Alabama VIEW STATE →

FEE SCHEDULE NEWS:

• The state has posted a new Physician and Hospital fee schedule effective January 1, 2017.  The rates for the ASC centers remain unchanged from the previous update.
• New changes to the hospital and ASC fee schedules are expected to be posted around April 1, 2017.

Alaska VIEW STATE →

FEE SCHEDULE NEWS:

• The state adopted a new medical and hospital fee schedule effective December 1, 2015 based on the RBRVS values as established by CMS with state published conversion factors. The state has adopted the Medicare Severity Diagnosis Related Groups (MS-DRG) weight published by CMS with the state’s individual conversion factor for inpatient hospital billing.  The data will be updated quarterly along with CMS data.

REGULATORY ACTIVITY:

• The Department of Labor and Workforce Development and the Alaska Workers’ Compensation Board give notice that amended versions of material adopted by reference in 8 AAC 45.083, dealing with fees for medical treatment and services, are in effect.
• Alaska has released bulletin 16-5 regarding Cost of Living Adjustment referenced in AS 23.30.175 and AAC 45.138.
• Notice of proposed changes relating to fees for medical treatment and services, second independent medical evaluation procedures, the second injury fund, hearing briefs, discovery, and subpoenas in the regulations of the Alaska department of labor and workforce development and the Alaska Workers’ Compensation Board. The Alaska Department of Labor and Workforce Development and the Alaska Workers’ Compensation Board propose to change regulations relating to fees for medical treatment and services, second independent medical evaluation procedures, the second injury fund, hearing briefs, discovery, and subpoenas.
• The State of Alaska Department of Labor and Workforce Development Workers' Compensation Board will meet January 12-13, 2017.
• Alaska released bulletin 16-06 regarding the second injury fund contribution rate for calendar year 2017.
• These bulletins can be found at http://labor.state.ak.us/wc/bulletins.htm.

Arizona VIEW STATE →

FEE SCHEDULE NEWS:

• The state adopted a new medical fee schedule effective October 1, 2016.
• “The Commission has also adopted by reference: 1) The unit values and guidance for consultative, diagnostic and therapeutic services published in the most recent edition of Relative Value Guide, American Society of Anesthesiologists; 2) The most recent edition of Complete Global Service Data for Orthopaedic Surgery, American Academy of Orthopaedic Surgeons; 3) The 1995 and 1997 Documentation Guidelines for Evaluation and Management Services, Centers for Medicare and Medicaid Services (CMS), and; 4) The National Correct Coding Initiative Edits, Additionally, in establishing the follow-up days for adopted codes in the Fee Schedule, the Commission uses the global periods published in the most recent edition of Relative Values for Physicians, Optuminsight, Inc.” The state adopted Medi-Span as the publication for determining the AWP under the Pharmaceutical Fee Schedule.
• The next update to the Arizona fee schedule is set for October 1, 2017.

REGULATORY ACTIVITY:

• The average monthly wage statutory maximum for injuries sustained on or after 1/1/2017 is $4,521.92.  This maximum will be effective through 12/31/2017.

LEGISLATIVE ACTIONS:

• House Bill 2240
  The enacted legislation authorizes the change of an administrative law judge as a matter of right and prescribes the rate of interest on the payment of benefits.  Changes to administrative law judges include:
  • Entitles any interested party regarding a hearing for a worker’s compensation claim to one administrative law judge change as a matter of right by filing a notice of change; Specifies the notice of change must:
    • a. Be signed by the interested party or the party’s authorized agent;
    • b. State the name of the administrative law judge to be changed;
    • c. Certify that the interested party has timely filed the notice of change (The notice is timely if filed not more than 30 days after the date of the notice of hearing or not more than 30 days after the new administrative law judge is assigned to the claim if another interested party has filed a notice of change as a matter of right); and
    • d. Certify that the interested party has not previously been granted a change for the claim.
  • Changes to administrative law judges also clarifies any interested party may file an affidavit that sets forth any of the grounds for an administrative law judge change for cause against a presiding administrative law judge;
  • States an affidavit for an administrative law judge change must be filed with the same time frames as a notice of change;
  • Asserts  the  employer  and  the  employer’s  insurance  carrier  are  considered  a  single  party unless the employer’s and the employer’s insurance company’s interest are in conflict.
  • In regards to payment of Interest on Awards it requires interest on the payment of benefits be paid at 10% or at the rate that is equal to 1% plus the prime rate as published by the Board of Governors of the Federal Reserve System, whichever is less and outlines the instances for when the interest is paid.
  • In addition, the amended statute also specifies only unemployment benefits received during the period of temporary partial disability are considered wages able to be earned. The enacted legislation includes translation services as a medical, surgical and hospital benefit and provides parameters for selecting a translator.  The legislation requires the Industrial Commission of Arizona to research and submit recommendations on ways to allow for investigations into the act or practice of workers’ compensation fraud impacting self-insured employers by December 31, 2016 and makes technical and conforming changes.  Effective Date August 6, 2016.

• House Bill 2350
  The enacted legislation stipulates that Post-Traumatic Stress Disorder (PTSD) of a peace officer is presumed to be a personal injury that is compensable pursuant to statute relating to workers’ compensation.  It requires  a  state  or  political  subdivision  of  the  state  to  establish  a  program  to  provide  a peace officer, firefighter or public safety employee up to 12 visits of licensed counseling, including telemedicine, paid for by the employer, if the employee was: a peace officer exposed to use of deadly force or subjected to deadly force in the line of duty, regardless of whether the officer was physically injured; a firefighter who witnessed the death of another firefighter while engaged in the line of duty; and a public safety employee who: visually  witnesses  the  death  or  maiming  of  one  or  more  persons  or  visually witnesses the immediate aftermath of the death or maiming; responds  to  or  was  directly  involved  in  a  criminal  investigation  of  a  dangerous crime against a child; or requires rescue in the line of duty where one’s life was endangered.  The bill stipulates that payment of licensed counseling by the employer does not create a presumption of a compensable mental injury, illness or condition related to workers’ compensation.   It exempts state employers that provide a program to its public safety employees which: is paid for by the employer; provides licensed counseling for any issue and, in a case related to trauma experienced while in the line of duty, occurs on the request of the employee and in-person; offers at least six visits per year before July 1, 2017; and offers at least 12 visits per year after July 1, 2017.  The enacted legislation defines licensed counseling and public safety employee.  It adds a repeal date of January 1, 2023.   Effective Date August 6, 2016.
• House Bill 2355
  The enacted legislation allows a pharmacist to dispense naloxone hydrochloride (Naloxone) without a prescription to a person at risk of experiencing an opioid-related overdose, a family member or community member in a position to assist that person. Allows a physician, licensed nurse practitioner or any other health professional who has prescribing authority to prescribe and dispense Naloxone to a person at risk, a family member in a position to assist a person at risk, a community organization that provides services to persons at risk or to any other person who is in a position to assist persons at risk.    The legislation requires a school governing board to prescribe and enforce policies and procedures for the emergency administration of Naloxone or any other opioid antagonist approved by the United States Food and Drug Administration by any employee of a school district. It permits a pharmacist to dispense Naloxone or any other opioid antagonist without a prescription to a person who is at risk of experiencing an opioid-related overdose, a family member who is in a position to assist that person or to a community member who is in a position to assist that person. The bill also requires a pharmacist who dispenses Naloxone or any other opioid antagonist to do the following: document the dispensing consistent with the Pharmacy Board rules; and instruct the individual to whom the opioid antagonist is dispensed to summon emergency services as soon as practicable either before or after administering the drug.  It states that the authority of a pharmacist to fill or refill a prescription for Naloxone will not be affected.  The enacted legislation specifies that a pharmacist who dispenses an opioid antagonist is immune from professional liability and criminal prosecution for any decision, act, omission or injury that results if the pharmacist acts with reasonable care and in good faith, except in cases of wanton or willful neglect. The legislation allows a licensed physician, nurse practitioner or any other health professional, who has prescribing authority and who is acting within their scope of practice, directly or by standing order, prescribe or dispense Naloxone to a person who is at risk of experiencing an opioid-related overdose, to a family member of that person, to a community organization that provides services to persons who are at risk of an opioid-related overdose or to any other person who is in a position to assist a person who is at risk of experiencing an opioid-related overdose. It mandates a physician, licensed nurse practitioner or other health professional who prescribes or dispenses Naloxone or any other opioid antagonist to instruct the individual to whom the opioid antagonist is dispensed, to summon emergency services as soon as practicable either before or after administering the opioid antagonist.  The act specifies that a physician, licensed nurse practitioner or any other health professional who prescribes or dispenses an opioid antagonist will be immune from professional liability and criminal prosecution for any decision, act, omission or injury that results if the physician acts with reasonable care and in good faith, except in cases of gross negligence, willful misconduct or intentional wrongdoing.  It states that before a physician, licensed nurse practitioner or other health professional prescribes an opioid antagonist, they may require the person receiving the prescription, as an indicator of good faith, to provide factual basis in writing for a reasonable conclusion that the person or entity meets the description of a person or entity who is able to receive an opioid antagonist. The enacted legislation allows a person to administer an opioid antagonist that is prescribed or dispensed by a physician, licensed nurse practitioner, pharmacist or other health professional to a person who is experiencing an opioid-related overdose. It specifies that a person who administers an opioid antagonist in good faith and without compensation to a person who is experiencing an opioid-related overdose is not liable for any civil or other damages as the result of any act or omission by the person rendering care, or as the result of any act or failure to act to arrange for further medical treatment or care for the person experiencing the overdose, unless the person rendering the care acts with gross negligence, willful misconduct or intentional wrongdoing. The enacted legislation defines person, for the purposes of A.R.S. §36-2226 and A.R.S. §36-2267 as an employee of a school district or charter school who is acting in the person’s official capacity and makes technical and conforming changes.  Effective Date August 6, 2016.
• Senate Bill 1283
  SB 1283 requires a medical practitioner to obtain a patient utilization report from the Controlled Substances Prescription Monitoring Program’s (CSPMP) central database tracking system before prescribing an opioid analgesic or benzodiazepine controlled substance listed in schedule, II, III or IV.  The legislation provides, beginning the later of October 1, 2017 or sixty days after the statewide Health Information Exchange (Exchange) has integrated the CSPMP data into the Exchange, a medical practitioner, before prescribing an opioid analgesic or benzodiazepine controlled substance listed in schedule II, III or IV for a patient, must obtain a patient utilization report regarding the patient for the preceding 12 months from the CSPMP central database tracking system at the beginning of each new course of treatment and at least quarterly while that prescription remains a part of the treatment. It states each medical practitioner regulatory board must notify the medical practitioners licensed by that board of the applicable date.  The legislation permits a medical practitioner a one-year waiver from the requirement due to technological limitations that are reasonably within the control of the practitioner or other exceptional circumstances demonstrated by the practitioner, pursuant to a process established by the Arizona State Board of Pharmacy (Board) by rule.  It stipulates that a medical practitioner is not required to obtain a patient utilization report from the central database tracking system if any of the following apply:
  • The patient is receiving hospice care or palliative care for a serious or chronic illness;
  • The patient is receiving care for cancer, a cancer-related illness or condition or dialysis treatment;
  • A medical practitioner will administer the controlled substance;
  • The patient is receiving the controlled substance during the course of inpatient or residential treatment in a hospital, nursing care facility, assisted living facility, correctional facility or mental health facility;
  • The medical practitioner is prescribing the controlled substance to the patient for no more than a ten-day period for an invasive medical or dental procedure or a medical or dental procedure that results in acute pain to the patient;
  • The medical practitioner is prescribing no more than a five-day prescription and has reviewed the  program’s central database tracking system for that patient within the last 30 days, and the system shows that no other prescriber has prescribed a controlled substance in the preceding 30 day period and,
  • The medical practitioner is prescribing the controlled substance to the patient for no more than a ten-day period for patient who has suffered an acute injury or a medical or dental disease process that is diagnosed in an emergency department setting and that results in acute pain to the patient.  An acute injury or medical disease process does not include back pain.
  • The legislation stipulates that if the medical practitioner uses electronic medical records that integrate data from the CSPMP, a review of the electronic medical records with the integrated data must be deemed compliant with the review of the program’s central database tracking system.  It requires the Board to promote and enter into data sharing agreements for the purpose of integrating the CSPMP into electronic medical records and states by complying with this, a medical practitioner acting in good faith, or the medical practitioner’s employer, is not subject to liability or disciplinary action arising solely from either: Requesting or receiving, or failing to request or receive, prescription monitoring data from the program’s central database tracking system, or acting or failing to act on the basis of the prescription monitoring data provided by the program’s central database tracking system.   The legislation provides that medical practitioners and their delegates are not in violation during any time period in which the CSPMP tracking system is suspended or is not operational or available in a timely manner. If the CSPMP if not accessible, the medical practitioner or their delegate must document the date and time the practitioner or delegate attempted to use the CSPMP.  It requires the Board to conduct an annual voluntary survey of program users to assess user satisfaction with the program’s central database tracking system. The survey may be conducted electronically.  The bill requires the Board, on or before December 1 of each year to provide a report of the survey results to the President of the Senate, the Speaker of the House of Representatives and the Governor along with a copy to the Secretary of the State.  The legislation permits a medical practitioner regulatory board to obtain and use information from the program’s central database tracking system. It stipulates that the Board contract with a third party to conduct an analysis of the CSPMP and report on at least the following: The usability and length of time to query data on the CSPMP’s central database tracking system and recommendations to improve system properties for more efficient and effective clinical use by medical practitioners, strategies to increase and promote use by medical practitioners, the quality of the data and recommendations to improve accuracy and validity, strategies to make it easier to integrate the CSPMP’s central database into electronic health records, an analysis of available and necessary resources for the Board to implement CSPMP provisions, and best practices in this state and other states that have a CSPMP or database. The enacted legislation specifies the report must be completed on or before January 1, 2017.  On or before January 15, 2017 the Board must deliver the report to the President of the Senate, the Speaker of the House of Representatives and the Governor and must provide a copy to the Secretary of State.  The legislation repeals the CSPMP analysis and report section from and after September 30, 2017.  It states on or before October 1, 2016 and every quarter for the following four years, the Board must complete a quarterly report on the number and names of electronic health records companies that have integrated the CSPMP’s central database or are in the process of integrating the database for use by medical practitioners.  The report must include the number of medical practitioners who will have access to the integrated data through an electronic health records system.  The Board must post each report on its public website.  Repeals this from and after September 20, 2021.  The bill exempts the Board for purposes related to this act, from the rule making requirements for one year after the effective date of this act and it also defines emergency department.  Effective August 6, 2016.
• Senate Bill 1500
  SB 1500 continues the Industrial Commission of Arizona (ICA), the Occupational Safety and Health Advisory Committee, the Boiler Advisory Board, with modifications, and the Occupational Safety and Health Review Board (Review Board) for eight years. Makes various changes to ICA per diem and requirements of the Arizona Division of Occupational Safety and Health (ADOSH).  The enacted legislation continues the following for eight years: ICA; Occupational Safety and Health Advisory Committee; Boiler Advisory Board; and Review Board.  The legislation specifies that a Commissioner receives per diem for each day the Commissioner prepares for or attends an ICA meeting rather than each day the Commissioner performs their duties.  It requires Commissioners to provide the ICA Director documentation explaining the duties completed for the day the Commissioner is seeking per diem. It permits the ICA Director to deny per diem for failure to provide documentation or if the duties were not related to preparing for or attending an ICA meeting.  The act stipulates the ICA Director is appointed by Governor, rather than the appointed by the ICA with consent of the Senate. The legislation requires ADOSH to contract with Office of Administrative Hearings (OAH) to conduct hearings and adjudicate contested cases on an employer filing a notice of contest, conditional upon federal approval.  It instructs the ICA Director to notify Legislative Council by January 15, 2019, of the date the condition was or was not met.  It stipulates OAH decisions are subject to appeal to the Review Board.  The legislation permits the ADOSH Director, or their authorized agent, and the ICA to consider violations of an employer’s substance abuse policies as evidenced by test results or other impairment in deciding to recommend and issue a citation.  It prohibits an ADOSH employee or the ICA from: communicating that the employer should not be represented by an attorney and that the employer may be treated more favorably if not represented; conducting an audio recording of an oral statement during an interview without the person’s knowledge and consent; and obtaining a written statement during an interview without informing the person of their right to receive a copy of the written statement within a reasonable time.  The act requires the person to be informed of their right to receive a copy of the recorded oral statement within a reasonable time.  It repeals the authority of the ICA to require the attendance and testimony of witnesses and the production of evidence under oath.  The legislation requires ADOSH to: certify special inspectors; inspect boilers and lined hot water storage heaters until July 1, 2017; and establish a schedule to require regular boiler and lined hot water heater inspections. The legislation amends the Boilers Advisory Board (Board) by codifying establishment of the Board to assist the ICA in drafting standards and regulations for boilers and lined hot water storage heaters consisting of the following members appointed by the ICA: one member representing the boiler or lined hot water storage manufacturer industry; one member representing a public utility; one member representing the insurance industry; one member who is an owner or operator of a boiler or lined hot water storage heater; and one member who is a licensed contractor.  It directs the initial members to assign themselves by lot to terms of one or two years and stipulates subsequent members serve three-year terms.  It requires the Board to: meet at least annually and on the call of the ICA; and annually elect a chairperson from amongst its membership.  It specifies that the ICA determines the time and place of Board meetings. The legislation also removes regulation of private employment agents by the ICA due to the sunset of the Employment Advisory Council.  It requires every employment agent to reasonably ensure any representations made are true and cover all the material facts affecting the employment in question and classifies the failure to comply as an unlawful practice in accordance with consumer fraud. The legislation modifies the definition of trade secret.  It makes technical and conforming changes.  Effective Date August 6 2016.

Arkansas VIEW STATE →

FEE SCHEDULE NEWS:

• The state adopted new 2016 CPT codes and descriptions and the 2016 National Physician Fee Schedule Relative Value file effective January 1, 2016.
• The next update is scheduled for January 1, 2017.

REGULATORY ACTIVITY:

• A catastrophic injury or death results in the loss of at least one-third of the worker’s average weekly wage.  This often leaves little or no money to assist the children of the worker in furthering their education beyond high school.  Kids’ Chance of Arkansas has joined with Kids’ Chance of America and other similar states organizations to increase awareness of this dilemma.   Kids’ Chance of Arkansas was fortunate to receive a Governor’s Proclamation declaring November 14 to 18, 2016, Kids’ Chance Awareness Week.
• The state has announced dates for their annual education conference for 2017.  The 2017 AWCC Education Conference will be held on October 18-19, 2017 in Little Rock at the Marriott Conference Center.

LEGISLATIVE ACTIONS:

• House Bill 1010
  The enacted legislation eliminates the Arkansas Workers’ Compensation Death and Permanent total Disability Trust fund.  No additional claims can be fined against the claim beyond June 30, 2019.  Effective Date August 23, 2016.

California VIEW STATE →

FEE SCHEDULE NEWS:

• Inpatient Hospital Fee Schedule has been updated with an effective date of January 1, 2017. The DWC has adopted the final rule of August 22, 2016 and the correction notice of October 5, 2016, published in the Federal Register, which changes the Medicare payment system.  Updates to the Composite Rate, Hospital Specific Outlier Factor, and Cost to Charge Ratio for the listed hospitals have been adopted.  The next update is scheduled for January 2018.
• The DMEPOS and Clinical Lab fee schedules have been updated with an effective date of January 1, 2017. The DWC has adjusted the Pathology and Clinical Laboratory fee schedule and also the DMEPOS schedule to conform with the changes to the Medicare payment system adopted by CMS for calendar year 2017. New changes to the Physician and Practitioner Services Medically Unlikely Edits and the National Correct Coding Initiative Practitioner PTP Edits are expected to become effective January 1, 2017.
• Medi-Cal rates have been released with an effective date of December 15, 2016 however; no changes were present in the data file.  The next update is scheduled for January 15, 2017.
• Ambulance Fee Schedule has been updated with an effective date of January 15, 2016. The state has adopted the 2016 changes to the Medicare Payment System for ambulance.  The next update is expected in January 2017.
• The Copy fee schedule was adopted with an effective date of May 1, 2015.
• The Outpatient and ASC fee schedule was updated with an effective date of December 15, 2016. The state has adopted the Medicare 2016 update to the hospital outpatient prospective payment system.

REGULATORY ACTIVITY:

• WCAB Issues Notice of January 4 Public Hearing on Proposed Amendments to Rules on Lien Claims Filing.  The public hearing is scheduled on Wednesday, January 4 2017 at 10 a.m. in the Milton Marks Conference Center, Santa Barbara Room of the Hiram Johnson State Office Building at 455 Golden Gate Avenue, San Francisco, CA 94102. Members of the public may also submit written comment on the proposed rules amendments until 5 p.m. that day.
• DWC Posts Proposed Further Amendments to its WCIS Regulations and EDI Implementation Guides.  The Division of Workers’ Compensation (DWC) posted proposed regulations further revising its Workers’ Compensation Information System (WCIS) regulations and Electronic Data Interchange (EDI) Implementation Guides. Members of the public were invited to present written comments regarding the proposed modifications to dwcrules@dir.ca.gov until 5 p.m. on Thursday, December 15, 2016.  Following the Office of Administrative Law’s publication of DWC’s initial draft of these regulations, a public hearing was held March 28. A second draft of the regulations was released for a 15-day comment period, which ended on June 9.  Additional revisions to the regulations and to the EDI Implementation Guide for First and Subsequent Reports of Injury (FROI/SROI), Version 3.1, and the EDI Implementation Guide for Medical Bill Payment Records, Version 2.0, have been made in response to changes suggested by trading partners and other stakeholders, and a few additional changes were made to improve the quality and integrity of the data to be reported to WCIS following implementation of these changes.
• The Workers’ Compensation Appeals Board (WCAB) has issued a notice of public hearing regarding a proposed addition and amendments to its Rules of Practice and Procedure. The primary purpose of this rulemaking is to implement legislative changes to the filing requirements for lien claims mandated by Senate Bill 1160.  SB 1160 amended Labor Code section 4903.05 to require that section 4903(b) lien claimants file a declaration that includes information regarding the type of services provided by the lien claimant. A lien claimant’s failure to timely file this declaration shall result in the dismissal of the lien with prejudice by operation of law per Labor Code section 4903.05(c) (3). This rulemaking will mandate use of an e-filed declaration form in order to ensure uniform procedures for lien claimants who first file their liens after January 1, 2017 and current lien claimants who are required to file a declaration by July 1, 2017.
• DWC Administrative Director Announced 2017 Profile Audit Review and Full Compliance Audit Performance.  Labor Code §§129 and 129.5 require the Audit and Enforcement Unit of the Division of Workers’ Compensation (DWC) to conduct a profile audit review (PAR) for all adjusting locations of California workers’ compensation claims at least once every five years. Performance of the adjusting locations is measured in five areas of claims administration:
  • The payment of accrued and undisputed indemnity
  • The late first payment of temporary disability / first notice of salary continuation
  • The late first payment of permanent disability and death benefits
  • The late subsequent indemnity payments
  • The provision of notices with QME/AME advice.
• The administrative director annually establishes profile audit review and full compliance audit (FCA) standards in accordance with Labor Code §§129(b) (1) and (2) and Title 8, California Code of Regulations §10107.1. The 2016 standards are based on the audit results of calendar years 2013 through 2015. The PAR performance standard for audits conducted in 2017 is 1.47885. Audit subjects with PAR performance ratings of 1.47885 or lower will be required to pay any unpaid compensation, but no penalties will be assessed.  If an audit subject’s PAR performance rating is 1.147886 or higher, the audit will expand to a FCA, and an additional sample of indemnity claims will be audited. The FCA performance standard for audits conducted in 2017 is 1.67487.  Audit subjects with an FCA performance rating of 1.67487 or less will be required to pay any unpaid compensation and penalties will be assessed for all violations involving unpaid and late paid compensation.  If an audit subject’s full compliance audit performance rating is 1.67488 or higher, an additional sample of denied claims as well as the expanded sample of indemnity claims will be audited.  Penalties will be assessed for all violations as appropriate pursuant to 8CCR §§10111 through 10111.2.  For additional information go to:  http://www.dir.ca.gov/dwc/audit.html.
• The Division of Workers’ Compensation (DWC) has announced the decrease of the mileage rate for medical and medical-legal travel expenses by one-half cent to 53.5 cents per mile effective January 1, 2017.  This rate must be paid for travel on or after January 1, 2017 regardless of the date of injury. Labor Code section 4600, in conjunction with Government Code section 19820 and the Department of Personnel Administration regulations, establishes the rate payable for mileage reimbursement for medical and medical-legal expenses and ties it to the Internal Revenue Service (IRS).  IRS Bulletin Number IR-2016-169 dated December 13, 2016 announced the rate decrease. The updated mileage reimbursement form is posted on the DWC website.
• The Division of Workers’ Compensation (DWC) issued its Notice of Emergency Regulatory Action to implement the provider suspension process required under Assembly Bill 1244. The bill, a major step to combat fraud in the workers’ compensation system, requires the suspension of medical providers found to have committed a felony or misdemeanor involving fraud or abuse of the Medi-Cal or Medicare programs, the workers’ compensation system itself, or fraud or abuse of any patient. The regulations provide for a hearing process should the provider wish to contest the suspension order.  The emergency regulations will be filed with the state’s Office of Administrative Law (OAL) on December 21, 2016. The regulations to be filed with OAL can be found on the DWC website. OAL has up to 10 days to consider the rules, but may approve them before the 10 days have elapsed. Upon OAL approval and filing with the Secretary of State, the regulations are effective for 180 days while the Division initiates formal rulemaking procedures to adopt permanent regulations. For information on the OAL procedure, and to learn how you may comment on the emergency regulations, go to the OAL’s website. A notice will be posted at the DWC website when the emergency regulations become effective.

