Workers' compensation: official medical fee schedule.

Existing law establishes a workers' compensation system, administered by the Administrative Director of the Division of Workers' Compensation, to compensate an employee for injuries sustained in the course of his or her employment. Existing law requires the administrative director, after public hearings, to adopt and revise periodically an official medical fee schedule that shall establish reasonable maximum fees paid for medical services, drugs and pharmacy services, health care facility fees, home health care, and all other treatment, care, services, and goods, other than physician services. Existing law, commencing January 1, 2004, and continuing until the time the administrative director has adopted an official medical fee schedule, as specified, requires maximum reasonable fees to be 120% of the estimated aggregate fees prescribed in the relevant Medicare payment system for the same class of services before application of certain inflation factors, except that for pharmacy services and drugs that are not otherwise covered by a Medicare fee schedule payment for facility services, existing law requires the maximum reasonable fees to be 100% of fees prescribed in the relevant Medi-Cal payment system. This bill would, instead, provide that for pharmacy services and drugs that are not otherwise covered by a Medicare fee schedule payment for facility services, the maximum reasonable fees shall be the lowest of the average wholesale price minus 17%, the federal upper limit, as defined, or the maximum allowable ingredient costs, as defined, plus a professional fee for dispensing that is no less than $7.25 per prescription.