Arkansas VIEW STATE →

FEE SCHEDULE NEWS:

• The state adopted new CPT codes and descriptions and the 2017 National Physician Fee Schedule Relative Value file effective January 1, 2017.
• A new update is expected for January 1, 2018.

California VIEW STATE →

FEE SCHEDULE NEWS:

• Medi-Cal rates have been released with an effective date of February 15, 2017. The next update is scheduled for March 15, 2017.
• Ambulance fee schedule has been updated with an effective date of March 1, 2017. The state has adopted the 2017 changes to the Medicare Payment System for ambulance.  The next update is expected in January 2018.

REGULATORY ACTIVITY:

• The Division of Workers’ Compensation (DWC) has posted an order adjusting the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) section of the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1.  The Centers for Medicare and Medicaid Services (CMS) initially released the DMEPOS Fee Schedule 2017 zip file update in December of 2016. The DMEPOS update was adopted by the DWC Acting Administrative Director’s order of December 15, 2016. Subsequently, CMS issued a revised DMEPOS Fee Schedule zip file for 2017 to implement changes required by the 21st Century Cures Act. The Acting Administrative Director has adopted the revised DMEPOS Fee Schedule zip file for services rendered on or after February 1, 2017.
• The Division of Workers’ Compensation (DWC) is accepting applications for the Qualified Medical Evaluator (QME) examination on Saturday, April 29. QMEs are independent physicians certified by the DWC Medical Unit to conduct medical evaluations of injured workers. Applications for the QME exam may be downloaded from the DWC website.  Applicants may also contact the Medical Unit at 510-286-3700 to request an application via U.S. mail, email or fax.  The deadline for filing the exam applications is March 16, 2017.  For more information please contact the Medical Unit at 510-286-3700 or by email at QMETest@dir.ca.gov.
• The Division of Workers’ Compensation (DWC) has posted an order adjusting the ambulance services section of the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1.  Effective for services rendered on or after March 1, 2017, the maximum reasonable fees for ambulance services shall not exceed 120% of the applicable California fees set forth in the calendar year 2017- Medicare Ambulance Fee Schedule file.  The adjustment incorporates the 2017 Ambulance Inflation Factor (AIF) which has been announced by the Centers for Medicare and Medicaid Services (CMS). The AIF for calendar year 2017 is 0.70 percent (0.70%).
• The Division of Workers’ Compensation (DWC) will begin the process of amending the MTUS regulations by posting the proposed changes to its online forum.   This round of proposed regulatory amendments will be made pursuant to the rulemaking provisions of the Administrative Procedure Act. These changes lay the foundation for the evidence-based guideline updates to the MTUS that for the first time will apply an expedited process pursuant to the recently amended Labor Code section 5307.27(a). Once the formal rulemaking process begins with these proposed regulatory amendments, DWC will begin the expedited process to update the evidence-based guidelines by Administrative Director order.

Delaware VIEW STATE →

REGULATORY ACTIVITY:

• Delaware has published their medical guidelines and fee schedule.  The medical guidelines and fee schedule were effective January 31, 2017.
• Delaware has published the 19th Annual Report on the Status of Workers' Compensation Case Management.

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, 2017 and the next update is scheduled for March 2018.

Florida WC VIEW STATE →

REGULATORY ACTIVITY:

• Florida held a public hearing for 69L-6.015 Record Maintenance and Production Requirements for Employers 69L-6.027 Penalty Calculation Worksheet.  The hearing was scheduled for Thursday, February 16, 2017 at Room 102, Hartman Building, 2012 Capital Circle SE, Tallahassee, FL.  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.
• Florida posted notice that a public hearing was not requested for either Rule 69L-6.015, 69L-6.027 regarding exemption from coverage or rule 69L-30 expert medical advisors and therefore not hearing was held.  The proposed rules remain as published when the notice was published.

Georgia VIEW STATE →

REGULATORY ACTIVITY:

• The WC-26, Consolidated Yearly Report of Medical Only Cases and Annual Payments on Indemnity Claims, is filed on or before March 1st following each calendar year in respect to all medical and indemnity payments for the previous year for work related injuries. This is to be filed annually even if no reportable injuries or payment occurred during the reporting year.

Idaho VIEW STATE →

REGULATORY ACTIVITY:

• The Idaho Industrial Commission (IIC), in association with Verisk Analytics/ISO, announced that the new Electronic Data Interchange (EDI) Claims website is now available at https://iicedi.info/.  Rolled out on January 25, 2017 the EDI involves a computer-to-computer exchange of data in a standardized format. That enables hundreds of different documents to be efficiently and legally exchanged. The EDI Claims 3.0 program, which will be implemented in July, will rely on use of the new website and will prepare the IIC for more efficient and accessible data processing for the average of 35,000 claims received each year.   Alongside with the website’s launch, an Implementation Guide is also available to help users understand how to conduct EDI business with the IIC while providing references to other important documents. It is available for download in the Implementation Guide Page of IIC EDI Claims website: https://iicedi.info/guide.  EDI Claims 3.0 will be an upgrade from EDI Claims 1.0 and is designed to reduce paper use by enabling the electronic submission of workers’ compensation forms and claims. The contract for developing EDI Claims 3.0 data services was awarded to Verisk Analytics/ISO effective November 28, 2016.  Its implementation is scheduled to be complete on July 1, 2017. Trading Partners are encouraged to complete a registration at https://iicedi.info/register no later than March 17, 2017.

