Alaska VIEW STATE →

FEE SCHEDULE NEWS:

• The state has released the Official Alaska Workers' Compensation Medical Fee Schedule effective April 1, 2017.  Most notable is the reinstatement of the fee schedule to non-physician practitioners, such as physical and occupational therapists.  Effective April 1, 2017, the maximum reimbursement for providers other than physicians, hospitals, outpatient clinics or ambulatory surgery centers, is the lower of 85% of the fee schedule allowance or the provider's charge for the service or treatment.

REGULATORY ACTIVITY:

• Posted notice of a new medical fee schedule to become effective April 1, 2017.
• The state has posted new regulations in their Administrative code. The amended regulations address the adoption of a new medical fee scheduled.

Arizona VIEW STATE →

REGULATORY ACTIVITY:

• Arizona published Lump Sum Settlement Discounts Tables for 2017.

LEGISLATIVE ACTIONS:

• House Bill 2307
  The enacted legislation modifies the process for a medical practitioner to gain access to the Controlled Substances Prescription Monitoring Program central database tracking system (CSPMP database), and requires a person who is authorized to access the CSPMP database to do so using only the person's assigned identifier. Allows data collected from the CSPMP database to be used for performing drug utilization review for controlled substances. Increases the amount of money that may be transferred annually from the Arizona Board of Pharmacy (Board) Fund to the CSPMP Fund from $395,795 to $500,000. It removes the requirement that registration with the CSPMP database be renewed biennially, and states a registration is valid in conjunction with a valid U.S. Drug Enforcement Agency registration number in addition to a valid license issued by the medical practitioner's regulatory board.  Allows Arizona Health Care Cost Containment System to use data collected from the CSPMP database for performing drug utilization review for controlled substances to help combat opioid overuse or abuse or for ensuring the continuity of care. Effective Date: July 15, 2017.

Arkansas VIEW STATE →

LEGISLATIVE ACTIONS:

• House Bill 1179
  The law increases death benefits for police officers of the State Police Commission who die in the line of duty from $25,000.00 to $50,000.00 for the surviving spouse. If not surviving spouse, the amount will be equally divided among surviving children. The increase in benefits will be for police officers who died in the line of duty on or after July 1, 2017.  Effective Date: July 3, 2017.

• House Bill 1180
  The enacted legislation establishes that when a law or rule requires the signature, certification, stamp, verification, affidavit, or endorsement by a physician the requirement may be fulfilled by an advanced practice registered nurse or physician assistant including workers’ compensation forms. It also authorizes for forms relating to absenteeism for employment and authorizations for durable medical equipment.  The law does not expand the scope of practice of either advanced practice registered nurse or physician assistants. Effective Date: July 3, 2017.

• House Bill 1262
  The law is administrative in nature in that it removes the Department of Labor from the Voluntary Program for Drug-Free Workplaces administered by the Workers’ Compensation Commission. Effective Date; July 3, 2017.

• House Bill 1436
  This law makes amendments to the Arkansas Medical Marijuana Amendment of 2016 regarding licenses for dispensaries and cultivation facilities. Effective Date: July 3, 2017.
• House Bill 1476
  The enacted legislation revised provisions related to the formation and operation of captive insurance companies. The statute introduces the term “Incorporated protected cell” into the statue.  Incorporated protected cell means protected cell that is established as a corporation or other legal entity separate from the sponsored captive insurance company or producer reinsurance captive company. The enacted law also removes some of the restrictions regarding what laws a captive insurance company can be formed. The statue also enacts other administrative and regulatory amendments.  Effective Date: July 3, 2017.
• Senate Bill 146
  The enacted legislation repeals Arkansas Code Section 17-80-118 and replaces it with a new Telemedicine Act. The new act defines telemedicine. The law it sets forth definitions; appropriate use of telemedicine; compliance and penalties; liability for noncompliance; authorizes rules regarding telemedicine; sets forth proper practitioner-patient relationships; which insurances are covered and establishes an effective date.  Effective Date: July 3, 2017.

• Senate Bill 247
  This law is known as the State Insurance Department General Omnibus Bill. The bill contains substantial changes to the insurance laws of Arkansas.  The bill impacts the Arkansas prepaid funeral benefits law; concerning disclosure of nonpublic personal information by the insurance commissioner; concerning the policyholder's bill of rights; concerning the disclosure of an examination report by the insurance commissioner; concerning immunity from prosecution in proceedings of the state insurance department; concerning annual statements filed with the insurance commissioner; concerning the application and licensing requirements of captive insurers; to revise the qualifications for holding an insurance adjuster's license; concerning licensure under the Arkansas health insurance marketplace navigator, guide, and certified application counselors act; concerning immunity from prosecution in proceedings of the state insurance department; to clarify the procedure for mandatory reporting of fraudulent insurance acts; to repeal the compilation of comparison data for private passenger automobile, homeowners multi-peril, and dwelling fire insurance policies; to repeal the annual report regarding personal insurance; concerning the applicability of the Arkansas insurance code to health maintenance organizations; to revise the definition of "covered claim" under the Arkansas property and casualty insurance guaranty act; concerning the risk retention and purchasing groups act; to clarify the annual payment date for an insurer's antifraud assessment; and for other purposes. Effective Date: July 3, 2017.

California VIEW STATE →

FEE SCHEDULE NEWS:

• The Physician and Practitioner Services Medically Unlikely Edits and the National Correct Coding Initiative Practitioner PTP Edits have been updated with an effective date of April 1, 2017.  The update incorporates changes to Medicare, including the revised RVUs for therapy evaluation codes 97161-97168.  Additionally the state adopts the DMEPOS Fee Schedule effective April 1, 2017.  The next updates are expected to become effective July 1, 2017.

REGULATORY ACTIVITY:

