PERAC Memo #60 - 2012: 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

PERAC Memo #60/2012 addresses the annual review of the medical testing fee under 840 CMR 10:10(3) and 10:15(4), which caps the cost of non-invasive medical tests the Commission will fund without prior approval when suggested by a Regional Medical Panel during disability evaluations. At its December 10, 2012 meeting, the Commission voted to maintain the existing $100.00 per-case limit that PERAC staff may approve for such testing. No action is required by boards, as this is informational; boards should simply be aware that testing costs exceeding $100.00 require advance PERAC approval.

Full Text

PERAC Memo # 60 / 2012

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 28, 2012

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 10, 2012, 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 .