LEGISLATIVE ACTIONS:

• House Bill 5
  The purpose of this bill is to enhance the use and functionality of the state's Prescription Monitoring Program ("PMP") database. Specifically, this bill allows medical and pharmacy students to access the PMP as a delegate of a supervising practitioner or pharmacist; limits the Board of Pharmacy's recordkeeping of PMP data to five (5) years; and requires one-time pharmacist registration for free PMP access in a manner similar to what is required for prescribers.  Effective Date: July 1, 2017.

Iowa VIEW STATE →

REGULATORY ACTIVITY:

• Iowa published on their web site Guidelines for Preparation of Hearing Exhibits.  Currently the guidelines are not mandatory but may be used however the guidelines do become mandatory May 1, 2017.

Kentucky VIEW STATE →

REGULATORY ACTIVITY:

• Kentucky Labor Cabinet: Department of Workers' Claims: Reminder - per 803 KAR 25:010 § 3(1) (b) effective July 1, 2017, the department of workers’ claims will no longer accept paper filings. If you wish to file a claim, please log on to (link below) and register with the Litigation Management System (LMS) https://kyworkersclaims.lms.ky.gov. Additional information is available at http://labor.kentucky.gov/workersclaims. Department of Workers' Claims is located at 657 Chamberlin Ave, Frankfort, KY 40601. Other questions concerning Department of Workers' Claims can be addressed by calling (502) 564-5550.

Louisiana VIEW STATE →

REGULATORY ACTIVITY:

• The Louisiana Workforce Commission gave notice of its intent to amend certain portions of the Medical Guidelines contained in the Louisiana Administrative Code, title 40, Labor and Employment, Part I, Workers’ Compensation Administration, Subpart 2, Medical Guidelines, Chapters 23 and 27, regarding implementation of medical treatment guidelines.  This Rule is promulgated by the authority vested in the director of the Office of Workers’ Compensation found in R.S.  23:1291 and R.S. 23:1310.1(C).  Public Hearing:  A public hearing will be held on March 31, 2017, at 9:30 a.m., at the LaSalle Building, 617 North Third Street, First Floor, in the LaBelle Hearing Room in Baton Rouge, LA. The public is invited to attend.

Maryland VIEW STATE →

REGULATORY ACTIVITY:

• As indicated in the Appeals Rules that were effective July 1, 2015, a transcript of the proceedings “shall be” produced for all appeals, whether on the record or de novo, in accordance with Rule 7-206 (b), paid for by the appealing party and will be made available to all parties electronically in the same manner as other Commission documents.
• Revised Forms- Settlement Worksheet (H-28R Revised 02/2017) - The revised form is available on our Forms and Instructions page. All questions must be answered.  Any incomplete or missing information will cause the Settlement Worksheet to be returned and the approval of the settlement will be delayed. Claimant’s Consent to Pay Attorney and Doctor Fees (H-44 Revised 02/2017) - The revised form is available on the Forms and Instructions page. The form has been revised to include a required attorney certification. The new form is to be used immediately.
• Maryland posted notice that proposed rules for Group Self Insurance for Workers' Compensation published on November 28, 2016 have been adopted as published on February 17, 2017.
• Reminder to Practitioners:  ‘Do not use color paper when sending/submitting paper documents to the Commission. This includes exhibits submitted at the hearing. Color paper does not work well with our scanning process and may render the document unreadable when converted to electronic format.’
• Settlement Worksheet (H-07R Revised 02/2017) - The revised form is available on the Forms and Instructions page. All questions must be answered. Any incomplete or missing information will cause the Settlement Worksheet to be returned and the approval of the settlement will be delayed. Copy of the form is attached.
• Claimant’s Consent to Pay Attorney and Doctor Fees (H-44 Revised 02/2017) - The revised form is available on the Forms and Instructions page. The form has been revised to include a required attorney certification. The form is to be used immediately.
• The Commission does not accept any form/document filing via email/attachment or FAX.

Massachusetts VIEW STATE →

REGULATORY ACTIVITY:

• Massachusetts is one of the first states to launch a ground­breaking program for workers’ compensation cases involving long-term opioid use which offers viable alternatives to fight the opioid epidemic. The MBA’s Workers’ Compensation Section invites you to attend this training session, featuring guest speaker Senior Judge Omar Hernandez of the Department of Industrial Ac­cidents (DIA). Topics will include:
  • A discussion of the opioid epidemic and its impact on the DIA;
  • An overview of the voluntary two-year pilot program;
  • A discussion of the types of cases suitable for the program;
  • The new DIA forms and their implementation;
  • An explanation of the “fast-track” court proceeding;
  • The role of care coordinators, insurers, attorneys, medical providers and injured workers
  • A question and answer session.
• The state issued a memo regarding assessment filings. Submission of the revised Form 50/51 assessment reporting template will become mandatory effective the quarter ending 9/30/17.  When submitting invoices for the period beginning 10/1/17 (policies effective July, August and September) the new standardized template will be required as supporting documentation for all quarterly filings.  Please note, when using the new template, do not make any changes to the original format of the document.  Rows may be added to the template to ensure all data is reported, but additional columns may not. For any questions, please contact:  Aalana Feaster (617) 626-5468 Director of Insurance or Nancy Moran (617) 626-5469 Program Coordinator I.
• Published a reminder in an administrative bulletin. The reminder was regarding courtroom protocols and procedures.

