Indiana House passes bill to cap some comp surgeries

The Indiana House of Representatives passed a bill that would cap reimbursement for ambulatory outpatient surgical centers treating injured workers.

Bipartisan bill H.B. 1332, introduced by Republican Rep. Matthew Lehman, passed with a 91-1 vote on Monday. The bill stipulates that reimbursement for ambulatory outpatient surgical center services covered under workers compensation may not exceed 225% of the Medicare reimbursement rate on the same day for the same service, unless an amount has been previously negotiated. The legislation also states that payment to an ambulatory surgical center for a medical device covered under workers comp may not exceed the invoice amount plus 3%.

According to the Workers Compensation Research Institute’s Indiana CompScope Benchmarks, 20th Edition, Indiana paid the highest of all 18 states for ambulatory surgical care in the 18 states studied by the institute, and paid more than the average for nonhospital care. WCRI speculated in its benchmark report that the lack of a fee schedule regulating reimbursement for ambulatory and nonhospital care and a higher overall surgery rate — nearly 40% of all comp claims in 2017 in the state required surgery at the one-year mark — were the drivers for the higher payments.

The legislation has been referred to the state’s Senate for consideration. If signed into law, it would apply to ambulatory outpatient surgical center services performed on or after Dec. 31, 2020.

This article was first published by Business Insurance.

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