• The Division of Workers’ Compensation (DWC) has posted an order adjusting the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1.   The Physician and Non-Physician Practitioner Fee Schedule update Order adopts the following Medicare changes:
  • Centers for Medicare and Medicaid Services (CMS) Medicare National Physician Fee Schedule Relative Value File RVU17B April 1, 2017 quarterly update
  • National Correct Coding Initiative Physician/Practitioner Services CCI Edits   April 1, 2017 quarterly update
  • National Correct Coding Initiative Medically Unlikely Edits April 1, 2017 quarterly update.
• The order adopting the OMFS adjustments is effective for services rendered on or after April 1, 2017 and can be found on the DWC website.
• The Division of Workers’ Compensation (DWC) reminds claims administrators that submitting the Supplemental Job Displacement (SJDB) payments/vouchers to the Workers’ Compensation Information System (WCIS) is a requirement.   Employees who have a permanent partial disability caused by an injury that occurred on or after January 1, 2004 may qualify for the benefit. It comes in the form of a voucher that can be used to pay for educational retraining or skill enhancement, or both, at state- approved schools.  Additional information on the SJDB is posted online.  Claims administrators who would like information and assistance in reporting the SJDB can refer to the WCIS Training Bulletin or contact WCIS directly at wcis@dir.ca.gov. California’s Workers’ Compensation Information System (WCIS) posts occasional announcements and technical updates on California’s workers’ compensation system online, and provides email notification on the updates.
• The Department of Industrial Relations’ Division of Workers’ Compensation (DWC) has issued a notice of public hearing on May 1 for the Medical Treatment Utilization Schedule (MTUS) Drug Formulary regulations, which includes a list of preferred drugs that can be dispensed without the need for prospective utilization review. The proposed rulemaking implements Assembly Bill 1124 (Statutes 2015, Chapter 525), which mandated the adoption of an evidence-based workers’ compensation drug formulary into the MTUS by July 1, 2017. The May 1 public hearing on the proposed regulations has been scheduled at 10 a.m. in the auditorium of the Elihu Harris Building, 1515 Clay Street, Oakland, CA 94612. Members of the public may also submit written comments on the regulations until 5 p.m. that day.  The MTUS Drug Formulary is based on, and consistent with, medical treatment guidelines created by the American College of Occupational and Environmental Medicine (ACOEM), which are published by Reed Group, Ltd. The preferred drug list was compiled by DWC, with assistance from ACOEM, and takes into consideration medications frequently prescribed for occupational injuries and the evidence-based drug recommendations in the guidelines.  “The formulary, designed to work in tandem with our medical treatment utilization guidelines, will incorporate the evidence-based standards of care that best meet the needs of California’s injured workers,” said Christine Baker, Director of DIR.  The proposed formulary regulations are to be adopted at section 9792.27.1, et seq. of Title 8 of the California Code of Regulations. DWC will consider all public comments, and may modify the proposed regulations for consideration during an additional 15-day public comment period.  The notice of rulemaking, text of the regulations, and the initial statement of reasons can be found on the DWC rulemaking web page. More information about the rulemaking process can be found on the Office of Administrative Law’s (OAL) website.
• DIR Issues Amended Regulations to the Return-to-Work Supplement Program that Extends Deadline to File for Benefits. An amendment that extends the deadline to file for the Return-to-Work Supplement Program (RTWSP) has been approved by the Office of Administrative Law (OAL) and filed with the Secretary of State, effective March 20, 2017.  The regulation amendment extends the deadline to file for RTWSP benefits for certain individuals who received the Supplemental Job Displacement Benefit (SJDB) voucher between April 13, 2015 and December 1, 2015, and who may not have received notice of their eligibility to apply for the RTWSP benefit.
• 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 to conform to the second quarter 2017 changes in the Medicare payment system as required by Labor Code section 5307.1.  The order, effective for services rendered on or after April 1, 2017, adopts the Medicare DMEPOS Quarter 2, 2017, DME17-B ZIP file. The 2017 Parenteral and Enteral Nutrition Fee Schedule File from DME 17-A was not updated for the second quarter, and remains in effect for services on or after April 1, 2017.

Colorado VIEW STATE →

REGULATORY ACTIVITY:

• Colorado posted that Rule 17 Exhibit 5 Cumulative Trauma Conditions Medical Treatment Guidelines Revised December 29, 2016 have become effective as of March 2, 2017.

LEGISLATIVE ACTIONS:

• House Bill 17-1048
  This bill makes changes to the language defining insurance fraud. It changes the statute of limitation for this offense, specifying that the period within which a prosecution must begin starts with discovery of the criminal act. The bill also adds insurance fraud to the list of crimes that may constitute racketeering activity. Effective Date: August 10, 2017.

• Senate Bill 17-146
  The enacted statute modifies provisions relating to licensed health professionals' access to the electronic prescription drug monitoring program as follows: allows a health care provider who has authority to prescribe controlled substances, or the provider's designee, to query the program regarding a current patient, regardless of whether the provider is prescribing or considering prescribing a controlled substance to that patient; specifies that a veterinarian who is authorized to prescribe controlled substances may access the program to inquire about a current patient or client if the veterinarian suspects that the client has committed drug abuse or mistreated an animal; and specifies that, in addition to accessing the program when dispensing or considering dispensing a controlled substance, a pharmacist or designee of the pharmacist may access the program regarding a current patient to whom the pharmacist is dispensing or considering dispensing a prescription drug. Effective Date: August 10, 2017.

Connecticut VIEW STATE →

FEE SCHEDULE NEWS:

• A new facility fee schedule has been adopted by the state with an effective date of April 1, 2017. This fee schedule is published by Optum360 and can be obtained by visiting https://www.optum360coding.com/ keyword “Connecticut”.

REGULATORY ACTIVITY:

• Connecticut has updated their medical protocols.   The update protocols were adopted and published March 27, 2017.

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, 2017. The fee schedule is published by Fair Health. The fee schedule is based on the 2017 Current Procedural Terminology (CPT). The next update is scheduled for April 1, 2018.

Idaho VIEW STATE →

REGULATORY ACTIVITY:

• The Commission has changed the mandate for EDI Claims Release 3 to November 4, 2017. To find complete information regarding Idaho go to: https://iicedi.info/ .

LEGISLATIVE ACTIONS:

• Senate Bill 1039
  The enacted statute amends Idaho Employment Security Law to change the status of Idaho Career Information staff from exempt to classified. The proposed change of status of four current Career Information System positions from exempt (non-classified) to classified involves no major changes in compensation, vacation, sick leave accrual or benefits. Based on the statutes already in place and followed by the Department of Labor, the four positions are earning a salary equivalent to an appropriate department classified pay grade, which is a pay grade "L" as shown in the current Fiscal Year 2017 compensation schedule as maintained by the Division of Human Resources.

Illinois VIEW STATE →

FEE SCHEDULE NEWS:

• The Illinois Department of Public Health has published an updated list of Trauma Centers on January 27, 2017 to add Decatur Memorial Hospital.
• The Illinois Workers' Compensation Commission has updated the Medical Fee Schedule rates for therapy evaluation codes 97161-97172 effective April 1, 2017.

