The North Carolina General Assembly enacted, and Governor James B. Hunt Jr. signed into law on 4 June 1997, a new law governing the amounts that hospitals in North Carolina can charge for inpatient treatment of workers' compensation patients.
The new law has as its goal to give the workers' compensation community each calendar year the same discount in hospital bills experienced by the State Health Plan during the immediate past fiscal year.
In calculating the inpatient hospital bills, the North Carolina Industrial Commission (NCIC) will compare the Diagnostic Related Grouping for each patient (DRG) to the hospital's itemized charges for that patient. During the remainder of calendar year 1997, the NCIC will approve the DRG charges whenever they fall between 90% and 100% of itemized charges, and the Industrial Commission will approve 90% of charges whenever the DRG charges fall below 90%.
From July 1, 1997 through December 31, 1997: the present 90-100% band stays in effect.
Starting January 1, 1998, the band will be set for an overall 6.9 percent discount from base-period charges, with the base period being the fiscal year ended June 30, 1997 and with the cap set at 100% of charges. (The NCIC will total all hospital charges in workers' compensation cases for the fiscal year ended June 30, 1997, and will set the lower end of the band at whatever figure produces a 6.9% discount for that base period and the higher end of the band at 100% of charges.)
In subsequent calendar years, the band will be calculated in the fourth quarter and is to be set on January 1 to yield the same percentage discount for workers' compensation cases as was experienced by the State Health Plan in the previous fiscal year.
Here is the actual language of the new law: Senate Bill 914.
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