Newsline No. 42-10
August 10, 2010
Division of Workers' Compensation posts proposed revision to the hospital outpatient
departments and ambulatory surgical centers fee schedule regulations for pre-rulemaking
public comment
The Division of Workers' Compensation (DWC) has posted an online forum for members of the public to
review and comment on drafts of revisions to the hospital outpatient departments (HOPD) and ambulatory
surgical centers (ASC) fee schedule regulations which includes modification of the multiplier for payment of
services performed in ambulatory surgical centers. These draft revisions to the regulations are part of the
division’s 12-point plan to monitor and help control medical costs in California ’s workers' compensation
system.
The forum can be found at http://www.dwc.ca.gov/DWCWCABForum/1.asp and members of the public
may comment until Aug. 24, 2010.
Labor Code Section 5307.1 requires that the official medical fee schedule (OMFS) for ASCs be based on
the fee-related structure and rules of Medicare program. The Labor Code caps the aggregate allowances
for ASCs at 120 percent of the fee paid by Medicare for the same services performed in a HOPD setting.
On May 27, 2010 the division held a stakeholder meeting to discuss issues relating to consideration of
basing the ASC fee schedule on the Medicare ASC fee schedule. After considering the comments and
concerns raised at the stakeholder meeting, DWC now proposes to revise the ambulatory surgical center
fee schedule by modifying the multiplier for ambulatory surgical center facility fees to 100% of the Medicare
outpatient fee schedule or 102% multiplier that includes an extra 2% reimbursement for high cost outlier
cases.
Minor amendments have been made to the hospital outpatient departments and ambulatory surgical centers
fee schedule to conform to the above proposed change, to update, clarify, and to improve the format of the
regulations.
August 10, 2010
Division of Workers' Compensation posts proposed revision to the hospital outpatient
departments and ambulatory surgical centers fee schedule regulations for pre-rulemaking
public comment
The Division of Workers' Compensation (DWC) has posted an online forum for members of the public to
review and comment on drafts of revisions to the hospital outpatient departments (HOPD) and ambulatory
surgical centers (ASC) fee schedule regulations which includes modification of the multiplier for payment of
services performed in ambulatory surgical centers. These draft revisions to the regulations are part of the
division’s 12-point plan to monitor and help control medical costs in California ’s workers' compensation
system.
The forum can be found at http://www.dwc.ca.gov/DWCWCABForum/1.asp and members of the public
may comment until Aug. 24, 2010.
Labor Code Section 5307.1 requires that the official medical fee schedule (OMFS) for ASCs be based on
the fee-related structure and rules of Medicare program. The Labor Code caps the aggregate allowances
for ASCs at 120 percent of the fee paid by Medicare for the same services performed in a HOPD setting.
On May 27, 2010 the division held a stakeholder meeting to discuss issues relating to consideration of
basing the ASC fee schedule on the Medicare ASC fee schedule. After considering the comments and
concerns raised at the stakeholder meeting, DWC now proposes to revise the ambulatory surgical center
fee schedule by modifying the multiplier for ambulatory surgical center facility fees to 100% of the Medicare
outpatient fee schedule or 102% multiplier that includes an extra 2% reimbursement for high cost outlier
cases.
Minor amendments have been made to the hospital outpatient departments and ambulatory surgical centers
fee schedule to conform to the above proposed change, to update, clarify, and to improve the format of the
regulations.
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