LEGISLATIVE ACTIONS:

• Assembly Bill 1244
  Under existing law, the Director of Health Care Services is authorized, for purposes of administering the Medi-Cal program, to suspend a provider of service from further participation under the program for specified reasons, including conviction of any felony or any misdemeanor involving fraud, abuse of the Medi-Cal program or any patient, or otherwise substantially related to the qualifications, functions, or duties of a provider of service. Existing law requires the director, upon receipt of written notification from the Secretary of the United States Department of Health and Human Services that a physician or other individual practitioner has been suspended from participation in the Medicare or Medicaid programs, to promptly suspend the practitioner from participation in the Medi-Cal program. Existing law establishes a workers’ compensation system, administered by the Administrative Director of the Division of Workers’ Compensation, that generally requires employers to secure the payment of workers’ compensation for injuries incurred by their employees that arise out of, or during, employment. Existing law requires an employer to provide all medical services reasonably required to cure or relieve the injured worker from the effects of the injury.  Existing law authorizes an insurer, employer, or entity that provides physician network services to establish or modify a medical provider network for the provision of medical treatment to injured employees and requires the administrative director to contract with individual physicians or an independent medical review organization to perform medical provider network independent medical reviews.
  The enacted legislation requires the administrative director to promptly suspend any physician, practitioner, or provider from participating in the workers’ compensation system if as a physician, practitioner, or provider the individual or entity meets specified criteria, including if that individual has been convicted of any felony or misdemeanor involving fraud or abuse of the Medi-Cal program, Medicare program, or workers’ compensation system, if that individual’ s license, certificate, or approval to provide health care has been surrendered or revoked, or if that individual or entity has been suspended, due to fraud or abuse, from participation in the Medicare or Medicaid programs. It requires the administrative director to adopt regulations for suspending a physician, practitioner, or provider from participating in the workers’ compensation system pursuant to these provisions, as specified, and would require the administrative director to furnish to the physician, practitioner, or provider written notice of the right to a hearing regarding the suspension and the procedure to follow to request that hearing. As enacted it also requires the administrative director to promptly notify the appropriate state licensing, certifying, or registering authority of a physician’s, practitioner’s, or provider’s suspension and to update the division’s databases of qualified medical evaluators and medical provider networks. The bill requires the administrative director to notify the chief judge of the division of a suspension under these provisions, as specified, and post a notice on the department’s Internet Web site. It enacts special lien proceedings for the adjudication of any liens of a physician, practitioner, or provider who has been suspended pursuant to these provisions because he or she has been convicted of a felony or misdemeanor that meets specified criteria. The bill also requires the Director of Health Care Services to notify the administrative director of a suspension of a physician from participation in the Medi-Cal program imposed pursuant to the provisions described above authorizing the director to suspend a provider of service from participation. Existing law establishes the Workers’ Compensation Appeals Board to exercise all judicial powers vested in it, as specified, including workers’ compensation proceedings for the recovery of compensation, or concerning any right or liability arising out of or incidental to the recovery of compensation. Existing law vests the appeals board with full power, authority, and jurisdiction to try and determine finally those matters, subject only to the review by the courts, as specified. Existing law authorizes the appeals board to determine, and allow as liens against any sum to be paid as compensation, as specified, a reasonable attorney’s fee for legal services and disbursements about those legal services. Existing law provides that a charge, claim, or agreement for those legal services or disbursements is not enforceable, valid, or binding more than a reasonable amount. Existing law also requires an attorney to furnish to the employee a written disclosure form describing the procedures available to the injured employee or his or her dependents and specified information regarding attorney’s fees. Existing law requires that a copy of the disclosure form be signed by the employee and the attorney and sent to the employer, or insurer or 3rd-party administrator, if either is known, by the attorney within 15 days of the employee’s and attorney’s execution of the form. Existing law also requires the employee, the insurer, the employer, and the attorneys for each party to sign and file with the board a statement, signed under penalty of perjury, attesting that the signatories have not violated specified laws prohibiting conflicts of interest. Existing law authorizes the appeals board, a workers’ compensation judge, or any party to the action or proceeding, as specified, to cause the deposition of witnesses in any investigation or hearing before the appeals board, and provides that the deponent is entitled to receive specified benefits, such as reasonable expenses of transportation, meals, and lodging, as specified. This bill prohibits payment for legal services or disbursements about those legal services, or expenses relating to the deposition of witnesses, incurred under the provisions described above, as specified, prior to the filing of the disclosure form with the appeals board and the sending of that form to the employer, or to the insurer or 3rd-party administrator, if either is known, by the attorney. The bill requires the disclosure form described above to contain a paragraph setting forth the exact location of the district office of the appeals board at which the employee’s case will be filed and to include a specified statement. It imposes other requirements regarding the signing and content of the form, including that the form be signed under penalty of perjury by the attorney representing the employee, and would require the form to be filed with the appeals board. The bill requires an attorney who subsequently assumes the representation of the employee in the same action or proceeding too complete and sign under penalty of perjury a disclosure form that meets the above-described requirements and the statement attesting that the signatories have not violated specified laws prohibiting conflicts of interest. As enacted it requires the attorney to file the form and statement with the appeals board, and send them to the employer, or insurer or 3rd-party administrator, if either is known, within 15 days of the employee’s and attorney’s execution of the form and statement. By expanding the scope of the crime of perjury under these provisions, this bill would impose a state-mandated local program.  Effective Date January 1, 2017.
• Assembly Bill 2503
  Existing law establishes a workers’ compensation system, administered by the Administrative Director of the Division of Workers’ Compensation, to compensate an employee for injuries sustained during his or her employment. Existing law requires every employer, for purposes of workers’ compensation, to establish a utilization review process to prospectively, retrospectively, or concurrently review and approve, modify, delay, or deny, based in whole or in part on medical necessity to cure and relieve, treatment recommendations by physicians prior to, retrospectively, or concurrent with the provision of medical treatment services, as provided. Existing law requires prospective or concurrent decisions to be made in a timely fashion that is appropriate for the nature of the employee’s condition. Existing law also requires that decisions to approve, modify, delay, or deny requests by physicians for authorization prior to, or concurrent with, the provision of medical treatment services to employees be communicated to the requesting physician within 24 hours of the decision. This bill would require a physician providing treatment to an injured worker to send any request for authorization for medical treatment, with supporting documentation, to the claims administrator for the employer, insurer, or other entity per rules adopted by the administrative director. The bill would also make technical changes. Effective Date January 1, 2017.
• Senate Bill 482
  The enacted legislation requires a health care practitioner authorized to prescribe, order, administer, or furnish a controlled substance to consult the CURES database to review a patient’s controlled substance history no earlier than 24 hours, or the previous business day, before prescribing a Schedule II, Schedule III, or Schedule IV controlled substance to the patient for the first time and at least once every 4 months thereafter if the substance remains part of the treatment of the patient. It exempts a veterinarian and a pharmacist from this requirement. The legislation also exempts a health care practitioner from this requirement under specified circumstances, including, among others, if prescribing, ordering, administering, or furnishing a controlled substance to a patient receiving hospice care, to a patient admitted to a specified facility for use while on facility premises, or to a patient as part of a treatment for a surgical procedure in a specified facility if the quantity of the controlled substance does not exceed a non-refillable 5-day supply of the controlled substance that is to be used in accordance with the directions for use. The bill would require, if a health care practitioner authorized to prescribe, order, administer, or furnish a controlled substance is not required to consult the CURES database the first time he or she prescribes, orders, administers, or furnishes a controlled substance to a patient pursuant to one of those exemptions, the health care practitioner to consult the CURES database before subsequently prescribing a Schedule II, Schedule III, or Schedule IV controlled substance to the patient and at least once every 4 months thereafter if the substance remains part of the treatment of the patient. The bill provides that a health care practitioner who fails to consult the CURES database is required to be referred to the appropriate state professional licensing board solely for administrative sanctions, as deemed appropriate by that board. The bill makes the above-mentioned provisions operative 6 months after the Department of Justice certifies that the CURES database is ready for statewide use and that the department has adequate staff, user support, and education, as specified. It also exempts a health care practitioner, pharmacist, and any person acting on behalf of a health care practitioner or pharmacist, when acting with reasonable care and in good faith, from civil or administrative liability arising from any false, incomplete, inaccurate, or misattributed information submitted to, reported by, or relied upon in the CURES database or for any resulting failure of the CURES database to accurately or timely report that information. The enacted legislation authorizes a health care practitioner to provide a patient with a copy of the patient’s CURES patient activity report if no additional CURES data is provided. The bill would also prohibit a regulatory board whose licensees do not prescribe, order, administer, furnish, or dispense controlled substances from obtaining data from the CURES database. Effective Date January 1, 2017.
• Senate Bill 1160
  This bill requires the administrative director to adopt regulations to provide employees with notice regarding access to medical treatment following the denial of a claim under the workers’ compensation system. Existing law requires the Administrative Director of the Division of Workers’ Compensation of the Department of Industrial Relations to develop a workers’ compensation information system in consultation with the Insurance Commissioner and the Workers’ Compensation Insurance Rating Bureau, with certain data to be collected electronically and to be compatible with the Electronic Data Interchange System of the International Association of Industrial Accident Boards and Commissions. Existing law requires the administrative director to assess an administrative penalty of not more than $5,000 in a single year against a claims administrator for a violation of those data reporting requirements. This bill increases that penalty assessment to not more than $10,000. It requires the administrative director to post on the Division of Workers’ Compensation Internet Web site, a list of claims administrators who are in violation of the data reporting requirements.
  The enacted legislation bill revises and recast provisions relating to utilization review, as specified, about injuries occurring on or after January 1, 2018. Among other things, the bill would set forth the medical treatment services that would be subject to prospective utilization review under these provisions, as provided. The bill authorizes retrospective utilization review for treatment provided under these provisions under limited circumstances, as specified. The bill would establish procedures for prospective and retrospective utilization reviews and set forth provisions for removal of a physician or provider under designated circumstances. On and after January 1, 2018, the bill would establish new procedures for reviewing determinations regarding the medical necessity of medication prescribed pursuant to the drug formulary adopted by the administrative director, as provided. The bill makes conforming changes to related provisions to implement these changes. The bill would, commencing July 1, 2018, require each utilization review process to be accredited by an independent, nonprofit organization to certify that the utilization review process meets specified criteria, including, but not limited to, timeliness in issuing a utilization review decision, the scope of medical material used in issuing a utilization review decision, and requiring a policy preventing financial incentives to doctors and other providers based on the utilization review decision. The bill would require the administrative director to adopt rules to implement the selection of an independent, nonprofit organization for accreditation purposes, as specified. It authorizes the administrative director to adopt rules to require additional specific criteria for measuring the quality of a utilization review process for purposes of accreditation and provide for certain exemptions. The bill requires the administrative director to develop a system for electronic reporting of documents related to utilization review performed by each employer, to be administered by the division. It requires the administrative director, on or after March 1,2019, to contract with an outside independent research organization to evaluate and report on the impact of provision of medical treatment within the first 30 days after a claim is filed, for claims filed on or after January 1, 2017, to January 1, 2019. The enacted legislation requires the report to be completed before January 1, 2020, and to be distributed to the administrative director, the Senate Committee on Labor and Industrial Relations, and the Assembly Committee on Insurance.
  The legislation requires certain lien claimants that file a lien under these provisions to do so by filing a declaration, under penalty of perjury, that includes specified information. The bill would require current lien claimants to also file the declaration by a specified date. The bill would make a failure to file a declaration under these provisions grounds for dismissal of a lien. Because the bill would expand the crime of perjury, the bill would impose a state-mandated local program. The bill also automatically stays any physician or provider lien upon the filing of criminal charges against that person or entity for specified offenses involving medical fraud, as provided. The bill would authorize the administrative director to adopt regulations to implement that provision. The bill would state findings and declarations of the Legislature about these provisions. Currently the law prohibits the assignment of a lien under these provisions, except under limited circumstances, as specified. This legislation would, for liens filed after January 1, 2017, invalidate any assignment of a lien made in violation of these provisions, by operation of law.
  This bill authorizes the administrative director to make updates to the utilization schedule by order, which would not be subject to the Administrative Procedure Act, as specified. The bill requires any order adopted pursuant to these provisions to be published on the Internet Web site of the division. Currently the statute requires a deponent to receive certain expenses and reimbursements if an employer or insurance carrier requests a deposition to be taken of an injured employee, or any person claiming benefits as a dependent of an injured employee. Existing law authorizes the deponent to receive a reasonable allowance for attorney’s fees, if represented by an attorney licensed in this state. This bill authorizes the administrative director to determine the range of reasonable fees to be paid to a deponent. The current statute provides that it is the responsibility of any party producing a witness requiring an interpreter to arrange for the presence of a qualified interpreter. It sets forth the qualifications of a qualified interpreter for these purposes, and provides for the settings under which a qualified interpreter may render services.  The enacted law requires the administrative director to promulgate regulations establishing criteria to verify the identity and credentials of individuals that provide interpreter services under these provisions.
  Currently the statute requires physicians, as defined, who attend to injured or ill employees to file reports with specific information prescribed by law. This bill revises those reporting requirements, as prescribed. Effective Date January 1, 2017.
• Assembly Bill 2710
  Existing law creates the California Insurance Guarantee Association (CIGA) and requires all insurers admitted to transact specified insurance lines in this state to become members. Each time an insurer becomes insolvent, to the extent necessary to secure funds for payment of covered claims of that insolvent insurer and also for payment of reasonable costs of adjusting the claims; CIGA is required to collect premium payments from its member insurers sufficient to discharge its obligations, as specified. This bill, among other things, would no longer require an insurer to become insolvent in order for CIGA to collect premium payments from the member insurers and would require CIGA to collect premiums in order to secure funds for the payment of its administrative expenses. Under existing law, CIGA is required to be a party in interest in all proceedings involving a covered claim, and has the same rights as the insolvent insurer would have had if not in liquidation, but CIGA has no cause of action against the insureds of the insolvent insurer for any sums it has paid out, except as provided.  This bill would provide that the above-stated provision denying CIGA a cause of action against insureds does not limit CIGA’s right to pursue unpaid reimbursements owed by an employer pursuant to a workers’ compensation insurance policy with a deductible if the employer was obligated to reimburse the insurer for benefits payments and related expenses paid by the insurer or CIGA from a special deposit or from other CIGA funds pursuant to the terms of the policy and related agreements.  Existing law requires that the rate of premium charged be a uniform percentage of net direct written premium, as defined, in the preceding calendar year applicable to specific categories of insurance. The rate of premium charges to each member insurer in the appropriate categories are initially based on the written premium of each insurer as shown in the latest year’s annual financial statement on file with the Insurance Commissioner and are later adjusted, as provided. Existing law authorizes CIGA to refund any credit due in a specific category of insurance to a member insurer as a result of the adjusted premium calculation, as provided. This bill would instead require CIGA, with regard to premium charges paid prior to January 1, 2017, to refund to a member insurer any credit due in a specific category as a result of the adjusted premium calculation.  This bill, with regard to premium charges paid on or after January 1, 2017, would delete the requirements that the rate of premium charges be initially based on the written premium of each insurer, that the premium charges be adjusted later as provided, and that the member insurer be eligible for a refund of any credit due to that member insurer as a result of the adjusted premium calculation, and would instead require that the rate of premium charges to each member insurer in the appropriate categories be based on the net direct written premium of each insurer as shown in the latest year’s annual financial statement on file with the commissioner. The bill would also make conforming changes.  Existing law authorizes CIGA to exempt or defer a member insurer from paying the premium charge if the payment would cause the member insurer’s financial statement to reflect an amount of capital or surplus less than the minimum amounts required for a certificate of authority by any jurisdiction in which the member insurer is authorized to transact insurance. Deferred premium charges are required to be paid when the payment will not reduce capital or surplus below required minimums. These payments are credited against future premium charges to those companies receiving larger premium charges by virtue of the deferment. This bill would delete the requirement that the payments be credited against future premium charges to those companies receiving larger premium charges by virtue of the deferment.  Existing law requires CIGA’s plan of operations to contain provisions requiring each member insurer to recoup the premium charge paid to CIGA from its insureds over a reasonable length of time by way of a reasonably calculated surcharge on insurance policies to which the provisions of CIGA apply.  This bill would instead require each member insurer to recoup the premium charge from its insureds in the year following the charge. The bill, with regard to premium charges paid on or after January 1, 2017, among other things, would require the member insurer to file a report in accordance with the provisions of the plan of operation indicating the number of surcharges it has collected, and would prohibit a member insurer electing to omit collecting surcharges from any of its insureds from being entitled to any reimbursement from CIGA, as specified. Effective January 1, 2016.
• Senate Bill 914
  Existing workers’ compensation law establishes a workers’ compensation system, administered by the Administrative Director of the Division of Workers’ Compensation, to compensate an employee for injuries sustained in the course of his or her employment. Existing law authorizes an insurer, employer, or entity that provides physician network services to establish or modify a medical provider network for the provision of medical treatment to injured employees, and requires the administrative director to contract with individual physicians or an independent medical review organization to perform medical provider network independent medical reviews. Existing law provides that if a treatment or diagnostic service remains disputed after a 3rd physician’s opinion, the injured employee may request a medical provider network independent medical review. Existing law requires the review to use standards established in statute or use the American College of Occupational and Environmental Medicine’s Occupational Medicine Practice Guidelines. This bill would delete the authorization to use the American College of Occupational and Environmental Medicine’s Occupational Medicine Practice Guidelines as standards for those independent medical reviews. The bill would make additional technical, non-substantive changes.  Effective Date January 1, 2017.
• Assembly Bill 2883
  Existing law establishes a workers’ compensation system, administered by the Administrative Director of the Division of Workers’ Compensation, within the Department of Industrial Relations, to compensate an employee for injuries sustained in the course of his or her employment. Existing law defines an employee, for purposes of the laws governing workers’ compensation, to include, among other persons, officers and members of boards of directors of quasi-public or private corporations while rendering actual service for the corporations for pay. Existing law excludes from that definition, among other persons, officers and directors of a private corporation who are the sole shareholders of the corporation and working members of a partnership or limited liability company, as specified, unless they elect to come under the compensation provisions of the laws governing workers’ compensation. This bill would revise those exceptions from the definition of an employee to apply to an officer or member of the board of directors, as specified, if he or she owns at least 15% of the issued and outstanding stock of the corporation, or an individual who is a general partner of a partnership or a managing member of a limited liability company, and that person elects to be excluded by executing a written waiver of his or her rights under the laws governing workers’ compensation, stating under penalty of perjury that he or she is a qualifying officer or director, or a qualifying general partner or managing member, as applicable. The bill would specify the effective date of the waivers. The bill would also make technical and clarifying changes to the provision excluding specified persons from the definition of employee.  Effective Date January 1, 2017.
• Senate Bill 1175
  Existing law establishes a workers’ compensation system, administered by the Administrative Director of the Division of Workers’ Compensation, to compensate an employee for injuries sustained in the course of his or her employment. Existing law requires the employer to provide medical, surgical, chiropractic, acupuncture, and hospital treatment, as specified that is reasonably required to cure or relieve the injured worker from the effects of his or her injury. Existing law requires a provider of those services to submit, among other documents, its request for payment with an itemization of services provided and the charge for each service. Existing law also requires the employer to reimburse the employee for his or her medical-legal expenses, as specified. This bill would require, effective for services on or after January 1, 2017, that requests for payment with an itemization of services provided and the charge for each service be submitted to the employer within 12 months of the date of service or within 12 months of the date of discharge for inpatient facility services. The bill would also require effective for services provided on or after January 1, 2017, that all bills for medical-legal evaluation or medical-legal expense be submitted to the employer within 12 months of the date of service in the manner prescribed by the administrative director. The bill would provide that requests for payment and bills for medical-legal charges are barred unless timely submitted. The bill would require the administrative director to adopt rules to implement the 12-month limitation period, as specified.  Effective Date January 1, 2017.

Colorado VIEW STATE →

FEE SCHEDULE NEWS:

• The Medical and Facility fee schedule has been updated as of January 1, 2017. The physician fee schedule is based on the 2016 Medicare Resource Based Relative Value Scale (RBRVS), except as prescribed by the rule, and conversion factors. The Inpatient Hospital Fee Schedule has adopted Version 34 of the MS-DRG in addition to new MS-DRG values. Outpatient Hospital Fee Schedule is based on the Medicare’s revised Addendum B from January 1, 2016.
• The next fee schedule update is scheduled for January 1, 2018.

REGULATORY ACTIVITY:

• A notice of a public hearing was given to afford all interested persons an opportunity to be heard prior to the adoption of proposed amendments to the Workers’ Compensation Rules of Procedure, 7 C.C.R. 1101-3.  The Director of the Division of Workers’ Compensation has the authority to promulgate rules pursuant to the Workers’ Compensation Act as set forth in section 8-47-107.  The date and time of hearing is December 19, 2016 9:30 a.m. at 633 17th Street, 12th Floor Denver, CO. The public hearing will be held in accordance with the provisions of the Colorado Administrative Procedures Act, section 24-4-103, CRS.  Any interested party is invited to appear at the hearing and testify or to submit written data, arguments or position papers to Paul Tauriello, Director, Division of Workers’ Compensation, 633 17th Street, Suite 400, Denver, CO 80202.  Any written submissions should be submitted to the Director prior to the hearing.  The topics to be considered are:  Rule 17, Exhibit 5 – Cumulative Trauma Conditions. The proposed rule changes were available at the Department’s website on or before November 15, 2016.  Copies of the proposed rules were also available by request on November 15, 2016 at the Division’s Customer Service Office, 633 17th Street, 4th Floor, Denver, Colorado.
• Colorado has issued an interpretive bulletin for the 2017 Fee Schedule.

