Maine § 39-A §209-A Medical fee schedule

Maine Statutes

§ 39-A §209-A — Medical fee schedule

Maine·Title 39-A WORKERS' COMPENSATION·Part 1 MAINE WORKERS' COMPENSATION ACT OF 1992·Ch. 5 COMPENSATION AND SERVICES

1.Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings.

2.Medical fee schedule. In order to ensure appropriate limitations on the cost of health care services while maintaining broad access for employees to health care providers in the State, the board shall adopt rules that establish a medical fee schedule setting the fees for medical and ancillary services and products rendered by individual health care practitioners and health care facilities in accordance with the following:

3.Annual updates. Notwithstanding Title 5, chapter 375, subchapter 2, the executive director of the board shall annually update the medical fee schedule developed pursuant to subsection 2. In order to facilitate the update, the executive di

Free access — add to your briefcase to read the full text and ask questions with AI

1.
Definitions.
As used in this section, unless the context otherwise indicates, the following terms have the following meanings.
2.
Medical fee schedule.
In order to ensure appropriate limitations on the cost of health care services while maintaining broad access for employees to health care providers in the State, the board shall adopt rules that establish a medical fee schedule setting the fees for medical and ancillary services and products rendered by individual health care practitioners and health care facilities in accordance with the following:
3.
Annual updates.
Notwithstanding Title 5, chapter 375, subchapter 2, the executive director of the board shall annually update the medical fee schedule developed pursuant to subsection 2. In order to facilitate the update, the executive director annually shall obtain from the Maine Health Data Organization the average total payments, including professional, facility, ancillary and patient cost-sharing contribution, across all providers in the Maine Health Data Organization database for the medical and ancillary services and products most commonly rendered during the immediately preceding calendar year under this Part.
4.
Reimbursement rate if medical fee schedule not established or updated.
If the board fails to adopt rules that establish a medical fee schedule in accordance with subsection 2 by December 31, 2011 or the executive director fails to annually update the medical fee schedule in accordance with subsection 3, the reimbursement rate for medical services is the amount established by the medical fee schedule in effect on the date the update is due.
5.
Periodic updates to the medical fee schedule.
In addition to the annual updates to the medical fee schedule required by subsection 3, the board shall undertake a comprehensive review of the medical fee schedule once every 3 years beginning in 2014. The board shall consider the following factors in setting or revising the medical fee schedule as required by this section:
6.
Associated services fee schedule.
The board shall adopt rules that establish a fee schedule or other standards of reimbursement for providers regarding administrative, case management, medical and legal and other activities unique to the treatment of injured workers in the workers' compensation system.
7.
MaineCare reimbursement.
MaineCare must be paid 100% of any expenses incurred for the treatment of an injury of an employee under this Title.