Newsline No. 42-10
August 10, 2010
Division of Workers' Compensation posts proposed revision to the hospital outpatient departments and ambulatory surgical centers
fee schedule regulations for pre-rulemaking public comment
The Division of Workers' Compensation (DWC) has posted an online forum for members of the public to review and comment on
drafts of revisions to the hospital outpatient departments (HOPD) and ambulatory surgical centers (ASC) fee schedule regulations
which includes modification of the multiplier for payment of services performed in ambulatory surgical centers. These draft revisions
to the regulations are part of the division’s 12-point plan to monitor and help control medical costs in California ’s workers'
compensation system.
The forum can be found at http://www.dwc.ca.gov/DWCWCABForum/1.asp and members of the public may comment until Aug. 24,
2010.
Labor Code Section 5307.1 requires that the official medical fee schedule (OMFS) for ASCs be based on the fee-related structure and
rules of Medicare program. The Labor Code caps the aggregate allowances for ASCs at 120 percent of the fee paid by Medicare for the
same services performed in a HOPD setting.
On May 27, 2010 the division held a stakeholder meeting to discuss issues relating to consideration of basing the ASC fee schedule on
the Medicare ASC fee schedule. After considering the comments and concerns raised at the stakeholder meeting, DWC now proposes
to revise the ambulatory surgical center fee schedule by modifying the multiplier for ambulatory surgical center facility fees to 100% of
the Medicare outpatient fee schedule or 102% multiplier that includes an extra 2% reimbursement for high cost outlier cases.
Minor amendments have been made to the hospital outpatient departments and ambulatory surgical centers fee schedule to conform to
the above proposed change, to update, clarify, and to improve the format of the regulations.
August 10, 2010
Division of Workers' Compensation posts proposed revision to the hospital outpatient departments and ambulatory surgical centers
fee schedule regulations for pre-rulemaking public comment
The Division of Workers' Compensation (DWC) has posted an online forum for members of the public to review and comment on
drafts of revisions to the hospital outpatient departments (HOPD) and ambulatory surgical centers (ASC) fee schedule regulations
which includes modification of the multiplier for payment of services performed in ambulatory surgical centers. These draft revisions
to the regulations are part of the division’s 12-point plan to monitor and help control medical costs in California ’s workers'
compensation system.
The forum can be found at http://www.dwc.ca.gov/DWCWCABForum/1.asp and members of the public may comment until Aug. 24,
2010.
Labor Code Section 5307.1 requires that the official medical fee schedule (OMFS) for ASCs be based on the fee-related structure and
rules of Medicare program. The Labor Code caps the aggregate allowances for ASCs at 120 percent of the fee paid by Medicare for the
same services performed in a HOPD setting.
On May 27, 2010 the division held a stakeholder meeting to discuss issues relating to consideration of basing the ASC fee schedule on
the Medicare ASC fee schedule. After considering the comments and concerns raised at the stakeholder meeting, DWC now proposes
to revise the ambulatory surgical center fee schedule by modifying the multiplier for ambulatory surgical center facility fees to 100% of
the Medicare outpatient fee schedule or 102% multiplier that includes an extra 2% reimbursement for high cost outlier cases.
Minor amendments have been made to the hospital outpatient departments and ambulatory surgical centers fee schedule to conform to
the above proposed change, to update, clarify, and to improve the format of the regulations.
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