Michigan VIEW STATE →

REGULATORY ACTIVITY:

• Governor Rick Snyder announced the appointment of John Housefield of Haslett as well as the reappointments of Keith Castora of Canton, Jane Colombo of Grosse Pointe, Lisa Woons of Grand Rapids, Robert Timmons of Grand Rapids and David Williams of Grosse Pointe Woods to the Workers’ Compensation Board of Magistrates.
• Form WC-104C, Application for Mediation or Hearing, has been updated. Please note that two additional “check box” options for users of Form WC-104C, Application for Mediation or Hearing have been added based on customer feedback.  With the addition of the options outlined below, the Workers’ Compensation Agency, in conjunction with the Board of Magistrates, hopes to continue the efforts to streamline operations and procedures to better serve their customers. The changes to Form WC-104C include new check boxes titled, “Petition to Determine Medical Treatment,” and “Redemption Only.”  Up until these additions, petitioners simply used the description section on the form to state their desire for a “redemption only” hearing.  Utilizing this check box will allow users to more easily indicate their intentions, and aid in processing.  Petitions received with the “Petition to Determine Medical Treatment,” box marked will be scheduled for a telephone mediation facilitated by Agency staff.  This informal dispute resolution forum will be utilized with the intent of providing the parties, including the carrier, the claimant, and the medical providers, with a less formal setting to discuss and resolve relevant issues. We believe that this new option is especially appropriate where issues have arisen surrounding reimbursement for opioid treatment per Rules 101008, 1008(a), and 1008(b).

Minnesota VIEW STATE →

REGULATORY ACTIVITY:

• Adopted Exempt Permanent Rules Relating to Workers’ Compensation Independent Medical Examination Fees in Minnesota Rules, Chapter 5219 and Workers’ Compensation Medical Services and Fees in Minnesota Rules, Chapter 5221 Subject matter.  The proposed good cause amendments to be adopted under Minnesota Statutes § 14.388 consist of updates to the workers’ compensation rules to implement the independent medical examination fee schedule in Minnesota Rules, Chapter 5219; and the medical rules of practice, billing and payment rules, the relative value fee schedule rules and the pharmacy fee schedule in Minnesota Rules, Chapter 5221.

Nebraska VIEW STATE →

REGULATORY ACTIVITY:

• The court's revised Rules of Procedure are now available in portable document format (pdf).  Amendments to the court's adjudicatory Rules 5 and 12 were adopted at a Dec. 14, 2016 public meeting and were approved by the Nebraska Supreme Court on Jan. 19, 2017. Amendments to the court's non-adjudicatory Rules 26, 63, and 73 were adopted, with varying effective dates, at a Dec. 14, 2016 public meeting.

New Jersey WC VIEW STATE →

REGULATORY ACTIVITY:

• New Jersey has adopted Medical Protocols for their PIP program.  The effective date is October 17, 2016 and the operative date is April 17, 2017.

LEGISLATIVE ACTIONS:

