Bill > HB2840

This bill amends the Workers' Compensation Act to establish a new medical fee schedule for healthcare services effective September 1, 2026. The bill creates four non-hospital and fourteen hospital fee schedule regions across different counties in Illinois, with fees calculated based on Medicare maximum fees. The Commission will determine the initial workers' compensation maximum fee for each medical procedure (CPT) and diagnosis-related group (DRG) code by comparing it to the Medicare fee and applying specific adjustment rules. For example, if a fee is less than 125% of the Medicare fee, it will be raised to 125%, and if it's over 225% of the Medicare fee, it will be reduced. The bill also allows healthcare providers to petition the Commission if they believe the fee schedule would significantly limit access to quality healthcare in a specific field or geographic area. The new fee schedule will be automatically adjusted annually by half the Consumer Price Index-U increase, and the existing fee schedule provisions will become inoperative after August 31, 2026. This approach aims to create a more standardized and potentially more affordable medical fee schedule for workers' compensation healthcare services across different regions of Illinois.

https://www.ilga.gov/legislation/BillStatus.asp?DocNum=2840&GAID=18&DocTypeID=HB&SessionID=114&GA=104