DWC issues second 15-day notice of modifications to text of proposed inpatient hospital fee schedule regulations and notice of additional documents added to the rulemaking file
The Division of Workers’ Compensation (DWC) has modified the text of proposed inpatient hospital fee schedule regulations. DWC has electronically distributed second 15-day notice of modification to interested parties and has posted the modified regulations on the DWC website. Members of the public may comment on the modifications until 5 p.m., November 28, 2012.
The proposed modifications to the text of the inpatient hospital fee schedule regulations are authorized by Labor Code sections 59, 133, 4603.5, 5307.1, and 5307.3.
The modifications in this draft of the regulations:
- Clarify how outlier cases are determined and how reimbursement is calculated.
For discharges before January 1, 2013, the charges for spinal devices reimbursed under section 9789.22(g)(1) is excluded from calculation of costs; and if the complex spinal surgery DRG qualifies as a cost outlier case, any spinal device costs will be separately reimbursed under section 9789.22(g)(1).
For discharges on or after January 1, 2013, the cost for spinal devices will be included when determining costs; and any additional allowance under section 9789.22(g)(2), will be included when determining the outlier threshold.
The outlier calculation is adjusted to avoid cost compression.
- Change the additional allowance for spinal devices used in specified complex spinal surgery MS-DRGs, for discharges on or after January 1, 2013 but before January 1, 2014. In particular, MS-DRGs 453, 454, and 455 shall receive an additional allowance of $9,140 for spinal devices; MS-DRG 456 shall receive an additional allowance of $3,170 for spinal devices; and MS-DRGs 028, 029, and 030 shall receive an additional allowance of $670 for spinal devices.
- Clarify that the administrative director may extend section 9789.22(g)(2) beyond the January 1, 2014 repeal date, through a later enacted regulation.
A list of additional documents added to the rulemaking file is provided, and the documents are available for public review at DWC’s office located at 1515 Clay St., 17th Floor, Oakland, during normal business days and hours.