JAN. 2 2009:NWLP
12/29/08
10:02 AM
Page 7
Workers’ Compensation Division
adopts final rule for medical fees
SALEM — The Oregon Workers'
Compensation Division has issued a fi-
nal rule that forbids insurance compa-
nies from unilaterally taking discounts
on health providers’ workers’ comp
bills unless the provider agrees upfront
to such a discount.
The new rules took effect Jan. 1,
2009.
The new rules replace temporary
rules on medical fees the division is-
sued in July and address concerns and
questions about the role of preferred
provider organizations (PPOs) in work-
ers’ compensation.
The Workers’ Comp Division issued
the emergency ruling after a Fortune
500 PPO — Maryland-based Coven-
try — threatened to leave the state if it
couldn’t bill injured workers’ cases at
its discounted PPO rates with health
care providers.
Doctors, union officials and several
lawmakers sounded off against the
emergency ruling, saying it resulted in
sweeping changes to a no-fault system
that had already undergone a wide-
spread, controversial overhaul in 1990.
Union officials also were outraged
that the emergency order came with lit-
tle or no input from the two main play-
ers in the workers’ comp system — la-
bor and management.
Prior to the emergency order, a
workers’ comp insurer paid medical
bills in one of three ways: At the pro-
vider’s normal fee; at the amount set by
law under the Oregon medical fee
schedule (if it is less than the normal
fee); or at the rate contracted with a
provider enrolled in a state-certified
managed care organization. MCO rates
typically are lower than both the med-
ical fee schedule and the provider’s
normal rate.
MCOs were allowed into Oregon’s
workers’ comp system as part of the
1990 overhaul. The state regulates
MCOs to ensure that injured workers
are getting good care. PPOs are not
regulated.
Only four MCOs are certified to
serve injured workers. They are Provi-
dence MCO, Kaiser Foundation, Ore-
gon Health Systems Inc., and Care-
Mark Comp, which is owned by
Legacy Health and Adventist Medical
Center.
“PPOs exist solely to reduce fees
paid to providers,” said Diana Godwin,
an attorney representing physical thera-
pists opposing the permanent ruling.
Godwin and other health care
providers said that doctors would quit
taking injured workers as patients if the
temporary rule was made permanent.
Union leaders said that if the emer-
gency rule was made permanent it
would entice employers to leave MCO
insurers in search of cheaper premiums
through PPO networks, thus forcing
medical providers out of the workers’
comp system.
After numerous public hearings, the
Workers’ Compensation Division re-
versed its temporary rule on PPOs.
The permanent rule prohibits PPO
discounts for medical services per-
formed by health care providers who
treat injured workers, but allows indi-
vidual providers to choose to offer dis-
counts as part of standardized agree-
ments with insurers or self-insured
employers. Network discounts con-
tinue to be allowed for prescription
drugs and hospital services.
“We have received very positive
feedback from medical providers,
workers, and others with a stake in the
workers’ compensation system about
these new rules,” said John Shilts, ad-
ministrator of the Workers’ Compensa-
tion Division. “We feel they will help
ensure Oregon’s injured workers con-
tinue to have access to quality medical
care.”
For more on the new ruling, go to
www.wcd.oregon.gov.
I NDEPENDENT R ETIREMENT L IVING
Westmoreland's
Union Manor
Kirkland
Union Manors
6404 SE 23rd Ave.
Portland 97202
3530 SE 84th Ave.
Portland 97266
503•233•5671
503•777•8101
Manors Make
the Difference
• Studio and One-Bedroom
Apartments
• Affordable Rent includes
Utilities ( EXCEPT PHONE AND CABLE )
• Planned Events, Clubs, and
Activities
• Ideal Locations offer easy
access to Bus Lines, Shopping,
and Entertainment
• No Costly Buy-In or
Application Fees
• Federal Rent Subsidies
Available (M UST Q UALIFY )
JANUARY 2, 2009
Doernbecher Christmas tree lighting
K IRKLAND U NION M ANORS I,II,III
Opened in 1980, 1985 & 1995
L ABOR L EADERS IN THE
P ORTLAND B UILDING T RADE
M OVEMENT ORGANIZED THE
U NION L ABOR R ETIREMENT
A SSOCIATION IN 1962, WITH THE SOLE PURPOSE
OF PROVIDING HOUSING FOR THE ELDERLY .
“ We believe that everyone earns the
right to retire, free from pressures
of earlier years.”
Kirkland
Union Plaza
Marshall
Union Manor
1414 Kauffman Ave. 2020 NW Northrup
Vancouver 98660
Portland 97209
360•694•4314
503•225•0677
WWW . THEUNIONMANORS . ORG
TDD 503•771•0912
NORTHWEST LABOR PRESS
Dynalectric employees from left Scott Calanca, Thomas Riehl, and Ryan
Balfour braved frigid temperatures a week before Christmas to hang lights on
a 60-foot-tall Christmas tree at the main entrance of Doernbecher Children’s
Hospital in Southwest Portland. Dynalectric employees — members of the
International Brotherhood of Electrical Workers Local 48 — have provided
the lighting and conducted a Christmas gift drive for children at Doernbecher
for the past 11 years. Dynalectric’s Project Manager Jim Lee orchestrated
the project, including getting a local construction equipment rental company
Star Rentals to assist with a boom-lift to reach the top of the tree. As the crew
was finishing the lighting of the tree, they were approached by a parent
bringing her child to the hospital. “Thank you very much for doing this,” the
woman said. “You have made Christmas for my child today. Nothing says
welcome like a lighted tree!”
Zachary
Zabinsky
• Social Security
• SSI - Disability Claims
Personal Attention To Every Case
Working For Disability Rights
Since 1983
NO FEE WITHOUT RECOVERY
621 SW Morrison, Portland
223-8517
PAGE 7