39-A §209. Medical fees; reimbursement levels
Title 39-A: WORKERS' COMPENSATION ENACTED BY PL 1991, C. 885, PT. A, §8
Part 1: MAINE WORKERS' COMPENSATION ACT OF 1992 ENACTED BY PL 1991, C. 885, PT. A, §8
Chapter 5: COMPENSATION AND SERVICES ENACTED BY PL 1991, C. 885, PT. A, §8
§209. Medical fees; reimbursement levels
1. Standards, schedules or scales. In order to ensure appropriate limitations on the cost of health care services, the board shall adopt rules that establish:
A. Standards, schedules or scales of maximum charges for individual services, procedures or courses of treatment. In establishing these standards, schedules or scales, the board shall consider maximum charges paid by private 3rd-party payors for similar services provided by health care providers in the State and shall consult with organizations representing health care providers and other appropriate groups. The standards must be adjusted annually to reflect any appropriate changes in levels of reimbursement. The standards apply to hospital costs and health care providers and must be in effect no later than January 1, 1993; and [1991, c. 885, Pt. A, §§9-11 (AFF); 1991, c. 885, Pt. A, §8 (NEW).]
B. Fees for the preparation of materials, including reports of treatment required in section 208, subsection 2, or attendance at depositions or hearings as may be required under this Act. [1991, c. 885, Pt. A, §§9-11 (AFF); 1991, c. 885, Pt. A, §8 (NEW).]
[ 1991, c. 885, Pt. A, §§9-11 (AFF); 1991, c. 885, Pt. A, §8 (NEW) .]
2. Payment for services. A health facility or health care provider must be paid either its usual and customary charge for any health care services or the maximum charge established under the rules adopted pursuant to subsection 1, whichever is less.
[ 1991, c. 885, Pt. A, §§9-11 (AFF); 1991, c. 885, Pt. A, §8 (NEW) .]
3. Limitation on reimbursement. In order to qualify for reimbursement for health care services provided to employees under this Title, health care providers providing individual health care services and courses of treatment may not charge more for the services or courses of treatment for employees than is charged to private 3rd-party payors for similar services or courses of treatment. An employer is not responsible for charges that are determined to be excessive or treatment determined to be inappropriate by an independent medical examiner appointed pursuant to section 312 or by the insurance carrier, self-insurer or group self-insurer pursuant to section 210, subsection 7 or the board pursuant to section 210, subsection 8.
[ 1991, c. 885, Pt. A, §§9-11 (AFF); 1991, c. 885, Pt. A, §8 (NEW) .]
4. MaineCare reimbursement. MaineCare must be paid 100% of any expenses incurred for the treatment of an injury of an employee under this Title.
[ 2007, c. 240, Pt. JJJ, §5 (NEW); 2007, c. 311, §2 (NEW) .]
SECTION HISTORY
1991, c. 885, §§A9-11 (AFF). 1991, c. 885, §A8 (NEW). 2007, c. 240, Pt. JJJ, §5 (AMD). 2007, c. 311, §2 (AMD).