REGULATORY ACTIVITY:

• Governor Rauner has appointed Ms. Ketki Steffen as an arbitrator for the Illinois Workers’ Compensation Commission.  Ms. Steffen had formerly been an arbitrator with the Commission and will call upon her extensive workers' compensation experience in her newly appointed role.
• Governor Rauner has appointed Ms. Deborah Simpson and Ms. L. Elizabeth Coppoletti to the Illinois Workers’ Compensation Commission.  Commissioner Simpson will assume the seat on Panel C formerly held by Commissioner Basurto.  Commissioner Coppoletti will assume the seat on Panel B formerly held by Commissioner White.
• Arbitrator evaluations are now available on the forms page. To obtain a copy go to http://www.iwcc.il.gov/forms.htm.
• Arbitrator Dollison will be in Waukegan to handle the April trial cycle. The call will be held on Friday, April 21st with hearing dates on April 24th, 25th, 26th, 27th and 28th. Please send all correspondence to Arbitrator Dollison at:
  • Arbitrator Dollison 1448 E 52nd St #436 Chicago, IL 60615-4122

Indiana VIEW STATE →

REGULATORY ACTIVITY:

• “No version of a Worker's Compensation Handbook put out by the Worker's Compensation Board of Indiana that can be found online should be relied on as accurate. This website contains updated information and all changes to the law or procedures of the Board will be set out here. Handbooks or Guidelines put out by other organizations are neither reviewed nor approved by the Board for accuracy.”
• Failure to timely submit State Form 48557 as set out at IC 22-3-3-7(b) may result in the rejection of the request for additional time and the imposition of a fine. IC 22-3-4-15.
• In cases where there is an accident number, filing of an Application for Adjustment of Claim with a stipulated settlement agreement is unnecessary and the Application will no longer be filed or processed.

Iowa VIEW STATE →

REGULATORY ACTIVITY:

• A notice from the Indiana Division of Workers’ Compensation was published on March 15, 2017:  “Please share this information with all customers and staff who contact Workers’ Compensation to make them aware there will be some delay in responding to inquiries. The Division of Workers’ Compensation is experiencing an extraordinary number of filings of Original Notices and Petitions which began two weeks ago. Our docket staff is diligently processing these petitions.  Soon we expect to start receiving replies and pleadings in response to each of those petitions, which will also require additional processing time. With such a significant increase in our workload, our response time to voicemails, return calls, and requests for information will not be as prompt as we would like.   Defense counsel offices: Please contact the insurance carrier/claim administrator for the compliance number and/or the DWC file number.  Answers and pleadings containing claimant’s name and injury date will provide sufficient information for us to link to the petition and process properly. While we expect, this inconvenience will be temporary, we have no way to determine a time frame.  We appreciate your patience and understanding during this time, and we thank you for your support.”

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, 2017. The next expected updates are for April 1, 2018.
• Anesthesia services.  The anesthesia time unit rounding was increased from 6 to 8 minutes.

REGULATORY ACTIVITY:

• Kentucky posted Hospital and ASC cost to charge ratios effective April 1, 2017.
• Labor Secretary Derrick Ramsey announced the appointment of Chief Administrative Law Judge Robert L. Swisher as the Acting Commissioner for the Department of Workers’ Claims beginning April 1st.

• 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.

LEGISLATIVE ACTIONS:

• House Bill 223
  Amend KRS 360.040 to make the state interest rate for most civil judgments, including judgments for prejudgment interest, 6 percent; provide that the judgment interest rate for unpaid child support is 12 percent; provide that the judgment interest rate on a contract, promissory note, or other written obligation is the rate established in that contract, promissory note, or other written obligation; amend KRS 342.040 to establish a 6 percent interest rate for worker's compensation orders and settlements; allow the administrative law judge to raise the interest rate to 12 percent; amend KRS 360.010 to conform; specify that the new interest rates only apply to judgments, orders, and settlements entered after the effective date of this Act. Effective Date: June 30, 2017.
• House Bill 276
  The enacted legislation repeals various sections in KRS Chapters 11, 15., 18A, 36, 64, 146, 147, 153, 158, 164, 171, 177, 198B, 205, 211, 216, 336, 342, and 403 to abolish inactive boards, commissions, committees, and councils, including the Agricultural Resource Development Authority, the Architectural Barriers Advisory Committee, the Athletic Trainers Advisory Council, the Auto and Truck Recyclers Licensing Advisory Board, the Capitol Centennial Commission, the Cardiovascular Disease Initiative, the Child Support Enforcement Commission, the Children’s Health Insurance Program Advisory Council, the Diabetes Research Board, the Council on Domestic Violence and Sexual Assault, the Advisory Committee for Educational Improvement, the e-Health Network Board, the Council for Families and Children, the Family Health Care Providers Board, the Innovation Commission, the Labor-Management Advisory Council, the My Old Kentucky Home Advisory Commission, the National Guard and Reserve Employers’ Council, the Natural History Museum Board of Directors, the Personnel Steering Committee, the Public Officials Compensation Commission, the Southern Growth Policies Board, the Underground Railroad Advisory Council, the War of 1812 Bicentennial Commission, the Workers’ Compensation Advisory Council, the Bicentennial Commission, the Health Care Infrastructure Authority, and the Historical Events Celebration Commission; amend KRS 148.400 to direct the use of funds in the “My Old Kentucky Home Endowment Fund”; amend KRS 403.705 to decrease the responsibilities of local domestic violence coordinating councils and to direct any recommendations be transferred to the commissioner of the Department for Community Based Services; repeal, reenact and amend KRS 407.707 to create a Sexual Assault Response Team Advisory Committee attached to the Department for Community Based Services, staffed as necessary by the secretary of the Cabinet for Health and Family Services; transfer any committee recommendations to the commissioner of the Department for Community Based Services; require the secretary to make certain appointments; establish continuation of service of members of the Sexual Assault Response Team Advisory Committee; direct transfer of funds of abolished boards, commissions, committees, and councils to the appropriate cabinets and agencies; amend various KRS sections to conform. It Establish the "Citizen and Taxpayer Stewardship Act of 2017"; direct the Cabinet for Health and Family Services utilize enhanced eligibility verification and periodic continuing monitoring of enrollees and applicants' finances and wealth; establish a process when discrepancies between reported finances and actual finances are discovered; recommend use of photographic ID within benefits programs such as food stamps or TANF; direct information sharing practices to better determine eligibility and establish a monitoring infrastructure; recommend how to refer cases of fraud and identity fraud; direct a resource limit for the food stamps program; recommends the use of the work requirements established for able-bodied Medicaid recipients in the KY HEALTH 1115 Waiver within the food stamps and TANF programs and any other benefits reform; prohibit seeking off waivers from 7 U.S.C. Section 2015 in any form; direct that progress reports and final presentations about the updates and direction of the benefits programs be given to the IJC on Health and Welfare and the Medicaid Oversight and Advisory Committee; request that all updates be completed, legislation recommended, and any necessary waivers requested by December 31, 2018.  Effective Date: June 30, 2017.

