44-510i.Medical benefits; appointment of medicaladministrator; maximum medical fee schedule; advisory panel.(a) The director shall appoint, subject to the approval of the secretary, aspecialist in health services delivery, who shall bereferred to as the medical administrator. The medicaladministrator shall be a person licensed to practice medicine and surgery inthis state and shall bein the unclassified service under the Kansas civil service act.
(b) The medical administrator, subject to the direction of thedirector, shall have the duty ofoverseeing the providing of health care services to employees in accordancewith the provisionsof the workers compensation act, including but not limited to:
(1) Preparing, with the assistance of the advisory panel, the fee schedulefor health careservices as set forth in this section;
(2) developing, with theassistance of the advisory panel, the utilization review programfor health care services as set forth in this section;
(3) developing a system forcollecting and analyzing data on expenditures for health careservices by each type of provider under the workers compensation act; and
(4) carrying out such other duties as may be delegated or directed by thedirector orsecretary.
(c) The director shall prepare and adopt rules and regulationswhich establish a scheduleof maximum fees for medical, surgical, hospital, dental, nursing, vocationalrehabilitation or anyother treatment or services provided or ordered by health care providers andrendered toemployees under the workers compensation actand procedures forappeals and review of disputed charges or servicesrendered by health care providers under this section;
(1) The schedule of maximum fees shall be reasonable, shall promote healthcare costcontainment and efficiency with respect to the workers compensation health caredeliverysystem, and shall be sufficient to ensure availability of such reasonablynecessary treatment, careand attendance to each injured employee to cure and relieve the employee fromthe effects of theinjury. The schedule shall include provisions and review procedures forexceptional casesinvolving extraordinary medical procedures or circumstances and shall includecosts and chargesfor medical records and testimony.
(2) In every case, all fees, transportation costs, charges under this sectionand all costsand charges for medical records and testimony shall be subject to approval bythe director andshall be limited to such as are fair, reasonable and necessary. The schedule ofmaximum feesshall be revised as necessary at least every two years by the director toassure that the schedule iscurrent, reasonable and fair.
(3) Any contract or any billing or charge which any health care provider,vocationalrehabilitation service provider, hospital, person or institution enters intowith or makes to anypatient for services rendered in connection with injuries covered by theworkers compensationact or the fee schedule adopted under this section, which is or may be inexcess of or not inaccordance with such act or fee schedule, is unlawful, void and unenforceableas a debt.
(d) There is hereby created an advisory panel to assist the director inestablishing aschedule of maximum fees as required by this section. The panel shall consistof thecommissioner of insurance and 11 members appointed asfollows: Oneperson shall beappointed by the Kansas medical society; one member shall be appointed bythe Kansasassociation of osteopathic medicine; one member shall be appointed by theKansas hospitalassociation; one member shall be appointed by the Kansas chiropracticassociation; one member shall be appointed by the Kansas physical therapyassociation, one member shall be appointed by the Kansas occupational therapyassociation andfive members shall be appointed by the secretary. Of themembers appointed bythesecretary, two shallbe representatives of employers recommended tothe secretary by the Kansaschamber ofcommerce and industry; two shall berepresentatives of employees recommendedto the secretaryby the Kansas AFL-CIO; and one shall be a representative of providers ofvocationalrehabilitation services pursuant to K.S.A. 44-510g and amendments thereto. Eachappointedmember shall be appointed for a term of office of two years which shallcommence on July 1 ofthe year of appointment. Members of the advisory panel attending meetings ofthe advisorypanel, or attending a subcommittee of the advisory panel authorized by theadvisory panel, shallbe paid subsistence allowances, mileage and other expenses as provided inK.S.A. 75-3223 andamendments thereto.