• Senate Bill 3
  This bill requires health insurance coverage for substance use disorders and regulates opioids and certain other prescription drugs in several ways. The bill requires health insurers, the State Health Benefits Program, and the School Employees’ Health Benefits Program, to adhere to certain coverage requirements for treatment of substance use disorders. The bill also places certain restrictions on the prescription of opioids, and requires certain notifications when prescribing Schedule II controlled dangerous substances used to treat chronic or acute pain. The bill also requires certain health care professionals to receive training on topics related to prescription opioid drugs.  Finally, the bill repeals certain sections of law that are obviated by the bill’s provisions. Specifically, the bill requires insurers to provide unlimited benefits for inpatient and outpatient treatment of substance use disorders at in-network facilities. The bill further specifies that the services for the treatment of substance use disorders shall be prescribed by a licensed physician, licensed psychologist, or licensed psychiatrist and provided by licensed health care professionals or licensed or certified substance use disorder providers in licensed or otherwise State-approved facilities, as required by the laws of the state in which the services are rendered. The bill provides that the benefits, for the first 180 days per plan year of inpatient and outpatient treatment of substance use disorder, shall be provided when determined medically necessary by the covered person’s physician, psychologist or psychiatrist without the imposition of any prior authorization or other prospective utilization management requirements. The facility shall notify the insurer of both the admission and the initial treatment plan within 48 hours of the admission or initiation of treatment. If there is no in-network facility immediately available for a covered person, an insurer shall provide necessary exceptions to their network to ensure admission in a treatment facility within 24 hours.  Under the bill, providers of treatment for substance use disorders to persons covered under a covered insurance policy shall not require pre-payment of medical expenses during the 180 days in excess of applicable co-payment, deductible, or co-insurance under the policy. The benefits for outpatient visits shall not be subject to concurrent or retrospective review of medical necessity or any other utilization management review. The benefits for the first 28 days of an inpatient stay during each plan year shall be provided without any retrospective review or concurrent review of medical necessity and medical necessity shall be as determined by the covered person’s physician. The benefits for days 29 and thereafter of inpatient care shall be subject to concurrent review as defined in the bill, initiated no more frequently than every two weeks. The bill establishes a process for concurrent review and an appeal process pursuant to the Independent Health Care Appeals Program in the Department of Banking and Insurance. The benefits for the first 28 days of intensive outpatient or partial hospitalization services shall be provided without any retrospective review of medical necessity and medical necessity shall be as determined by the covered person’s physician. The benefits for days 29 and thereafter of intensive outpatient or partial hospitalization services shall be subject to a retrospective review of the medical necessity of the services. The bill specifies that benefits for inpatient and outpatient treatment of substance use disorder after the first 180 days per plan year shall be subject to the medical necessity determination of the insurer and may be subject to prior authorization or, retrospective review and other utilization management requirements. The medical necessity review shall utilize an evidence-based and peer reviewed clinical review tool to be designated through rulemaking by the Commissioner of Human Services in consultation with the Department of Health.  The benefits for outpatient prescription drugs used to treat substance abuse disorder shall be provided when determined medically necessary by the covered person’s physician, psychologist or psychiatrist without the imposition of any prior authorization or other prospective utilization management requirements. The bill defines a “substance use disorder” as defined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and any subsequent editions and includes substance use withdrawal. “Concurrent review” is defined to mean inpatient care is reviewed as it is provided. Medically qualified reviewers monitor appropriateness of the care, the setting, and patient progress, and as appropriate, the discharge plans. The bill provides that the first 180 days per plan year of benefits shall be computed based on inpatient days. One or more unused inpatient days may be exchanged for two outpatient visits. All extended outpatient services such as partial hospitalization and intensive outpatient, shall be deemed inpatient days for the purpose of the visit to day exchange as provided in the bill. The bill stipulates that the Attorney General’s Office shall be responsible for overseeing any violations of law that may result from the bill, including fraud, abuse, waste, and mistreatment of covered persons. The bill also makes clear that the provisions requiring health insurance coverage do not apply to plans administered by the Department of Human Services. The bill also places certain restrictions on how opioids and other Schedule II controlled substances may be prescribed. In cases of acute pain, the bill provides that a practitioner shall not issue an initial prescription for an opioid drug in a quantity exceeding a five-day supply, and must be for the lowest effective dose of an immediate-releasing opioid drug. In cases of acute or chronic pain, prior to issuing an initial prescription of a Schedule II controlled dangerous substance or any other opioid drug in a course of treatment for acute of chronic pain, a practitioner shall: take and document the results of a thorough medical history, including the patient’s experience with non-opioid medication and non-pharmacological pain management approaches and substance abuse history; conduct, as appropriate, and document the results of a physical examination; develop a treatment plan, with particular attention focused on determining the cause of the patient’s pain; access relevant prescription monitoring information under the Prescription Monitoring Program; and limit the supply of any opioid drug prescribed for acute pain to a duration of no more than five days as determined by the directed dosage and frequency of dosage. No less than four days after issuing the initial prescription of an opioid drug that is subject to the 5-day limit, the practitioner, after consultation with the patient, may issue a subsequent prescription for the drug to the patient in any quantity that complies with applicable State and federal laws, provided that: the subsequent prescription would not be deemed an initial prescription under this section; the practitioner determines the prescription is necessary and appropriate to the patient’s treatment needs and documents the rationale for the issuance of the subsequent prescription; and the practitioner determines that issuance of the subsequent prescription does not present an undue risk of abuse, addiction, or diversion and documents that determination. The bill also requires, prior to issuing the initial prescription of a Schedule II controlled dangerous substance or any other opioid drug in a course of treatment for acute or chronic pain, and again prior to issuing the third prescription of the course of treatment, a practitioner shall discuss with the patient, or the patient’s parent or guardian if the patient is under 18 years of age and is not an emancipated minor, the risks associated with the drugs being prescribed, including but not limited to: the risks of addiction and overdose associated with opioid drugs and the dangers of taking opioid drugs with alcohol, benzodiazepines and other central nervous system depressants; the reasons why the prescription is necessary;  alternative treatments that may be available; and risks associated with the use of the drugs being prescribed, specifically that opioids are highly addictive, even when taken as prescribed, that there is a risk of developing a physical or psychological dependence on the controlled dangerous substance, and that the risks of taking more opioids than prescribed, or mixing sedatives, benzodiazepines or alcohol with opioids, can result in fatal respiratory depression. The practitioner shall include a note in the patient’s medical record that the patient or the patient’s parent or guardian, as applicable, has discussed with the practitioner the risks of developing a physical or psychological dependence on the controlled dangerous substance and alternative treatments that may be available. The Division of Consumer Affairs shall develop and make available to practitioner’s guidelines for the discussion required pursuant to the bill.  