• House Bill 293
  The bill amends KRS 12.020 and 336.020 to rename divisions within the Labor cabinet, move the Division of Workers' Compensation Funds to the Department of Workers' Claims, move the Office of General Counsel from the Department of Workers' Claims to the Labor Cabinet's Office of General Counsel, and abolish the Workers' Compensation Advisory Council; amend KRS 336.164, 336.165, 342.120, 342.122, and 342.382 to conform; amend KRS 342.215 and 342.230 to exempt Workers' Compensation Board members, department employees, and administrative law judges from the classified service; repeal KRS 342.0012, relating to the Workers' Compensation Advisory Council; confirm Executive Order 2016-855. Effective Date: June30, 2017.

• House Bill 299
  The enacted legislation amends KRS 342.213 to abolish the Workers' Compensation Nominating Commission; create the Workers' Compensation Nominating Committee; set the number and experience of members; describe the duties and responsibilities of the committee; amend KRS 12.020, 336.020, and 342.228 to conform; confirm Executive Order 2016-319. Effective Date June 30, 2017.

• House Bill 305
  The enacted legislations purpose of the measure is to establish procedures for involuntary treatment for alcohol and other drug abuse. Section 1 amends KRS 222.431 to specify that no person shall be ordered to undergo alcohol and other drug abuse treatment unless the person can reasonably benefit from treatment in accordance with a qualified health professional's recommendation.  Section 2 amends KRS 222.432 to provide that a judge can order a person to undergo treatment for up to one year; clarifies that the petition for treatment may be initiated in a District Court in the county in which the person resides on a permanent or temporary basis; clarifies that the petitioner is responsible for only those costs of evaluation and treatment not covered by a third party payor; and clarifies that no petitioner shall be required to place a deposit with the court to cover the costs of evaluation and treatment.  Section 3 amends KRS 222.433 to clarify that the petitioner can choose the qualified health professionals who will evaluate the respondent; allows an examination of a qualified health professional performed within the last three months to be admissible as one of the required examinations; allows the petitioners an opportunity to file the correct paperwork and to gather additional evidence; allows for the renewal of the petition for treatment beyond one year; allows the court order to be amended to place the respondent in a more appropriate treatment program; and specifies that the fee for any appointed counsel for the respondent shall not exceed $500.  Section 4 amends KRS 222.434 to clarify that the District Court of any county where the person may be found may issue a 72-hour emergency treatment order, and to specify the procedures to be followed in contempt proceedings.  Section 5 creates a new section of KRS 222.430 to 222.437 to require treatment programs to notify the court when the respondent fails to appear or participate in treatment as ordered by the court.  Section 6 amends KRS 222.435 to allow the petitioner, or a person chosen by the petitioner, to transport the respondent to a hospital, to an examination, or to a treatment program.  Section 7 creates a new section of KRS 222.430 to 222.437 to provide that proceedings are not open to the public and that any court records of a respondent are confidential.  Section 8 amends KRS 222.470 to require Medicaid and private insurers to use comparative medical necessity and reimbursement methodology to cover alcohol and other drug abuse treatment services.  Section 9 amends KRS 620.100 to raise the maximum payment for legal representation for minors and/or indigent custodians in dependency, neglect, and abuse cases with final disposition in District Court from $250 to $500 (consistent with Circuit/Family Court).   Effective Date: June 30, 2017.

• Senate Bill 151
  The bill amends KRS 337.010, 338.021, 341.070, 342.690, and 344.030 to provide that neither a franchisee nor an employee of a franchisee shall be deemed to be an employee of the franchisor for purposes of KRS Chapters 337, 338, 341, 342, and 344, respectively; provide that neither a franchisor or employee of a franchisor shall be deemed to be an employee of the franchisee for purposes of KRS Chapters 337, 338, 341, 342, and 344, respectively; define "franchisee" and "franchisor.” Effective Date: June 30, 2017.

Louisiana VIEW STATE →

REGULATORY ACTIVITY:

• A notice was published March 13, 2017: “Pursuant to a judgment signed by 19th Judicial District Court Judge Donald Johnson on March 2, 2017, the OWCA was:

  Enjoined, restrained, and prohibited from applying and/or enforcing the statutes and regulations which establish the system for the administrative determinations of form 1009 claims for medical benefits for injured workers by a medical director employed by the Office of Workers’ Compensation of the Louisiana Workforce Commission and administrative appeals therefore to Office of Workers’ Compensation judges. The enjoined statutes and regulations are as follows:
  La. R.S. 23:1203.1 (J) (1), (K), (M);
  2. La. R.S. 23:1314 (D) – E (1) inclusive;
  3. 40 LAC 2715(B) (3), (d), (e), (f); and
  4. 40 LAC 2715(E) (2), (F), (H), (I), (J), (K) and (L).

  The OWCA filed a Suspensive Appeal, which was granted on March 9, 2017. Therefore, pending further action of the Appellate Court, the 1009 review process has resumed effective March 10, 2017, and will continue to operate as usual and as it had prior to the injunction.”

• Another notice was published on March 15, 2017: “Due to the recent decision in Barber, et al. v. LWC, et al., 621,071, Sec. “26”, 19th Judicial District Court, rendered by Judge Donald R. Johnson on March 2, 2017, the Office of Workers’ Compensation Administration has determined that it would be in the best interest of all parties to halt the rule making process initiated by a Notice of Intent to revise 40 LAC § 2328, 2715, 2718 and 40 LAC § 5507 published in the Louisiana Register on February 20, 2017.”

Maryland VIEW STATE →

REGULATORY ACTIVITY:

• The Negligence, Insurance and Workers’ Compensation Section of the Maryland State Bar Association presented a program on the UEF and SIF at the MD Workers’ Compensation Commission, 3rd floor meeting space, on Monday, March 20, 2017 at 4:30 pm. The program included a panel discussion, including tips on how to present a case involving the UEF and/or SIF. The Speakers were Scott Massengill, Principal Counsel, UEF; Terrance Doyle, Assistant Attorney General, SIF. The panel included Chairman R. Karl Aumann, Commissioner Delia Turano Schadt, Commissioner Jeffrey T. Weinberg and Commissioner Patricia Adams with Moderators Mitchel M. Gordon, Esq. and Joan P. Adelman, Esq.
• A reminder to practitioners was released:  “Do not use color paper when sending/submitting 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.”

Massachusetts VIEW STATE →

FEE SCHEDULE NEWS:

• Hospital fee schedule has been updated as of January 1, 2017.
• The state has posted updates for the following modules:
  • 101 CMR 346.00: Increased rates for certain substance-related and addictive disorder programs retroactive to January 1, 2017.
  • 101 CMR 350.00: Home Health Services, retroactive to January 1, 2017
  • 101 CMR 323.00: Hearing Services, effective for dates of service provided on or after April 7, 2017.
  • 101 CMR 331.00: Prescribed Drugs (emergency adoption), effective April 1, 2017.

• The percentage of the Health Safety Net Uniform Assessment was revised from 0.82% to 0.80% for dates of service on or after October 1, 2016 in Administrative Bulletin 17-02.

