| Summary: |
California’s Official Medical Fee Schedule (OMFS) establishes the maximum allowable fee
for medical services provided under the state’s workers compensation program unless the payer
and provider contract for a different payment amount. The OMFS allows facility fees for surgical
services performed in an ambulatory surgical center. The allowances are based on the Medicare
fee schedule for hospital outpatient services, which includes only services that the Centers for
Medicare & Medicaid Services has determined can be safely performed in the outpatient setting
on Medicare beneficiaries. It excludes services that Medicare has decided can only be performed
on an inpatient basis, such as multi-level spinal fusions, and hip and knee replacements.
California Senate Bill 863 requires that the Department of Industrial Relations study the
feasibility of establishing facility fees for Medicare’s “inpatient only†procedures when they are
performed on workers’ compensation patients in an ambulatory surgical center and report the
study findings to the Senate Labor Committee and Assembly Insurance Committee. The
Department asked RAND to examine the feasibility and appropriateness of including Medicare’s
“inpatient only†procedures on the OMFS.
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