PERAC Memo #43 - 2011: 840 CMR 10:10(3) & 10:15(4)–Annual Review of Medical Testing Fee

840 CMR 10:10(3) & 10:15(4)–Annual Review of Medical Testing Fee

Summary

This memo announces PERAC's annual review of the medical testing fee cap under 840 CMR 10:10(3) and 10:15(4), which governs reimbursement for non-invasive medical tests ordered by Regional Medical Panels during disability evaluations. At its December 12, 2011 meeting, the Commission voted to continue past practice, maintaining the $100.00 per case cap that PERAC staff may approve without further Commission review. No action is required of boards, as this is informational, though boards should be aware that any test costs exceeding $100 require advance Commission approval.

Full Text

MEMORANDUM #43, 2011 Gregory R. Mennis M E M O R A N D U M TO: All Retirement Boards FROM: Joseph E. Connarton, Executive Director RE: 840 CMR 10:10(3) & 10:15(4)–Annual Review of Medical Testing Fee DATE: December 21, 2011 As you know, 840 CMR 10:10(3) and 10:15(4) states “the medical panel may suggest ‘non-invasive’ medical tests, which the panel considers necessary to render an opinion of the member’s medical condition.” The regulation further states that the “Commission shall assume the cost of any non-invasive test suggested by the medical panel up to an amount that the Commission shall determine annually. This annual determination will be communicated to all retirement boards. No test, the cost of which exceeds the annual amount determined by the Commission, shall be ordered or required by the medical panel without the advance approval of the Commission”. There are very few instances where reimbursements for medical services ordered by a Regional Medical Panel exceed $100.00. Medical panel physicians conduct very few medical tests during the examination process. The member’s medical provider generally orders the necessary medical tests during the evaluation and treatment phase, and provides this information to the Regional Medical Panel. The Regional Medical Panel physicians consider the results of these studies as part of the panel examination. Please be advised at their meeting held December 12, 2011, the Commission voted to continue the past practice of allowing PERAC staff to approve up to $100.00 per case for non-invasive medical testing associated with the medical panel process. If you have questions, please contact PERAC’s Disability Unit at 617-666-4446.