REGULATORY ACTIVITY:

• The Department of Industrial Accidents has made a revision to the Form 105 – Agreement to Extend 180 Day Pay Without Prejudice Period.  The revision appears in the notice just below the employee’s signature and is intended to clarify the purpose and scope of the agreement to extend benefits under the pay without prejudice clause in M.G.L. c. 152, Sec. 8.  The new form 105 shall take effect on March 31, 2017.
• The following regulations have been recently adopted:
  • 101 CMR 206.00:  Standard Payments to Nursing Facilities
    http://www.mass.gov/eohhs/gov/laws-regs/hhs/hospitals-nursing-homes-and-rest-homes.html#114_2_6
  • 101 CMR 350.00:  Home Health Services
    http://www.mass.gov/eohhs/gov/laws-regs/hhs/community-health-care-providers-ambulatory-care.html#101cmr350
  • Massachusetts has posted two new rules and two new bulletins.  Bulletins 17-04 and 17-05 and Rules 101-cmr-323 Hearing Services and 101-cmr-Restorative Services.  The bulletins although just published are effective January 1, 2017.  The two rules are adopted and become effective April 7, 2017.

Medicare VIEW STATE →

FEE SCHEDULE NEWS:

• Physician – CMS has posted new updates to the National Physician Fee Schedule Relative Value File effective April 1, 2017. The next expected update is July 1, 2017.
• HCPCS – Several codes have been updated as of April 1, 2017.  The next expected update is in July 2017.
• DMEPOS – CMS has released a new update effective April 1, 2017. The next update is expected on July 1, 2017.
• ASC – CMS has released a new quarterly update to the ASC fee schedule with an effective date of April 1, 2017. The next expected update is July 1, 2017.
• OPPS – CMS has released a new quarterly update to the hospital outpatient fee schedule with an effective date of April 1, 2017. The next expected update is July 1, 2017.
• CCI and MUE Edits – CMS has released the April 1, 2017 changes for the MUE and CCI edits. The next expected update is for July 1, 2017.

Michigan VIEW STATE →

REGULATORY ACTIVITY:

• Michigan sent out a notice regarding yearly compensation payment validation report.  “In alignment with the agency’s mission to efficiently administer the Act and provide prompt, courteous and impartial service to all customers, we have begun to implement a series of changes with how we collect and examine weekly benefit payment(s). Some of these changes impact only our internal operations while others will impact how we interact with our external customers. One such change relates to the YEARLY COMPENSATION PAYMENT VALIDATION report. Effective immediately with the 2016 annual report we now require a response from all insurers and self-insurers or their respective third party claims handler. Upon receipt please review the annual report and certify compliance with its requirements.  Select for a sample letter that will accompany the validation reports.   This change will assist in ensuring that our records accurately portray the status of indemnity benefit payments by the industry. Where available, the service company or third party claims handler will receive the report.  However, it remains the responsibility of the self-insurer or the insurer of record writing the policy covering the date of injury to see that all items related to the claim are resolved timely and appropriately reported to the agency in accordance with the Michigan Workers’ Disability Compensation Act.  Another change is the requirement to file form WC-701 to terminate benefits that have been reduced to zero after applying adjustments “A” thru “G” (coordination of benefits) for more than 14 consecutive calendar days.  Form WC-701 must be submitted to terminate benefits for each claim in Category 4 (All Others) of the Validation report for Year Ending 2016 where COMPENSATION RATE of zero was started during 2016.  The WC-701 form should be submitted with filing reason “C” (Terminating Benefits); Through date should be 15^th day after From date, Termination Reason “H” (Other) and “Coordination reduced to 0 more than 14 days” on the comment line provided below Part D of the form. The Form WC-701 instructions have been updated to reflect these changes. If you have open claims where indemnity payments are being made and they do not appear on this report please immediately report them to our agency by completing the appropriate forms.”
• The 2016 Pay Lag Reportshowing the pay lag results by industry group as well as individual company is now available. “We continue to emphasize the need to investigate all claims as soon as possible and to provide payment of benefits to all entitled individuals commencing on the 14th day as required by law. This report only covers claims where an initial Form 701 was submitted from 1/1/16 through 12/31/16. Only voluntary payment claims were selected. We have excluded any claims in which a Form 104A or 104C was filed, a Form 107 was received before the initial Form 701, or in which partial benefits were initially paid. We urge you to review your company's performance over the last year. You should also review the manner in which your Form 701 filings are being made. Filling this form out incorrectly can impact the number of pay lag days. If you have any questions or would like to see the detailed report for your company, please contact Ken Smith at 517- 284-8914 or email him at smithk5@michigan.gov.”

Minnesota VIEW STATE →

REGULATORY ACTIVITY:

• Minnesota Adopted Exempt Permanent Rules Relating to Workers' Compensation; Independent Medical Examination Fees in Minnesota Rules, chapter 5219; Workers' Compensation Medical Services and Fees in Minnesota Rules, chapter 5221.
• Minnesota has published in its state register on March 27, 2017 Amendments to the following fee schedule rules:
  • Excessive Charges
  • Provider Responsibilities
  • Surgery Fees
  • Pharmacy
  • Instructions for Application of Fee Schedules.

Mississippi VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted select 2017 CPT and HCPCS effective March 1, 2017, including new therapy evaluation codes 97161-97172.  Deleted codes 97001-97006 should not be used for dates of service on or after March 1, 2017.

REGULATORY ACTIVITY:

• Posted notice of settlement schedule changes.  The notice posted state that the Mississippi Workers' Compensation Commission will not be processing walk-in settlement approvals on either Tuesday April 18 or Wednesday April 19.
•  Montana has posted the proposed facility fee schedule to become effective on July 1, 2017.

LEGISLATIVE ACTIONS:

• House Bill 346
  The enacted legislation establishes that certain fiscal agents are employers of record for purposes of Montana’s labor laws specifically in regard to the workers’ compensation act. Effective Date: October 1, 2017.

• Senate Bill 142
  The enacted legislation requires employers for certain emergency personal to notify the employee if workers’ compensation insurance is not provided for the services provides. Effective Date: October 1, 2017.

Nebraska VIEW STATE →

REGULATORY ACTIVITY:

• The Nebraska Survey of Occupational Injuries and Illnesses for 2015 and Nebraska Census of Fatal Occupational Injuries for 2015 are now available in portable document format (pdf).
• The Schedules of Fees for Inpatient Hospital Diagnostic Related Group (DRG) and Inpatient Hospital Trauma Services have been updated with information from CHI Health Creighton University Medical Center Bergan Mercy that was previously unavailable.
• Published the results of their Vocational Rehabilitation meeting announcement and results of the 02/03/2017 meeting are now available in portable document format (pdf).

