FAIR Health Tailors Workers’ Compensation Services to States

February 16, 2023

FAIR Health has helped a number of states develop and update their workers’ compensation fee schedules. To meet the needs of each state, we work closely with agency officials to understand the state’s profile and stakeholder concerns and provide services tailored to each state.

When beginning a workers’ compensation project, FAIR Health does not start with preconceived notions or a standard “template.” We ask states about their goals, hear from stakeholders about their concerns and research how other states may approach similar issues. We provide information and alternative methodologies and discuss them with the states so they can make decisions about solutions that will work best in their jurisdictions. Then FAIR Health helps state officials implement the solutions they have chosen. FAIR Health has supported workers’ compensation programs in Arizona, Colorado, Georgia, Kentucky, Mississippi, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina and Tennessee, among other states.

Research and Reports
Sometimes, FAIR Health is commissioned to do research on a particular topic related to workers’ compensation. For a state that did not already have a facility fee schedule, we were asked to conduct a study comparing the state’s facility payments for workers’ compensation to those of states with facility fee schedules and to private health insurance charges and allowed amounts for similar services. The resulting report was of great value to the state in planning next steps.

In a report commissioned by another state, FAIR Health analyzed two evaluation and management codes that are important to workers’ compensation but are not priced by Medicare. Since the state’s fee schedule is based only on Medicare, the state wanted to learn how other states handled these codes and what the costs were under private health insurance (although the codes are used differently in private health insurance than in workers’ compensation). At the state’s request, FAIR Health presented the report to the state’s stakeholders.

Developing Fee Schedules
FAIR Health has also helped several states create new fee schedules or add new services to existing fee schedules. For example, we helped several states develop fee schedules for dental rates. For another state, we helped add a fee schedule for ambulatory surgery centers to its medical fee schedule.

When helping states develop fee schedules, FAIR Health makes many different types of contributions. We typically research and report to states on topics that are creating issues or posing obstacles to access to care. Examples of some of these issues include reimbursing for drug testing, costs for compound drugs and topical patches, updating guidelines as the industry changes (e.g., for evaluation and management, telehealth) and developing fee schedule rates for services that are performed in an outpatient setting but that the Centers for Medicare & Medicaid Services (CMS) pays for only in an inpatient setting. We have, likewise, helped states develop methodologies for facility payments for implants. In some states, we analyze CMS changes and present them to the state so it can decide which updates to adopt.

We also help states after the fee schedule is published. Our state agency clients receive many questions about the fee schedule, and FAIR Health can help them answer complex questions.

Throughout the process, FAIR Health is attuned to states’ concerns. For example, one key concern for states is balancing costs with access to care. It is important to states that injured workers are able to make appointments with providers in the specialties needed and that providers are willing to treat injured workers in spite of the additional paperwork and reports that are often required.

FAIR Health President Robin Gelburd stated: “There is no one solution for workers’ compensation fee schedules. Each state is unique and has different goals and its constituents have different needs. The key to our success in this area is that we listen carefully and work closely with our clients to understand their stakeholders’ concerns so they can make the best decisions for their state.”

For more information about the wide range of services FAIR Health offers state workers’ compensation programs, contact FAIR Health by email at info@fairhealth.org or call 855-301-FAIR (3247), Monday through Friday, 9 am to 6 pm ET.