recommendation to the legislature concerning whether adoption and implementation of a fixed fee medical payment schedule and also determine the effects such a system would have on the workers’ compensation system generally.”

The proposal also would put the onus on health care providers to prove a charge is reasonable rather than keeping that responsibility with employers and insurers.

Nancy Grover is the president of NMG Consulting and the Editor of Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at [email protected]

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