Nevada VIEW STATE →

REGULATORY ACTIVITY:

• The Division of Industrial Relations posted notice of public meetings for the Board of Self-Insured Employers (March 15, 2017), and for the Board of Associations (March 9, 2017) on their web site.

New Mexico VIEW STATE →

REGULATORY ACTIVITY:

• The IME Provider Selection Committee organized pursuant to §52-1-1.2. D is revising its list of qualified IME Providers. A list of all applications received from new and continuing IME providers is available from the Medical Cost Containment Unit, P.O. Box 27198, Albuquerque, NM 87125-7198, (505) 841-6811. Written public comments on any health care provider being considered for inclusion or continuation in the list of certified IME providers will be accepted from May 1, through the close of business May 31, 2017.  In making its decisions, the Committee shall, "to the greatest extent possible, designate only health care providers whose judgments are respected, or not objected to, by recognized representatives of both employer and worker interests and whose judgments are not perceived to favor any particular interest group."

LEGISLATIVE ACTIONS:

• House Bill 122
  The enacted legislation specifies that pharmacy benefit managers (PBMs) could not charge a fee to pharmacies for the following parts of the adjudication of claims made by a pharmacy to a PBM: Adjudication of the claim; Receipt and processing of the claim; Development or management of a claim processing network, and Participation in a claim processing network. Effective Date: June 18, 2017.

New York VIEW STATE →

REGULATORY ACTIVITY:

• On September 11, 2016, Governor Andrew M. Cuomo signed legislation that extends workers’ compensation eligibility and benefits for World Trade Center workers (paid workers and volunteers) under Article 8-A. Most notably, the legislation reopens the World Trade Center Registry; extends the deadline period for filing the Registration of Participation in World Trade Center Rescue, Recovery and/or Clean-up Operations (Form WTC-12) from September 11, 2014, to September 11, 2018; and reopens previously time-barred World Trade Center claims and considers them timely.  New York releases Bulletin Subject No. 046-927.

LEGISLATIVE ACTIONS:

• Senate Bill 03353
  The enacted legislation excludes certain musicians or persons who are an executive officer of a corporation who contracts for the musician or person's services from the definition of employee for purposes of the workers' compensation law. Effective Date March 15, 2017.

North Carolina VIEW STATE →

REGULATORY ACTIVITY:

• The Industrial Commission is pleased to announce the creation of a Twitter account that will provide updates on the Commission’s breaking news and important announcements. This additional media platform demonstrates the Commission’s commitment to providing quality customer service and connecting with all interested stakeholders. Please follow the N.C. Industrial Commission on Twitter @IC_NC_GOV.
• Governor Roy Cooper has nominated Philip A. Baddour, III for appointment as a Commissioner to the North Carolina Industrial Commission for a six-year term, pending confirmation by the North Carolina General Assembly.  Philip A. Baddour, III joined the Industrial Commission as a Deputy Commissioner in November 2000.  In August 2015, he was appointed to a six-year term to continue serving as a Deputy Commissioner. Prior to the Commission, Mr.  Baddour practiced law in Goldsboro, N.C.  from 1996 to 1999, primarily representing plaintiffs in the areas of tort and workers’ compensation litigation.  In 1999, he joined the North Carolina Department of Justice as an Assistant Attorney General defending state agencies in workers' compensation and tort claim actions.  Mr. Baddour also previously served as a JAG Officer in the North Carolina National Guard, achieving the rank of Captain before receiving an honorable discharge.  Mr. Baddour received his B.A. degree from the University of North Carolina at Chapel Hill in 1992. He earned his law degree from Campbell University and was admitted to the North Carolina Bar in 1996.

North Dakota VIEW STATE →

FEE SCHEDULE NEWS:

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

LEGISLATIVE ACTIONS:

• House Bill 1086
  The enacted legislation removes the requirement that a treating doctor be notified when an injured employee is notified of the intention to discontinue benefits. It also specifies how an overpayment of benefits can be recovered. The legislation also changes the amount involved regarding fraud for a class C felony from $500.00 to $1,000.00 regarding benefits. The legislation also makes non-substantial clerical changes to the statute.  Effective Date: August 1, 2017.

• Senate Bill 2048
  The enacted bill will serve to increase injured employee attorney fees in limited instances. It may also serve to increase the number of cases proceeding to an administrative hearing. The agency by rule will establish cost payable to the injured worker’s attorney. Effective Date: August 1, 2017.
• Senate Bill 2093
  The enacted legislation amends the statute relating to subrogation liens; provides that an interested party can request and WSI shall provide an appealable determination if WSI does not issue an order within 60 days of receiving a request for reconsideration; and updates Decision Review Office statute to conform to previous statutory changes. Effective Date: August 1, 2017.

Ohio VIEW STATE →

REGULATORY ACTIVITY:

• Ohio has posted notice of three rule sets that are awaiting review.  The rules under consideration are the Marine Industry Fund Rules, 4123-17-16 Penalties late payment and reporting and 4123-17-16 Five-year rule review.
• Ohio has posted amendments to two rules.  The amended rules are 4123-15-09 Prohibition against unnecessary claim file possession and 4123-15-03 Standard of conduct.
• Ohio's ASC fee schedule becomes effective May 1, 2017.

Oregon VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted a new medical fee schedule effective April 1, 2017.  New updates to the medical fee schedule are expected January 2018.
• The state has also adopted changes to the Hospital Cost-to-Charge Ratios effective April 1, 2017. The next expected update is on October 1, 2017

REGULATORY ACTIVITY:

• The Workers’ Compensation Board held a meeting at 10 a.m. on Thursday, March 16, 2017, in Hearing Room A, at 2601 25th St. SE, Suite 150, Salem, OR.  On the agenda is:  Discussion of proposed rule concepts concerning cost bill procedures (OAR 438-015-0019).
• The Workers’ Compensation Board revised Bulletin 144, "Premium assessments," and Form 910, "Workers' Compensation Insurer Premium Assessment Report". These are available online: http://wcd.oregon.gov/Bulletins/bul_144.pdf (Bulletin 144);
  http://wcd.oregon.gov/WCDForms/910.xls (Form 910).
• Oregon has released Bulletin 290 to become effective April 1, 2017. This bulletin provides updated adjusted cost-to-charge ratios. This bulletin replaces corrected Bulletin 290 issued Sept. 19, 2016.
• The Workers' Compensation Division revised the following forms: Form 1867, "Application for Self-Insured Employer Group:" http://wcd.oregon.gov/WCDForms/1867.doc; Form 1868, "Application for Self-Insurance:" http://wcd.oregon.gov/WCDForms/1868.doc; and Form 1969, "Endorsement to Self-Insured Group Application:" http://wcd.oregon.gov/WCDForms/1869.doc.

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 February 27, 2017.

