(a) Except as set forth in subdivision (b) herein, [P]payment for ambulatory surgery services shall be made according to the ambulatory patient groups (APG) methodology, governing reimbursement for licensed freestanding ambulatory surgical centers and hospital-based ambulatory surgery services as set forth herein and subject to WCB specific adjustments. The effective date of this Subpart shall be October 1, 2015.

1. Statutory authority: Workers’ Compensation Law (WCL) § 117(1) and 142 authorizes the Chair of the Workers’ Compensation Board (Board) to adopt reasonable rules consistent with, and supplemental to, the provisions of the WCL. WCL § 13 requires the Chair to set fee schedules for medical treatment.

2. Legislative objectives: The emergency adoption and permanent proposal seeks to align fees for similar medical procedures whether they are performed as an out-patient procedure or in-patient. WCL § 13 requires the Chair to consult with various medical professionals when setting fee schedules. During the COVID pandemic the discrepancy in certain fees has become more pronounced due to restrictions in scheduling in-patient surgery. This regulation will ensure that a proper fee is in place for certain procedures.

3. Needs and benefits: The emergency adoption seeks to make fees for similar procedures more equal to encourage efficient and safe management of injured worker’s health care made more pronounced by the COVID pandemic. It is needed to ensure that injured workers are not put at risk due to delays in treatment or unnecessary in-patient procedures.

4. Costs: The costs for certain delineated out-patient procedures will increase. However, these costs are still less than if the procedure were performed in-patient. Thus, the Board believes the costs for these procedures may actually decrease when more procedures are performed out-patient due to fee equity.

5. Local government mandates: The proposed amendments do not impose any additional program, service, duty, or responsibility upon any county, city, town, village, school district, fire district, or other special district – they simply change the fees for ambulatory surgery services.

6. Paperwork: The emergency adoption does not require any additional paperwork – it changes the fees for ambulatory surgery services.

7. Duplication: The emergency adoption does not duplicate other regulatory initiatives.

8. Alternatives: An alternative would be to not file an emergency adoption making these fees more equal. However, this could lead to less equal health care for injured workers, especially in the midst of the COVID-19 pandemic.

9. Federal standards: There are no applicable Federal Standards.

10. Compliance schedule: The emergency adoption takes effect immediately upon filing to ensure that the updated fees are used to help provide efficient and safe management of injured workers’ health care.

The rule will not impose any adverse economic impact or reporting, recordkeeping or other compliance requirements on small businesses or local governments. The emergency adoption simply changes the fees for ambulatory surgery services.

The rule will not impose any adverse economic impact or reporting, recordkeeping or other compliance requirements on rural areas. The emergency adoption simply changes the fees for ambulatory surgery services.

A Job Impact Statement is not required because the emergency adoption will not have any impact on jobs or employment opportunities. The emergency adoption makes fees for similar procedures more equal to encourage efficient and safe management of injured worker’s health care made more pronounced by the COVID pandemic.