LEGISLATIVE ACTIONS:

• House Bill 16-1323
  This bill changes the name of the Division of Labor and Employment within the Colorado Department of Labor and Employment (CDLE) to the Division of Labor Standards and Statistics. Effective Date August 10, 2016.
• Senate Bill 16-158
  The bill clarifies and expands the duties that a physician may delegate to a physician assistant within his or her scope of practice, including allowing physician assistants to:
  • issue certain statements verifying a medical condition;
  • obtain Level I accreditation in workers’ compensation matters;
  • qualify as providing direct access to a health care provider under health insurance plans in regards to several conditions where direct access is mandated in law;
  • work under the direction and supervision of a podiatrist (up to four physician assistants per podiatrist) ;
  • serve as a public health director for a county or district board of health; and
  • issue certificates of immunization or medical exemptions to immunizations for K-12 and university students. In addition, the bill requires that prescriptions for schedule II controlled substances issued by a physician assistant be imprinted with the name of the supervising physician or podiatrist.  All other prescriptions issued by physician assistants must be imprinted with the name and address of the facility where the physician assistant practices.  Effective Date August 10, 2016.
• Senate Bill 16-217
  This bill establishes new requirements concerning the reduction of workers’ compensation payments in cases that involve an admission of liability (known as safety rule violations) by an employer and propose to reduce the amount of compensation paid to a claimant.  Under the bill, any reduction in compensation must include a statement from the employer listing the specific facts on which the reduction is based.  If the insurer or self-insured employer admits liability for the claim, any party may request an expedited hearing if the application is filed within 45 days.  The director of the Colorado Department of Labor and Employment (CDLE) is required to schedule the hearing within 60 days of the date of the application.  If the party does not request an expedited hearing, the hearing must be set according to provisions under current law.  Under the bill, the time frame for conducting any expedited hearing is extended from 40 days to 60 days from the date of application and the bill permits a party to request an expedited hearing on the question of whether a compliant designated medical provider list was provided. The bill allows the CDLE to provide a standardized form to be used by the injured employee to request that his or her personal physician or chiropractor provide treatment or to request a change of physician.  If an injured employee is permitted to change physicians, the bill clarifies that the initial physician’s relationship with the employee terminates once he or she visits the new physician. In addition, the initial physician’s authorized work restrictions and return to work opinions control until such time that a new physician expressly modifies them.  This bill may alter workers’ compensation claims paid by insurers.  To the extent that this increases or reduces the amounts paid in premiums by state or local government employers, these impacts have not been estimated.  Hearings within the CDLE are conducted by administrative law judges who are under the auspices of the Department of Personnel and Administration. This bill is expected to affect the timing and frequency of hearings conducted by the CDLE for workers’ compensation claims. As of this writing, the increases and reductions in workload are not anticipated to result in adjustments in appropriations for any state agency.  The bill creates the right to request expedited hearings for safety rule violations and change of physician issues.  This is expected to result in additional hearings. Workload will also increase for the CDLE to develop the standardized medical forms; this workload increase is minimal.  Workload for administrative law judges may be reduced by a minimal amount as a result of several factors.  Extending the time period that expedited hearings must be held from 40 days to 60 days reduces workload. By requiring that an employer provide documentation prior to reducing claimant wages, the bill may reduce other hearing requests from certain existing claimants whose wage replacement has been lowered.  Creation of a standardized medical form and clarification about when a physician relationship with an injured employee terminates may also reduce requests for hearings.  To the extent that this bill alters the amount of payment for certain workers’ compensation claims or reduces the workload associated with those claims, it would potentially affect underwriting practices or premiums for Pinnacol Assurance, a statutory public entity. Effective Date June 10, 2016.
• Senate Bill 16-198
  This bill adds advisory organizations and rating organizations to the list of entities required to comply with current law regarding submission of policy forms, which may include any endorsement, rider, letter, notice, or other document affecting an insurance policy or contract. These materials are to be submitted to the Commissioner of Insurance in the Division of Insurance (DOI) within the Department of Regulatory Agencies via an annual report due by July 1 of each year.  The annual report must include certification that the documents are, to the best of an officer’s knowledge, in compliance with Colorado law.  If a workers’ compensation carrier uses forms, without modification, prepared by an advisory or a rating organization, the carrier is required to notify the DOI that it adopted the annual report filed by the advisory or rating organization and does not have to submit its own certification. Every carrier, advisory organization, and rating organization must also submit a list of any new or revised policy forms as may be requested by the DOI at least 31 days prior to their use. Unless a carrier notifies the DOI otherwise, policy forms submitted on behalf of a member of an advisory or rating organization are deemed to be automatically adopted by the carrier without modification. Effective Date June 8, 2016.

Connecticut VIEW STATE →

FEE SCHEDULE NEWS:

• Ambulance Rates Schedule has been updated as of January 1, 2016. The next update is scheduled for January 1, 2017.
• The Medical fee schedule has been updated as of July 15, 2016. The new schedule includes updates to rules, fees and new 2016 CPT codes.  The fee schedule “is effective for medical services rendered on or after July 15, 2016, which are payable to health care providers authorized or permitted to render care under the Connecticut Workers’ Compensation Act.”  The next physician fee schedule update is scheduled for July 2017.
• The new Facility fee schedule has been adopted by the state with an effective date of April 1, 2016. Published by Optum360, this new fee schedule includes a link to Medicare’s PC Pricer tool and instructions for computation of inpatient reimbursement. For outpatient hospital and ambulatory surgical center reimbursement this publication includes facilities’ wage index groups and corresponding fees based on the established formulae pursuant to §31-294d(d) C.G.S. (as amended by Public Act 14-167).
  • “The hospital inpatient rate shall be 174% of the Medicare rate payable to that facility.
  • The hospital outpatient and hospital-based ambulatory surgical center shall be 210% of the Medicare rate payable to that facility.
  • The non-hospital based ambulatory surgical center rate shall be 195% of the hospital-based outpatient Medicare rate payable in the same CBSA (Core Based Statistical Area).
  • Where there is no Medicare rate for the services in an outpatient hospital setting, the parties shall negotiate the reimbursement rate. If negotiation is not successful, the parties may request a hearing with the Commission; however, treatment shall proceed pending same.”

REGULATORY ACTIVITY:

• The state posted new benefit rates effective October 1, 2016.  The State Labor Commissioner has determined that the estimated average weekly earnings of all employees in Connecticut effective October 1, 2016 will be $1,292.00. Therefore, the maximum compensation rate for total disability and decedents’ dependents will also be $1,292.00 for injuries occurring on or after October 1, 2016.  The maximum compensation rate for partial disability (incapacity), i.e., benefits pursuant to § 31-308, is equivalent to the average weekly earnings of production and related workers in manufacturing in Connecticut. The State Labor Commissioner has determined that the average weekly earnings of production and related workers in manufacturing in Connecticut effective October 1, 2016 will be $1063.00.
• The state also posted a memorandum regarding weekly benefit calculations without FICA and/or Medicare Deductions and a memorandum regarding the availability of benefit rate tables.

LEGISLATIVE ACTIONS:

• House Bill 5262
  This bill creates the firefighters’ cancer relief account and the firefighter’s cancer relief program to provide wage replacement benefits to eligible paid and volunteer firefighters diagnosed with cancer. The bill establishes a new cancer relief subcommittee of the Connecticut State Firefighters Association to award benefits under the program. Firefighters are not eligible until July 1, 2019 (although another part of the bill states that eligibility starts in 2022, five years after the bill’s effective date). The account will be funded through a diversion of money from the enhanced emergency 9-1-1-program, which is funded through a monthly subscriber fee that the Public Utilities Regulatory Authority (PURA) imposes on phone service (see BACKGROUND). The bill requires, to the extent permitted under federal law, an amount from the fee equal to one cent per month per access line to be remitted from the fee to be deposited in the account the bill establishes. Under the bill, “firefighter” includes any (1) local fire marshal, deputy fire marshal, fire investigator, fire inspector, and other classes of inspectors and investigators for whom the State Fire Marshal and the Codes and Standards Committee have jointly adopted minimum qualification standards; and (2) uniformed member of a paid municipal, state, or volunteer fire department. An eligible firefighters’ wage replacement benefits under the bill must be approved by the association subcommittee, which is authorized to determine the weekly amount benefit and the benefit duration, provided (1) the weekly benefit does not exceed 100% of the average weekly earnings of all workers in the state for the year in which the cancer was diagnosed and (2) the benefits are not provided for more than two years. The bill specifically excludes a firefighter who receives benefits from the account from concurrently receiving unemployment or workers’ compensation benefits or any other municipal, state, or federal wage replacement benefits. It also specifies that receiving benefits under the bill cannot be used as evidence for or an acknowledgement of liability under the workers’ compensation law.  Effective Date February 1, 2017.
• House Bill 5364
  The enacted legislation establishes an additional requirement when an employee of a municipality files a workers’ compensation claim.  The amended requirement provides that an employee of a municipality send a copy of the notice of the claim to the town clerk of the municipality in which employed. Effective Date July 1, 2016.

Delaware VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted their new medical and facility fee schedule with an effective date of January 31, 2016. The state has adopted a 7% reduction below the current fee schedule (1/31/2015) to be applied to every health care code and service other than anesthesia.  For the anesthesia services, the state has adopted a reduction of 27% for all applicable codes to bring those codes in line with the other reductions.  The next update is scheduled for January 31, 2017.

REGULATORY ACTIVITY:

• The update to the Healthcare Provider Certification course has been completed. The course can now be accessed. Any provider whose certification expired during the period that the course was inaccessible due to the update process now has until November 19, 2016 to complete the course. After that date, those providers whose certification expired earlier this year who have not completed the certification course will be listed as no longer being a workers’ compensation certified healthcare provider.

LEGISLATIVE ACTIONS:

• Senate Bill 116
  This bill (i) clarifies that various provisions of Chapter 17 relating to licensing, examinations, monitoring and regulation of producers apply equally to adjusters and appraisers; (ii) adds the lines of crop insurance and workers’ compensation insurance to the lines of authority that may be transacted by adjusters; (iii) requires the automatic lapse of a license by operation of law for (a) failure to pay renewal fees or complete the education requirements set forth in Chapter 17 or (b) a nonresident licensee whose home state license is no longer in good standing; (iv) requires licensees to provide to the Department electronic email addresses for communications with the Department; (v) adds a provision that applicants who are denied a license pursuant to Section 1712 are not eligible to reapply for a license for a period of 12 months following the final denial; (vi) adds additional violations under Section 1712 that may result in actions against the licensee (providing false documentation to the Department and failing to promptly respond to Department inquiries); (vii) requires non-resident adjusters whose home states do not have continuing education requirements to complete the State’s continuing education requirements; and (viii) adds a provision regarding when the payment of a referral fee is permissible.  Effective Date April 20, 2016.

District of Columbia VIEW STATE →

FEE SCHEDULE NEWS:

• The state adopts the quarterly Medicare updates. Please refer to the Medicare modules section for more information.

Florida No-Fault VIEW STATE →

FEE SCHEDULE NEWS:

• The state adopts the Medicare modules that are in effect on January 1^st of each year with an effective date of March 1. The most recent update is March 1, 2016 and the next update is scheduled for March 2017.

Florida WC VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted a new manual for Ambulatory Surgical Centers with an effective date of January 1, 2016. On February 10^th, 2016 the state published a notification for a technical correction in the manual for CPT code 64492 which had an incorrect MRA value.  The new value is $1,059.90 and it is retroactive to January 1, 2016.
• The state has adopted the new Florida Workers’ Compensation Health Care Provider Reimbursement Manual 2015 Edition with an effective date of July 1, 2016.

REGULATORY ACTIVITY:

• A public meeting was held on December 6, 2016 in Room 102 Hartman Building at 2012 Capital Circle SE, Tallahassee, Florida to take comments on the rules regarding Expert Medical Advisors.
• The Workers’ Compensation Appeals Board (WCAB) has issued a notice of public hearing regarding a proposed addition and amendments to its Rules of Practice and Procedure. The primary purpose of this rulemaking is to implement legislative changes to the filing requirements for lien claims mandated by Senate Bill 1160.  SB 1160 amended Labor Code section 4903.05 to require that section 4903(b) lien claimants file a declaration that includes information regarding the type of services provided by the lien claimant. A lien claimant’s failure to timely file this declaration shall result in the dismissal of the lien with prejudice by operation of law per Labor Code section 4903.05(c) (3). This rulemaking will mandate use of an e-filed declaration form to ensure uniform procedures for lien claimants who first file their liens after January 1, 2017 and current lien claimants who are required to file a declaration by July 1, 2017.
• The Florida Department of Economic Opportunity has determined the statewide average weekly wage paid by employer’s subject to the Florida Reemployment Assistance Program Law to be $886.46 for the four calendar quarters ending June 30, 2016.  Section 440.12(2), Florida Statutes (2016), expressly provides that, for injuries occurring on or after August 1, 1979, the weekly compensation rate shall be equal to 100 percent of the statewide average weekly wage, adjusted to the nearest dollar, and that the average weekly wage determined by the Department of Economic Opportunity for the four calendar quarters ending each June 30 shall be used in determining the maximum weekly compensation rate with respect to injuries occurring in the calendar year immediately following.  Accordingly, the maximum weekly compensation rate for work-related injuries and illnesses occurring on or after January 1, 2017, shall be $886.00.  If you have any questions regarding this Informational Bulletin, please contact Mr. Ryan Gagne, Government Analyst II, Division of Workers’ Compensation, Bureau of Monitoring and Audit, at 850- 413-1771.
• Florida is proposing to amend Rule Numbers 69L-31.03-69L-31.017 regarding resolution of reimbursement disputes between workers' compensation carriers and health care providers.  The proposed amendments are scheduled for a hearing if requested on January 5, 2017 at 1:00 p.m. in room 102 of the Hartman Building 2012 Capital Circle SE, Tallahassee, Florida. The proposed rulemaking amends existing rules governing the process for the resolution of reimbursement disputes between workers’ compensation carriers and health care providers, creates two new rules, and repeals an existing rule. Noteworthy highlights of the proposed rulemaking are as follows: Rule 69L-31.005, F.A.C., is amended to provide greater detail regarding the materials that must accompany a petition for dispute resolution; Rule 69L-31.008, F.A.C., is amended to clarify the computation of the time period within which a petition for dispute resolution must be submitted to the Division, to increase the time period from 30 days to 45 days for the submission of a Petition Form, to add a link to the Division’s Web Portal, and to provide additional guidance regarding the electronic submission of a Petition Form; Rule 69L-31.009, F.A.C., is amended to increase the time period for a carrier to respond to a petition from 10 days to 30 days; Rule 69L-31.012, F.A.C., is repealed; proposed new Rule 69L-31.016, F.A.C., specifies that the scope of Department determinations involving reimbursement disputes is limited to findings relating to reimbursement schedules, practice parameters, and protocols of treatment, and clarifies that the Department will issue no findings regarding an improper disallowance or adjustment in reimbursement involving managed care contracts or when the carrier asserts that medical treatment was either not compensable or not medically necessary; and proposed new Rule 69L-31.017, F.A.C., stipulates the consequences for failure to comply with Department determinations. Certain rule section titles are revised to more accurately reflect the subject matter or issues addressed by the underlying rule. The proposed rules include additional minor edits and technical changes, and have been renumbered accordingly. Revised forms are also adopted.
• Florida has posted notice of a rules work shop for Rules 69L-6.015, FAC and 69L-6.027, FAC for Monday December 19, 2016 at 9:30 A.M. in room 102, Hartman Building, 2012 Capital Circle SE, Tallahassee, Florida.  Proposed Rule 69L-6.015, F.A.C., deletes the requirement for corporations with exempt officers who are engaged in the construction industry to maintain written statements of those exempted persons acknowledging each such individual’s exempt status. Proposed Rule 69L-6.027, F.A.C., incorporates to the Penalty Worksheet the 25% penalty reduction for eligible employers and the reduced imputed payroll multiplier changes.

LEGISLATIVE ACTIONS:

• House Bill 613
  The legislation regards Workers’ Compensation System Administration. The legislation requires members of limited liability companies to submit specified notices however it deletes a required item to be listed on notice of election to be exempt.  The legislation revises specified rules regarding maintenance of business records by an officer of corporation.  It provides and removes duties of the Department of Financial Services.   The legislation prohibits application of specified credit unless employer provides specified documentation & proof of payment to department within specified period.  The bill revises penalty calculation for imputed weekly payroll for an employee.  It eliminates certification requirements when expert medical advisor is selected by judge of compensation claims.  The enacted legislation deletes requirement that employers notify department within 24 hours of any injury resulting in death. The bill revises requirements for filing claim. The legislation eliminates the preferred worker program. The enacted legislation deletes notification fees on certain filed claims which supplement Special Disability Trust Fund.  The legislation deletes fee for certain registration of insurance carriers.  Effective Date October 1, 2016.
• Senate Bill 828
  The enacted legislation substantially revises the FWCIGA assessment process. The bill: Increases the assessment cap for self-insurance funds from 1.5 to 2 percent of net direct written premiums in Florida for workers’ compensation insurance, which is consistent with the assessment cap for insurers and revises the insurer’s premium subject to an assessment from being based on the prior year’s net direct written premium to the net direct written premium of the calendar year of the assessment.  It transfers the authority to order assessments and other FWCIGA reporting related to insurer financial condition from the DFS to the OIR.  The bill provides that only insurers are subject to assessments by the FWCIGA and the provisions do not give a policyholder a cause of action regarding the FWCIGA assessments.  It provides that the failure of an insured to pay the surcharge or the recoupment of an assessment is considered nonpayment of premium, which could result in the cancellation of a policy and provides that an insurer is not liable for any uncollectible assessments.  Effective Date July 1, 2016.

Georgia VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted changes to the Physician, Home Care, Transportation, Inpatient and Outpatient/ASC Facility Fee Schedules with an effective date of April 1, 2016. The fee schedule is published by Fair Health.  The most current CMS 1500 billing form, version 2/12, is adopted by this fee schedule.  The next update is scheduled for April 1, 2017.

REGULATORY ACTIVITY:

• Posted on February 12, 2016 that the Workers’ Compensation New Board Rules and Forms will become effective February 16, 2016.  A summary of the board rule changes effective February 16, 2016 is attached.  The forms revised include Form 6 Wage Statement; Form 14 Notice of Claim; Form 14a Request to Change Employee Information; From 20a Medical Report; Form 25 Application/Objection for Lump Sum Settlement/Advance Payment; From 100 Request for Settlement Mediation; Form R1 Request for Rehabilitation; Form R2 Employee’s Request for Catastrophic Designation; Form Rehab Objection Form Change of Address; and Form Change of Information (new form).

LEGISLATIVE ACTIONS:

• House Bill 402
  The enacted legislation amends Chapter 9 of Title 33 and Chapter 9 of Title 34 of the Official Code of Georgia Annotated relating to the regulation of insurance rates and workers’ compensation. The legislation strives to encourage employers to provide work based learning opportunities for students age 16 and older.  In order to provide for optional reduction in workers’ compensation premiums for employers that provide work based learning.  The legislation provides that work based learning students are covered under workers’ compensation insurance.  The legislation establishes criteria for employers providing work based learning. Effective Date July 1, 2016.
• House Bill 818
  Amends Chapter 9 of Title 34 of the Official Code of Georgia Annotated, relating to workers’ compensation. The legislation increases the maximum average weekly wage for temporary total benefits from $550.00 per week to $575.00 per week.  The legislation also increases the maximum average weekly wage for temporary partial benefits from $367.00 per week to $383.00 per week not to exceed a period of 350 weeks. Compensation for death benefits is increased from $220, 00.00 to $230,000.00.  The enacted legislation revised Code Section 34-9-381(Self-Insurers Guaranty Trust Fund). Part of the revision includes a list of entities that may not be members or participate in the Self-insurers’ Guaranty Trust Fund.  The legislation also provides that administrative law judges are subject to the Georgia Code of Judicial Conduct. The legislation also establishes provisions related to an employer’s duties to provide the State Board of Workers’ Compensation with certain information. Effective Date July 1, 2016.
• Senate Bill 347
  Amends Title 33 of the Official Code of Georgia Annotated.  The enacted legislation relates to insurance.  It provides for extensive changes to the captive insurance company provisions of this title.  The enacted legislation provides for definitions for types of captive insurance companies and for creation and regulation of different types of captive insurance companies.  It provides for certain exemptions and changes certain requirements.  The legislation also provides for regulation by the Commissioner and repeals conflicting laws.  Effective Date July 1, 2016.

Hawaii No-Fault VIEW STATE →

FEE SCHEDULE NEWS:

• New ambulance rates have been adopted by the Department of Health with an effective date of January 1, 2017.
• The state has adopted the Medicare 2016 version effective January 1, 2016. The next update is expected January 1, 2017.

Hawaii WC VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted changes to the Physician, Drug and Biological (ASP), Clinical Lab and DME fee schedules with an effective date of January 1, 2016. The next expected update is for January 1, 2017.

REGULATORY ACTIVITY:

• The Workers’ Compensation Medical Fee Schedule public hearing took place on November 17, 2016 at 8:30 a.m. at the Kellikolani Building 830 Punchbowl Street Rooms 310, 313, and 314 in Honolulu, Hawaii.
• The proposed changes to the Workers’ Compensation Medical Fee Schedule in Title 12, Chapter 15, HAR, and Exhibit A are:
  • to implement Act 101, effective June 21, 2016 (SLH 2016), which allows physicians and providers of service other than physicians to transmit a workers’ compensation treatment plan by mail or facsimile to an address or facsimile number provided by the employer
  • pursuant to section 386-21(c), HRS, which requires the director to update the fee schedule every three years or annually, as required
  • pursuant to Act 97 (SLH 2013) which required the State Auditor to assist the Director of Labor and Industrial Relations in the administrative adjustment of the workers’ compensation medical fee schedule
• David Ige signed into law Acts 187 and 192 on July 1, which increase the penalties for non-compliance with certain labor laws administered by the Department of Labor and Industrial Relations (DLIR). Act 187 also excludes some employers from having to provide Temporary Disability Insurance (TDI) for themselves if they perform services for their own corporation, limited liability company (LLC), limited liability partnership (LLP), partnership, or sole proprietorship.
• “DLIR supported the substantial increase in penalties to serve as a deterrent to help enforce the law,” said DLIR Director Linda Chu Takayama. “It also makes for a more level playing field for law-abiding employers who pay their fair share and provide the statutory benefits to their workers.”  Earlier this year DLIR participated in an on-site investigation of tenant contractors working on the new Ewa Wing at Ala Moana Center. The regulatory action uncovered dozens of violations related to unlicensed activity, uninsured workers and unpaid taxes.
• The new laws increase penalties for workers’ compensation insurance from $10 per employee per day to $100 per employee per day, the first increase in 28 years. The penalty for non-compliance with maintaining temporary disability insurance increased from $1 per employee per day to $100 per employee per day. TDI penalties had not changed since they were first established 47 years ago in 1969.

LEGISLATIVE ACTIONS:

• House Bill 2017 HD1 SD2 CD1
  The enacted legislation authorizes physicians to submit workers’ compensation treatment plans to employers by mail or facsimile. Beginning January 1, 2021, requires employers to allow physicians to submit workers’ compensation treatment plans to employers by mail, facsimile, or secure electronic means.  Specifies requirements for receipt and acceptance of treatment plans.  Effective Date June 22, 2016.
• House Bill 2353 HD2 SD2 CD1
  The enacted legislation makes various positions within the state energy office exempt from civil service. For a period of three years, authorizes the department of health to establish 18 exempt forensic psychologist positions and 2 exempt Hawaii state hospital primary care physician positions.  For a period of three years, provides a civil service exemption for various positions in the department of human services, department of public safety, and the department of health. Effective Date July 1, 2016.
• House Bill 2363
  This legislation amends Hawaii’s laws on workers’ compensation (WC) and temporary disability insurance (TDI) to:
  • Exclude the following from providing TDI coverage for services they provide for themselves: sole proprietors, an individual partner of a partnership, a partner of a limited liability partnership with an interest of at least 50 percent, an individual member of a limited liability company with a distributional interest of at least 50 percent, or individual owning at least 50 percent of a corporation;
  • Allow the Director of Labor and Industrial Relations to receive electronic copies of injury and other reports;
  • Increase the penalty for employers who do not have TDI coverage for employees from not less than $25 or $1 per employee per day, to not less than $500 or $100 per employee per day;
  • Increase the penalty from not more than $2,500 to not more than $5,000 against an employer or insurance carrier for failure to make correct or timely benefit payments or to terminate such benefits without approval or statutory cause;
  • Increase the penalty for failure to file medical reports from $250 to $500, and for employer’s failure to provide copies of requested medical reports from $1,000 to $5,000;
  • Increase the penalty for employers who do not have WC coverage for employees from not less than $250 or $10 per employee per day, to not less than $500 or $100 per employee per day; and
  • Increase the penalty from $2,500 to $5,000 against an employer for the deduction of premium payments from an employee’s wages. Effective Date July 1, 2016.
• House Bill 2715
  The enacted legislation requires the Auditor to contract with an actuarial firm that has experience conducting workers’ compensation closed claims studies in the United States to perform a study of closed claims in the State’s workers’ compensation system, subject to consultation and conference with two members of the Legislature selected by the House Speaker and the Senate President, respectively. Appropriates funds and requires matching funds.  Effective Date July 1, 2016.

Idaho VIEW STATE →

FEE SCHEDULE NEWS:

• The Medical fee schedule has been updated as of January 1, 2016 with the new 2016 National Physician Fee Schedule Relative Value File.
• The Inpatient fee schedule was updated as of October 1, 2016 with the current MS-DRG weights, multiplied by a state-specific base rate. The next update is expected on October 1, 2017.
• The Outpatient and ASC fee schedules have been updated to use the 2016 Medicare OPPS APC relative weights effective July 1, 2016.  The Commission adopted rules to incorporate APC Status Indicator J1. Rehabilitation Services are now payable under the acute-care hospital payment methodologies.  The next update is expected in January 2017.

REGULATORY ACTIVITY:

• The Industrial Commission announced information regarding EDI Claims Release 3.0: the technical tables are complete, but they are subject to change. The implementation guide, tables and supporting documentation can be found at:  https://iic.idaho.gov/EDI/edi_3.0.html.