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 April 1, 2017.  The next expected update is for July 1, 2017.

South Carolina VIEW STATE →

REGULATORY ACTIVITY:

• “Over the past few years the Commission has experienced an increased number of Consent Orders submitted as an alternative to Settlement Agreements and Release. The documents contain language creating a “hybrid” between an Agreement and Release and a Consent Order, making it difficult to discern how it should be processed.  Consent Orders, pursuant to S.C.  Code Ann.  42-17-10 are signed and served by each Commissioner’s office.   Agreement and Releases, pursuant to S.C. Code Ann. § 42-9-390, are stamped received by Claims and returned to the parties once they are properly filed.  To eliminate any confusion for processing these documents, we request your assistance. When preparing a Consent Order, please title the document “Consent Order” and include the language “we consent” at the signature lines for the parties and a signature line for the Commissioner at the bottom of the document. When preparing a settlement or “clincher” agreement, title the document “Settlement Agreement and Release.” The title should not contain the word “Order.”  A signature line for a Commissioner is required only if the claimant is unrepresented.  We appreciate your cooperation by immediately submitting Consent Orders and Settlement Agreements and Releases following the format provided in the attached examples. Effective March 1, 2017, all Consent Orders and Settlement Agreements received by the Commission which are not in the attached format will be returned to the appropriate parties.   Thank you for your cooperation in this matter. Please direct any questions or comments to:  Amy Bracy Judicial Director abracy@wcc.sc.gov.”

South Dakota VIEW STATE →

LEGISLATIVE ACTIONS:

• Senate Bill 4
  The enacted legislation requires the pharmacy board to, before the fourth Tuesday in January of each year, report to the Senate and House standing committees on health and human services on the monitoring and use of prescription opioids. This report shall include the number of opioid prescriptions from the prior three years. The report shall also include an update to any changes or advances made to the prescription drug monitoring program. Effective Date: June 30, 2017.

Tennessee VIEW STATE →

REGULATORY ACTIVITY:

• The Bureau of Workers’ Compensation announces the appointment of Deana Seymour as a trial judge on the Court of Workers’ Compensation Claims. Ms. Seymour will sit in Memphis after her swearing-in on April 5, 2017. One judge currently sits in Memphis: the Honorable Jim Umsted, who will retire the first week of April.
• Registration is now open for the 3rd Annual Physicians/Attorney Education Conference. Please join as The Guest House at Graceland in Memphis hosts us on June 10-11, 2017. Saturday's sessions will teach the proper application of the AMA Guides™ to Permanent Evaluation, 6th Edition. Sunday's session will cover medical and legal aspects of a workers' compensation claim, including how to determine medical causation.

Texas VIEW STATE →

REGULATORY ACTIVITY:

• Texas has revised four forms effective immediately. Two of the revised forms dwc045mbrc and dwc045msbrc are forms in English and Spanish regarding a request for schedule, reschedule, or cancel a benefit review conference to appeal a medical fee dispute decision.  Two of the revised forms dwc049mcch and dwc049smcch are forms in English and Spanish regarding a request to schedule a medical contested case hearing.
• The Texas Department of Insurance, Division of Workers’ Compensation (DWC) has finalized its revision of several workers’ compensation forms by removing or limiting social security numbers. In an effort to better protect confidential information and streamline processes, DWC evaluated the need for social security numbers on various workers’ compensation forms and ultimately determined to either: (1) remove the social security number field completely, or (2) request only the last four digits of the social security number. The revisions apply to English and Spanish versions of the forms.
• The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) is accepting comment on the proposed Fiscal Year 2017 Research Agenda of the Workers’ Compensation Research and Evaluation Group (REG).  Labor Code § 405.0026 requires the REG to prepare and publish annually in the Texas Register a proposed research agenda for commissioner review and approval.  Under section 405.0026, the commissioner must accept public comments on the research agenda and hold a public hearing on the proposed research agenda if a hearing is requested by interested persons.
• On December 21, 2016, the Division of Workers’ Compensation (DWC) solicited and received input from workers’ compensation system participants regarding two potential categories for the CY 2017 Medical Quality Review Annual Audit Plan (Annual Plan).  The Division appreciates the input provided by system participants.  All comments were carefully considered and discussed.  The Commissioner of Workers’ Compensation W. Ryan Brannan approved the CY 2017 Annual Audit Plan on March 3, 2017. The Annual Plan sets priorities for the types of audits the Medical Quality Review Panel (MQRP) will initiate during the year as laid out in Section IV of Annual Plan.  At a future date, the DWC will obtain stakeholder input on the development of each individual plan-based audit proposal for categories within the Annual Plan.  At that time the DWC will post a plan-based audit that includes:
  • inclusion and exclusion criteria;
  • service time frame to be audited;
  • same size; and
  • subject and case file selection.
• All medical quality reviews initiated on or after January 1, 2017 will be performed in accordance with the approved medical quality review process (Process).  The Process and Annual Plan, including any changes, are posted on the TDI website at www.tdi.texas.gov/wc/hcprovider/medadvisor.html.
  • The Texas Department of Insurance’s Division of Workers’ Compensation (DWC) re-certified seven employers to self-insure workers’ compensation claims. Together, the companies employ about 30,000 people in Texas.

    DWC renewed:

    •    Bradford Holding Company, Inc.
    •    Textron, Inc.
    •    Weyerhaeuser Company
    •    Jacobs Engineering Group Inc.
    •    PACCAR Inc
    •    Ascension Health Alliance
    •    ABF Freight System, Inc.

    To be certified to self-insure, a company must meet state requirements and have a minimum workers’ compensation insurance unmodified manual premium of $500,000. For more information on applying to the Self-Insurance Regulation program, visit the TDI website at www.tdi.texas.gov/wc/si/index.html.

• As part of the agency’s paper reduction initiative, the Division of Workers’ Compensation (DWC) is offering insurance carriers and injured employee representatives two services for submitting claim documents electronically.
• Secure File Transfer Protocol (SFTP)
• The SFTP service allows external participants a secure electronic location where they can save documents. DWC can then retrieve those documents and place them in our system. This service is for the exchange of certain files related to Benefit Review Conferences (BRC). Examples of these filings include BRC Exchange Packets, BRC Exchange Supplemental Packets and Scheduling Order Status Reports. This service is currently a one-way exchange and is only available for an external participant to drop these specific files for DWC processing.
• Fax Back Receipt
• The Fax Back Receipt service allows our external participants to fax any single document for a single claim or dispute to a designated fax number that will then return a page-for-page fax with a DWC date stamp. This can be used for all claim related filings requiring a DWC date stamp.
• The benefits of these services include:

• • • More secure – reduced risk of losing printed copies or receipts with sensitive information.
    • Save printing costs and paper – no need to print filings for submission.
    • Save delivery costs – electronic delivery means no trip to DWC or paying postage for mailing.
    • Instant delivery – get filings to DWC more quickly.
    • Expedited processing – DWC does not have to sort, distribute and scan documents prior to processing.
    • Reduced customer scanning –the Fax Back Receipt files can be saved and stored electronically (this requires the participant to have electronic fax receipt and electronic storage.)