At the time of the issuance of the third prescription for a prescription opioid drug, the practitioner shall enter into a pain management agreement with the patient. When a Schedule II controlled dangerous substance or any other prescription opioid drug is continuously prescribed for three months or more for chronic pain, the practitioner shall: review, at a minimum of every three months, the course of treatment, any new information about the etiology of the pain, and the patient's progress toward treatment objectives and document the results of that review; assess the patient prior to every renewal to determine whether the patient is experiencing problems associated with physical and psychological dependence and document the results of that assessment; periodically make reasonable efforts, unless clinically contraindicated, to either stop the use of the controlled substance, decrease the dosage, try other drugs or treatment modalities in an effort to reduce the potential for abuse or the development of physical or psychological dependence and document with specificity the efforts undertaken; review the Prescription Drug Monitoring information in accordance with section 8 of P.L.2015, c.74 (C. 45:1-46.1); and (5) monitor compliance with the pain management agreement and any recommendations that the patient seek a referral. The bill clarifies in its definition of “practitioner” that the bill is not intended to alter the scope of practice of any health care practitioner. The bill exempts from the prescription limitations above the following: a patient who is currently in active treatment for cancer, receiving hospice care from a licensed hospice or palliative care, or is a resident of a long-term care facility, and any medications that are being prescribed for use in the treatment of substance abuse or opioid dependence. The bill provides that the any State-regulated health benefits plan, and every contract purchased by the School Employees’ Health Benefits Commission or State Health Benefits Commission, that provides coverage for prescription drugs subject to a co-payment, coinsurance or deductible shall charge a co-payment, coinsurance or deductible for an initial prescription of an opioid drug prescribed pursuant to this section that is either: (1) proportional between the cost sharing for a 30-day supply and the amount of drugs the patient was prescribed; or (2) equivalent to the cost sharing for a full 30-day supply of the opioid drug, provided that no additional cost sharing may be charged for any additional prescriptions for the remainder of the 30-day supply. The bill also would require certain health care professionals to receive training on topics related to prescription opioid drugs. Health care professionals who have the authority to prescribe opioid medications, including physicians, physician assistants, dentists, and optometrists (who have limited authority to prescribe only hydrocodone), will be required to complete one continuing education credit on topics that include responsible prescribing practices, alternatives to opioids for managing and treating pain, and the risks and signs of opioid abuse, addiction, and diversion. For advance practice nurses, who also have prescribing authority, their required six contact hours of continuing professional education in pharmacology related to controlled substances will include issues concerning prescription opioid drugs, including responsible prescribing practices, alternatives to opioids for managing and treating pain, and the risks and signs of opioid abuse, addiction, and diversion. Health care professionals who do not have prescribing authority but who frequently interact with patients who may be prescribed opioids, including pharmacists, professional nurses, and practical nurses, would also be required to complete one continuing education credit on topics that include alternatives to opioids for managing and treating pain and the risks and signs of opioid abuse, addiction, and diversion. The continuing education credits required under the bill will be part of a professional’s regular continuing education credits and will not increase the total number of continuing education credits required. The bill additionally provides that certified nurse midwives will be required to complete one credit of educational programs or topics related to prescription opioid drugs as part of the 30 contact hours in pharmacology training that is required for them to be authorized to prescribe drugs. The bill also requires the Commissioner of Health, in consultation with the Commissioner of Banking and Insurance, to submit reports to the Legislature and the Governor concerning implementation of the bill. One report is to be submitted six months, and the second report is to be submitted 12 months, after the date of enactment of the bill. Finally, the bill repeals several statutes, initially enacted in 1977 and 1985, which required coverage for the treatment of alcoholism. Because the bill expands that coverage to include treatment for all types of substance use disorder, including alcohol abuse, those sections of law specific to alcoholism are no longer required. The committee amendments to the bill: require that a facility providing inpatient or outpatient treatment of substance use disorder notify the patient’s health coverage provider of both the admission and the initial treatment plan within 48 hours of the admission or initiation of treatment; provide that insurers may initiate concurrent review of medical necessity of inpatient treatment every two weeks, rather than every three weeks, after the first 28 days of treatment; require that an initial prescription of an opioid drug for acute pain be for the lowest effective dose of an immediate-releasing opioid drug; clarify that provisions of the bill concerning health care practitioners’ prescribing apply to prescriptions of Schedule II controlled dangerous substance or any other opioid drug in a course of treatment for acute or chronic pain, excluding the five-day restriction on initial prescriptions, which applies only to acute pain; require that a practitioner include a note in a patient’s medical record, rather than a written acknowledgement, that the patient or the patient’s parent or guardian, as applicable, has discussed with the practitioner the risks of developing a physical or psychological dependence on the controlled dangerous substance and alternative treatments that may be available; clarify that the bill’s definition of “practitioner” applies only to those professionals acting within their licensed scope of practice; and provide that health insurance contracts that provide coverage for prescription drugs subject to a co-payment, coinsurance or deductible shall charge a co-payment, coinsurance or deductible for an initial prescription of an opioid drug prescribed pursuant to this section that is either: (1) proportional between the cost sharing for a 30-day supply and the amount of drugs the patient was prescribed; or (2) equivalent to the cost sharing for a full 30-day supply of the opioid drug, provided that no additional cost sharing may be charged for any additional prescriptions for the remainder of the 30-day supply.  Effective Date May 15, 2017.

