California Senate Bill SB896 Latest Draft

 BILL NUMBER: SB 896AMENDED BILL TEXT AMENDED IN SENATE APRIL 27, 2011 INTRODUCED BY Senator De Len FEBRUARY 18, 2011 An act to amend Section 5318 of the Labor Code, relating to workers' compensation. LEGISLATIVE COUNSEL'S DIGEST SB 896, as amended, De Len. Workers' compensation:  spine   spinal  surgeries. Existing law establishes a workers' compensation system, administered by the Administrative Director of the Division of Workers' Compensation, to compensate an employee for injuries sustained in the course of his or her employment. Existing law, operative only until the administrative director adopts a regulation specifying separate reimbursement, if any, for implantable medical hardware or instrumentation for complex spinal surgeries, requires that implantable medical devices, hardware, and instrumentation for specified Diagnostic Related Groups (DRGs) be separately reimbursed in accordance with a prescribed formula. This bill would instead require that specified  spine   spinal  surgeries be reimbursed  to the performing hospital at the rate of 1.8 times the applicable DRG rate, with no separate reimbursement for any implantable devices, hardware, or instrumentation   in accordance with the prescribed formula, but, unless the case qualifies for outlier reimbursement, the bill would cap the total payment to the provider at 2 times the applicable rate  . Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 5318 of the Labor Code is amended to read: 5318.  Spine   Spinal  surgeries with implantable medical devices, hardware, and instrumentation  for   as defined by Medical Severity  Diagnostic Related Groups  (DRGs)   (MSDRGs) 028, 029,  030, 453, 454, 455,  457,   456, 457, 458,  459, 460, 471,  473, and 491   472, and 473, or successor MSDRGs, shall be  reimbursed to the performing hospital at the rate of 1.8 times the applicable DRG rate, with no separate reimbursement for any implantable devices, hardware, or instrumentation.   separately reimbursed at the provider's documented paid cost, plus an additional 10 percent of the provider's documented paid cost, not to exceed a maximum of two hundred fifty dollars ($250), plus any sales tax and shipping and handling charges actually paid. Unless the case qualifies for outlier reimbursement, total payment to the provider shall not exceed 2 times the applicable MSDRG rate.