LEGISLATIVE ACTIONS:

• House Bill 501
  The purpose of this legislation is to allow insurance companies to utilize certain Idaho bonds as security deposits for the Idaho Industrial Commission.  Effective Date March 30, 2016.
• House Bill 554
  This bill addresses the nearly impossible burden of proving occupational disease associated with firefighting within the workers’ compensation system.   Research has established that firefighters are significantly more likely to develop certain types of cancer than the general population. Under current law, the burden of proof for these known occupational diseases is nearly impossible to overcome as exposures are chronic, occur over long periods of time, and are uncertain regarding specific toxins and carcinogens present at any given structure fire. This bill would change existing workers’ compensation law so that it would be presumed that such diseases were occupationally related unless medical evidence showed otherwise.  Effective Date July 1, 2016.

Illinois VIEW STATE →

FEE SCHEDULE NEWS:

• A new Medical and Hospital fee schedule has been adopted by the state of Illinois with an effective date of January 1, 2017.  The following resources were adopted by the Illinois Workers’ Compensation Commission for their fee schedule: 2016 CPT, 2017 HCPCS published by CMS, 2017 National Correct Coding Policy Manual, 2017 Relative Value Guide and the November 2016 Federal Register.  The next update is expected on January 1, 2018.

REGULATORY ACTIVITY:

• Governor Bruce Rauner has appointed Mr. Michael Glaub as an arbitrator for the Illinois Workers’ Compensation Commission.  Mr. Glaub was formerly an attorney with the firm Hennessy & Roach.  Mr. Glaub brings nearly 30 years of experience in workers’ comp law.  Mr. Glaub is a graduate of the Southern Illinois University and DePaul University Law School.
• Governor Bruce Rauner has appointed Mr. Frank J. Soto as an arbitrator for the Illinois Workers’ Compensation Commission.  Mr. Soto was formerly an attorney with the firm Law Offices of Mr. Frank J. Soto while serving as the Village of Bensenville President. Mr. Soto is a graduate of Eastern Illinois University and the John Marshall Law School.

Indiana VIEW STATE →

FEE SCHEDULE NEWS:

• The Outpatient and Inpatient fee schedules follow Medicare reimbursement guidelines and are updated when these Medicare modules become effective. The last update for the Inpatient fee schedule was October 1, 2015 and January 1, 2016 for the Outpatient fee schedule.

REGULATORY ACTIVITY:

• On November 9, 2016 the state of Indiana has published Title 631 of the Administrative Code regarding the workers’ compensation board of Indiana indicating the code has been updated.

Iowa VIEW STATE →

REGULATORY ACTIVITY:

• The Iowa Workers’ Compensation Division published on July 5, 2016 emergency regulation regarding workers’ compensation payroll taxes. This amendment updates references to the tables which determine payroll taxes. In compliance with Iowa Code section 17A.4 (3) “a,” the Workers’ Compensation Commissioner finds that notice and public participation are unnecessary. Rule 876—8.8(85,17A) is noncontroversial and, further, Iowa Code section 85.61(6) requires adoption of current tables to determine payroll taxes by July 1 of each year. The Division must wait until the Internal Revenue Service and the Iowa Department of Revenue determine whether there will be changes in their publications on July 1 of the current year.

Kentucky VIEW STATE →

FEE SCHEDULE NEWS:

• Updates to the Out of State Hospital Cost-to-Charge Ratios, Adjusted Cost-to-Charge Ratio for ASCs per County and Kentucky Hospitals Cost-to-Charge Ratios became effective April 1, 2016. The next expected updates are for April 1, 2017.
• The state has adopted changes to the Physicians fee schedule effective October 7, 2016. The fee schedule is based on 2014 CPT codes, descriptions and modifiers. The update also included a change to anesthesia services.  The anesthesia time unit rounding was increased from 6 to 8 minutes.

REGULATORY ACTIVITY:

• As of November 1, 2016, the Department of Workers’ Claims will no longer be serving pleadings in paper form on attorneys or parties who have registered to use the Litigation Management Service and have elected to receive notifications from the Department in electronic form except the initial application for resolution of a claim.  This includes ALJ orders and Opinions.  When an order or Opinion is issued, it will appear in the “Notifications” tab of all attorneys associated to the claim in which it is issued and will appear in “Documents” tab on the Claims Detail page of that claim.

Louisiana VIEW STATE →

FEE SCHEDULE NEWS:

• The state has posted corrections for two radiology codes, 72149 and 72170 in their October Register.  These code corrections are retroactive to June 20, 2016.

REGULATORY ACTIVITY:

• Published workers’ compensation benefit limits effective September 1, 2016.   The new rates are:
  • State Wide Average Weekly Wage $876.00
  • Maximum Compensation Rate $657.00
  • Minimum Compensation Rate $175.00.
• In addition, the commission published the new travel reimbursement effective July 1, 2016.  The new travel reimbursement is $0.51 per mile.

LEGISLATIVE ACTIONS:

• House Bill 865
  Provides relative to licensing of insurance producers, including producer licensing requirements for business entities. Specifies that a resident individual shall pass an examination for each line of insurance that an applicant seeks to transact in this state.  Further requires that an applicant shall pass the examination with a score of at least 70%. Present law requires a business entity acting as an insurance producer to obtain an insurance producer license. Also requires that every member, partner, officer, director, stockholder, and employee of the business entity personally engaged in this state in soliciting or negotiating policies of insurance shall be registered with the Dept. of Insurance (DOI) under such business entity’s license. Further requires each such person to also qualify as an individual licensee for any line of insurance the business entity is licensed to transact. Specifies that licensing of any limited liability company or limited liability partnership as an insurance producer is subject to prior approval of the commissioner of insurance. Proposed law retains requirement that a business entity acting as an insurance producer obtain an insurance producer license. However, provides that every member, partner, officer, director, and person who controls directly or indirectly 10% or more of the applicant shall be registered with DOI under such business entity’s license. Adds a requirement that every individual who is personally engaged in soliciting or negotiating policies in this state shall be registered with the DOI under such business entity’s license and shall also qualify as an individual licensee for any line of insurance that the business entity is licensed to transact. Further authorizes the commissioner of insurance to require that such registered individuals submit fingerprints.  Present law requires each licensee to notify the commissioner of any alteration in his residential, mailing, or business address within 30 days of the alteration or receive a $50 penalty per violation.  Proposed law instead requires each licensee to notify the commissioner of any change of address, legal name, or information submitted on the application within 30 days of the change or receives a $50 penalty per violation. Adds  the  following as grounds  for license denial, nonrenewal, or revocation by the commissioner: If the producer is a business entity, refusing to remove or discharge a person registered pursuant to present law who has been convicted or pleaded nolo contendere to any felony, participated in a pretrial diversion program pursuant to a felony charge, suspension and deferral of sentence, and probation pursuant to the Code of Criminal Procedure, or been convicted of any misdemeanor involving moral turpitude or public corruption.  If the producer is a business entity, refusing to remove or discharge any person registered pursuant to present law who has had an insurance producer license revoked or suspended or is found to have violated any provision of the Insurance Code.  Present law prohibits any insurer or insurance producer from paying   any money or commission or brokerage, or giving or allowing any valuable consideration or compensation to any person or business entity not duly licensed as an insurance producer, nor to an insurer not licensed to do business in this state, for or because of service rendered or performed in this state in selling, soliciting, negotiating, or effecting a contract of insurance on any property or risks, or insurable interests, or business activities located within or transacted within this state. Further provides that this prohibition shall not apply to the owners of an insurance agency.  Proposed law provides that this prohibition shall not apply to the owners of a business entity licensed as a producer so long as that entity has complied with the provisions of present law and the owners are not persons who: Have been convicted or pleaded nolo contendere to any felony, participated in a pretrial diversion program pursuant to a felony charge, suspension and deferral of sentence, and probation pursuant to the Code of Criminal Procedure, or been convicted of any misdemeanor involving moral turpitude or public corruption.  Have had an insurance producer license revoked or suspended or are found to have violated any provision of the Insurance Code.  Effective Date June 2, 2016.
• Senate Bill 44
  Present law provides that when an injury has occurred to an employee which is subject to the payment of workers’ compensation benefits but such action was caused, in whole or in part, by a party who other than the employer or employee, (commonly referred to as a “third party” but referred to in the statute as “third person”) who has a legal liability to pay damages, the employee may file a lawsuit in district court to recover damages for the injury. Present law provides that when an injury occurs to an employee and a third party is liable, in whole or in part, the workers’ compensation insurer or group self-insurance fund may file suit against the third party to recoup the workers’ compensation benefits paid to the employee but the employer must notify the employee of the suit against the third party.  Present law provides that when an injury occurs to an employee and a third party is liable, in whole or in part, the employee may file suit against the third party for damages but must notify the workers’ compensation insurer or group self-insurance fund when any workers’ compensation benefits which have been paid to or on behalf of the injured worker.  Present law provides that if a settlement occurs or a judgment is obtained against the third party and the employee receives funds from the third party, the employer or insurer shall receive a dollar-for- dollar credit for workers’ compensation benefits paid against the full amount paid in settlement or judgment, less attorney fees and costs paid by the employee in prosecution of the third party claim. Present law requires the employee to obtain written approval from the employer or workers’ compensation insurer before such settlement or compromise is obtained by the employee. Present law provides an insurer shall grant its insured a dollar-for-dollar credit for any amount on any claim paid on the employer’s behalf and recovered in the current year, less any reasonable expenses incurred in the recovery by the insurer, in an action or compromise.  Proposed law retains present law but provides that the credit shall be used by the insurer in the calculation of the loss experience modifier specifically promulgated by and in accordance with the rules of the National Council on Compensation Insurance (NCCI), to be applied in determining the annual premium paid by the employer for workers’ compensation insurance. Proposed law provides that the group self-insurance fund shall apply the loss experience modifier authorized by present law applicable to group self-insurance funds.   Effective Date August 1, 2016.
• Senate Bill 266
  Present law requires all business entities applying to do business as independent adjusting companies to provide a listing of all executive officers and directors of the applicant and of all executive officers and directors of entities owning and any individuals owning, directly or indirectly, 10% or more of the outstanding voting securities of the applicant. Provides that in order to make a determination of eligibility, the commissioner may require all executive officers and directors to submit addresses, social security numbers, criminal and administrative history, fingerprints, background checks, and biographical statements. Proposed law changes “owning” to “controlling” and defines “control” to have the same definition as in present law (R.S. 22:691.2).  Present law provides for reciprocity for licensed claims adjusters for those from states that require licensure. Proposed law deletes present law and provides for the designation of La. the home state for licensure for nonresident adjusters from states that do not require licensure and provides that the adjusters meet all of the requirements required of La resident adjusters. Present law provides that an individual who applies for a claim adjuster license in La. who was previously licensed as a claim adjuster in another state based on a claim adjuster examination shall not be required to complete an examination. Provides that this exemption is available only if the person is currently licensed in that state or if the application is received within 12 months of the cancellation of the applicant’s previous claims adjuster license and if the prior state issues a certification that, at the time of cancellation, the applicant was in good standing in that state, or the state’s producer database records or records maintained by the National Association of Insurance Commissioners (NAIC), its affiliates, or subsidiaries, indicate that the adjuster is or was licensed in good standing.  Proposed law deletes present law.
  • Present law provides that an individual licensed as a claims adjuster in another state based on a claims adjuster examination who moves to this state shall make application within 90 days of establishing legal residence to become a resident claims adjuster licensee pursuant to present law (R.S. 22:1665). Provides that no examination is required of that individual to obtain a claims adjuster license. Proposed law limits this exemption from examination requirements to a person who is currently licensed in another state or if the application is received within 90 days of the cancellation of the applicant’s previous claims adjuster license and if the prior state issues a certification that, at the time of cancellation, the applicant was in good standing in that state or the state’s producer database records or records maintained by the National Association of Insurance Commissioners (NAIC), its affiliates, or subsidiaries, indicate that the adjuster is or was licensed in good standing.
  • Present law provides that an individual who applies for a claims adjuster license in La. who was previously licensed as a claims adjuster in La. shall not be required to complete an examination. This exemption is available only if the application is received within 12 months of the cancellation of the applicant’s previous claims adjuster license in La. and if, at the time of cancellation, the applicant was in good standing in La., and had passed the required examination. Proposed law changes the exemption time frame from 12 to 24 months.
  • Proposed law permits the commissioner to waive the workers’ compensation examination requirement for an individual who has three years of verifiable experience adjusting workers’ compensation claims within the preceding five years, provided the application is received on or before August 1, 2017. Proposed law provides that a claims adjuster may receive qualification for a license in one or more of the following lines of authority: Property and casualty, Workers’ compensation, Crop and Any limited line for which the commissioner issues a limited license.
  • Present law provides that a claims adjuster whose license has lapsed may, within 12 months from the expiration date of the renewal, reinstate the license upon approval of the commissioner. Provides that a penalty in the amount of double the unpaid renewal fee shall be required for the reinstatement of the claims adjuster license. Provides that reinstatement shall be effective on the date the commissioner of insurance approves the request for reinstatement. Proposed law deletes present law and provides that a licensed claim adjuster who allows his license to lapse may, within two years from the expiration date of the license, reinstate the same license upon proof of fulfilling all continuing education requirements through the date of reinstatement and upon payment of all fees due. Provides that if the license has been lapsed for more than two years, the applicant shall fulfill the requirements for issuance of a new license.
  • Present law provides that the commissioner may place on probation, suspend, revoke, or refuse to issue, renew, or reinstate a claims adjuster’s license or may levy a fine not to exceed $500 for each violation up to $10,000 aggregate for all violations in a calendar year, unless a fine is established by separate statute Title 22 authorizing a greater penalty, or any combination of actions, for any one or more of the following causes: (1) Providing incorrect, misleading, incomplete, or materially false information in the license application. (2) Violating any state insurance law or regulation or a subpoena or order of the commissioner of insurance or of another state’s insurance commissioner. (3) Obtaining or attempting to obtain a license through misrepresentation or fraud. (4) Improperly withholding, misappropriating, or converting any money or property received in the course of conducting insurance business. (5) Intentionally misrepresenting the terms of an actual or proposed insurance contract or application for insurance. (6) Conviction of a felony related to the adjustment of insurance claims. (7) Admitting to or committing fraud or unfair trade practices. (8) Using fraudulent, coercive, or dishonest practices. (9) Demonstrating incompetence, untrustworthiness, or financial irresponsibility while conducting business. (10) Denial, suspension, or revocation of an insurance license, or its equivalent, in any other state, province, district, or territory.  (11) Forging a name on an application for insurance or any document related to an insurance transaction.  (12)  Cheating, including improperly using notes or any other reference material, to complete an examination for an insurance license.  (13) Knowingly accepting insurance business from an individual who is not licensed but who is required to be licensed by the commissioner of insurance.  (14) Failure to comply with an administrative or court order imposing a child support obligation. (15) Failure to pay state income tax or comply with any administrative or court order directing payment of state income tax.  (16) Violating R.S. 22:1674(F).  (17) Failure to complete assignment of adjustment of a claim in a thorough and timely manner, including submission of the adjustment of a claim to the party which made that assignment.  Proposed law retains present law and adds the following reasons:  (1) Providing incorrect, misleading, incomplete, or materially false information in the license renewal application.  (2) Violating the insurance laws or regulations of the United States or any other jurisdiction. (3) Intentionally misrepresenting the terms of an actual or proposed insurance binder rider, or plan, including all forms or documents that are attached, or will be attached, to an actual or proposed insurance contract, binder, rider, plan, or application for insurance.  (4) Conviction of or    a nolo contendere plea to any felony, participation in a pretrial diversion program pursuant to a felony charge, suspension and deferral of sentence and probation pursuant to Article 893 of the Code of Criminal Procedure or similar law of another state, or conviction of any misdemeanor involving moral turpitude, or public corruption, or the adjustment of insurance claims. (5) The refusal to submit physical evidence of identity or the conviction of a felony, in accordance with R.S. 22:1922(B) and (C).  (6) Employing or allowing to associate with his business, in any manner, any person engaged in the business of insurance who has been convicted of a felony under the laws of this or any other state, the United States, or any other jurisdiction. As used in proposed law, “business of insurance” means the writing of insurance or the reinsuring of risks by an insurance producer or insurer, including all acts necessary or incidental to such writing or reinsuring, and the activities of persons who act as, or are, officers, directors, agents, or employees of producers or insurers, or who are other persons authorized to act on behalf of such persons. (7) The conviction of a felony involving dishonesty or breach of trust pursuant to 18 U.S.C. §1033 and §1034, without written consent from the commissioner of insurance pursuant to 18 U.S.C. §1033, or any successor statute regulating crimes by or affecting persons engaged in the business of insurance whose activities affect interstate commerce. The above provisions are effective August 1, 2016.  Present law provides an exemption from licensure for workers’ compensation adjusters.  Proposed law repeals that exemption effective August 1, 2017.  Effective Date August 1, 2016.

Maine VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted new Inpatient DRG values effective October 1, 2016 based on version 34 of the US Federal Government’s DRG Grouper for FY 17.  The next update is expected in October 2017.
• The state has adopted changes to the Physician, Outpatient and ASC Facility Fee Schedules with an effective date of January 1, 2017. The next fee schedule update is expected in January 2018.

REGULATORY ACTIVITY:

• The Board has completed the annual update of its Medical Fee Schedule. Appendix II (professional fees) and Appendix IV (outpatient facility fees) have been updated in accordance with Title 39-A M.R.S.A. Section 209-A for dates of service on or after January 1, 2017. Questions or concerns regarding the annual update may be addressed to Kimberlee.Barriere@Maine.Gov.

LEGISLATIVE ACTIONS:

• House Bill 1553
  This enacted legislation makes the following changes to the Maine Workers’ Compensation Act of 1992. It transfers the predetermination of independent contractor status process to the Department of Professional and Financial Regulation, Bureau of Insurance. It establishes that rebuttable presumptions granted as a result of a request for a predetermination are admissible only in proceedings arising under the Maine Revised Statutes; Title 24-A. Conclusive predeterminations received by landowners continue to be admissible in proceedings under the Maine Workers’ Compensation Act of 1992. It modifies the law after the Law Court’s decision in Workers’ Compensation Board Abuse Investigation Unit v. Nate Holyoke Builders, Inc., et al., 2015 ME 99 and ensures employers that misclassify employees as independent contractors are subject to penalties under the Maine Workers’ Compensation Act of 1992. It increases the Workers’ Compensation Board’s assessment cap starting in fiscal year 2016-17. It establishes that appeals to the Law Court from the Workers’ Compensation Board are from decisions of the Workers’ Compensation Board’s Appellate Division and not an individual administrative law judge.  Effective Date July 20, 2016.
• House Bill 1646
  This bill establishes a very aggressive law to prevent opiate abuse by strengthening the controlled substances prescription monitoring program and other programs related to narcotic drugs. The legislation establishes definitions for acute pain, administer and chronic pain. The legislation amends the definition of prescriber. The act authorizes the sharing of information with Canadian provinces.  The legislation establishes a penalty for failure to submit information.  Establishes that prescribers and dispensers are required to check prescription monitoring information periodically and under certain conditions.   Establishes a fine for failure to check monitoring information.   Establishes exemptions from opioid medication limitations until January 2017.  Requires rulemaking by the state regarding this statute no later than January 1, 2015.  Requirements regarding prescription of opioid medication Limits on opioid medication prescribing, exceptions, electronic subscribing. The legislation establishes continuing education requirements.    The legislation provides for amendments to limits on opioid prescribing.  Establishes limits on opioid medication prescribing but does allow for exceptions. Amends the controlled substances prescription monitoring program.  Effective Date July 20, 2016.

Maryland VIEW STATE →

FEE SCHEDULE NEWS:

• The state has released new conversion factors and reimbursement rates for Medical, Anesthesia, Orthopedic and Neurological Surgical Services, and Ambulatory Surgical Centers with an effective date of January 1, 2017.  The next fee schedule update is expected in January 2018.

REGULATORY ACTIVITY:

• Maryland has revised three forms.  The revised forms are:
  • form H2BR Request for Continuance of Hearing
  • C-2 Statement of Wages
  • H33r Request to Implead a party H33R.
• A copy of the revised forms can be located at:  http://www.wcc.state.md.us/Adjud_Claims/Forms.html.
• Maryland has posted notice that its annual prescription drug survey is available. You can access the survey by going to: http://www.wcc.state.md.us/Gen_Info/Rx_study_2016.html.
• Maryland had released the indemnity benefit rates for 2017.

LEGISLATIVE ACTIONS:

• House Bill 631
  This bill expands the circumstances under which a Howard County deputy sheriff is considered a public safety employee, thereby making the deputy sheriff eligible for enhanced workers’ compensation benefits. Specifically, the bill repeals a provision that only considers a deputy sheriff a public safety employee when he or she is performing law enforcement duties expressly requested, defined, and authorized in accordance with a written memorandum of understanding executed between the Howard County Sheriff and other law enforcement agencies.    The bill must be construed to apply only prospectively and may not be applied or interpreted to have any effect on, or application to, any claims arising before the bill’s effective date.  Effective Date October 1, 2016.
• Senate Bill 505
  This bill authorizes a workers’ compensation insurer to file a rating plan that provides a premium discount of up to 4% to its insured employers if they have an alcohol- and drug-free workplace policy that includes at least one of six specified programs.  An insurer is not required to provide the premium discount if the insured employer is required by federal or State law to test its employees for drugs or otherwise maintain an alcohol- and drug-free workplace.  A workers’ compensation insurer may provide a premium discount to an insured employer for: an alcohol and drug testing program; an employee education program on alcohol and drug abuse; a supervisor education program on alcohol and drug abuse; an employee assistance program that includes referrals of employees for appropriate diagnosis, treatment, and assistance; a program requiring an employee who has caused or contributed to an accident while at work to undergo alcohol or drug testing; and any  other  program  that  the  insurer  deems  effective  to  encourage  an  alcohol- and drug-free workplace.  Effective Date October 1, 2016.

Massachusetts VIEW STATE →

FEE SCHEDULE NEWS:

• Hospital fee schedule has been updated as of July 1, 2016.
• The state has adopted changes to professional service rates at community health and mental health centers as of January 1, 2015.

REGULATORY ACTIVITY:

• Governor Charlie Baker joined Secretary of Labor and Workforce Development Ronald L. Walker, II and Secretary of Health and Human Services Marylou Sudders to announce a new voluntary program to assist injured workers who have settled workers’ compensation claims get treatment for pain management, aimed at limiting the use of opioids or other narcotics. “Coordinating alternative viable chronic pain management options between an injured worker and their insurance company can reduce the chance of addiction to prescription opioids,” said Governor Baker. “Judges have seen a rising number of overdoses and deaths as these proceedings play out in the courts and this pilot will help resolve cases more swiftly as another tool for fighting the opioid epidemic.” The program seeks to resolve court cases more swiftly by assigning a care coordinator to mediate treatment options between an injured worker and the insurance company paying for medical care.

LEGISLATIVE ACTIONS:

• House Bill 4056
  Is not specifically written for the workers’ compensation system in the state.  The legislation actually amends a number of existing Massachusetts rules that address the issue of substance abuse more specifically opioid abuse.  The bill addresses law enforcement, treatment facilities, rehabilitation facilities, hospitals and physicians.  Section 23 and 24 of the legislation provide specific actions that providers are required to accomplish prior to prescribing opioids. In particular, the legislation provides: A registered pharmacist filling a prescription for an opioid substance in schedule II of section 3 may dispense the prescribed substance in a lesser quantity than the recommended full quantity indicated on the prescription if requested by the patient provided that the prescription complies with subsection (c) of section 22. The remaining quantity in excess of the quantity requested by the patient shall be void.  In the event that a practitioner recommends that an extended-release long-acting opioid be utilized during the course of long-term pain management, the practitioner registered under section 7 shall enter into a written pain management treatment agreement with the patient that appropriately addresses the benefits as well as the risk factors for abuse or misuse of the prescribed substance under guidelines published by the department. Such an agreement shall be filed in the patient’s medical record or included in the patient’s electronic health record; and when issuing a prescription for an opiate to an adult patient for outpatient use for the first time, a practitioner shall not issue a prescription for more than a 7-day supply. A practitioner shall not issue an opiate prescription to a minor for more than a 7-day supply at any time and shall discuss with the parent or guardian of the minor the risks associated with opiate use and the reasons why the prescription is necessary.  It should be noted that these sections are general law applicable to all patients in Massachusetts and not just workers’ compensation patients. There are numerous effective dates regarding the legislation based on the sections.  Effective Dates:  Section 29 no later than March 1, 2017; Sections 8, 9, 32, 43-51 July 1, 2016; Section 4 September 1, 2016; Section 27 October 15, 2016; Section 23 December 1, 2016; Sections 7, 29 and 69 December 1, 2016; Section 31 January 1, 2017, 55 December 31, 2021; The balance of the sections become effective June 14, 2016.