(e) All fees and other charges paid for such treatment, care and attendance,including treatment, care and attendance provided by any health care provider,hospital or other entity providing health care services, shall not exceed theamounts prescribed by the schedule of maximum fees established under thissection or the amounts authorized pursuant to the provisions and reviewprocedures prescribed by the schedule for exceptional cases.With the exception of the rules and regulations established for the paymentof selected hospital inpatient services under the diagnosis related groupprospective payment system, a health care provider, hospital or otherentity providing health care services shall be paid either such health careprovider, hospital or other entity's usual and customary charge for thetreatment, care and attendance or the maximum fees as set forth in theschedule, whichever is less. In reviewing and approving the schedule of maximumfees, the director shall consider the following:
(1) The levels of fees for similar treatment, care and attendance imposed byother healthcare programs or third-party payors in the locality in which such treatment orservices arerendered;
(2) the impact upon cost to employers for providing a level of fees fortreatment, care andattendance which will ensure the availability of treatment, care and attendancerequired forinjured employees;
(3) the potential change in workers compensation insurance premiums or costsattributable to the level of treatment, care and attendance provided; and
(4) the financial impact of the schedule of maximum fees upon health careproviders andhealth care facilities and its effect upon their ability to make available toemployees suchreasonably necessary treatment, care and attendance to each injured employee tocure and relieve the employee from the effects of the injury.
History: L. 2000, ch. 160, § 2; L. 2001, ch. 121, § 2;L. 2005, ch. 198, § 1; July 1.
44-510i.Medical benefits; appointment of medicaladministrator; maximum medical fee schedule; advisory panel.(a) The director shall appoint, subject to the approval of the secretary, aspecialist in health services delivery, who shall bereferred to as the medical administrator. The medicaladministrator shall be a person licensed to practice medicine and surgery inthis state and shall bein the unclassified service under the Kansas civil service act.
(b) The medical administrator, subject to the direction of thedirector, shall have the duty ofoverseeing the providing of health care services to employees in accordancewith the provisionsof the workers compensation act, including but not limited to:
(1) Preparing, with the assistance of the advisory panel, the fee schedulefor health careservices as set forth in this section;
(2) developing, with theassistance of the advisory panel, the utilization review programfor health care services as set forth in this section;
(3) developing a system forcollecting and analyzing data on expenditures for health careservices by each type of provider under the workers compensation act; and
(4) carrying out such other duties as may be delegated or directed by thedirector orsecretary.
(c) The director shall prepare and adopt rules and regulationswhich establish a scheduleof maximum fees for medical, surgical, hospital, dental, nursing, vocationalrehabilitation or anyother treatment or services provided or ordered by health care providers andrendered toemployees under the workers compensation actand procedures forappeals and review of disputed charges or servicesrendered by health care providers under this section;
(1) The schedule of maximum fees shall be reasonable, shall promote healthcare costcontainment and efficiency with respect to the workers compensation health caredeliverysystem, and shall be sufficient to ensure availability of such reasonablynecessary treatment, careand attendance to each injured employee to cure and relieve the employee fromthe effects of theinjury. The schedule shall include provisions and review procedures forexceptional casesinvolving extraordinary medical procedures or circumstances and shall includecosts and chargesfor medical records and testimony.
(2) In every case, all fees, transportation costs, charges under this sectionand all costsand charges for medical records and testimony shall be subject to approval bythe director andshall be limited to such as are fair, reasonable and necessary. The schedule ofmaximum feesshall be revised as necessary at least every two years by the director toassure that the schedule iscurrent, reasonable and fair.
(3) Any contract or any billing or charge which any health care provider,vocationalrehabilitation service provider, hospital, person or institution enters intowith or makes to anypatient for services rendered in connection with injuries covered by theworkers compensationact or the fee schedule adopted under this section, which is or may be inexcess of or not inaccordance with such act or fee schedule, is unlawful, void and unenforceableas a debt.
