Administrative – Industrial Commission Fee Schedule – Hospitals & Ambulatory Surgical Centers

Surgical Care Affiliates, LLC v. North Carolina Industrial Commission (Lawyers Weekly No. 011-368-17, 12 pp.) (Wanda Bryant, J.) Appealed from Wake County Superior Court (Paul Ridgeway, J.) N.C. App.

Holding: The purpose of 2013 N.C. Sess. Laws ch. 410, § 33.(a)(1) is to contain medical care costs attributable to injured workers while reasonably reimbursing medical care providers for services. The Industrial Commission‘s inclusion of ambulatory surgical centers in the definition of “hospital,” thus subjecting petitioner to the “Medicare methodology for . . . hospital fee schedules” does not appear to frustrate this objective and may be construed in harmony with the reason for the session law.

We reverse the superior court’s decision that the session law did not authorize the Commission to adopt new maximum fees for ambulatory surgical centers.

The superior court referred to the Hospital Licensure Act, found in G.S. Chap. 131E, to define “hospital” as it was used in the session law, which concerns a fee schedule adopted by the Commission pursuant to the Workers’ Compensation Act. On this basis, the court concluded “that hospitals are separate and legally distinct entities from ambulatory surgical centers.” We hold the court erred.

As that definition of “hospital” was essential to the lower court’s determination that the session law did not authorize the Commission to adopt new maximum fees for ambulatory surgical centers, we reverse the court’s decision and remand for entry of an order affirming the Commission’s declaratory ruling.