New York VIEW STATE →

REGULATORY ACTIVITY:

• Published bulletin 046-919 on February 7, 2017 regarding Transition from Special Funds Conservation Committee to Special Funds Group on all §§ 14(6) and 15(8) Claims Effective January 1, 2017.

North Carolina VIEW STATE →

REGULATORY ACTIVITY:

• Industrial Commission Chairman Charlton Allen announced on February 7, 2017 the establishment of a task force to study and recommend solutions for the problems arising from the intersection of the opioid epidemic and related issues in workers’ compensation claims.

North Dakota VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted changes to the medical and hospital fee schedules effective January 1, 2017. The next expected update is set for April 1, 2017.

REGULATORY ACTIVITY:

• North Dakota has published the full version of their fee schedule and treatment guidelines.  The treatment guidelines include guidelines for Ambulance, Ambulatory Surgery Center, Anesthesia, Clinical Laboratory, Durable Medical Equipment, Home Health, Inpatient Hospital, Medical Provider, Outpatient Hospital and Physician Administered Drugs.
• WSI recently implemented Documentation Policies to reinforce existing guidelines and/or clarify documentation standards. The following three new policies outline WSI’s expectations of specific documentation components reviewed during the bill audit process.
• Evaluation and Management (E&M): This policy replaces the existing guidelines regarding WSI’s adoption of the 1997 Documentation Guidelines for Evaluation and Management Services from the Centers for Medicare & Medicaid Services (CMS) for the auditing of E&M services.
• Falsified Medical Records: This is a new policy which outlines that WSI considers any record containing non-authentic documentation as a falsified medical record.
• Physical Medicine and Rehabilitation (PM&R) Time-Based Services: This policy clarifies WSI’s adoption of the HCPCS coding requirements from The Centers for Medicare & Medicaid Services (CMS) for the evaluation of documentation and billing of time-based PM&R codes.
• A provider should review the new Documentation Policies in conjunction with WSI’s Fee Schedule Guidelines to ensure the submission of proper documentation and billing.

Ohio VIEW STATE →

REGULATORY ACTIVITY:

• Ohio has published notice of a rule package in the category Workers’ Compensation - Bureau of Workers’ Compensation is being considered for review:
  • Package Title: BWC - Pharmacy Rules
    Rule Numbers: 4123-6-21 Payment for outpatient medication.
    4123-6-21.1 Payment for outpatient medication by self-insuring employer.
    4123-6-21.2 Pharmacy and therapeutics committee.
• Ohio has published notice of a rule in the category Workers’ Compensation - Bureau of Workers’ Compensation is being considered for review:
  • Rule Title: Penalties: late payment and reporting.
    Rule Number: 4123-17-16
    Proposed Action: Amended
• Reminder: The Bureau has published three rules for comment.  Comments are due in by March 23, 2017.  The rules subject to comment are rules 4123-6-8 Bureau fee schedule; 4123-6-37.2 Payment of hospital outpatient services; and 4123-6-37.3. Payment of ambulatory surgical center services.
• Ohio has published a rule package in the category Workers’ Compensation - Bureau of Workers’ Compensation is being considered for review:
  • Package Title: Marine Industry Fund Rules
    Rule Numbers: 4123-20-01
    4123-20-02
    4123-20-03
    4123-20-04
    4123-20-05
    4123-20-06
    4123-20-07

Oregon VIEW STATE →

REGULATORY ACTIVITY:

• Published Bulletin No 147 Revised January 4, 2017 regarding security deposits for self-insured employers, self-insured employer groups, and other interested parties. This bulletin explains the acceptable forms of security deposit allowed under Oregon Administrative Rule (OAR) 436-050-0165. This bulletin replaces Bulletin 147 issued January 25, 2010.  Important changes include:
  • Addition of new language to Forms 824 and 1810 concerning self-insured entities
  • Elimination of Form 3640b “Irrevocable Standby Letter of Credit”
  • Removal of the “a” from the title of Form 3640a “Irrevocable Standby Letter of Credit”
  • Structural changes to the bulletin language and additional information regarding irrevocable standby letters of credit (ISLOCs). 