Medicare VIEW STATE →

FEE SCHEDULE NEWS:

• Physician – CMS has posted the new National Physician Fee Schedule Relative Value File for calendar year 2017 with the new GPCI and Anesthesia Conversion Factors with an effective date of January 1, 2017. The next expected update is April 2017.
• HCPCS – The new 2017 HCPCS codes have been released for an effective date of January 1, 2017.  The next expected update is in April 2017.
• Clinical Laboratory – CMS has released the new 2017 Clinical Laboratory Fee Schedule with an effective date of January 1, 2017. The next expected update is January 1, 2018.
• DMEPOS – CMS has released the new 2017 DMEPOS and PEN (Parenteral and Enteral Nutrition Items and Services) fee schedule codes and values with an effective date of January 1, 2017. The next expected update is April 1, 2017.
• ASC – CMS has released the new CY 2017 ASC Fee Schedule with an effective date of January 1, 2017. The next expected update is April 1, 2017.
• Ambulance – CMS released the 2017 Ambulance Fee Schedule with an effective date of January 1, 2017. The next expected update is scheduled for January 1, 2018.
• OPPS – CMS has released the new CY 2017 Hospital Outpatient Fee Schedule with an effective date of January 1, 2017. The next expected update is April 1, 2017.
• Inpatient Hospital – CMS has released the new Inpatient Fee Schedule for FY 2017 with an effective date of October 1, 2016. The next expected update is October 1, 2017.
• Inpatient Rehab Hospital – CMS has released the new FY 2017 Inpatient Rehab Fee Schedule with an effective date of October 1, 2016. The next expected update is October 1, 2017.
• Skilled Nursing Facility – CMS has released the new FY 2017 Skilled Nursing Facility Fee Schedule with an effective date of October 1, 2016. The next expected update is October 1, 2017.
• CCI and MUE Edits – CMS has released the 2017 NCCI Policy Manual and the associated changes for MUE and CCI edits effective January 1, 2017. The next expected update is for April 1, 2017.

Michigan VIEW STATE →

FEE SCHEDULE NEWS:

• Hospital fee schedule has been updated with new rates effective August 1, 2016.
• The state has adopted changes to the Physician fee schedule effective September 15, 2015. The fee schedule is based on 2014 CPT codes, descriptions and modifiers.  A new update to the medical fee schedule is expected in December 2016.

REGULATORY ACTIVITY:

• The Bureau of Labor Market Information & Strategic Initiatives has reported the state average weekly wage as of June 30, 2016, to be $965.62. In accordance with Section 418.355(2) of the Workers' Disability Compensation Act, the 2017 maximum weekly benefit based on 90% of the state average weekly wage is $870.00.

LEGISLATIVE ACTIONS:

• House Bill 4362
  The bill would amend the Workers’ Disability Compensation Act to specify that each employer member that participated in a self-insurer group would possess ownership in its proportional share of the assets of the group in excess of the group obligations.  Each employer subject to the Act must secure the payment of compensation by either:
  a) receiving authorization from the Director of the Workers’ Compensation Agency to be a self- insurer, or
  b) insuring against liability with an authorized insurer within this State.  Two or more employers in the same industry with combined assets of $1.0 million or more, or two or more public employers of the same type of unit, may enter into agreements to pool their liabilities for the purpose of qualifying as self-insurers.  Under the bill, each of the employer members that participated in a self-insurer group would possess ownership in its proportional share of the assets of the group in excess of the self- insurer group obligations.  The trustees of a self-insurer group, acting in their fiduciary capacity, would have to establish processes and procedures for distributing excess assets with the Director’s approval.  Effective Date February 14, 2016. 
• Senate Bill 493
  The bill amends the Workers’ Disability Compensation Act to specify when an employee of a franchisee would be considered an employee of the franchisor. Specifically, an employee of a franchisee would not be considered an employee of the franchisor for purposes of the Act unless the following were met:
  a) the franchisee and franchisor shared in the determination of or codetermined the matters governing the essential terms and conditions of the employee’s employment; and
  b) the franchisee and franchisor directly and immediately controlled matters relating to the employment relationship, such as firing, discipline, supervision, and direction.
  Effective Date December 31, 2015.

Minnesota VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted a new payment methodology based on the Medicare MS-DRG system with an effective date of January 1, 2016.
• New conversion factors have been adopted effective October 1, 2016. The next update is scheduled for October 1, 2017.

REGULATORY ACTIVITY:

• The proposed good cause amendments under Minnesota Statutes § 14.388 consist of updates to the rules to implement the independent medical examination fee schedule in Minnesota Rules, Chapter 5219, and the relative value and pharmacy fee schedules in Minn. R., Chapter 5221. The amendments reflect:
  • statutes in Minn. Stat. §§ 176.135 and 62J, requiring all Minnesota providers and payers to utilize electronic medical billing and payment;
  • statutory changes related to billing and payment of workers’ compensation medical and hospital bills; and
  • wording, formatting and renumbering changes recommended by the reviser.
• A copy of the proposed rule has not been drafted to date.

LEGISLATIVE ACTIONS:

• House File 2478
  The legislation clarifies the process for attorneys claiming legal fees in workers’ compensation cases. It clarifies the procedure in the Workers’ Compensation Court of Appeals for attorneys appealing their fee awards.  The enacted legislation eliminates the requirement of paying a bond for parties appealing a decision of Workers’ Compensation Court of Appeals to the Minnesota Supreme Court. Makes changes to conform to appellate court rules.  The legislation deletes language related to the bonds at issue in Section 3. Provides that the Workers’ Compensation Court of Appeals may require a bond in extraordinary circumstances. It also extends the time limit, from five to ten days, for seeking costs from the losing party in a workers’ compensation case. Current law provides that the prevailing party in such a case is entitled to costs incurred during the litigation.  Effective Date August 1, 2016.
• House File 2994
  This bill allows workers’ compensation insurers to maintain a jumbo retention limit, meaning an amount equal to ten times the low retention limit. Retention limits are the amount a workers’ compensation insurer must pay for workers’ compensation benefits before the Workers’ Compensation Reinsurance Association will begin covering the insurer’s losses. This change is effective January 1, 2018. The low retention limit is changed to $500,000 for 2016, with the board of the Workers’ Compensation Reinsurance Association making adjustments to this amount in the future, with approval from the commissioner of labor and industry.  Effective Date August 1, 2016.
• Senate File 1440
  The legislation makes a number of modifications to the prescription monitoring program. The legislation amends the definition of “controlled substances” by removing tramadol and including gabapentin. It makes a technical change to clarify that the Prescription Monitoring Program Task Force does not expire.  The bill specifies that an occupational licensing board or agency may access the database to substantiate a disciplinary action against a prescriber.  (Continues to prohibit access to initiate a disciplinary action).  Removes the requirement that data retained beyond 24 months must be de-identified.  It modifies who has access to the reporting system database. A modification that permits a prescriber access to the database to the extent the information relates specifically to a current patient to whom the prescriber is providing other medical treatment for which access to the data may be necessary and with the provision that the prescriber remains responsible for the use or misuse of data accessed by a delegated agent or employee. (Removes the requirement that the patient must consent before the prescriber has access under this circumstance). A modification that permits access to a licensed pharmacist who is providing pharmaceutical care for which access to the data is necessary or when consulted by a prescriber who is requesting data in accordance with the amended statute. A modification that permits personnel or designees of a health-related licensing board or the Emergency Medical Services Regulatory Board conducting an investigation of a complaint alleging that a specific licensee is impaired by the use of a drug for which data is collected in the database, has engaged in activity that would constitute a crime as defined under section 152.025, or has engaged in the behavior specified in subdivision 5, paragraph (a). A new clause is added to the legislation permitting personnel or designees of a health-related licensing board conducting an investigation of a complaint alleging that a specific licensee is inappropriately prescribing controlled substances. The enacted legislation requires by April 1, 2016, every prescriber who is authorized in this state to prescribe controlled substances for humans and who holds a current registration issued by the FDA, and every licensed pharmacist practicing in this state to register and maintain a user account with the prescription monitoring program. Data submitted with the registration application other than their name, license number, and license type is classified as private data pursuant to section 13.02, subd. 12.  It clarifies that only the specified permissible users may directly access the data electronically.  The legislation repeals a conflicting expiration date for the Prescription Monitoring Program Task Force from last session. Effective Date June 1, 2016.

Mississippi VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted a new Medical Fee Schedule effective November 12, 2016. The Commission requires the use of the most current CPT, CDT and HCPCS codes and modifiers in effect at the time services are rendered.
• The state has adopted new DRG Relative Weights and Cost-to-Charge Ratios effective October 1, 2016.   The next update is expected for October 1, 2017.

REGULATORY ACTIVITY:

• Posted notice of Attorney Transmittal Online System (ATMOS).  The prehearing statement can now be filed electronically.  Until further notice from the Commission, all parties shall continue to serve and certify service of copies of all documents to each other party to the case by mail pursuant to Miss. Work. Comp. Com. Procedural Rule 20. Now, the filing of a document through ATOS does not constitute service of that document to another party.  To gain access to the system go to: http://www.mwcc.ms.gov/atos/#/login.

LEGISLATIVE ACTIONS:

• Senate Bill 2193
  The enacted legislation amends section 27-15-97, Mississippi code of 1972, by revising the privilege license tax upon each person, company, firm or association engaged in the business of adjusting insured losses.  It amends section 83-17-401, Mississippi code of 1972, to define the term “workers’ compensation adjuster” as used in the article which provides for the licensing of insurance adjusters. The legislation amends section 83-17-415, Mississippi code of 1972, to revise the continuing education requirements for insurance adjusters.  It amends section 83-17-419, Mississippi code of 1972, changing the license period to a biennial issuance and renewal period.  The legislation amends section 83-17-513, Mississippi code of 1972, to revise the   continuing education requirements for public adjusters. It amends section 83-17-517, Mississippi code of 1972, to change the license period to a biennial issuance and renewal period for public adjusters and for related purposes.  Effective Date July 1, 2016.

Missouri VIEW STATE →

REGULATORY ACTIVITY:

• Posted Adoption of Division 50 Division of Workers’ Compensation Chapter 2-Procedure Rule as proposed on August 3, 2015.  The rule will become effective February 3, 2016.

LEGISLATIVE ACTIONS:

• House Bill 2194
  This bill repeals provisions which require individual risk premium modification rating plans used by workers’ compensation insurers to be actuarially justified, not result in premiums which are excessive, inadequate, or unfairly justified, and be applied on a statewide basis. The bill also removes the prohibition on the removal or reduction of premium credits unless there is a change in the insurer, the insurer amends or withdraws the rating plan, or there is a change in the insured employer’s operations. When premium modifications result due to a schedule rating plan with an underwriter determining individual risk characteristics, then up to an additional 10% credit may be given for a reduction in the insurer’s expenses, rather than “an additional 10%” reduction. The legislation allows insurance companies to file one affidavit, when market conduct reports from the Department of Insurance, Financial Institutions and Professional Registration are adopted, indicating acceptance of such reports rather than requiring all directors of a company to file an affidavit. This affidavit will be executed by its general counsel or chief legal officer. It specifies that when an insurer transfers an insurance policy among affiliated insurers within an insurance holding company, it is not considered to be a cancellation or nonrenewal. If the transfer policy is substantially different than the original policy the insurer must notify the insured at least 15 days in advance of the effective date of the assignment or transfer. INSURERS (Section 379.125) This enacted legislation will allow property and casualty insurers and reinsurers to write limited amounts of life insurance business outside of the United States which is written or assumed as a rider attached to a base policy, provided the aggregate premium assumed annually does not exceed 3% of the capital and surplus of the company as of December 31 of the previous year. This bill creates a regulatory system for self-service storage insurance and the selling of such insurance. A limited lines self-service storage producer is allowed to offer and disseminate self-service storage insurance. Producers shall meet certain licensing and training criteria and maintain a register of individuals that offer self-service storage insurance for the producer and provide such information to the Department of Insurance, Financial Institutions and Professional Registration upon request. Employees and authorized representatives offering self-service storage insurance shall receive training that meets minimum standards as outlined, which shall be reviewed and approved by the department director. Producers offering self-service storage insurance shall provide brochures or other print materials to prospective purchasers that meet minimum standards as outlined in the bill. Self-service storage insurance producer’s employees and authorized representatives shall not engage in certain activities including evaluating the technical terms of the policies or holding themselves out as insurance producers. Limited lines self-service storage insurance producers, operators, employees and authorized representatives can offer self-service storage insurance policies in an amount not to exceed $5,000 per customer per unit.  Effective Date August 28, 2016.
• Senate Bill 613
  This act permits volunteer fire protection associations to apply to the State Fire Marshal for grants for the purpose of funding the workers’ compensation insurance premiums for the association’s volunteer firefighters. Grants shall be disbursed by the Marshal, subject to appropriations, based upon the number of volunteer firefighters which received workers’ compensation benefits from claims arising out of and in the course of the prevention or control of fire or the underwater recovery of drowning victims in the preceding calendar year. The schedule is as follows:
  • Associations which had 0-5 claims shall be eligible for $2,000;
  • Associations which had 6-10 claims shall be eligible for $1,500;
  • Associations which had 11-15 claims shall be eligible for $1,000; and
  • Associations which had 16-20 claims shall be eligible for $500.

Currently, the uniform experience rating plan of workers’ compensation insurance must prohibit an adjustment to the experience modification of an employer if the total medical cost does not exceed $1,000, the employer pays all of the medical costs, there is no lost time from the employment (subject to exceptions), and no claim is filed. This act changes the medical cost amount limit to 20% of the current split point of primary and excess losses under the uniform experience rating plan.

The act further provides that, for purposes of calculating the premium credit under the Missouri contracting classification premium adjustment program, an employer within the construction group of code classifications may submit to the advisory organization the required payroll record information for the first, second, third, or fourth calendar quarter of the year prior to the workers’ compensation policy beginning or renewal date, provided the employer clearly indicates for which quarter the payroll information is being submitted.  Effective Date August 28, 2016.

• Senate Bill 700
  This act permits volunteer fire protection associations to apply to the State Fire Marshal for grants for the purpose of funding the workers’ compensation insurance premiums for the association’s volunteer firefighters. Grants shall be disbursed by the Marshal, subject to appropriations, based upon the number of volunteer firefighters which received workers’ compensation benefits from claims arising out of and in the course of the prevention or control of fire or the underwater recovery of drowning victims in the preceding calendar year. The schedule is as follows:
  • Associations which had 0-5 claims shall be eligible for $2,000;
  • Associations which had 6-10 claims shall be eligible for $1,500;
  • Associations which had 11-15 claims shall be eligible for $1,000; and
  • Associations which had 16-20 claims shall be eligible for $500.

Currently, the uniform experience rating plan of workers’ compensation insurance must prohibit an adjustment to the experience modification of an employer if the total medical cost does not exceed $1,000, the employer pays all of the medical costs, there is no lost time from the employment (subject to exceptions), and no claim is filed. This act changes the medical cost amount limit to 20% of the current split point of primary and excess losses under the uniform experience rating plan.

The act further provides that, for purposes of calculating the premium credit under the Missouri contracting classification premium adjustment program, an employer within the construction group of code classifications may submit to the advisory organization the required payroll record information for the first, second, third, or fourth calendar quarter of the year prior to the workers’ compensation policy beginning or renewal date, provided the employer clearly indicates for which quarter the payroll information is being submitted. Effective Date August 28, 2016.

• Senate Bill 865
  This act creates the “Missouri Palliative Care and Quality of Life Interdisciplinary Council,” which shall consult with and advise the Department of Health and Senior Services on matters related to the establishment, maintenance, operation, and outcomes evaluation of palliative care initiatives in the state, as well as submit an annual report to the General Assembly assessing the availability of palliative care in the state for patients at early stages of serious disease and analyzing barriers to greater access to palliative care.  This act also creates the “Palliative Care Consumer and Professional Information and Education Program,” which shall be designed to maximize the effectiveness of palliative care in the state by ensuring the public availability of comprehensive and accurate information about palliative care. The program shall encourage hospitals to have a palliative care presence on their intranet or internet website and to develop and distribute information about palliative care to patients. These provisions expire on August 28, 2022. This act provides that all licensees, registrants, and permit holders regulated by the Board of Pharmacy shall report to the Board any final adverse action taken by another licensing jurisdiction against such person or entity’s license, permit, or authorization to practice or operate as a pharmacist, intern pharmacist, pharmacy technician, pharmacy, drug distributor, drug manufacturer, or drug outsourcing facility. Additionally, all licensees, registrants, and permit holders shall report any surrender of a license or authorization to practice while under disciplinary investigation by another jurisdiction, and any exclusion to participate in any government funded health care program for fraud, abuse, or submission of any false claim, payment, or reimbursement request. This act provides that a pharmacist may dispense varying quantities of maintenance medication per fill up to the total number of dosage units as authorized by the prescriber, unless the prescriber has specified that dispensing a prescription for maintenance medication in an initial amount is medically necessary. When the dispensing of the maintenance medication is based on refills then the pharmacist shall dispense no more than a 90-day supply and the patient must have already been prescribed the medication for 3 months. This act provides that the Board of Pharmacy shall not renew a nonresident pharmacy license if the applicant does not hold a current pharmacy license in the state in which the nonresident pharmacy is located. Additionally, the Board shall not renew an out-of-state wholesale drug distributor, out-of-state pharmacy distributor, or drug distributor license if the applicant does not hold a current license in the state in which the distribution facility is located. If the applicant is a drug distributor registrant, then the entity must be authorized and in good standing with the Food and Drug Administration or within the state where the facility is located in order for the Board to renew the registration. This act adds the U.S. Department of Health and Human Services to the list of entities with which the Director of the Department of Insurance, Financial Institutions, and Professional Registration may cooperate to regulate insurance and financial services.  This act requires a health carrier or managed care plan that provides prescription drug coverage in the state to offer medication synchronization services. A health carrier or managed care plan that provides prescription drug coverage shall not charge any amount in excess of the otherwise applicable co-payment for dispensing a prescription drug in a quantity that is less than the prescribed amount and shall provide a full dispensing fee to the pharmacy that dispenses the prescription drug so long as the terms of the medication synchronization services are met. This act also requires each contract between a pharmacy benefit manager (PBM) and a pharmacy or pharmacy’s contracting representative to include sources utilized to determine maximum allowable cost and update such pricing information at least every seven days. A PBM shall maintain a procedure to eliminate products from the maximum allowable cost list of drugs (MAC list) or modify maximum allowable cost pricing within seven days if the drugs do not meet the standards as provided in the act. A PBM shall reimburse pharmacies for drugs subject to maximum allowable cost pricing based upon pricing information which has been updated within seven days. A drug shall not be placed on a MAC list unless there are at least two therapeutically equivalent multi-source generic drugs, or at least one generic drug available from at least on manufacturer and is generally available for purchase from national or regional wholesalers. All contracts shall include a process to internally appeal, investigate, and resolve disputes regarding MAC pricing as provided in the act. Appeals shall be upheld if the pharmacy being reimbursed for the drug on the MAC list was not reimbursed according to the act or the drug does not meet the requirements for being placed on the MAC list. The act creates the “Missouri Health Insurance Rate Transparency Act” to apply to health benefit plans, excluding large group market, long-term care, and Medicare supplemental plans, delivered, issued for delivery, continued, or renewed on or after January 1, 2018. Under this act, no health carrier shall deliver, issue for delivery, continue, or renew a health benefit plan until the rates for that plan have been filed with the Director of the Department of Insurance, Financial Institutions, and Professional Registration in the manner specified in the act. Rates shall be filed for excepted health benefits plans, as defined in the act, and grandfathered health benefit plans 30 days prior to use for informational purposes only. For all other plans, a health carrier may use rates on: (1) the date the Director determines such rates are reasonable, (2) the date the health carrier notifies the Director of its intent to use rates the Director has determined are unreasonable, or (3) 60 days after filing rates with the Director. The Director shall determine by rule when rates filed by health carriers shall be made publicly available and shall provide a means by which the public can submit written comments concerning proposed rate increases. The Director shall review the proposed rate and accompanying documentation and determine whether the rate is reasonable or unreasonable. Within 60 days of rate filing, the Director shall provide the health carrier with written notice detailing whether the proposed rate is reasonable or unreasonable. If the Director deems the rate is unreasonable, the written notice shall specify the deficiencies and detailed reasons why the rate is excessive, inadequate, unfairly discriminatory, or unjustified. Within 30 days of receiving written notice that the proposed rate is unreasonable, the health carrier may amend its rate, request reconsideration, or implement the proposed rate. The health carrier shall notify the Director of its intention within 30 days of receipt of the written notice. If a health carrier implements a rate determined to be unreasonable, the Department shall make such determination public. The Director shall publish final rates on the Department’s website no earlier than 30 days prior to the first day of the annual open enrollment period in the individual market for the applicable calendar year. The act extends the sunset provision for coverage of early refills of prescription eye drops from January 1, 2017, to January 1, 2020. Effective Date August 28, 2016.

Montana VIEW STATE →

FEE SCHEDULE NEWS:

• A new medical and hospital fee schedule has been adopted as of July 1, 2016. The next update is scheduled for July 2017.

REGULATORY ACTIVITY:

• For the third straight year, Montana’s workplace safety has improved and injury and illness rates have declined. The annual Survey of Occupational Injuries and Illnesses conducted by the Research & Analysis Bureau of the Montana Department of Labor & Industry shows that private industry workplaces in Montana have reported an incidence rate of 4.3 injury and illness cases per hundred full-time workers in 2015.  The 2014 incidence rate was 4.5 cases per hundred full-time workers. The 2013 incidence rate was 4.7 cases per hundred full-time workers.

Nebraska VIEW STATE →

FEE SCHEDULE NEWS:

• A new medical fee schedule has been adopted with an effective date of January 1, 2017. The fee schedule is based on 2017 CPT codes, descriptions, modifiers and the National Correct Coding Initiative as established by Centers for Medicare and Medicaid Services.  New conversion factors have been adopted.  The next update is scheduled for January 2018.
• The state has also adopted changes to Inpatient DRG/Trauma hospital rates with an effective date of January 1, 2017. The next update is expected in January 2018.

REGULATORY ACTIVITY:

• Effective January 3, 2017, to revise or supplement a Lump Sum Settlement Application, the court will require parties to submit either an Amended Lump Sum Settlement Application or a Joint Stipulation setting forth the charges. No Filing fee will be required for either document.  If an Amended Lump Sum Settlement is submitted all attachments must be included.  If a Joint Stipulation is used attachments may be added or removed as applicable.  A revised proposed order approving the Amended Lump Sum Settlement or Joint Stipulation and Lump Sum Settlement will also be required.  The procedures are already utilized in e-filed lump sum settlement applications and will supersede the current practice of allowing substitute pages to make revisions.
• Governor Pete Ricketts announced his appointment of Dirk V. Block to the Nebraska Workers’ Compensation Court.   Block, 55, is managing member of Marks, Clare, and Richards, LLC in Omaha where he leads a team of attorneys who try cases before the Nebraska Workers’ Compensation Court and counsel clients on employments matters.  He has also worked as a partner and associate attorney at the firm.  Block was previously an associate attorney at Knapp, Mues, Beaver, and Luther in Kearney. Block holds a Bachelor of Science in Criminal Justice from the University of Nebraska-Omaha and a Juris Doctor from Creighton University School of Law.  He has received the Martindale Hubbell “AV” peer review rating since 2005. The vacancy is due to the retirement of Judge Laureen K. van Norman, effective January 1, 2017.
• Effective January 1, 2017, the mileage rate will become 53.5 cents per mile for travel to seek medical treatment or while participating in a vocational rehabilitation plan. This conforms to the reimbursement rate paid to State of Nebraska employees.
• The Nebraska Workers’ Compensation Court held a public hearing on amendments to four rules and the adoption of a fifth. Under Rule 5, Interpreters, amendments would provide deadlines for submission of requests for interpreters; require an affidavit affirming the selection of the interpreter, and that person’s name and date of the legal proceeding. New Rule 12, Withdrawal of Counsel, would establish the procedures for attorneys of record to withdraw from cases. Under amendments to Rule 26, Schedules of Fees for Medical, Surgical and Hospital Services, the agency would adopt a new fee schedule effective Jan. 1. It would include 2017 current procedural terminology codes and relative value units established by the Centers for Medicaid & Medicaid Services, and include Medicare Diagnostic Related Groups with the inpatient hospital fee schedule. Rule 63, Independent Medical Examiner Selection, would be amended to provide that once an IME is assigned; neither party can submit additional questions without the court’s approval. And Rule 73, Self-Insurance Security, would be amended to provide that no security will be released for at least two years after the last payment to the claimant on all claims arising during the time the employer was approved for self-insurance.

