Passage of House Bill 334
As a result of HB 334, insurers are able to approve the medical provider chosen by the injured employee or designate an appropriate treating physician for injuries and occupational diseases occurring after July 1, 2011. In part because of this change in the law, effective July 8 MSF will end its relationship with Montana Health Systems, a contracted managed care organization used to assist us with managing claims. Claims actively enrolled in the MCO will continue care with their MCO-designated treating physician and will receive additional payment based on fee schedule changes delineated below.
A brief synopsis of HB 334 as it pertains to payment of medical bills:
- Closure of medical benefits 60 months from the date of injury or date of diagnosis of occupational disease on or after July 1, 2011.
- Choice of physician – an injured employee can choose a treating physician (subject to approval by the insurer or the designation of another provider). The treating physician will:
- Coordinate the medical care.
- Provide timely determination such as MMI, return to work, restrictions, etc.
- Provide or arrange for treatment within the Utilization and Treatment Guidelines.
- Conduct or arrange for timely impairment ratings.
- Receive 110 percent of the fee schedule amount if designated by the insurer as the treating physician (other providers will receive 90 percent to 100 percent of fee schedule depending upon role).
- Medical Fee Schedules – Beginning July 1, 2011, the DLI rates and relative value units as of December 31, 2010, are to be used until June 30, 2013. Fee schedule reimbursement will vary based on provider status:
|– Treating physician (as designated by the insurer)||110% of fee scheduled amount|
|– Initial/emergency health care provider||100% of fee scheduled amount|
|– Other providers referred by the treating physician||90% of fee scheduled amount|
- A universal workers’ compensation Medical Status Form will be created by DLI and completion will be required by the treating physician after every visit.