FEE SCHEDULE NEWS:

• Ambulance Rates Schedule has been updated as of January 1, 2016. The next update is scheduled for January 1, 2017.
• The Medical fee schedule has been updated as of July 15, 2016. The new schedule includes updates to rules, fees and new 2016 CPT codes.  The fee schedule “is effective for medical services rendered on or after July 15, 2016, which are payable to health care providers authorized or permitted to render care under the Connecticut Workers’ Compensation Act.”  The next physician fee schedule update is scheduled for July 2017.
• The new Facility fee schedule has been adopted by the state with an effective date of April 1, 2016. Published by Optum360, this new fee schedule includes a link to Medicare’s PC Pricer tool and instructions for computation of inpatient reimbursement. For outpatient hospital and ambulatory surgical center reimbursement this publication includes facilities’ wage index groups and corresponding fees based on the established formulae pursuant to §31-294d(d) C.G.S. (as amended by Public Act 14-167).
  • “The hospital inpatient rate shall be 174% of the Medicare rate payable to that facility.
  • The hospital outpatient and hospital-based ambulatory surgical center shall be 210% of the Medicare rate payable to that facility.
  • The non-hospital based ambulatory surgical center rate shall be 195% of the hospital-based outpatient Medicare rate payable in the same CBSA (Core Based Statistical Area).
  • Where there is no Medicare rate for the services in an outpatient hospital setting, the parties shall negotiate the reimbursement rate. If negotiation is not successful, the parties may request a hearing with the Commission; however, treatment shall proceed pending same.”

REGULATORY ACTIVITY:

• The state posted new benefit rates effective October 1, 2016.  The State Labor Commissioner has determined that the estimated average weekly earnings of all employees in Connecticut effective October 1, 2016 will be $1,292.00. Therefore, the maximum compensation rate for total disability and decedents’ dependents will also be $1,292.00 for injuries occurring on or after October 1, 2016.  The maximum compensation rate for partial disability (incapacity), i.e., benefits pursuant to § 31-308, is equivalent to the average weekly earnings of production and related workers in manufacturing in Connecticut. The State Labor Commissioner has determined that the average weekly earnings of production and related workers in manufacturing in Connecticut effective October 1, 2016 will be $1063.00.
• The state also posted a memorandum regarding weekly benefit calculations without FICA and/or Medicare Deductions and a memorandum regarding the availability of benefit rate tables.

LEGISLATIVE ACTIONS:

• House Bill 5262
  This bill creates the firefighters’ cancer relief account and the firefighter’s cancer relief program to provide wage replacement benefits to eligible paid and volunteer firefighters diagnosed with cancer. The bill establishes a new cancer relief subcommittee of the Connecticut State Firefighters Association to award benefits under the program. Firefighters are not eligible until July 1, 2019 (although another part of the bill states that eligibility starts in 2022, five years after the bill’s effective date). The account will be funded through a diversion of money from the enhanced emergency 9-1-1-program, which is funded through a monthly subscriber fee that the Public Utilities Regulatory Authority (PURA) imposes on phone service (see BACKGROUND). The bill requires, to the extent permitted under federal law, an amount from the fee equal to one cent per month per access line to be remitted from the fee to be deposited in the account the bill establishes. Under the bill, “firefighter” includes any (1) local fire marshal, deputy fire marshal, fire investigator, fire inspector, and other classes of inspectors and investigators for whom the State Fire Marshal and the Codes and Standards Committee have jointly adopted minimum qualification standards; and (2) uniformed member of a paid municipal, state, or volunteer fire department. An eligible firefighters’ wage replacement benefits under the bill must be approved by the association subcommittee, which is authorized to determine the weekly amount benefit and the benefit duration, provided (1) the weekly benefit does not exceed 100% of the average weekly earnings of all workers in the state for the year in which the cancer was diagnosed and (2) the benefits are not provided for more than two years. The bill specifically excludes a firefighter who receives benefits from the account from concurrently receiving unemployment or workers’ compensation benefits or any other municipal, state, or federal wage replacement benefits. It also specifies that receiving benefits under the bill cannot be used as evidence for or an acknowledgement of liability under the workers’ compensation law.  Effective Date February 1, 2017.
• House Bill 5364
  The enacted legislation establishes an additional requirement when an employee of a municipality files a workers’ compensation claim.  The amended requirement provides that an employee of a municipality send a copy of the notice of the claim to the town clerk of the municipality in which employed. Effective Date July 1, 2016.