Maine Workers’ Compensation Updates, December Edition
1. After Eighteen Long Years, At Last A Medical Fee Schedule That Addresses Hospital Costs
The Maine Workers’ Compensation Board has finally succeeded in crafting a Medical Fee Schedule that addresses the ever-increasing costs of work-related in-patient, out-patient, ambulant care and surgical center costs. Ever since the massive overhaul of the law in 1992 (effective 1/1/93) Maine has labored without a Fee Schedule addressing these critical areas in the health care billing spectrum. With the new rule, adopted on December 11, 2011, facility costs for workers’ compensation payers will be brought into line with those costs paid by private 3rd party payers. The hope is that the new Fee Schedule will reduce costs in the workers’ compensation system, particularly for facility fees.
The Board is continuing to analyze data on private 3rd party payer rates for professional services and hopefully will have updated recommendations on that topic in the New Year.

2. Changes afoot for unemployed injured workers
39-A M.R.S.A. §214 has long contained a little-if-ever used provision requiring insurance carriers or self-insureds to notify the Bureau of Employment Services of the name of any injured employee who is unemployed and to whom the insurer or self-insured is paying workers’ compensation benefits. Executive Director Paul Sighinolfi has communicated his intent to begin requiring compliance with this provision, as well as the companion provision directing the Bureau of Employment Services to give priority to finding employment for such persons and to notify the Board, in writing, if any such person refuses a “bona fide offer of reasonable employment”. Under Section 214(1), refusal of a “bona fide offer of reasonable employment” subjects the injured worker to the risk of a suspension of indemnity benefits “during the period of refusal”, a fairly significant incentive to encourage return to work. A group is being organized affiliated with the Workers’ Compensation Coordinating Council to brainstorm ways to ensure the most reasonable and cost-effective application of these provisions, and to avoid any unintended pitfalls for employers and insurers subject to the provisions of the Maine Workers’ Compensation Act.