About the Medical Regulations Unit

Additional Links

About the Medical Regulations Unit

The Medical Regulations Unit (Unit) now reports to the Bureau Chief of the Workers’ Compensation Claims Assistance Bureau. Among other tasks, the Unit is responsible for publishing updates to the Montana Non-Facility Fee Schedule and the various Facility Fee Schedule components on the Department’s website. The Unit is also responsible for developing, interpreting and implementing the numerous statutes and administrative rules that provide direction on how the fee schedules are administered. The Medical Regulations Unit is also responsible for the implementation and maintenance of the Montana Utilization and Treatment Guidelines and the web-based delivery system designed for and accessible from the Department’s website. We also serve as administrators for the Subsequent Injury Fund (SIF) which was developed to encourage employers to hire and retain injured workers. In general, The Medical Regulations Unit serves as a liaison between the Department and those who have questions or need assistance with issues relating to the medical regulation of workers’ compensation claims in Montana.

39-71-704 MCA

The Department develops, implements, and monitors medical cost-containment strategies, including fee schedules to reimburse Facility and NonFacility providers. The Facility Fee Schedule has an effective date of December 1, 2008. The NonFacility Fee Schedule was effective January 1, 2008. Training for the new Facility Fee Schedule can be found under "Additional Links" in the left margin, under the heading, "Understanding Workers' Compensation (WC) Facility Fee Schedule". The NonFacility Fee Schedule has an instruction set on its web page. The Facility Fee Schedule applies to Montana facilities, namely Acute Care Hospitals (ACHs) and Ambulatory Surgery Centers (ASCs), for WC services provided on or after December 1, 2008.

In 2007, the Montana legislature passed legislation directing the Department to establish a “Resource-Based Relative Value Scale (RBRVS) fee schedule for NonFacility medical services provided to injured workers. This fee schedule applies to all NonFacility procedures and services provided on or after January 1, 2008.

No Base Rate Adjustments for January 1, 2010

The base rates for hospital inpatient, outpatient and ambulatory surgery centers will not be adjusted until the Department has an opportunity to review payment data received from carriers and medical providers. Providers were given the opportunity to report to the Department quarterly, so the impact of new DRG and APC fee schedules could have been evaluated earlier. No providers submitted any information during this voluntary submission period.

Hospitals and ambulatory surgery centers are required by section 24.29.1432(8) to submit payment information on an annual basis. The rule states “Hospitals and ASCs must, on an annual basis, submit to the department data reporting Medicare, Medicaid, commercial, unrecovered, and workers' compensation claims reimbursement in a standard form supplied by the department.” The format for these reports was sent out previously and a reminder notice will be going out soon.