DWC Adopts Geographic Practice Cost Index Rules

Friday, September 28, 2018 | 0

The California Division of Workers’ Compensation gave notice Thursday that it has adopted rules that implement Medicare's Geographic Practice Cost Index for the state's Official Medical Fee Schedule, marking the first time that the state has set regional prices for medical services.

The amendments to California Code of Regulations Section 9789.12.1 through 9789.19.1 replace the average statewide geographic adjustment factor with local geographic adjustment factors, effective Jan. 1.

“Adoption of the Medicare MSA-based locality GPCIs will improve payment allowance accuracy by reflecting the resources required to provide a service according to specific regions,” the division said. “The amendments also make minor clarifying revisions to the regulations.”

The DWC said it has asked the Office of Administrative Law to file the amended regulations with the Secretary of State.

The GPCI rules establish 32 separate regions within California and set specific price modifiers for each. An analysis by Rand Corp. found that this will increase payments in 12 counties, have no impact in Sonoma County and reduce payments in all others. 

San Benito County will see the largest increase, at 9.8%. The largest reduction will be in Shasta County, where reimbursements will decline, by 5.3%.