Nevada VIEW STATE →

FEE SCHEDULE NEWS:

• The Division of Industrial Relations of the Department of Business and Industry in Nevada has revised their fee schedule to use the most recent editions of the Relative Value for Physicians, Relative Value Guide of Anesthesiologists, CMS 2007 list of ambulatory surgical codes and payment groups, Medicare’s current reimbursement for HCPCS codes K and L and the Nevada Specific Codes with an effective date of February 1, 2016. The next expected update is scheduled for February 1, 2017.

REGULATORY ACTIVITY:

• The Division of Industrial  Relations,  Department of Business and Industry,  State of Nevada  (the “Division”), conducted a public hearing to amend NAC 616C.498, to comply with NRS 616C.495, as amended by Section 3 of Senate Bill 232, Chapter 240, Statutes of Nevada 2015, at page 1141.  The Division held a public hearing on these proposed regulations by video conference at 2:00 p.m. on Wednesday, November 16, 2016 at the following locations:  NV OSHA 1301 N. Green Valley Parkway Henderson, Nevada; Workers’ Compensation Section 400 W. King Street Carson City, Nevada.
• The Board for the Administration of the Subsequent Injury Account for Self-Insured Employers held a public meeting on November 16, 2016 at 10:00 a.m., at 1301 North Green Valley Parkway, Conference Room B, Henderson, Nevada.  The public is advised that some of the members of the Board may participate in the meeting via

New Hampshire VIEW STATE →

REGULATORY ACTIVITY:

• Posted notice of a public hearing held on May 23, 2016 regarding amendments to regulations regarding stop loss insurance policies.

LEGISLATIVE ACTIONS:

• House Bill 1331
  This bill clarifies the experience that the members of the compensation appeals board must have to be members of the workers’ compensation appeals board. The statute requires that an individual have at least 5 years’ experience in the area of workers’ compensation, human resources or administrative law.  As a condition to maintaining eligibility to hear appeals, board members must have at least 10 hours annually of training and a briefing in the area of workers’ compensation and relevant disciplines.   Effective Date January 1, 2017.
• Senate Bill 203
  This bill allows an injured worker whose treatment is purposely postponed for medical treatment beyond the fourth anniversary of the date of denial or last payment of compensation to petition the commissioner of labor, within a certain time frame, to review such denial or award of compensation. Effective Date September 19, 2016.
• Senate Bill 238
  The enacted legislation adjusts the size of the workers’ compensation appeals board to be not less than 21 members but not more than 33 members, and raises the per diem amount from $200 to $400 for attorney members and $150 to $250 for all other members of the board.  The Department states each appeal pre-hearing and hearing consists of three members (one attorney and two other members).  There are approximately 246 hearings and 12 pre-hearings conducted each year.  Additionally, the Department states there would be an increase in costs related to attendance at the training meetings, monthly meetings and the completion of writing decisions, mainly completed by attorneys.  The Department estimates this bill may increase operating costs associated with per diem reimbursement by$169,600 each year. The Department states the increased costs would be paid for from the workers’ compensation administrative fund.  The fund is funded by carriers and self-insurance payments.  As employers, state, county and local governments would have an increase in expenditures based on their portion paid for the workers’ compensation administrative fund.  The Department states the increase would be indeterminable.  Effective Date January 1, 2016.
• Senate Bill 319
  This bill adds definitions of “adult child” and “dependent child” for purposes of determining survivor benefits for families of police officers and firefighters killed in the line of duty. The bill also increases the time periods for determining whether a death benefit is awarded. Effective Date June 21, 2016.
• Senate Bill 409
  This bill extends the prospective repeal of the first responder’s critical injury benefit. This bill also establishes a committee to study soft tissue injuries for purposes of workers’ compensation permanent impairment awards.  Effective Date June 21, 2016.

New Jersey No-Fault VIEW STATE →

REGULATORY ACTIVITY:

• Published its schedule of disabilities and maximum benefits exclusive of amputations and enucleation
• New Jersey has adopted Medical Protocols for their PIP program.  The effective date is October 17, 2016; the operative date is April 17, 2017.
• New Jersey just enacted legislation that requires providers to transmit and for payers to be able to receive medical bills electronically.  The bill is effective on the day it was signed into law November 14thn 2016 however, compliance is delayed by 18 months to give the state time to adopt guidelines and for payers to be in compliance with those guidelines.  It also exempts providers that bill less than 25 bills per month from compliance with electronic submission.  It is anticipated that the state will adopt the IAIABC e-billing guidelines which we are already in compliance.  The bill does not require payers to submit the medical bills to the state electronically so all it does is require electronic submission and acceptance of a medical bill.

New Jersey WC VIEW STATE →

REGULATORY ACTIVITY:

• Published its schedule of disabilities and maximum benefits exclusive of amputations and enucleation
• New Jersey has adopted Medical Protocols for their PIP program.  The effective date is October 17, 2016; the operative date is April 17, 2017.
• New Jersey just enacted legislation that requires providers to transmit and for payers to be able to receive medical bills electronically.  The bill is effective on the day it was signed into law November 14thn 2016 however, compliance is delayed by 18 months to give the state time to adopt guidelines and for payers to be in compliance with those guidelines.  It also exempts providers that bill less than 25 bills per month from compliance with electronic submission.  It is anticipated that the state will adopt the IAIABC e-billing guidelines which we are already in compliance.  The bill does not require payers to submit the medical bills to the state electronically so all it does is require electronic submission and acceptance of a medical bill.

New Mexico VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted a new Hospital and Healthcare Provider Fee Schedules effective January 1, 2017.   The next expected update is January of 2018.
• A new Gross Tax Receipts has also been adopted for the period of January 1 through June 30 2017.

REGULATORY ACTIVITY:

• New Mexico has released their fee schedule for 2017.  Also, released the Director's Fee Schedule Order and the agency's response to public comment.
• The Director of the NM WCA announces the vacancy of an Administrative Law Judge, effective April 1, 2017. The primary location of the position is in Albuquerque, NM, with travel throughout the state. The agency is currently accepting applications and will begin the review process beginning Jan. 3, 2017. The application process will be ongoing until filled.

LEGISLATIVE ACTIONS:

• House Bill 43
  The legislation relates to public employees. The legislation amends the public employees’ retirement act and the public employer group insurance provisions. The amended statute requires that an affiliated public employer pay certain employee’s member contributions and group insurance contributions if the employee sustains a non-administrative work-related injury rendering the employee absent from work on approved workers’ compensation leave.  Effective Date July 1, 2016.
• House Bill 168
  The enacted legislation relates to transportation. The legislation enacts the Transportation Company Services Act.  It provides for the administration of the act by the public regulation commission.  The legislation creates a dedicated fund to support the required activities.  The legislation provides for penalties for violations of requirements set forth in the legislation.   Effective Date June 14, 2016.
• Senate Bill 108
  The enacted legislation relates to the insurance industry in general. It increases the minimum capital, surplus and deposit requirements for insurance carriers acquiring a certificate of authorization. It changes the terms “insurance agent”, “insurance broker” and “insurance solicitor” to “insurance producer. It makes changes to the licensing and renewal requirements for insurance producers.  It enacts insurance producer license renewal and fee requirements.  It introduces licensing and fee requirements for independent review organizations.  The legislation introduces filing fee for continuing education providers.  The legislation introduces penalties for late notification of change of name or address. It requires adjusters to fulfill continuing education requirements and requires applicants for adjuster licenses to pass an examination. Effective Date July 1, 2016.
• Senate Bill 214
  The enacted legislation repeals and amends Section 52-1-12.1 Reduction in Compensation When Alcohol or Drugs Contribute to the Injury or Death section of the state’s workers’ compensation statute. The current section is repealed and replaced with a new section which includes a definition of intoxication or influence.  It further provides that drug or controlled substance does not include medications prescribed to a worker by the worker’s licensed health care provide and taken in accordance with the directions of the health care provider unless the medication is combined with alcohol or a non-prescribed drug or controlled substance. The statute is amended by allowing for a benefit that is otherwise due and payable be reduced by the degree to which the intoxication or influence contributed to the worker’s injury or death provided that the reduction shall be a minimum of 10 percent but no more than 90 percent. Further, the amended statute provides that test results relied on as evidence of a worker’s intoxication or influence shall not be considered in making a reduction unless the test and testing procedures conform with standard testing procedures generally accepted in the medical community.  Further, that the test is performed by a laboratory certified to do the testing by an organization nationally recognized.  The workers’ compensation agency is directed to adopt rules regarding test, testing and cutoff level for intoxication or influence. The enacted legislation further provides that if the injured employee refuses to submit to the test or release the results to the employer no compensation is due. The act requires that the test samples shall be taken as a split sample with one part of the sample to be held by the testing facility for twelve months from the date of the original test.  The worker is provided the right to request a second test be conducted within that 12-month period at the worker’s expense.   The amended act bares the employer from claiming the reduction if, before the accident, the employer had actual or constructive knowledge of the worker’s intoxication or influence and had a reasonable opportunity to take appropriate measures in response to the condition of the employee.  Further, the employer is barred from claiming the reduction if the employer fails to implement a written policy that declares a drug- and alcohol-free workplace and provides the employee such notice.  Reduction in benefits shall not affect payment of medical benefits nor shall affect payments of benefits to the dependents of the deceased worker.  Effective Date June 18, 2016.
• Senate Bill 263
  The enacted legislation establishes a new section in New Mexico Drug, Device and Cosmetic Act. The new section requires a practitioner who prescribes or dispenses an opioid to a patient to obtain and review reports from the state’s prescription monitoring program. The practitioner is also required to obtain reports for adjacent states if that information is accessible from the adjacent states. The act clarifies that practitioner does not include a pharmacist, veterinarian or euthanasia technician.   The practitioner must obtain and review such reports every three months for each established patient for whom the practitioner continuously prescribes or dispenses opioids.  The practitioner shall document the receipt and review of reports in the patient’s medical record. Effective Date: January 1, 2016

New York VIEW STATE →

FEE SCHEDULE NEWS:

• New York Workers’ Compensation Board has posted a notice of Fee Schedule changes for Podiatrists retroactive to February 17, 2014.  Changes are to allow qualified Board-authorized podiatrists to bill codes 27600 – 27745 (excluding 27702, 27703, 27727, 27740 and 27742) as well as 27760 – 27823, 27840 – 27871 and 27888 – 27899 when performing surgical procedures on the ankle.
• New changes to the DMEPOS Fee Schedule have been adopted with an effective date of January 1, 2017 and February 15, 2017.
• The state has adopted the EAPG (Enhanced Ambulatory Patient Groups) methodology for reimbursement of ASC and OPPS services with an effective date of October 1, 2015.
• The state has released new inpatient rates effective January 1, 2015.
• The latest medical fee schedule was effective December 1, 2010.

REGULATORY ACTIVITY:

• Posted three bulletins in November:
  • Bulletin Subject Number 046-896 – New York Workers’ Compensation Board Announces 2017 Assessment Rate
  • Bulletin Subject Number 046-892 – Board Announces New Hearing Purpose for Opioid Weaning Issues
  • Bulletin Subject Number 046-891 – Revised Procedure for Entering Stipulations.
• Pursuant to WCL §151, the Chair of the Workers’ Compensation Board shall annually establish an assessment rate for all employers by November 1st of each year, to be effective January 1st of the subsequent calendar year. For calendar year 2017, the rate shall be 2% of the standard premium or premium equivalent. The new rate shall be effective for policies renewing on or after January 1, 2017 and represents a decrease from the 2016 rate of 12.9%.
• Board Announces New Hearing Purpose for Opioid Weaning Issues.

LEGISLATIVE ACTIONS:

• Assembly Bill 9005
  Enacts into law major components of legislation necessary to implement the state public protection and general government budget for the 2016-2017 state fiscal year; intentionally omitted (Part A); amends Part H of chapter 503 of the laws of 2009, relating to the disposition of monies recovered by county district attorneys before the filing of an accusatory instrument, in relation to the effectiveness thereof (Part B); amends the tax law, in relation to suspending the transfer of monies into the emergency services revolving loan fund from the public safety communications account (Part C); intentionally omitted (Part D); amends chapter 268 of the laws of 1996, amending the education law and the state finance law relating to providing a recruitment incentive and retention program for certain active members of the New York army national guard, New York air national guard, and New York naval militia, in relation to the effectiveness of such chapter (Part E); amends chapter 83 of the laws of 1995 amending the state finance law and other laws relating to bonds, notes, and revenues, in relation to extending the expiration date of certain provisions thereof; amends chapter 1 of the laws of 2005 amending the state finance law relating to restricting contacts in the procurement process and the recording of contacts relating thereto, in relation to extending the expiration date of certain provisions thereof; and amends the state finance law, in relation to allowing the state comptroller to excuse non-material deviations in a procurement, authorizing the commissioner of the office of general services and state agencies to provide unsuccessful offerors a reasonable opportunity for debriefing, increase the threshold for the state comptroller’s approval of certain contracts and clarify the valuation of non-cash contracts by the state comptroller, and the commencement of the restricted period during the procurement process (Part F); amends the workers’ compensation law, in relation to authorizations of assessments for annual expenses, and payment of claims of affected World Trade Center volunteers (Part G); intentionally omitted (Part H); intentionally omitted (Part I); intentionally omitted (Part J); intentionally omitted (Part K); amends the civil service law, in relation to the expiration of public arbitration panels (Part L); amends the state finance law, in relation to the dedicated infrastructure investment fund (Part M); intentionally omitted (Part N); amends the public lands law, in relation to state aid on certain state leased or state owned land (Part O); amends the real property tax law, in relation to property tax benefits for anaerobic digestion of agricultural waste (Part P); amends the executive law, in relation to a mid-year report regarding the contracts awarded to service-disabled veteran-owned businesses; and providing for the repeal of such provisions upon expiration thereof (Part Q); amends chapter 747 of the laws of 2006, amending the state finance law relating to the tribal-state compact revenue account, in relation to the effectiveness thereof; amends part W of chapter 60 of the laws of 2011, amending the state finance law relating to disbursements from the tribal-state compact revenue account to certain municipalities, in relation to the effectiveness  thereof;  and amends the state finance law, in relation to the Niagara Falls underground railroad interpretive center (Part R); amends the legislative law, in relation to extending the expiration of payments to members of the assembly serving in a special capacity; amends chapter 141 of the laws of 1994, amending the legislative law and the state finance law relating to the operation and administration of the legislature, in relation to extending such provisions (Part S). Effective Date – Multiple effective dates however the part of the legislation that addresses workers compensation fund transfers Part G became effective on April 13, 2016.

North Carolina VIEW STATE →

FEE SCHEDULE NEWS:

• The North Carolina Industrial Commission has adopted changes to their Medical Fee Schedule with current Medicare Fee Schedules effective date of July 1, 2015. The next update to the physician fee schedule is scheduled for January 1, 2017.
• The state adopted a new payment methodology for Inpatient and Outpatient facility billings based on Medicare methodology, effective April 1, 2015. Additional rate decreases were scheduled for January 2016 and 2017.

REGULATORY ACTIVITY:

• The North Carolina Industrial Commission has established the maximum weekly benefit for 2017 pursuant to C. Gen. Stat. § 97-29. Effective January 1, 2017, the maximum weekly benefit applicable to all injuries and claims arising on and after January 1, 2017, shall be nine hundred seventy-eight dollars ($978.00).
• The North Carolina Industrial Commission has approved the temporary rule presented at a public meeting on November 18, 2016 amending their medical fee schedule rule 04 NCAC 10J.0101 regarding reimbursement for services provided by Ambulatory Surgical Centers.  The rule was adopted December 6, 2016 and takes effect on January 1, 2017.
• The temporary rule amendment to Rule 04 NCAC 10J .0103 adopted by the Industrial Commission was reviewed and approved by the Rule Review Commission on December 15, 2016 and which will go into effect on January 1, 2017.
• Notice of Proposed Amendment to Industrial Commission Rule 04 NCAC 10A .0108
• Please click here to view a notice regarding proposed changes to the Commission’s electronic filing rule, 04 NCAC 10A .0108, including the public hearing date and the written comment period for the proposed rule amendment. The notice contains the website link for the fiscal note approved by the Office of State Budget and Management regarding the proposed rule amendment.
• The Commission held the public hearing on Friday, November 18, 2016. Please click here to view a transcript of the public hearing. The written comment period closed on December 16, 2016. The Commission did not receive any written comments.
• The Commission approved a permanent rule amending 04 NCAC 10A .0108. The rule was filed with the Rules Review Commission at the Office of Administrative Hearings on December 20, 2016. Please click here to view the permanent rule.

North Dakota VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted changes to the Physician, ASC, DME and Hospital Outpatient and ASC Surgical Facility Fee Schedules effective October 1, 2016. The next expected update is set for January 1, 2017.

REGULATORY ACTIVITY:

• WSI recently revised the First Report of Injury (FROI) form and the Online First Report of Injury (OFROI). Please use the revised form effective immediately.  Changes to the form include the following:
  • General wording changes
  • Revised section headers
  • Addition of section for additional information or comments
• WSI encourages workers and employers to file a claim online to speed up the claim registration process. When completing the online form, please use the previous and next buttons located at the bottom of the page to move through the form.

Ohio VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted a new Inpatient fee schedule with an effective date of February 1, 2017. The next expected update will be on February 1, 2018.
• A new medical fee schedule has been adopted as of January 1, 2017. The next scheduled update is for January 2018.
• The state has adopted changes to the ASC and Outpatient fee schedule rates effective May 1, 2016. The next update is scheduled for May 2017.

REGULATORY ACTIVITY:

• Ohio’s Bureau of Workers’ Compensation has posted notice of its intent to review several rules.  Among the rules awaiting Common Sense Initiative are 4123-3-23 Limitations on the filing fee bills; 4123-6-21 Payment for outpatient medication; 4123-6-21.1 Payment for outpatient medication by self-insuring employer; 4123-6-21.3 Outpatient medication formulary; and 4123-6-37.1 payment of hospital inpatient services.

LEGISLATIVE ACTIONS:

• House Bill 207
  Workers’ compensation claims involving motor vehicle accidents.  This legislation requires workers’ compensation claims to be charged to the Surplus Fund Account in lieu of to a state fund employer’s experience in certain circumstances when a claim is based on a motor vehicle accident involving a third party.  It allows a state fund employer who believes that a claim may qualify to be charged to the Surplus Fund Account under the act to file a request with the Administrator of Workers’ Compensation for a determination.   The legislation requires the Administrator to make the determination within 180 days after the Administrator receives the request and requires any amount collected by the Administrator through the subrogation process for compensation or benefits that were charged to the Surplus Fund Account to be credited to the Surplus Fund Account and not applied to an individual employer’s account.  The legislation eliminates the minimum number of employees required for a private sector employer or board of county commissioners to obtain self-insuring status under the Workers’ Compensation Law.  The legislation requires a self-insuring employer who resumes paying premiums to the state insurance fund to provide the Administrator with any information that the Administrator may require to develop a state fund experience modification factor.  The legislation requires, if a professional employer organization agreement is terminated, a self-insuring professional employer to provide the Administrator with information that the Administrator must use to develop a state fund experience modification factor for each client employer formerly subject to the agreement.  Workers’ compensation claims involving motor vehicle accidents charging experience for certain claims to the Surplus Fund Account  The act requires the Administrator of Workers’ Compensation, for workers’ compensation claims arising on or after July 1, 2017, to charge a state fund employer’s experience to the Surplus Fund Account created under continuing law within the State Insurance Fund and not to the employer’s experience for payments made in a workers’ compensation claim, if all of the following apply:
  • The claim is based on a motor vehicle accident involving a third party;
  • The third party is issued a citation for a violation of any law or ordinance regulating the motor vehicle’s operation arising from the accident on which the claim is based;
  • Either of the following circumstances apply to the claim:
    • Any form of insurance maintained by the third party covers the claim;
    • Uninsured or underinsured motorist coverage covers the claim.

        Effective Date August 31, 2016.

Oklahoma VIEW STATE →

FEE SCHEDULE NEWS:

• Several rules were adopted as of September 12, 2016 as follows:
  • A certified advanced practice registered nurse shall be allowed eighty-five percent (85%) of the fee schedule allowance for Evaluation and Management services and other services performed within the advanced practice registered nurse’s license and certification, subject to the conditions and procedures set forth in General Ground Rule 13 of the 2012 fee schedule.
  • Appeals process for drugs excluded from the closed formulary:
    • For situations in which the prescribing doctor determines and documents that a drug excluded from the closed formulary is medically necessary to treat an injured employee’s compensable injury and has prescribed the drug, the prescribing doctor, other requestor, or injured employee must request approval of the drug by requesting preauthorization from the insurance carrier, or pursuant to the preauthorization requirements of a certified workplace medical plan, if the claim is subject to the plan.
    • If preauthorization is requested by an injured employee or a requestor other than the prescribing doctor, and the injured employee or other requestor requests a statement of medical necessity, the prescribing doctor shall provide a statement of medical necessity as set forth in Subsection (e) of 810:15-5-1 to facilitate the preauthorization submission.
    • If preauthorization for a drug excluded from the closed formulary is denied, the requestor may request a hearing before an administrative law judge of the Commission by filing a CC-Form-9 as provided in 810:10-5-16.
    • In the event of an unreasonable risk of a medical emergency, an interlocutory order may be obtained in accordance with 810:15-5-4.
  • 810:15-7-2. Controlled substance monitoring and drugs of abuse testing for chronic pain management. One presumptive drug test is allowable at each individual office visit for chronic pain management. Definitive drug testing following a suspected abnormality on the presumptive drug test is permissible for not more than forty (40) individual definitive drug tests every twelve (12 months).
  • No physician may receive more than Four Hundred Dollars ($400.00) in advance in order to schedule a deposition. The advance payment shall be applied against amounts owed for testimony fees.
• The last medical and hospital fee schedule the state adopted was effective January 1, 2012.
• The DMEPOS and Ambulance services are based on the values referenced by the CMS DMEPOS and Ambulance Fee Schedules and have been updated as of January 1, 2017.

REGULATORY ACTIVITY:

• Effective January 1, 2017, the Internal Revenue Service has announced a decrease in the mileage reimbursement rate from $.54 to $.535 per mile.  (See IR-2016-169, Issued 12/13/2016).  The new rate applies to mileage incurred on or after January 1, 2017.

Oregon VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted new 2017 CPT codes with an effective date of January 1, 2017.  New updates to the medical fee schedule are expected April 2017.
• The state has also adopted changes to the Hospital Cost-to-Charge Ratios effective October 1, 2016. The next expected update is on April 1, 2017.

