DAR File No. 37960

Insurance, Administration

Rule R590-267

Personal Injury Protection Relative Value Study Rule

Notice of Proposed Rule

(New Rule)

DAR File No.: 37960
Filed: 09/03/2013 11:35:12 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this rule is to establish a reasonable value of services and accommodations for the diagnosis, care, recovery, or rehabilitation of an injured person under automobile personal injury protection coverage as described in Subsection 31A-22-307(1)(a).

Summary of the rule or change:

This rule establishes a reasonable value of services and accommodations for the diagnosis, care, recovery, or rehabilitation of an injured person under automobile personal injury protection coverage.

State statutory or constitutional authorization for this rule:

• Subsection 31A-2-201(3)
• Subsection 31A-22-307(2)

Anticipated cost or savings to:

the state budget:

The department will be required to purchase two hard copies of the incorporated by reference Relative Values for Dentists (RVD) publication at $129 each and the Relative Values for Physicians (RVP) publication at $330 each; one copy each to be maintained by the department and one copy for the Division of Administrative Rules to comply with the rulemaking requirements. In the past, the department has printed 100-200 relative value study books containing reasonable fees for all CPT and CDT codes used by medical and dental providers in billing for the treatment of injuries in automobile accidents. Cost for printing was about $5 per book and the department sold them for $13 each. This rule changes that process. The rule contains the conversion factors health care providers will use to calculate reasonable fees for medical and dental services based on CPT and CDT codes. Now that the relative value study book is not required to be provided by the party doing the study for the department, cost of the study has decreased from $25,000 to $20,000 saving the department $5,000 for biennial study.

local governments:

This rule will have no impact on local government. It affects the process by which reasonable fees for treatment of injuries in automobile accidents are determined.

small businesses:

Medical, dental, and chiropractic offices that provide services for individuals injured in auto accidents will need to purchase individually or as a group, the RVD or RVP publication incorporated by reference in the rule. The cost of the RVP will be $330 for a hard copy and $700 for a data file; and the RVD will be $129 for a hard copy and $119 for an electronic file. By using the publication with the conversion factors in the rule, they will be able to determine the reasonable charges for services they provide to those injured in automobile accidents.

persons other than small businesses, businesses, or local governmental entities:

Auto insurers, or those they contract with to service their claims, may purchase the RVD or RVP publication incorporated by reference in the rule. The cost of the RVP will be $330 for a hard copy and $700 for a data file; and the RVD will be $129 for a hard copy and $119 for an electronic file. By using the publication with the conversion factors in the rule they will be able to determine the reasonable charges of medical and dental services they are required to reimburse providers for treatment under personal injury protection coverage in Utah.

Compliance costs for affected persons:

Auto insurers, or those they contract with to service their claims, may purchase the RVD or RVP publication incorporated by reference in the rule. This is also true of health care providers who provide services or accommodations to those injured in auto accidents. The cost of the RVP will be $330 for a hard copy and $700 for a data file; and the RVD will be $129 for a hard copy and $119 for an electronic file.

Comments by the department head on the fiscal impact the rule may have on businesses:

Following the dissolution of arrangement with RVS, Inc. to conduct a study and to provide the department with the RVS book every two years the department found themselves in a situation where they could be in violation of copyright laws by continuing to put together an RVS book containing information from RVS, Inc.

Todd E. Kiser, Commissioner

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Insurance
Administration
Room 3110 STATE OFFICE BLDG
450 N MAIN ST
SALT LAKE CITY, UT 84114-1201

Direct questions regarding this rule to:

• Jilene Whitby at the above address, by phone at 801-538-3803, by FAX at 801-538-3829, or by Internet E-mail at [email protected]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

10/15/2013

Interested persons may attend a public hearing regarding this rule:

• 10/01/2013 11:00 AM, Senate (East) Bldg, 420 N State St, Spruce Rm, Salt Lake City, UT

This rule may become effective on:

10/22/2013

Authorized by:

Todd Kiser, Commissioner

R590. Insurance, Administration.

R590-267. Personal Injury Protection Relative Value Study Rule.

R590-267-1. Authority.

This rule is promulgated by the insurance commissioner pursuant to Sections 31A-2-201(3), and 31A-22-307(2).

 

R590-267-2. Purpose.

(1) The purpose of this rule is to establish a reasonable value of services and accommodations for the diagnosis, care, recovery, or rehabilitation of an injured person under automobile personal injury protection coverage as described in 31A-22-307(1)(a).

(2) As required by 31A-22-307(2), the reasonable value is based on the 75th percentile of medical, dental, and chiropractic charges, as they presently exist in the most populous county in this State.

 

R590-267-3. Scope.

This rule applies to services and accommodations:

(1) provided under automobile personal injury protection coverage as described in 31A-22-307(1)(a); and

(2) provided on or after January 1, 2014.

 

R590-267-4. Definitions.

(1) As used in this rule "Conversion Factor" means a multiplier used to convert the relative value unit or units of a service or a procedure to a reimbursement rate.

(2) As used in this rule "RVD" means 2013 Edition of the Relative Values for Dentists published by Relative Values Studies, Inc., 12301 N. Grant St., Suite 230, Thornton, CO, 80241; phone: (866) 310-7874; email: [email protected]; website: www.rvsdata.com.

(3) As used in this rule "RVP" means 2013 Edition of the Relative Values for Physicians published by OptumInsight, 2525 Lake Park Blvd., Salt Lake City, UT 84120; phone: (800) 464-3649; email: [email protected]; website: www.optum.com.

(4) As used in this rule "Relative Value Unit" means a numerical value assigned to a medical or dental procedure as published in RVP and RVD respectively.

(5) The publications identified in Subsections R590-267-4.(2) and (3) are hereby incorporated by reference within this rule.

 

R590-267-5. Conversion Factors.

(1) The following conversion factors shall be used to determine the reasonable value of medical services or accommodations:

(a) anesthesia, 91.57;

(b) surgery, 180.00;

(c) radiology, 35.18;

(d) pathology, 23.85;

(e) medicine, 10.87;

(f) evaluation and management, 11.85.

(2) The conversion factor used to determine the reasonable value of dental services or accommodations shall be 55.00.

 

R590-267-6. Fee Schedule.

The reasonable value of any service or accommodation shall be calculated by multiplying the relative value unit assign to the service or accommodation by the applicable conversion factor prescribed in R590-267-5.

 

R590-267-7. Penalties.

A person found to be in violation of this rule shall be subject to penalties as provided under Section 31A-2-308.

 

R590-267-8. Enforcement Date.

The commissioner will begin enforcing the provisions of this rule on January 1, 2014.

 

R590-267-9. Severability.

If any provision of this rule or its application to any person or situation is held to be invalid, that invalidity shall not affect any other provision or application of this rule which can be given effect without the invalid provision or application, and to this end the provisions of this rule are declared to be severable.

 

KEY: relative value study

Date of Enactment or Last Substantive Amendment: 2013

Authorizing, and Implemented or Interpreted Law: 31A-2-201(3); 31A-22-307(2)