The California Division of Workers’ Compensation (DWC) gave notice this week that it has adopted an amendment to hospital outpatient departments and ambulatory surgical centers fee schedule (HOPD/ASC fee schedule). The proposed changes call for the elimination of the alternative payment methodology.
According to the DWC, only one ASC in the state currently participates in the alternative payment methodology, often referred to as high cost outlier program. Most ASCs adopt to utilize the maximum allowable payment, which is based on a multiplier that includes an extra percentage reimbursement for high cost outlier cases, in lieu of additional payment for high cost outlier cases. Due to the lack of utilization by ASCs of the alternative payment methodology, and the fact that ASCs are not licensed and do not report cost data, the DWC is proposing to eliminate the alternative payment methodology.
Most disturbing is that the DWC has eliminated the additional payment from the current 82% of the Hospital Outpatient Department Prospective Payment System (HOPD PPS) fee schedule, to a percentage amount of 80.8 percent of the HOPD PPS fee schedule for all ASC providers. These changes are scheduled to take place September 1, 2014.
CASA strongly opposed these amendments and are extremely disappointed the DWC moved forward with this decrease. We voiced our concern through a series of formal comments, testified at public hearings and conducted meetings with the DWC staff and California Labor Secretary, David Lanier. Senator Mark Wyland and Insurance Commissioner Dave Jones sent letters urging the DWC to not make these changes. Several of our CASA members raised their own concerns regarding these changes as over 200 letters were sent to the DWC.
The DWC has yet to approve an updated fee schedule for 2014. We suspect that this will happen when these changes are adopted in September. ASCs should continue to utilize the 2013 fee schedule until the DWC formally adopts a schedule for 2014. CASA will provide an updated workers compensation calculator at this time.