Bulletin No. 16-04
April 9, 2004

Clarification of alternate payment methodology time frame

In Newsline #14-04, dated April 6, 2004, we noted that the list of medical facilities for outpatient services electing to use the "high cost outlier" payment methodology provided for in Labor Code section 9789.33 (b) has been posted to the DWC web site at: http://www.dir.ca.gov/IMC/costchrg.html. However, we neglected to point out the period of time for which the election is effective. For the facilities listed, the formula applies for one year beginning with dates of admission on or after April 1, 2004.

Specifically, Labor Code section 9789.33 (c) (1) states that: "a facility seeking to be paid for high cost outlier cases under subdivision 9789.33 (b) must file a written election using DWC Form 15 "Election for High Cost Outlier," contained in Section 9789.37. The form must be filed by March 1 of each year and shall be effective for one year commencing with services furnished on or after April 1 of the year in which the election is made."