Bath Iron Works Corp. v. Maine Workers' Compensation Bd.

CourtSuperior Court of Maine
DecidedAugust 11, 2008
DocketKENap-06-74
StatusUnpublished

This text of Bath Iron Works Corp. v. Maine Workers' Compensation Bd. (Bath Iron Works Corp. v. Maine Workers' Compensation Bd.) is published on Counsel Stack Legal Research, covering Superior Court of Maine primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bath Iron Works Corp. v. Maine Workers' Compensation Bd., (Me. Super. Ct. 2008).

Opinion

STATE OF MAINE SUPERIOR COURT KENNEBEC, ss. CIVIL ACTION Docket No. AP-06-74

BATH IRON WORKS CORP.

Petitioner

v.

MAINE WORKERS' COMPENSATION BOARD

Respondent

v. DECISION AND ORDER

MAINE WORKERS' CONIPENSATION COORDINATING COUNCIL, et al.

Intervenors

MAINE HOSPITAL ASSOCIATION,

Amicus Curiae

Pursuant to M.R. Civ. P. SOc, 1 the petitioner seeks judicial review of the

respondent Maine Workers' Compensation Board (the Board)'s final agency action with

regard to whether the respondent's 5% discount for prompt payment set out in the

Board Rule Chapter 5, Section 3,2 satisfies the statutory requirements of title 39-A,

1 In their complaint, the intervenors question whether the $60 conversion factor in the Board's Medical Fee Schedule is too high based on the terms of § 209. This issue is not part of the 80C Petition and has been briefed only by the respondent and the intervenors. Contrary to the Board's argument, consideration of this issue at this time appears contrary to the pre-trial orders dated 6/7/07 and 8/7/07.

2 § 3. PAYMENT TO HOSPITALS

Hospital out-patient charges only are subject to this fee schedule to the extent that those services can be identified by CPT code. section 209(1)(A) of the Maine Revised Statutes. 3 In count I of the petition, the

petitioner requests that the court remand this matter to the Board to comply with the

mandate of section 209(l)(A) by adopting "standards, schedules, or scales of maximum

charges" for medical facilities. M.R. Civ. P. SOC(c); 5 M.R.S. §§ 11001(2) & 11007(4)(B)

(2007).

The Board has established a fee schedule for maximum charges for professional

or physician services, but has established only a 5% discount for prompt payment for

hospital or facility charges. The petitioner argues that a 5% discount does not comply

with the legislative mandate of section 209(1)(A) because 1) the schedule, standard or

scale established by a 5% discount on charges determined by the hospital or facility

does not as a matter of law comply with the mandate of section 209(1)(A); and 2) the

Board was statutorily required to "consider maximum charges paid by private 3rd­

party payors for similar services provided by health care providers in the State" in

Hospital reimbursement for services provided to an injured worker who is an inpatient at a hospital shall be discounted at 5% based on payment received within 30 days of the original billing date. Full hospital rates will apply when payment is not made within the 3D-day period ..

The Workers' Compensation medical fee schedule for surgical procedures was intended to cover the professional component of those services only. It is not intended to cover the facility charges for those same services ...Reimbursement for services provided to an injured worker who is an inpatient at a surgical center shall be discounted at 5% based on payments received within 30 days of the original billing date. Full rates will apply when payment is not made within the 30 day period.

(R. Vol. IX at 3620.)

3 Title 39-A, section 209 ofthe Maine Revised Statutes provides, in part: 1. Standards, schedules or scales. In order to ensure appropriate limitations on the cost of health care services, the board shall adopt rules that establish:

A. Standards, schedules or scales of maximum charges for individual services, procedures or courses of treatment. In establishing these standards, schedules or scales, the board shall consider maximum charges paid by private 3rd-party payors for similar services provided by health care providers in the State and shall consult with organizations representing health care providers and other appropriate groups. The standards must be adjusted annually to reflect any appropriate changes in levels of reimbursement. The standards apply to hospital costs and health care providers and must be in effect no later than January 1, 1993 ....

2 establishing a schedule, standard or scale, and the record does not reveal that this was

done.

This case raises an issue of statutory interpretation by an administrative agency. Our primary purpose in statutory interpretation is to give effect to the intent of the Legislature. We do so first by reviewing the plain language of the statute, and if the language is unambiguous, we interpret the statute according to its plain language. When a statute is ambiguous we defer to the interpretation of the agency charged with its administration, if the agency's interpretation is reasonable.

Arsenault v. Secretary of State, 2006 ME 111, c:rr 11, 905 A.2d 285, 287-88 (citations omitted).

I. Whether the 5% discount is a standard, schedule or scale identified in section 209(1)

After the parties filed briefs in this case, the Law Court rendered its opinion in the

combined cases of Fernald v. Shaw's Supermarkets, Inc. and Babine v. Bath Iron Works, 2008

ME 81, 946 A.2d 395. 4 In the combined cases, the Law Court considered whether a Workers'

Compensation Board hearing officer erred when, in the absence of a promulgated fee schedule

for facility charges, the hearing officer ordered employers to pay the facility's "usual and

customary charges" without allowing the employers to inquire about the amount charged to

private third-party payors for the same services or to challenge the reasonableness of the

charges. Id. c:rr I, 946 A.2d at 396; 39-A M.R.S. §§ 209(1) & (2) (2007).

The Court affirmed the hearing officer's decisions. The majority opinion noted from the

outset that "[t]he Workers' Compensation Board has not established maximum charges for

medical facility charges." Id. c:rr I, n.l, 946 A.2d at 396. The majority further explained,

"[b]ecause the Board has not, to date, established maximum charges or a fee schedule for

facilities such as CMO, health care facilities are entitled to be paid to the extent of their usual

and customary charges, with a discount for timely payment." Id. c:rr 14, 946 A.2d at 400. The

majority rejected the employers' proposed procedure, by which the "usual and customary"

4 After a telephone conference with counsel, the court decided to wait for the Fernald decision to be issued before addressing this 80C petition.

3 charge by third-party payors is determined on a case-by-case basis because such an "ad hoc

procedure raises the very likely scenario where different hearing officers might arrive at

notably different figures for usual and customary charges for the same services by the same

providers." Id.

inconsistency was "likely why the Legislature has rejected this approach and opted for

maximum charges to be established by section 209(1)." Id.

The dissenters considered the failure of the Board to perform the statutory mandate

with respect to facility charges a central piece in framing the question for resolution:

The Board, however, has not promulgated rules establishing maximum charges applicable to facilities for outpatient surgical procedure. In the absence of rules promulgated by the Board, we are asked to decide whether workers' compensation insurers and employers are entitled to challenge the amount billed to them by outpatient surgical facilities on the ground that the charges are not the facility's "usual and customary charges" or that the charges are unreasonable.

Id.

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Fernald v. Shaw's Supermarkets, Inc.
2008 ME 81 (Supreme Judicial Court of Maine, 2008)

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