• The Division posted bulletin 151 regarding revised list of vocational rehabilitation providers.  The bulletin provides a link to the updated list of registered vocational rehabilitation providers as required by ORS 656.340(10).  The Workers’ Compensation Division publishes bulletin 151 annually.  This bulletin replaces the one issued on January 21, 2016.
• Oregon just released Bulletin 342 regarding Determination of "gainful occupation" for permanent total disability evaluations.  This bulletin provides examples of gainful occupation to be used to determine eligibility for PDT benefits under ORS 656.206 and updates the annual percentage of change in the federal poverty guidelines for a family of three that apply to Oregon residents.  This bulletin replaces the one dated February 6, 2016.
• The Division also published the January edition of news and case notes.
• The Division revised Form 5042, "Claim Move Notice: Changing locations of processing or storing of claims." This form is for use by insurers and self-insured employers to provide required notification to the division of a change in processing or storage location for claims. http://wcd.oregon.gov/WCDForms/5042.doc (Form 5042)
• The Division created a new form, Form 5188, "Insurer Contact Update." This form is for use by insurers and self-insured employers to provide required notification to the division of a change in contact information.
• The Division revised Form 4875, "Preferred Worker Placement Assistance Agreement," to add to the WCD USE ONLY section of the form the line, "Maximum approved under this agreement: $____________." The division normally publishes this form under Bulletin 189 however, because no substantive changes affecting customer use of the form were made, the bulletin was not republished. The revised version of Form 4875 (2/10) should be used immediately.
• The Workers’ Compensation Division has recently revised the Claims Examiners Guide for Interaction with Independent Medical Exam Providers. Reading this guide covers the one-hour training requirement for claims examiner interaction with IME providers (OAR 436-055).
• The 16-page guide explains:
  • The differences between IMEs, WRMEs, medical arbiter exams, and physician review exams;
  • Who can perform IMEs;
  • IME standards;
  • Appropriate communication with IME providers;
  • Insurer responsibilities;
  • Worker’s rights and responsibilities;
  • IME reports; and
  • Workers’ compensation terms.

Pennsylvania WC VIEW STATE →

REGULATORY ACTIVITY:

• The 16th Annual, Pennsylvania Workers’ Compensation Conference will be held on June 12-13, 2017 at the Hershey Lodge and Convention Center, Hershey, Pennsylvania.

Rhode Island VIEW STATE →

REGULATORY ACTIVITY:

• A new meeting of the Rhode Island Workers’ Compensation Court Medical Advisory Board was held on Tuesday, February 28, 2017, 6:00 p.m., at Workers’ Compensation Court Room 4M, One Dorrance Plaza, Providence, Rhode Island.
• New forms have been released regarding Electronic Payment of Workers' Compensation Benefits:
  • DWC-EB1 is the agreement for electronic payment
  • DWC-EB2 is the rescission of agreement electronic payment.

South Dakota VIEW STATE →

LEGISLATIVE ACTIONS:

• House Bill 1017
  An act to revise the definition of compensation for purposes of the South Dakota Retirement System, to provide a penalty for falsely reporting compensation, and to update references to the Internal Revenue Code.  Effective Date January 1, 2018.

Tennessee VIEW STATE →

REGULATORY ACTIVITY:

• The 20th Annual Tennessee Workers' Compensation Educational Conference will be held on June 13-15, 2017 at the Embassy Suites by Hilton Nashville SE Murfreesboro.

Texas VIEW STATE →

REGULATORY ACTIVITY:

• The Texas Department of Insurance, Division of Workers’ Compensation (DWC) is offering a grace period for employers without workers’ compensation insurance coverage (non-subscribers) to provide any late required reports to DWC without penalty.  By law, non-subscribers must annually notify DWC of their decision not to obtain workers’ compensation insurance coverage by submitting the DWC Form-005, Employer Notice of No Coverage or Termination of Coverage.  Non- subscribers must also report each on-the-job injury, occupational illness, or fatality resulting in more than one day of lost time to DWC by filing DWC Form-007, Employer’s Report of Non-Covered Employee’s Occupational Injury or Disease.  This grace period allows non-subscribers that have not reported their non-coverage status for prior years to submit the DWC Form-005 without an administrative penalty during the current February 1, 2017, through April 30, 2017 reporting period. Additionally, this grace period allows non-subscribers that have not previously reported their injuries, illnesses, and fatalities for prior years to submit the DWC Form-007 without an administrative penalty until April 30, 2017.  Non-subscribers can file the DWC Form-005 with DWC online, by fax, or by mail. The DWC Form-007 may be filed by fax or by mail. Non-subscriber Reporting Requirements:
  • A non-subscriber must file the DWC Form-005, Employer Notice of No Coverage or Termination of Coverage to DWC:
    • between February 1 and April 30 each year;
    • within 30 days of hiring its first employee;
    • within 10 days of DWC’s request.
  • Non-subscribers with five or more employees must report each fatality, occupational disease, and on-the-job injury that results in more than one day of lost time to the DWC.
  • Non-subscribers must submit the DWC Form-007, Employer’s Report of Non-Covered Employee’s Occupational Injury or Disease to the DWC within the seventh day of the month following the month in which:
    • the death occurred;
    • the employee was absent from work for more than one day because of the on-the-job injury;
    • the employer acquired knowledge of the occupational disease.
  • Additional information on non-subscriber reporting requirements is available on the TDI website at tdi.texas.gov/wc/employer/cb007.html.
• On January 11, 2017, Commissioner of Workers’ Compensation Ryan Brannan adopted the 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 adoption was filed with the Office of the Secretary of State on January 19, 2017. The adoption will be published in the February 03, 2017, issue of the Texas Register and may be viewed on the Secretary of State website at sos.state.tx.us/texreg/index.shtml.  A courtesy copy of the adoption order is available on the TDI-DWC website at www.tdi.texas.gov/wc/rules/2017rules.html.
• The TDI-DWC adopts the repeal of 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 adopted repeal is a result of the 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 and every four years after that date.
• The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) recently adopted the repeal and re-enactment of §152.3 and §152.4, as well as new §152.6.  New §152.4 increases the maximum hourly rates that may be charged by attorneys and legal assistants in the workers’ compensation system. Effective January 30, 2017, the maximum hourly rates increased from $150 an hour to $200 for attorneys, and from $50 an hour to $65 for legal assistants.  New §152.4 also includes the following increases in the guidelines for legal services: the service maximum for communications per month increased from two hours to three hours, the service maximum for direct dispute resolution negotiation with the other party increased from three hours to three and a half hours, and the service maximum for preparation and submission of an agreement or settlement increased from one hour to two hours, effective January 30, 2017.
• The insurance commissioner in Texas has issued bulletin number B-0001-17 regarding revised workers' compensation classification relativities and instructions on making rate filings.