REGULATORY ACTIVITY:

• The Department of Labor and Industries updated its rules website. Division: Insurance Services (Employer Services) Topic: Adoption (CR-103) - 2017 Industrial Insurance Premium Rates Brief Description: This rule amends the tables of classification base premium rates, experience rating plan parameters, experience modification factor calculation limitations and retrospective rating plan size groupings for the workers' compensation insurance program for calendar year 2017. Classification base rates were amended for updated loss and payroll experience. The department is adopting a 0.7 percent overall average premium rate increase.  The rule also repeals WAC 296-17-86507, 2007 Claim-free experience modification phase-in limitation which is now obsolete.  This rulemaking also provides notice that as part of rebuilding the contingency reserves, the Director is transferring the amount of the accident and medical-aid funds combined that exceed 10 percent of funded liabilities as required by RCW 51.44.023. The department's decision to increase overall rates is intended to ensure adequate premiums to cover expected losses for 2017 claims and to continue rebuilding the contingency reserves to adequate levels. Washington law provides that rates should be adjusted annually to reflect the hazards of each industry and in accordance with recognized workers' compensation insurance principles.
• Revised Bulletin 209, "Report of losses instructions and guidelines," and related forms are available online:
• The forms below are effective January 1, 2017 http://wcd.oregon.gov/forms/Pages/index.aspx (Forms and bulletins page) http://wcd.oregon.gov/Bulletins/bul_209.pdf (Bulletin 209) http://wcd.oregon.gov/WCDForms/2808.doc (Form 2808 - revised) http://wcd.oregon.gov/WCDForms/2809.xls (Form 2809 - revised) http://wcd.oregon.gov/WCDForms/2810.doc (Form 2810 - not revised) http://wcd.oregon.gov/WCDForms/2937.xls (Form 2937 - not revised)
• Oregon has announced the revision of two forms.  While the forms can be found at the web links below a copy of each of the revised forms is attached. Revised forms 1880, "Vocational Assistance Certification Program Individual Certification under OAR 436-120," and 4619, "Request for approval of training program by vocational rehabilitation counselor," are now available online: http://wcd.oregon.gov/forms/Pages/forms.aspx (forms page) Changes to Form 1880 include restructuring the form for ease of use and adding fields to capture provider information. Form 1880: http://wcd.oregon.gov/WCDForms/1880.doc Changes to Form 4619 include updating contact information and adding a rule citation. Form 4619: http://wcd.oregon.gov/WCDForms/4619.doc
• Oregon has posted notice of adopted rules.
• The Oregon Workers’ Compensation Division has published final (permanent) administrative rules to its website:
• General link to “New rules” page: http://wcd.oregon.gov/laws/Pages/new-rules.aspx
• Direct links to revised rules:
• 436-050, Employer/Insurer Coverage Responsibility, effective 1/1/2017 Clean copy:  http://wcd.oregon.gov/laws/Documents/New_rules/50_16054.pdf With marked revisions:  http://wcd.oregon.gov/laws/Documents/New_rules/50_16054ub.pdf
• 436-060, Claims Administration, effective 1/1/2017 Clean copy: http://wcd.oregon.gov/laws/Documents/New_rules/60_16055.pdf With marked revisions: http://wcd.oregon.gov/laws/Documents/New_rules/60_16055ub.pdf
• 436-105, Employer-at-Injury Program, effective 1/1/2017 Clean copy: http://wcd.oregon.gov/laws/Documents/New_rules/105-16056.pdf With marked revisions: http://wcd.oregon.gov/laws/Documents/New_rules/105-16056ub.pdf
• 436-110, Preferred Worker Program, effective 1/1/2017 Clean copy: http://wcd.oregon.gov/laws/Documents/New_rules/110-16057.pdf With marked revisions: http://wcd.oregon.gov/laws/Documents/New_rules/110-16057ub.pdf
• 436-120, Vocational Assistance to Injured Workers, effective 1/1/2017 Clean copy: http://wcd.oregon.gov/laws/Documents/New_rules/120-16058.pdf With marked revisions: http://wcd.oregon.gov/laws/Documents/New_rules/120-16058ub.pdf
• Revised Bulletin 260, "Employer-at-Injury Program Reimbursement Request Form," is available online: http://wcd.oregon.gov/forms/Pages/index.aspx (main forms and bulletins page) http://wcd.oregon.gov/Bulletins/bul_260.pdf (Bulletin 260) http://wcd.oregon.gov/WCDForms/2360.doc (Form 2360)
• The Workers’ Compensation Division has developed a new training tool and resource for providers. Whether you are new to or very familiar with the workers’ compensation system, we designed the handbooks to be a helpful tool to look up topics for your specific provider type. The handbooks do not replace the Oregon workers’ compensation statutes and rules; however, they are designed to help explain some of the rules and give clarification. There are eight provider-specific handbooks, located along the right-hand side of the handbook web page. Each handbook will help you become familiar with workers’ compensation requirements, as well as responsibilities and treatment limitations specific to your specialty. Also, these handbooks have tips to help you avoid problems when treating workers’ compensation patients. The handbooks are replacing five existing publications (Guides to Oregon On-the-Job Injuries).
  • Acupuncturists
  • Chiropractors
  • Massage therapists
  • MDs, DOs, and Podiatrists
  • Naturopathic physicians
  • Nurse practitioners
  • Physical therapists
  • Physician assistants
• The Workers' Compensation Division has published temporary rules to adopt 2017 medical billing codes. These rules are effective Jan. 1, 2017, and will allow providers and insurers to use either the 2016 or 2017 codes until the agency adopts revised, permanent rules, effective April 1, 2017.  A copy of the Rule is attached.
• Oregon has also adopted additional rules that become effective on January 1, 2016. Rule 436 Division 50 Employer/Insurer Coverage Responsibility, 436 Division 060 Claims Administration, Division 436 Division 105 Employer -at- Injury Program, 436 Division 110 Preferred Worker Program, and 436 Division 120 Vocational Assistance to Injured Workers have all been amended and these rules become effective January 1, 2017.

OWCP VIEW STATE →

FEE SCHEDULE NEWS:

• The U.S. Department of Labor’s Office of Workers’ Compensation Programs has adopted a new schedule for Medical, Inpatient, Outpatient and ASC services with an effective date of August 1, 2015.

Pennsylvania No-Fault VIEW STATE →

FEE SCHEDULE NEWS:

• The state adopts quarterly Medicare updates. Please refer to the Medicare modules section for more information.

Pennsylvania WC VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted changes to the PAWC Part A and Part B Fee Schedule services with an effective date of January 1, 2017.  Fees have been increased 1.7% per the new statewide average weekly wage and are applicable to all services rendered on and after January 1, 2017.  The next expected update is for April 1, 2017.

REGULATORY ACTIVITY:

• The statewide average weekly wage for injuries occurring on and after Jan. 1, 2017, is $995.00 per week and represents an increase of 1.7 percent from 2016.

Rhode Island VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted changes to the Inpatient, ASC and Emergency Room Hospital Fee Schedule effective July 1, 2016. The next expected update is scheduled for July 1, 2017.
• The state has also released their new Physician Fee Schedule with an effective date of July 15, 2016.

REGULATORY ACTIVITY:

• Rhode Island had released two new forms regarding electronic payments.

LEGISLATIVE ACTIONS:

• Senate Bill 2045 Sub A
  This act increases the daily reimbursement for members of the medical advisory board from three hundred dollars ($300) to five hundred dollars ($500). It postpones from the years 2021 to the year 2023 the partial incapacity benefits deadline. The act extends the commencement date of the payments to employees of uninsured employers’ statute from January 1, 2017, to July 1, 2017. It changes the mileage rate that employees who attend medical examinations or rehabilitation are paid to the Internal Revenue Service allowable rate and how the distance for the visit is calculated. This act authorizes the Director of Labor and Training to recover the cost of legal services and fees incurred in fraud investigations and examinations.  Effective Date July 13, 2016.

South Carolina VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted a new Medical Services Provider Manual based on current CPT codes and the 2016 CMS Relative Value Units (RVU) with an effective date of September 1, 2016.  A new physician fee schedule is set to become effective September 1, 2017.
• For Hospital and ASC schedules, the state adopts the Medicare Prospective Payment Systems with a 140% markup.

REGULATORY ACTIVITY:

• The Commission will conduct a public hearing on January 5, 2017 at 10:30 a.m. in Hearing Room A at the Commission to receive comments on the proposed changes to Chapter 67. The full text of the proposed regulations is available on the South Carolina General Assembly home page http://www.scstatehouse.gov/regnsrch.php (enter 4735 as the document number).  Written comments on the proposed regulation may be submitted to Gary M. Cannon Executive Director, South Carolina Workers’ Compensation Commission, Post Office Box 1715, Columbia, South Carolina 29202-1715.  Comments must be received no later than 5:00 p.m. on December 26, 2016.
• On December 1, 2016, South Carolina published an advisory notice regarding submission of Dependency Investigations. Regulation 67-902(B) governs the discovery of beneficiaries when a fatality has occurred as a result of a work-related injury.  It requires the employer’s representative to attach to the Form 12A a list of the names, addresses, and ages of all known beneficiaries.  The list must be submitted with the dependency investigation filed with the Commission.
• In September of this year, the Commission revised the language on the Form 14B for clarifying information on whether or not future medical care and treatment will be required (R67-802 and R67-803).  The change prompted several stakeholders to express concerns about about the form’s revised language. Chairman Beck convened an ad hoc advisory group of stakeholder representatives to discuss the concerns and recommend any changes to the Commission to address the expressed concerns.  The group met over several weeks and presented their recommendations to the Commission. The commission reviewed the recommendations and supporting information and approved the language on Form 14B.  The Commission prefers that the parties begin using the revised Form 14B immediately however, the Commission will continue to accept the previous Form 14B (dated 9/13) so long as it is completed by the physician before January 1, 2017. Beginning on March 1, 2017, the Commission will require the use of the newly revised Form 14B (dated 12/2016).

• At the Business Meeting on December 12, 2016, the Commission approved the maximum weekly compensation rate at $806.92 for injuries arising on and after January 1, 2017. The South Carolina Department of Employment and Workforce certified the average weekly wage July 1, 2015 through June 30, 2016.   As provided in Title 42 of the SC Code of Laws, 1976 the maximum weekly compensation rate equals 66⅔% of an individual’s average weekly wage, not to exceed the average weekly wage in this State for the preceding fiscal year as determined by the South Carolina Department of Employment and Workforce.

LEGISLATIVE ACTIONS:

• Senate Bill 975
  The enacted legislation amends subsection (b) of section 42-3-20 of the South Carolina code of laws, 1976, so as to provide that the governor may reappoint a person as chairman of the workers’ compensation commission, and to further provide that the commission is not required to elect a chairman from among its members in the event the governor does not appoint or reappoint a chairman. Effective Date:  March 14, 2016.

South Dakota VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted a new fee schedule with an effective date of June 28, 2016. The state is adopting the 2015 Relative Values for Physicians and conversion factors.  The state has increased the conversion factors approximately 1.5% for each category with the exception of two sections that had no changes.  The dental conversion factor has been increased 6.1% since the last update.

REGULATORY ACTIVITY:

• A public hearing will be held in the Conference Room 3, Kneip Building, 700 Governors Drive, Pierre, SD on Sept. 6, 2016, at 1 p.m. to consider the adoption and amendment of proposed rules to Chapter 47:01:01. The Rules Text can be viewed at http://dlr.sd.gov/dlr_public_hearing.aspx.

LEGISLATIVE ACTIONS:

• House Bill 1084
  The bill defines when concurrent employment may be used to calculate earnings in workers’ compensation cases.  The enacted legislation abrogates the ruling of the courts in the Wheeler v. Cinna Bakers LLC, 2015 864 N.S. 2d 17, 2015 regarding the aggregation of wages.  The legislation establishes that if an employee was working for more than one employer, the employee’s earnings used to calculate the employee’s average weekly wage in §§ 62-4-24, 62-4-25, or 62-4-26 shall include the amount of compensation for the number of hours commonly regarded as a day’s work for each employer in which the person was concurrently employed at the time of the person’s injury;  however, an employee’s earnings from concurrent employment are aggregated only if the injury occurred when the employee was actively working in the concurrent employment and when the injury prevents the employee from performing the employee’s duties at the employee’s other concurrent employment.  Further the legislation establishes a definition for earnings as the amount of compensation for the number of hours commonly regarded as a day’s work for the employment in which the employee was working at the time of the employee’s injury. It includes payment for all hours worked, including overtime hours at straight-time pay, and does not include any sum which the employer has been accustomed to pay the employee to cover any special expense entailed by the employee by the nature of the employment; wherever allowances of any character made to an employee in lieu of wages are specified as a part of the wage contract, the allowances shall be deemed a part of the employee’s earnings.  The legislation also places certain requirements on employers that have concurrent employees and receive a demand for information from any employer or insurer against whom an injured employee has made a workers’ compensation claim.  Effective Date July 1, 2016.

Tennessee VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted new state specific conversion factors and specialty based markups.

REGULATORY ACTIVITY:

• The State of Tennessee Bureau of Workers’ Compensation is requesting interested and qualified attorneys to apply for the position of Workers’ Compensation Judge, to be in West Tennessee. The successful candidate will be appointed to serve an initial term that will expire on June 30, 2019 and will be eligible to serve an additional three (3) full terms (See Code Anno. §50-6-238(a)(1)(B)). All interested applicants must complete a questionnaire. Workers’ Compensation Judges must have a valid and active Tennessee law license, be at least thirty (30) years old, and have at least five (5) years’ experience in Tennessee workers’ compensation matters (See Tenn. Code Anno. §50-6-238(a)). For additional information on the workers’ compensation judgeships, please contact the Bureau of Workers’ Compensation Administrator, Abbie Huggens, at Abbie.Hudgens@tn.gov. Please return the completed application, with required attachments, to Janie.L.Dorris@tn.gov. Completed questionnaires received by the bureau on or before Friday, January 6, 2017 will be considered.

LEGISLATIVE ACTIONS:

• House Bill 1622
  As enacted, the legislation extends the advisory council on workers’ compensation four years to June 30, 2020. The bill replaces a reference to the Alliance of American Insurers with a reference to the Property Casualty Insurers Association of America in the provision giving examples of the interested insurance organizations that may submit a list of qualified persons that the governor may consider in appointing the nonvoting insurance company representative to the advisory council on workers’ compensation.  Effective Date March 22, 2016.
• Senate Bill 1758
  This legislation amends the statute to allow the state to take action on a complaint from medical providers regarding medical reimbursement. A written complaint alleging a violation of this section by individuals or entities licensed by the department of commerce and insurance may be filed with the bureau of workers’ compensation.  The bureau may investigate complaints made under this subsection (e) and shall direct all such complaints, along with any investigatory materials, to the department of commerce and insurance.  The commissioner of commerce and insurance may take appropriate action in accordance with § 56-2-305. A written complaint alleging a violation of this section by individuals or entities not licensed by the department of commerce and insurance may be filed with the bureau.  The bureau may investigate all complaints made under this subsection (e) and shall have the authority to establish and collect penalties for violations of this section in accordance with § 50-6-118.  Effective Date July 1, 2016.
• Senate Bill 1880
  The enacted legislation limits the amount a provider may charge for copies of materials. Effective Date April 14, 2016.
• Senate Bill 2563
  This bill revises various provisions of the Workers’ Compensation Law, as follows: Under present law, “employee” includes a sole proprietor or a partner who devotes full time to the proprietorship or partnership and elects to be included in the definition of employee by filing written notice of the election with the bureau of workers’ compensation at least 30 days before the occurrence of any injury or death, and may at any time withdraw the election by giving notice of the withdrawal to the bureau. This bill adds members of a limited liability company to this definition of “employee.”Present law authorizes a workers’ compensation judge to approve a proposed settlement among the parties if the settlement agreement has been signed by the parties; and the workers’ compensation judge has determined that the employee is receiving, substantially, the benefits provided by the Law, or, in cases subject to the provisions discussed below, if the workers’ compensation judge has determined that the settlement is in the best interest of the employee. This bill revises these provisions to instead provide that interested parties will have the right to settle all matters of compensation between themselves, but all settlements must be reduced to writing and must be approved by a judge of the court of workers’ compensation claims before they are binding on either party. It will be the duty of the judge of the court of workers’ compensation claims to whom any proposed settlement is presented for approval, to examine the proposed settlement to determine whether the employee is receiving, substantially, the benefits provided by the law. In all cases where the settlement proceedings or any other court proceedings for workers’ compensation involve a subsequent injury wherein the employee would be entitled to receive or is claiming compensation from the second injury fund, the administrator must be made a party defendant to the proceedings in an action filed by either the employer or the injured employee, and an attorney representing the bureau under the supervision of the attorney general and reporter will represent the administrator in the proceeding. The court of workers’ compensation claims, by its decree, will determine the right of the employee to receive compensation from the fund.  Under present law, an employee who is determined to be permanently and totally disabled is not allowed to compromise and settle the employee’s rights to future medical benefits. This bill retains this prohibition on settling future medical benefits for a person determined to be permanently and  totally disabled, but adds that otherwise parties are not prohibited from compromising and settling the issue of future medical benefits, so long as the settlement agreement is approved by a judge of the court of workers’ compensation claims, and includes a provision confirming that the employee has been informed of the potential consequences of the settlement, if any, with respect to Medicare and TennCare benefits and liabilities. This bill clarifies what is an original award, what is a resulting award, and the calculations for further increasing a resulting award in the case of a person with a partial permanent disability who returns to work at wages less those received prior to the injury. Under present law, any party aggrieved by an order for temporary disability or medical benefits or an order either awarding permanent disability or medical benefits or denying a claim for permanent disability or medical benefits issued by a workers’ compensation judge may appeal the order to the workers’ compensation appeals board. This bill revises this provision to apply to any party aggrieved by any order issued by a workers’ compensation judge. This bill clarifies certain of the provisions governing such review. Under present law, workers’ compensation judges and any person appointed to serve as a judge on the workers’ compensation appeals board must take an oath or affirmation to support the constitutions of the United States and of this state, and to administer justice without respect of persons, and impartially to discharge all the duties incumbent upon a judge to the best of the judge’s skill and ability. The oath may be taken before another workers’ compensation judge, any inferior court judge, a retired judge, a retired chancellor, or an active or retired judge of the court of general sessions. This bill revises the persons before whom the oath may be taken to be, in the case of a judge on the workers’ compensation appeals board, the governor or any active or retired Tennessee judge or chancellor, and, in the case of a workers’ compensation judge, to be the governor, an active or retired Tennessee judge or chancellor, or an active or retired judge of the court of workers’ compensation claims or court of workers’ compensation appeals. Under present law, in certain cases, the court of workers’ compensation claims may award attorneys’ fees and reasonable costs, including reasonable and necessary court reporter expenses and expert witness fees for depositions and trials incurred when the employer fails to furnish appropriate medical, surgical and dental treatment or care, medicine, medical and surgical supplies, crutches, artificial members, and other apparatus to an employee provided for in a settlement or judgment. This bill adds that such fees and costs may also be awarded in connection with an expedited hearing order or compensation hearing order. Under present law, the amounts of compensation payable periodically under the Law may be commuted to one or more lump sum payments.  These may be commuted upon motion of any party subject to the approval of the circuit, chancery, or criminal court. This bill revises the approval provision to only require approval of the court of workers’ compensation claims. Present law provides for certain additional disability benefits in extraordinary cases. Under present law, these provisions will not apply to persons on or after July 1, 2016. This bill removes this limitation on these provisions. Present law provides that the uninsured employers fund must be used for payment of the costs incurred by the bureau of workers’ compensation to administer the assessment of and collection of penalties for noncompliance with insurance requirements. This bill adds that the funds will also be used for the costs of administering the fund, including but not limited to lien fees or fees of third party administrators.  Effective Date April 14, 2016.

Texas VIEW STATE →

FEE SCHEDULE NEWS:

• New conversion factors have been adopted as of January 1, 2017. The next update is scheduled for January 1, 2018.
• The state of Texas adopts the quarterly Medicare modules update. Please refer to the Medicare modules section for more information.
• The quarterly Home Health and Dental fee schedules published by Medicaid have been updated as of January 1, 2017. Next update is scheduled for April 1, 2017.

REGULATORY ACTIVITY:

• The Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) is accepting comments on the proposed repeal of 28 TAC Chapter 57, Request for Case Folders and Certification of Actions of the Board.  Title 28 TAC Chapter 57 includes 28 TAC §57.5, concerning request for copies or statistical information; 28 TAC §57.10, concerning written request for public information; and 28 TAC §57.15, concerning telephone request for public information. The TDI-DWC proposes to repeal 28 TAC Chapter 57 because the rules are outdated and no longer necessary since other statutes and rules currently govern access to TDI-DWC records and requests for public information. The proposed repeal is a result of TDI-DWC reviewing its rules pursuant to Government Code §2001.039. Texas Government Code §2001.039 requires TDI-DWC to review and consider re-adopting, amending, or repealing its rules no later than the fourth anniversary of the rule’s effective date. If you want to comment on the proposal, submit your written comments by 5:00 p.m. Central time on January 02, 2017. A request for public hearing must be sent separately from your written comments. Send written comments or hearing requests by email to rulecomments@tdi.texas.gov or by mail to: Texas Department of Insurance, Division of Workers’ Compensation Maria Jimenez Office of General Counsel MS – 40 7551 Metro Center Drive, Suite 100   Austin, Texas 78744 -1645.  The proposal will be published in the December 2, 2016 issue of the Texas Register and will be available at sos.state.tx.us/texreg/index.shtml once published. A courtesy copy will also be available on the TDI-DWC website at www.tdi.texas.gov/wc/rules/2016rules.html.
• To provide predictability and reflect changes in medical service delivery costs to system participants, DWC established a conversion factor and an annual update as part of 28 TAC §134.203(c).  The annual update is based on the Medicare Economic Index (MEI), which is a weighted average of price changes for goods and services used to deliver physician services.  The MEI for 2017 reflects an increase of 1.2 percent. For services provided in calendar year 2017, the new Medical Fee Guideline conversion factors are $57.50 and $72.18.  The conversion factor of $57.50 applies to service categories of evaluation and management, general medicine, physical medicine and rehabilitation, radiology, pathology, anesthesia, and surgery when performed in an office setting.  The conversion factor of $72.18 applies to surgery when performed in a facility setting.
• The Texas Department of Insurance issued a mandatory data call under Texas Insurance Code, Sections 003, 2251.008, and 38.001. This data call is the basis for a report that TDI is required to submit annually to the governor, lieutenant governor, the speaker, the Legislature, and the public. You must respond to this data call using the instructions linked to this bulletin no later than February 10, 2017. You also must retain underlying data, individual source documents, and other information used to develop your response until at least February 10, 2019.

Utah No-Fault VIEW STATE →

FEE SCHEDULE NEWS:

• The last fee schedule update was on January 1, 2016.

Utah WC VIEW STATE →

FEE SCHEDULE NEWS:

• The state adopted changes to their Physician fee schedule rates with an effective date of December 1, 2016. The next update is expected in December 2017.
• Ambulance rates have been updated as of July 1, 2016. The next expected update is scheduled for July 2017.

REGULATORY ACTIVITY:

• Utah has proposed a rule regarding nurse practitioners in regards to their duties in the workers’ compensation system.  The proposed rule was filed on 10/28/2016.  Comments must be submitted no later than December 15, 2016 by 5:00 P.M.

LEGISLATIVE ACTIONS:

• House Bill 230
  The enacted legislation modifies provisions related to the Workers’ Compensation Fund to address it board of directors.  It limits compensation for directors to an amount not to exceed the reasonable market rate for directors of similarly situated insurance carriers.  The enacted legislation modifies requirements for and restrictions on who can be a director.  The bill allows for the number of directors to increase by two under certain circumstances.  The legislation addresses terms, quorum and voting requirements if the board is increased to nine directors.  The bill makes technical and conforming amendments.  Effective Date May 10, 2016.
• House Bill 236
  This bill creates a program that allows certain pharmacies to accept and dispense donated unused prescription medications to certain individuals.  The bill amends the pharmacy practice act and defines terms.  The bill directs the Division of Occupational and Professional Licensing (DOPL) to make rules, in consultation with the Utah State Board of Pharmacy to create a charitable prescription drug recycling program.  The legislation establishes criteria for prescription drugs eligible for the program.  It establishes requirements for donors and pharmacies and limits the liability of program participants and drug manufacturers.  It directs the DOPL to make rules establishing certain requirements, standards, procedures and processes. Effective Date May 10, 2016.
• Senate Bill 76
  This enacted legislation defines terms.  The legislation provides that volunteers are not employees for purposes of workers’ compensation unless the nongovernment entity for which the volunteer provides services elects to cover the volunteer with workers’ compensation coverage.  The legislation clarifies the application of the exclusive remedy and provides how disability compensation is to be determined.  The legislation addresses how premiums are calculated.  Effective Date May 10, 2016.
• Senate Bill 127
  The legislation modifies provisions related to payment of workers’ compensation benefits.  It repeals language related to liability for extended benefits.  The legislation imposes time frames within which claims for reimbursement from the Employer’s Reinsurance Fund may be submitted. For reimbursement related to medical benefits or compensation paid on or before July 1, 2016 claims must be submitted by June 30, 2018.  For claim for benefits after July 1, 2016 the filing must be within 24 months of the date the benefits or compensation are paid or the date the Employers’ Reinsurance Fund is determined liable.  It also makes technical changes.  Effective Date May 10, 2016.
• Senate Bill 146
  The legislation modifies the language regarding an employee’s burden in establishing that an employee has a permanent and total disability.  Effective Date May 10, 2016.
• Senate Bill 216
  This legislation modifies provisions related to reimbursement of hospitals for certain services by establishing that in lieu of a contract the carrier shall pay eighty-five percent of billed covered charges.  The legislation requires a study regarding hospital cost be conducted by the workers’ compensation advisory committee.  Specifically it requires that the advisory council study how hospital costs may be reduced for purposes of medical benefits for workers’ compensation. The council shall report to the Business and Labor Interim Committee the council’s recommendations by no later than November 30, 2017.  The legislation establishes reasonable standards for hospital costs.  It addresses contracting with hospitals.  It prohibits balanced billing by hospitals and addresses coordination of benefits.  Effective Date May 10, 2016.

Vermont VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted changes to Physician Fee Schedule rates with an effective date of January 1, 2017. Next expected update is in January 2018.

REGULATORY ACTIVITY:

• Held their public hearing for proposed rule 45 regarding administrative citations, penalties, stop work orders and debarment.
• The draft forms that were provided preauthorization form and form 7 earlier are now effective.