(d) There is hereby created an advisory panel to assist the director inestablishing aschedule of maximum fees as required by this section. The panel shall consistof thecommissioner of insurance and 11 members appointed asfollows: Oneperson shall beappointed by the Kansas medical society; one member shall be appointed bythe Kansasassociation of osteopathic medicine; one member shall be appointed by theKansas hospitalassociation; one member shall be appointed by the Kansas chiropracticassociation; one member shall be appointed by the Kansas physical therapyassociation, one member shall be appointed by the Kansas occupational therapyassociation andfive members shall be appointed by the secretary. Of themembers appointed bythesecretary, two shallbe representatives of employers recommended tothe secretary by the Kansaschamber ofcommerce and industry; two shall berepresentatives of employees recommendedto the secretaryby the Kansas AFL-CIO; and one shall be a representative of providers ofvocationalrehabilitation services pursuant to K.S.A. 44-510g and amendments thereto. Eachappointedmember shall be appointed for a term of office of two years which shallcommence on July 1 ofthe year of appointment. Members of the advisory panel attending meetings ofthe advisorypanel, or attending a subcommittee of the advisory panel authorized by theadvisory panel, shallbe paid subsistence allowances, mileage and other expenses as provided inK.S.A. 75-3223 andamendments thereto.
(e) All fees and other charges paid for such treatment, care and attendance,including treatment, care and attendance provided by any health care provider,hospital or other entity providing health care services, shall not exceed theamounts prescribed by the schedule of maximum fees established under thissection or the amounts authorized pursuant to the provisions and reviewprocedures prescribed by the schedule for exceptional cases.With the exception of the rules and regulations established for the paymentof selected hospital inpatient services under the diagnosis related groupprospective payment system, a health care provider, hospital or otherentity providing health care services shall be paid either such health careprovider, hospital or other entity's usual and customary charge for thetreatment, care and attendance or the maximum fees as set forth in theschedule, whichever is less. In reviewing and approving the schedule of maximumfees, the director shall consider the following:
(1) The levels of fees for similar treatment, care and attendance imposed byother healthcare programs or third-party payors in the locality in which such treatment orservices arerendered;
(2) the impact upon cost to employers for providing a level of fees fortreatment, care andattendance which will ensure the availability of treatment, care and attendancerequired forinjured employees;
(3) the potential change in workers compensation insurance premiums or costsattributable to the level of treatment, care and attendance provided; and
(4) the financial impact of the schedule of maximum fees upon health careproviders andhealth care facilities and its effect upon their ability to make available toemployees suchreasonably necessary treatment, care and attendance to each injured employee tocure and relieve the employee from the effects of the injury.
History: L. 2000, ch. 160, § 2; L. 2001, ch. 121, § 2;L. 2005, ch. 198, § 1; July 1.
44-510i.Medical benefits; appointment of medicaladministrator; maximum medical fee schedule; advisory panel.(a) The director shall appoint, subject to the approval of the secretary, aspecialist in health services delivery, who shall bereferred to as the medical administrator. The medicaladministrator shall be a person licensed to practice medicine and surgery inthis state and shall bein the unclassified service under the Kansas civil service act.
(b) The medical administrator, subject to the direction of thedirector, shall have the duty ofoverseeing the providing of health care services to employees in accordancewith the provisionsof the workers compensation act, including but not limited to:
(1) Preparing, with the assistance of the advisory panel, the fee schedulefor health careservices as set forth in this section;
(2) developing, with theassistance of the advisory panel, the utilization review programfor health care services as set forth in this section;
(3) developing a system forcollecting and analyzing data on expenditures for health careservices by each type of provider under the workers compensation act; and
(4) carrying out such other duties as may be delegated or directed by thedirector orsecretary.