Vermont VIEW STATE →

REGULATORY ACTIVITY:

• Vermont Rule 45 Rules for Administrative Citations and Penalties, Stop Work Orders and Debarment became effective February 13, 2017.

Washington VIEW STATE →

REGULATORY ACTIVITY:

• The Department intends to review Chapter 296-20 WAC, Medical Aid Rules, for consistency with recent changes in other statues and state rules. Definitions need to be amended to be consistent with recently amended definitions of the Washington State Health Care Authority (HCA) regarding Washington State’s Prescription Drug Program (PDP). Language also should incorporate by reference to incorporate by reference HCA’s rules for therapeutic alternatives and the therapeutic interchange. This will allow the Departments’ rules on this program to be consistent with HCA language now and for future amendments. Existing rules will also be amended to include new content regarding “interchangeable biologics” that is explicitly and specifically dictated by statute (RCW 69.41.110).
• Changes to Rule Chapter 296-17A become effective April 1, 2017.
• L&I has adopted a Health Technology Clinical Committee (HTCC) coverage decision: Fecal Microbiota Transplantation (FMT).  The effective date is April 1, 2017. Preauthorization is required for self-insureds as well as state L and I claim. The conditions are:
  • Patients with Clostridium difficile infection who have failed an appropriate course of antibiotic therapy.
  • FMT is not covered for treatment of inflammatory bowel disease, such as ulcerative colitis or regional enteritis.
  • FMT is considered investigational for any other condition.

Labor and Industries, along with a workgroup from its Industrial Insurance Medical Advisory Committee, has expanded the current Carpal Tunnel Guideline to address computer use in the section on work-relatedness.  No changes were made to any other section.  Public comments on the work-relatedness section are being accepted through 3/14/2017.  The draft guideline will be presented, along with all public comments and responses, at the April 27th Industrial Insurance Medical Advisory Committee meeting. The Department of Labor and Industries (L&I) is proposing an update to the Washington Administrative Code that affects the Medical Aid Rules. The proposed change is scheduled to become effective July 1, 2017, and is summarized below.

• WAC section 296-20-135:
  • The amendment changes the conversion factor for services reimbursed under the Washington Resource Based Relative Value Scale (RBRVS) fee schedule from $61.52 to $63.25.
  • The amendment changes the conversion factor for services reimbursed under the anesthesia fee schedule from $3.41 to $3.44 per minute.
• WAC sections 296-23-220 and 296-23-230:
  • The amendments change the maximum daily reimbursement level for physical and occupational therapy services from $125.68 to $126.94.

The public hearing relating to these changes will be held at the Department of Labor and Industries on Wednesday, March 29, 2017, at 9:00 AM. The L&I building is located at 7273 Linderson Way SW in Tumwater. To reach the site, take Interstate 5 to Exit 101 (Tumwater Boulevard), drive east on Tumwater Boulevard, turn left on Linderson Way and left into the L&I visitors' entrance. The hearing will be held in room S117.  Those who wish to comment on the proposed changes may testify at the public hearing or send written comments to: Emily Stinson Department of Labor and Industries Health Services Analysis PO Box 44322 Olympia, WA 98504-4322 Phone:  360-902-5974 FAX:  360-902-4249 E-mail:  Emily.Stinson@LNI.WA.GOV. Washington posted notice of final adoption of rule WAS 296-14 regarding the pension discount rate for 2017.   The adopted rule becomes effective on April 1, 2017. Pension Discount Rate 2017 (Chapter 296-14 WAC Industrial Insurance) This rulemaking amends WAC 296-14-8810 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. This is the third gradual reduction in the pension discount rate. This reduction better aligns with return rates of long term bonds and more accurately states pension liabilities. 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. The changes were adopted 2/14/2017 and will be effective on 4/1/2017.

West Virginia VIEW STATE →

REGULATORY ACTIVITY:

• West Virginia Office of Insurance Commissioner Division of Workers’ Compensation has published two new forms regarding request for x-rays and request for original x-rays.

Wisconsin VIEW STATE →

FEE SCHEDULE NEWS:

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

Wyoming VIEW STATE →

FEE SCHEDULE NEWS:

• The state has updated the RVU data effective January 1, 2017.
• The next update is expected on January 1, 2018.