CHA News Article

DWC Issues Revised Regulations Regarding Spinal Implant Reimbursement

The Division of Workers’ Compensation (DWC) has released a second 15-day notice of proposed inpatient hospital fee schedule regulations authorized by SB 863 (Chapter 363, Statutes of 2012). The new law will make wide-ranging changes to California’s workers’ compensation system beginning next year. During the initial comment period, CHA expressed concern with the inadequacy of the proposed add-on amounts for complex spinal procedures as well as the proposed mechanism for calculating outlier reimbursement. In response, DWC proposes significantly increasing the add-on payment amounts for complex spinal procedures to $9,140 for Medicare severity diagnosis-related groups (MS-DRGs) 453, 454 and 455; $3,170 for MS-DRG 456; and $670 for MS-DRGs 028, 029 and 030. DWC also proposes updating the outlier calculation to include the costs associated with the spinal hardware. Members of the public may comment on the modifications until 5 p.m. Wednesday, Nov. 28. For instructions on submitting comments, see attached notice. The proposed regulations are available on the DWC website.