As the cost of medical care for injured workers continues to grow, this study provides policymakers and system stakeholders with an inventory of the cost containment initiatives employed by 51 jurisdictions. This study updates the tables from the previous edition with the statutory provisions, administrative rules, and administrative procedures as of January 2013. However, it does not provide written explanations of the initiatives in use by each state.

The report contains key features of each state’s cost containment initiatives, including  

• medical fee schedules;
• regulation of hospital charges;
• choice of provider;
• treatment guidelines;
• utilization review/management;
• managed care;
• pharmaceutical regulations;
• urgent care and ambulatory surgical center fee schedules; and
• medical dispute regulations.

These initiatives aim to curb the cost of a particular service or to reduce the amount of services provided. Cost containment regulatory initiatives entail a balancing act of limiting the cost of services and inappropriate or unnecessary treatment without negatively affecting the quality of treatment or access to care for injured workers. The 2013 edition includes new information about ability to settle costs of future medical care and whether there is a finite period of time for medical care.  

Workers' Compensation Medical Cost Containment: A National Inventory, 2013. Ramona P. Tanabe. February 2013. WC-13-02.

Copyright: WCRI