A proposal to help keep workers’ compensation surgical costs from spiking in Connecticut is in danger because of an effort to carve out the facilities that perform most of those procedures.   

Under SB 61, the Workers’ Compensation Commission would establish a pre-determined fee schedule for hospital or ambulatory surgical centers services. The ambulatory centers do the bulk of workers’ compensation surgeries in Connecticut.

But a proposed amendment carves out the ambulatory centers from the bill, making it ineffective and opening the door to skyrocketing workers’ comp medical costs for the state, municipalities, and private-sector employers.

Lawmakers should reject that amendment.

What’s more, SB 61 needs to be modified to set the fee schedule’s reimbursement rate at 150% of Medicare—not at the more costly 200% rate the bill now specifies.

Ultimately, legislators should make sure that adoption of SB 61: 

  • Includes ambulatory surgical centers
  • Establishes a medical fee schedule that’s limited to 150% of Medicare, as is the case with the federal workers’ compensation system.

Those key factors will ensure surgical service reimbursement rates that are fair both to employers and the medical facilities for the treatment of work-related injuries or illnesses.

The facilities will be able to recover costs more quickly, workers’ compensation claimants to focus on their recovery, and the Workers’ Compensation Commission to avoid having to divert key resources to resolving fee disputes.

And use of a fee schedule for hospital and ambulatory surgical centers also will help calm rising workers' compensation costs throughout Connecticut—especially after those costs increased by 5.7% on  Jan. 1, 2014. It also makes great sense—currently 41 other states use such a fee schedule. 

CBIA supports SB 61 as originally proposed because it offers a reasonable and viable remedy for employers, employees, and hospitals on costly workers’ comp medical procedures. We urge lawmakers to reject the proposed amendment because it will rule out achieving that critical goal.

For more information, email Faith Gavin Kuhn.