LEGISLATIVE ACTIONS:

• Senate Bill 216
  This act directs the Green Mountain Care Board to identify annually up to 15 prescription drugs on which the State spends significant health care dollars and for which the wholesale acquisition cost has increased by 50 percent or more over the past five years or by 15 percent or more over the past 12 months. The Board must provide the list of prescription drugs and the percentage that the wholesale acquisition cost for each drug increased to the Attorney General’s Office and post the information on the Board’s website.  For each drug listed, the Attorney General’s Office must require the drug’s manufacturer to provide a justification for the wholesale acquisition cost increase, and the manufacturer must submit to the Office relevant information and supporting documentation.  The act requires the Attorney General to provide an annual report to the General Assembly based on the information the Office receives from manufacturers and to post the report on the Office’s website.   The act requires the Commissioner of Financial Regulation to adopt rules requiring health insurers that offer plans through the Vermont Health Benefit Exchange to provide searchable information online about their Exchange plan prescription drug formularies.  It directs the Department of Vermont Health Access to use the same dispensing fee in its reimbursement formula for 340B prescription drugs as it uses to pay for non-340B prescription drugs under the Medicaid program, and to provide information to the General Assembly about 340B drug reimbursement and the 340B program.  It allows at least one bronze-level Exchange plan offered for the 2018 plan year to have a higher out-of-pocket limit on prescription drug spending than the limit established in statute and directs the Department of Vermont Health Access to convene an advisory group to develop options for 2018 bronze plans.  The act requires the Director of Health Care Reform in the Agency of Administration to report on whether the Secretary of the U.S. Department of Health and Human Services has the authority to waive annual limits on out-of-pocket expenses or actuarial value requirements for bronze-level plans, or both, and if so, to apply for such a waiver by March 1, 2017.  It also directs the Department of Vermont Health Access to provide information to the General Assembly about bronze-level plans and enrollment trends and recommendations on the out-of-pocket prescription drug limit. Effective Date:  June 2, 2016.

Virginia VIEW STATE →

FEE SCHEDULE NEWS:

• The state of Virginia released an emergency regulations effective January 11, 2016 that includes redefined Communities (reduced from 15 to 5), as well as Out-of-State provider region determination.

REGULATORY ACTIVITY:

• The Division has published a medical fee schedule project update.

LEGISLATIVE ACTIONS:

• House Bill 44
  The enacted legislation establishes presumptions in claims under the Virginia Workers’ Compensation Act that the accident arose out of and in the course of employment if (i) the employee dies with there being no evidence that he ever regained consciousness after the accident, (ii) dies at the accident location or nearby, or (iii) is found dead where he is reasonably expected to be as an employee. These presumptions will exist in the absence of a preponderance of evidence to the contrary and where the factual circumstances are of sufficient strength from which the only rational inference to be drawn is that the accident arose out of and in the course of employment. Effective Date: July 1, 2016.
• House Bill 378; Senate Bill 631
  Both of the pieces of legislation have been passed and enacted into law and they are identical. The legislation directs the Workers’ Compensation Commission (the Commission) to adopt regulations establishing fee schedules setting the maximum pecuniary liability of the employer for medical services provided to an injured person pursuant to the Virginia Workers’ Compensation Act, in the absence of a contract under which the provider has agreed to accept a specified amount for the medical service. The regulations implementing the fee schedules shall become effective on January 1, 2018. The initial fee schedules will set amounts based on a reimbursement objective, which is the average of all amounts paid to providers in the same category of providers for the medical service in the same medical community. The Commission is required to retain a firm to assist it in establishing the initial fee schedules. The firm will recommend a methodology that will provide statistically valid estimates of the reimbursement objective for fee scheduled medical services within the medical communities. Reimbursements for medical services provided to treat traumatic injuries and serious burns are excluded from the fee schedules and liability for their treatment costs will be based, absent a contract, on 80 percent of the provider’s charges. However, the required reimbursement will be 100 percent of the provider’s charges if the employer unsuccessfully contests the compensability of the claim. The Commission is required to review and revise the fee schedules in the year after they become effective and biennially thereafter. The liability of the employer for certain medical services not included in a fee schedule will be set by the Commission. A stop-loss feature allows hospitals to receive payments or reimbursements that exceed the fee schedule amount for certain claims when the total charges exceed a charge outlier threshold, which initially is 150 percent of the maximum fee for the service set forth in the applicable fee schedule. Providers are prohibited from using a different charge master or schedule of fees for any medical service provided for workers’ compensation patients than the provider uses for health care services provided to patients who are not claimants. The measure requires the Commission, when determining whether the employee’s attorney’s work with regard to a contested claim resulted in an award of benefits that inure to the benefit of a third-party insurance carrier or health care provider, and in determining the reasonableness of the amount of any fee awarded to an attorney, to consider only the amount paid by the employer or insurance carrier to the third-party insurance carrier or health care provider for medical services rendered to the employee through a certain date and not to consider additional amounts previously paid to a health care provider or reimbursed to a third-party insurance carrier. The Commission shall have an independent, peer-reviewed study conducted every two years. The regulations setting fee schedules are exempt from the Administrative Process Act if the Commission utilizes a regulatory advisory panel to assist in the development of such regulations and provides an opportunity for public comment on the regulations prior to adoption. The measure prohibits certain practices involving the use by third parties of contracts whereby a provider agrees to accept payment of less than the fee scheduled amount, including restricting the sale, lease, or other dissemination of information regarding the payment amounts or terms of a provider contract without the express written consent and prior notification of all parties to the provider contract and prohibiting an employer from shopping for the lowest discount for a specific provider among the provider contracts held in multiple PPO networks. The regulatory advisory panel is directed to make recommendations to the Commission prior to July 1, 2017, on workers’ compensation issues relating to (i) pharmaceutical costs not previously included in the fee schedules; (ii) durable medical equipment costs not previously included in the fee schedules; (iii) certain awards of attorney fees; (iv) peer review of medical costs; (v) prior authorization for medical services; and (vi) other issues that the Commission assigns to it. The existing peer review provisions are repealed.   Effective Date: March 7, 2016.

Washington VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted the new CPT and HCPCS codes with an effective date of January 1, 2017.  To view the payment and billing manual go to:
  http://www.lni.wa.gov/ClaimsIns/Providers/Billing/FeeSched/2016/policy2016.asp.

REGULATORY ACTIVITY:

• Washington has published notice and text of proposed rule regarding Pension Discount Rate 2017 (Chapter 296-14 WAC Industrial Insurance). The purpose of this rulemaking is to reduce the current pension discount rate to 6.2 percent in 2017. The pension discount rate is the interest rate used to account for the time value of money when evaluating the present value of future pension payments. Currently, WAC 296-14-8810 sets the pension discount rate at 6.3 percent. The department has worked with the Workers’ Compensation Advisory Committee (WCAC) to develop a plan for reducing the pension discount rate annually, through 2022, until it reaches 4.5 percent.
• Washington has posted notice of proposed amendment to the Medical aid rule: Medical Aid Rules Update (WAC 296-20-135, WAC 296-23-220, WAC 296-23-230). The purpose of this rulemaking is to update the Medical Aid Rules rates. The affected rules describe elements used in the process of updating the maximum allowable payments for most professional health care services. These elements are set in rule to follow the established methodologies of L&I and maintain consistency with the Health Care Authority and Medicaid Purchasing Administration. Specifically, the proposed rule changes will do the following: 1. WAC 296-20-135: Update the conversion factors used by the department for calculating reimbursement rates for most professional health care and anesthesia services. The conversion factors will be updated to correspond to changes in the medical procedure codes, the relative value units, and anesthesia base units. These changes will enable the department to continue a reimbursement methodology consistent with other state agencies. Cost-of-living increases may be incorporated into the changes in the conversion factors. 2. WAC 296-23-220 and 230: Update the maximum daily reimbursement level for physical and occupational therapy services so the department may, if necessary, give cost-of-living increases to affected providers.

LEGISLATIVE ACTIONS:

• House Bill 2730
  Requires a practitioner to use the prescription monitoring program established in chapter 70.225 RCW before initially prescribing a substance included in schedule II or III for the treatment of non-cancer-related chronic or intractable pain. Authorizes the department of health to provide data in the prescription monitoring program to: (1) Persons authorized to prescribe or dispense legend drugs for the purpose of providing medical or pharmaceutical care for their patients; and (2) A health care facility or entity for the purpose of providing medical or pharmaceutical care to the patients of the facility or entity; and (3) A health care provider group of five or more providers for purposes of providing medical or pharmaceutical care to the patients of the provider group.  Effective Date June 9, 2016.
• Senate Bill 6293
  Individual employers may provide medical aid benefits to: (1) student volunteers enrolled and participating in a program authorized by any public or private school, including institutions of higher education; and (2) “unpaid students” who are in school- sponsored, unpaid work-based learning.    Work-based learning includes cooperative education, clinical experiences, and internship programs.  An employer may annually elect to pay the L&I volunteer premiums and assessments for 100 hours of service for each volunteer, student volunteer and unpaid student, instead of tracking the actual number of hours of service for each volunteer.  An employer selecting this option must use the method for the entire calendar year.  Effective Date June 9, 2016.

West Virginia VIEW STATE →

FEE SCHEDULE NEWS:

• The state follows Medicare methodology and codes become valid for payment once CMS adopts them. Please refer to the Medicare modules section for more information.

REGULATORY ACTIVITY:

• West Virginia Office of Insurance Commissioner Division of Workers' Compensation Fund Availability Calendar has published the schedule of EFT availability and Check Mailings.

LEGISLATIVE ACTIONS:

• Senate Bill 419
  The enacted legislation amends and reenacts §4-11A-18 of the Code of West Virginia, 1931, as amended; to amend and reenact §11-13A-3b of said code; to amend and reenact §11-13V-4 of said code; to amend and reenact §11-21-96 of said code; to amend and reenact §23-2C-3 of said code; and to amend and reenact §29-22A-10d and §29-22A-10e of said code, all relating to termination of transfers of certain personal income tax revenues to the Workers’ Compensation Debt Reduction Fund; reestablishing and imposing increased severance tax on severance of timber effective July 1, 2016; termination of additional severance taxes on severance of coal, natural gas and timber on and after July 1, 2016; authorizing earlier termination date; authorizing redirection of additional severance tax revenues to the General Revenue Fund for period prior to termination date; delaying transfers of certain personal income tax revenues to the West Virginia Retiree Health Benefit Trust Fund; eliminating transfers of certain personal income tax revenues to the Post-July 1, 2010, Employee Trust Fund; authorizing redirection of amounts collected from certain surcharges and assessments on workers’ compensation insurance policies for periods prior to July 1, 2017; authorizing redirection of amounts collected from certain deposits of revenues derived from net terminal income for periods prior to July 1, 2017. Effective Date: June 1, 2016.
• Senate Bill 621
  This bill exempts taxicab companies with independent contract drivers from providing workers’ compensation coverage.  Provided that any such taxicab driver identified an in independent contractor shall not be eligible for workers’ compensation benefits under this chapter as an employee of the taxicab company.  The electronic agreement that identifies the taxicab driver as an independent contractor must be consistent with the United States Internal Revenue code requirements for persons acting as independent contractors. Effective Date June 29, 2016.

Wisconsin VIEW STATE →

FEE SCHEDULE NEWS:

• The certified physician database has been updated with an effective date of July 1, 2016. The next update is scheduled for January 2017.
• The certified radiology database has been updated with an effective date of July 1, 2016.  The next update is scheduled for January 1, 2017.

REGULATORY ACTIVITY:

• Wisconsin adopted emergency rule Chapter DWD 131 Pre-Employment Drug Testing, Substance Abuse Treatment Program and Job Skills Assessment. The rule is a new rule chapter effective immediately.  The rule can have an impact on workers’ compensation benefits.
• The state’s Controlled Substances Board has posted rules related to the Prescription Drug Monitoring Program. The posted rules are both emergency and permanent.   The posted rules revise Chapter CSB 4.  A correction was also filed regarding the revised rules.  The correction is: The effective date of the creation of section CSB 4.04 (2) (p) is April 8, 2017. It was incorrectly shown as May 1, 2016. The corrected Chapter CSB 4 will be published in Register 724B on May 31, 2016.

LEGISLATIVE ACTIONS:

• Assembly Bill 724
  Wisconsin enacted Assembly Bill 724 into law.  The bill contains a number of changes to the state’s workers’ compensation system.  For all but two sections of the law the legislation became effective on March 2, 2016.  Two Sections of the statute; those sections dealing with administrative review of a workers’ compensation decision and judicial review of a worker’s compensation decision become effective on July 1, 2016.  The enacted legislation deals with a number of aspects of the state’s workers’ compensation system including: general coverage, payment of benefits, hearing and procedures; and program administration.

Below summarize those sections of the statute that became effective on March 2, 2016.

General Coverage:

This bill changes the term “municipality” to “local governmental unit” for purposes of the workers’ compensation law and redefines that term to mean a political subdivision of this state; a special purpose district or taxing jurisdiction in this state; an instrumentality, corporation, combination, or subunit of any of the foregoing; or any other public or quasi-public corporation.  Under current law, cities, villages, towns, and counties are political subdivisions of this state; special purpose districts include school districts, sewer districts, drainage districts, and other districts created for special purposes; and taxing jurisdictions are entities, not including the state, that are authorized by law to levy property taxes. This bill provides that an individual who is performing services for a person receiving long-term care benefits under certain long-term care programs administered by the Department of Health Services, including the Community Options Program, the Community Integration Program, Family Care, the Family Care Partnership Program, a self-directed program commonly referred to as IRIS, or the Children’s Long-Term Support Home and Community-Based Medicaid Waiver Program, on a self-directed basis and who does not otherwise have worker’s compensation coverage for those services is considered to be an employee of the entity that is providing financial management services for the person who is receiving the benefits.  As such, the financial management services entity is liable for any injury sustained by the individual while performing those services and is required to insure payment of that liability either by purchasing insurance from an insurer authorized to do business in this state or, if permitted by DWD, by self-insuring for that liability.  The bill also prohibits an individual providing long-term care services who is considered an employee of a financial management services entity for purposes of worker’s compensation coverage and who files a claim for worker’s compensation from bringing an action in tort against the person who received the long-term care services from which the claim arose.

Payment of Benefits

This bill provides that if an employee violates an employer policy against drug or alcohol use and such violation is causal to the employee’s injury, then neither the employee nor the employee’s dependents may receive, under the workers’ compensation law, any compensation, including the death benefit, relating to that injury.  The bill specifies, however, that this provision does not reduce or eliminate an employer’s liability for the cost of treating the employee’s injury.  Under current law, if an employee is injured as a result of intoxication by alcohol, controlled substances, or controlled substance analogs, the compensation, including the death benefit, is reduced by 15 percent. This bill provides that an employer is not liable for temporary disability benefits during an employee’s healing period if the employee is suspended or terminated from employment due to misconduct, as defined in the unemployment insurance law, or substantial fault, as defined in the unemployment insurance law, by the employee connected with the employee’s work. The unemployment insurance law defines misconduct” as action or conduct evincing such willful or wanton disregard of an employer’s interests as is found in 1) deliberate violation or disregard of standards of behavior that an employer has a right to expect of his or her employees; or 2) carelessness or negligence of such degree or recurrence as to manifest culpability, wrongful intent, or evil design in disregard of the employer’s interests or to show an intentional and substantial disregard of an employer’s interests or of an employee’s duties and obligations to his or her employer.

The unemployment insurance law defines “substantial fault” as acts or omissions of an employee over which the employee exercised reasonable control that violate reasonable requirements of the employee’s employer, but not including minor infractions, inadvertent errors, or failure to perform work due to insufficient skill, ability, or equipment.

This bill provides that if an injured employee has incurred permanent disability, but a percentage of that disability was caused by an accidental injury sustained in the course of employment and a percentage of that disability was caused by other factors, whether occurring before or after the time of the accidental injury, the employer is liable only for the percentage of permanent disability that was caused by the accidental injury.  If, however, previous permanent disability is attributable to occupational exposure with the same employer, the employer is also liable for that previous permanent disability.

This bill increases the maximum weekly compensation rate for permanent partial disability from $322 to $342 for injuries occurring before January 1, 2017, and to $362 for injuries occurring on or after that date.

This bill provides that an injured employee who is receiving the maximum weekly benefit in effect at the time of the injury for permanent total disability or continuous temporary total disability resulting from an injury that occurred before January 1, 2003, is entitled to receive supplemental benefits for a week of disability beginning after the effective date of the bill in an amount that, when added to the employee’s regular benefits, equals $669.  Under current law, supplemental benefits are payable only for an injury occurring prior to January 1, 2001, and the maximum supplemental benefit amount for a week of disability is an amount that, when added to the employee’s regular benefits, equals $582.

This bill provides that an application for workers’ compensation for a traumatic injury filed more than six years after the date of injury or date that worker’s compensation was last paid is barred by the statute of limitations and that, for traumatic injuries for which there is no statute of limitations, benefits or treatment expenses for traumatic injury becoming due six years after the date of injury or the date that compensation was last paid are paid by DWD from the Work Injury Supplemental Benefit (WISB) fund, if that date is before April 1, 2006.  Under current law, an application for worker’s compensation that is not filed within 12 years from the date of the injury or from the date that worker’s compensation was last paid is barred by the statute of limitations and, in cases in which there is no statute of limitations, benefits or treatment expenses for traumatic injury becoming due 12 years after the date of injury or the date that compensation was last paid are paid by DWD from the WISB fund if that date is before April 1, 2006.

This bill eliminates an April 30, 2014, sunset date for a provision under which compensation for temporary disability on account of receiving vocational rehabilitation services is not reduced on account of any wages earned for the first 24 hours worked by an employee during a week in which the employee is receiving those services and only hours worked in excess of 24 during that week are offset against the employee’s average weekly wage in calculating compensation for temporary disability.  Generally, under current law, all hours worked by an employee who has incurred partial disability are offset against the employee’s average weekly wage in calculating compensation for temporary disability.

This bill specifies that the current law that limits the liability of an employer or insurer for the cost of a prescription drug to the average wholesale price of the prescription drug, as quoted in the Drug Topics Red Book (average wholesale price), applies to a prescription drug dispensed outside of a licensed pharmacy. The bill also provides that DWD may use an alternative nationally recognized prescription drug pricing source for determining average wholesale prices of prescription drugs if the Drug Topics Red Book is discontinued and becomes unavailable.

This bill requires DWD, at least once every eight years, to review and revise the minimum permanent partial disability ratings that DWD has promulgated by rule for certain amputation levels, losses of motion, sensory losses, and surgical procedures resulting from injuries for which permanent partial disability is claimed. Before revising those ratings, DWD must appoint a medical advisory committee, composed of physicians practicing on one or more areas of specialization or treating disciplines within the medical profession, to review those ratings and recommend revisions of those ratings, based on typical loss of function, to DWD and the Council on Workers’ Compensation.

Hearing and Procedures

This bill permits a physician, chiropractor, psychologist, podiatrist, dentist, physician assistant, advance practice nurse prescriber, hospital, or health service provider, upon request by an injured employee, employer, insurer, or DWD, to provide that person with any written material that is reasonably related to an injury for which the employee claims worker’s compensation in electronic format upon payment of $26 per request.  Current law requires those practitioners to provide that material to those requesters upon payment of the actual cost of providing those materials, not to exceed the greater of 45 cents per page or $7.50 per request, plus the actual costs of postage, but does not address providing those materials in electronic format. This bill prohibits DWD from requiring a treating practitioner to submit a final report to DWD if 1) an injured employee has a period of temporary disability of more than three weeks or a permanent disability, has undergone surgery to treat an injury, other than surgery to correct a hernia, or sustains an eye injury requiring medical treatment on three or more occasions off the employer’s premises; 2) the employer or insurer denies the employee’s claim for workers’ compensation in its entirety; and 3) the employee does not contest that denial.  Current law prohibits DWD from requiring submission of a final report under those circumstances, but does not specify that the employee’s claim for compensation must be denied in its entirety.  The bill also requires a treating practitioner to complete a final report on a timely basis and permits a treating practitioner to charge no more than $100 for completing a final report. This bill permits DHA to include in an interlocutory or final award or order an order directing the employer or insurer to pay for a future course of instruction or other rehabilitation training services provided under a rehabilitation training program.  Current law specifically permits DHA to include in an interlocutory or final award or order an order directing the employer or insurer to pay for any future treatment that may be necessary to cure and relieve an injured employee from the effects of the employee’s injury, but does not specifically permit DHA to include in such an order or award an order directing payment for a future course of instruction or other services provided under a rehabilitation training program.

Program Administration

This bill permits DWD to request the Department of Justice (DOJ) to assist DWD in an investigation of a false or fraudulent workers’ compensation claim or any other suspected fraudulent activity on the part of an employer, employee, insurer, health care provider, or other person related to workers’ compensation.  If, based on the investigation, DWD has a reasonable basis to believe that theft, forgery, fraud, or any other criminal violation has occurred, DWD must refer the matter to the district attorney or DOJ for prosecution.

Election by governmental employer to self-insure.  This bill codifies into statute certain DWD rules that permit the state or a local governmental unit to self-insure its workers’ compensation liability without further order of DWD. Specifically, the bill permits the state or a local governmental unit that has independent taxing authority (governmental employer) to elect to self-insure its workers’ compensation liability without further order of DWD if the governmental employer agrees to report all compensable injuries and to comply with the workers’ compensation law and the rules of DWD.  Under the bill, a local governmental unit that elects to self-insure its liability for the payment of worker’s compensation must notify DWD of that election in writing before commencing to self-insure that liability, must notify DWD of its intent to continue to self-insure that liability every three years after that initial notice, and must notify DWD of its intent to withdraw that election not less than 30 days before the effective date of that withdrawal. This bill permits DWD to revoke an election by a governmental employer to self-insure its liability for workers’ compensation, without seeking the advice of the Self-Insurer’s Council, if DWD finds that the governmental employer’s financial condition is inadequate to pay its employees’ claims for compensation, that the governmental employer has received an excessive number of claims for compensation, or that the governmental employer has failed to discharge faithfully its obligations under the workers’ compensation law and the rules of DWD.  Under the bill, once such an election is revoked, the governmental employer whose election is revoked may not elect to self-insure its liability for the payment of worker’s compensation unless at least three calendar years have elapsed since the revocation and DWD finds that the governmental employer’s financial condition is adequate to pay its employees’ claims for compensation, that the governmental employer has not received an excessive number of claims for compensation, and that the governmental employer has faithfully discharged its obligations under the worker’s compensation law and the rules of DWD.

This bill requires an initial assessment for the self-insurer’s fund, which is a fund that is used to pay the worker’s compensation liability of self-insured employers that cannot pay that liability, to be prorated on the basis of the gross payroll for this state of the self-insured employer, as reported to DWD for the previous calendar year for purposes of unemployment insurance.  Current law requires subsequent assessments for the self-insurer’s fund to be so prorated and requires an initial assessment for that fund to be equal to the amount assessed upon each other self-insured employer.

The bill also clarifies that governmental employers are not covered under the self-insurer’s fund.  Specifically, the bill prohibits DWD from 1) requiring a governmental employer that elects to self-insure its liability for the payment of worker’s compensation to pay into the self-insurer’s fund; and 2) making payments from that fund for the liability under the workers’ compensation law of such an employer, whether currently or formerly exempt from the duty to insure.

Below summarize those sections of the statute that become effective on July 1, 2016.

Hearing and Procedures 

Administrative Review of a workers’ compensation decision:  This bill requires the Labor and Industry Review Commission (LIRC) to dismiss a petition for review that is not filed within 21 days after DWD or DHA mailed a copy of the examiner’s findings and order to the petitioner’s last-known address unless the petitioner shows that the petition was filed late for a reason that was beyond the petitioner’s control.  Currently, LIRC must dismiss a petition for review that is not “timely” filed unless the petitioner shows probable good cause that the reason for failure to timely file the petition was beyond the petitioner’s control.  The bill also allows LIRC to set aside a decision for further consideration within 28 days after the date of the decision, not within 28 days after the date of its mailing as under current law.

Judicial Review of a workers’ compensation decision:  This bill requires LIRC to identify in an order or award made by LIRC the persons that must be made parties to an action for judicial review of the order or award.  The bill also requires the summons and complaint in the action to name those persons as defendants.  In addition, the bill permits the circuit court to join as a party to the action any other person determined necessary for the proper resolution of the action, unless joiner of the person would unduly delay the resolution of the action.

Effective Date for Administrative and Judicial Review is July 1, 2016.  Effective Date for the other sections of the legislation is March 2, 2016.

• Senate Bill 21
  The enacted legislation relates to state finances and appropriations, constituting the executive budget act.  The act does address workers’ compensation coverage for students at institutions of higher education who are a part of school work training or work study program. Effective Date May 18, 2016.