(c) The director shall prepare and adopt rules and regulationswhich establish a scheduleof maximum fees for medical, surgical, hospital, dental, nursing, vocationalrehabilitation or anyother treatment or services provided or ordered by health care providers andrendered toemployees under the workers compensation actand procedures forappeals and review of disputed charges or servicesrendered by health care providers under this section;
(1) The schedule of maximum fees shall be reasonable, shall promote healthcare costcontainment and efficiency with respect to the workers compensation health caredeliverysystem, and shall be sufficient to ensure availability of such reasonablynecessary treatment, careand attendance to each injured employee to cure and relieve the employee fromthe effects of theinjury. The schedule shall include provisions and review procedures forexceptional casesinvolving extraordinary medical procedures or circumstances and shall includecosts and chargesfor medical records and testimony.
(2) In every case, all fees, transportation costs, charges under this sectionand all costsand charges for medical records and testimony shall be subject to approval bythe director andshall be limited to such as are fair, reasonable and necessary. The schedule ofmaximum feesshall be revised as necessary at least every two years by the director toassure that the schedule iscurrent, reasonable and fair.
(3) Any contract or any billing or charge which any health care provider,vocationalrehabilitation service provider, hospital, person or institution enters intowith or makes to anypatient for services rendered in connection with injuries covered by theworkers compensationact or the fee schedule adopted under this section, which is or may be inexcess of or not inaccordance with such act or fee schedule, is unlawful, void and unenforceableas a debt.
(d) There is hereby created an advisory panel to assist the director inestablishing aschedule of maximum fees as required by this section. The panel shall consistof thecommissioner of insurance and 11 members appointed asfollows: Oneperson shall beappointed by the Kansas medical society; one member shall be appointed bythe Kansasassociation of osteopathic medicine; one member shall be appointed by theKansas hospitalassociation; one member shall be appointed by the Kansas chiropracticassociation; one member shall be appointed by the Kansas physical therapyassociation, one member shall be appointed by the Kansas occupational therapyassociation andfive members shall be appointed by the secretary. Of themembers appointed bythesecretary, two shallbe representatives of employers recommended tothe secretary by the Kansaschamber ofcommerce and industry; two shall berepresentatives of employees recommendedto the secretaryby the Kansas AFL-CIO; and one shall be a representative of providers ofvocationalrehabilitation services pursuant to K.S.A. 44-510g and amendments thereto. Eachappointedmember shall be appointed for a term of office of two years which shallcommence on July 1 ofthe year of appointment. Members of the advisory panel attending meetings ofthe advisorypanel, or attending a subcommittee of the advisory panel authorized by theadvisory panel, shallbe paid subsistence allowances, mileage and other expenses as provided inK.S.A. 75-3223 andamendments thereto.
(e) All fees and other charges paid for such treatment, care and attendance,including treatment, care and attendance provided by any health care provider,hospital or other entity providing health care services, shall not exceed theamounts prescribed by the schedule of maximum fees established under thissection or the amounts authorized pursuant to the provisions and reviewprocedures prescribed by the schedule for exceptional cases.With the exception of the rules and regulations established for the paymentof selected hospital inpatient services under the diagnosis related groupprospective payment system, a health care provider, hospital or otherentity providing health care services shall be paid either such health careprovider, hospital or other entity's usual and customary charge for thetreatment, care and attendance or the maximum fees as set forth in theschedule, whichever is less. In reviewing and approving the schedule of maximumfees, the director shall consider the following:
(1) The levels of fees for similar treatment, care and attendance imposed byother healthcare programs or third-party payors in the locality in which such treatment orservices arerendered;
(2) the impact upon cost to employers for providing a level of fees fortreatment, care andattendance which will ensure the availability of treatment, care and attendancerequired forinjured employees;
(3) the potential change in workers compensation insurance premiums or costsattributable to the level of treatment, care and attendance provided; and
(4) the financial impact of the schedule of maximum fees upon health careproviders andhealth care facilities and its effect upon their ability to make available toemployees suchreasonably necessary treatment, care and attendance to each injured employee tocure and relieve the employee from the effects of the injury.
History: L. 2000, ch. 160, § 2; L. 2001, ch. 121, § 2;L. 2005, ch. 198, § 1; July 1.