• The Texas Division of Workers’ Compensation rolled out a statewide program in October 2016 that has helped speed up the resolution of some disputes. The program splits up related claim issues so that a hearing officer can decide the most far-reaching issue first. This can clear the way for secondary issues to be resolved sooner. In the pilot program, the approach helped speed resolution of many workers’ compensation disputes. “We’re always looking for ways to stay on the cutting edge of workers’ compensation, and this process is a great example of finding a way to improve efficiency in the system,” said Workers’ Compensation Commissioner Ryan Brannan. “From what we’ve seen in the pilot project and in the statewide roll-out, the two-step approach to deciding some of the most complex issues in a dispute is a good option for system participants in many cases.” When an injured employee has a dispute about a claim, it often involves three issues: extent of the injury, the date that the employee reached maximum medical improvement and the impairment rating for the injury. According to Deputy Commissioner for Hearings Kerry Sullivan, even though extent of injury is a “threshold issue” that can affect the other issues, it’s often addressed at the same time as the other issues in the dispute process. “It can be challenging to come into a hearing and know there are so many alternatives for the hearing officer to address,” Sullivan said. Parties in a dispute may base their arguments about impairment ratings and dates of maximum medical improvement on what they think the extent of injury should be. If the hearing officer decides a different extent of injury, then parties will often have to request more time to adjust those recommendations. The new two-step program is voluntary, and the existing system is still used in many cases. The option to participate is presented by the presiding officer at the initial benefit review conference for cases that may benefit from the approach. The two-step approach is used only if both parties agree to it. “The presiding officer usually knows going into the dispute whether a decision on extent of injury will move things along,” Sullivan said. “Deciding the extent of injury issue first can lead to a better outcome, a more efficient hearing, and more agreements. We’re pleased it’s been working out so well.” The two-step program started at DWC’s Weslaco office in May 2015 and soon was expanded to Dallas. It’s now available at all 20 offices statewide.
• The Texas Department of Insurance, Division of Workers' Compensation has determined, pursuant to the authority and direction given under the Texas Workers' Compensation Act (Texas Labor Code, §401.023), that any interest or discount provided for in the Act shall be at the rate of 4.50 percent. This rate is computed by using the treasury constant maturity rate for one-year treasury bills (1.00 percent) issued by the United States Government, as published by the Federal Reserve Board on March 17, 2017 (the 15th day preceding the first day of the calendar quarter for which the rate is to be effective), plus 3.5 percent as required by Texas Labor Code, §401.023. The rate shall be effective April 1, 2017, through June 30, 2017. The rate in effect or the previous period of January 1, 2017 through March 31, 2017 was 4.41 percent. For more information regarding calculation of the Discount Rate and Interest Rate, contact Dylan McCoy, Texas Department of Insurance, Financial Services at 512-676-6195.

Utah WC VIEW STATE →

REGULATORY ACTIVITY:

• Utah has published notice of intent to amend rule R590-248-4 Mandatory Fraud Reporting Process.  The proposed amendment would change the email address for reporting from mandatory reporting @utah.gov to fraud@utah.cov

LEGISLATIVE ACTIONS:

• Senate Bill 57
  The enacted legislation changes workers’ compensation related premium assessments. Effective Date: May 9, 2017.

• Senate Bill 58
  The enacted legislation changes the name of the Uniform Fraudulent Transfer Act to Uniform Voidable Transactions Act. It makes changes consistent with the 2014 version of the Uniform Fraudulent Transfer Act.  It modifies and defines terms; modifies provisions relating to the determination of insolvency; enacts provisions relating to the burden of proof; modifies provisions relating to the transfer and recovery of assets; enacts a governing law provision; addresses the bill’s applicability to a series of organization; enacts transitional language; addresses the applicability of the Relation to Electronic Signatures in Global and National Commerce Act and makes technical and conforming changes.  Effective Date:  May 9, 2017.

• Senate Bill 62
  The enacted legislation modifies the information required to be filed to obtain a workers’ compensation waiver. It modifies the circumstances under which a motor carrier may elect not to include an officer or director as an employee for the purposes of the Workers’ Compensation Act and the Utah Occupational Disease Act.  Effective Date May 9, 2017.

• Senate Bill 92
  The enacted bill: repeals the statute creating the Workers' Compensation Fund; removes statutory references to the Workers' Compensation Fund; addresses the obligation to write workers' compensation insurance and residual market mechanisms; provides for the Workers' Compensation Fund's transition to a mutual corporation; modifies membership on the workers' compensation advisory council; addresses methods to obtain workers' compensation insurance; amends the provision addressing penalty for failure to obtain workers' compensation; modifies the provision addressing exemptions for employees temporarily in state; addresses continuing education requirements for contractor licensees; and makes technical and conforming amendments. Effective Date:  December 31, 2017.

• Senate Bill 104
  The enacted legislation modifies provisions related to enforcement of administrative orders from within the Utah Labor Commission. The law provides that a district court may renew as a judgment of the district court certain final administrative orders related to wage claims and workers’ compensation claims. Effective Date May 9, 2017.

• Senate Bill 120
  The enacted legislation modifies the calculation of death benefits paid to one or more dependents of a deceased employee. Effective Date: May 9, 2017.

• Senate Bill 170
  The enacted legislation creates the Workers’ Compensation Workgroup; establishes the workgroup’s membership, chair and duties; addresses member compensation and requires the workgroup to present a final report. The workgroup will make recommendations on the following subjects: award of attorney fees, medical examinations by insurance carriers; general guideline for claims adjusters; medical panel utilization and consistency; dependent compensation; improving injured worker’s access to the Division of Industrial Accidents and other issues critical to the workers’ compensation system in Utah.  Effective Date:  May 9, 2017.

Vermont VIEW STATE →

REGULATORY ACTIVITY:

• Vermont has posted two rules to be amended.  The posting numbers are 17P007 and 17P008.  These amendments were posted on March 1st.  While these two postings do not directly impact workers' compensation they do address in Vermont drug issues that could be beneficial to workers' compensation.
• 17P007
  • Title: Regulated Drug Rule. Type: Standard. Status: Proposed. Agency: Department of Health
  • Legal Authority: 3 V. S. A. §§ 801(b) (11) and 3003; 18 V. S. A. §§ 4201 and 4202.
  • Summary: This rulemaking adds new drugs and other chemical substances that are illegal or judged to be potentially fatal or harmful for human consumption unless prescribed and dispensed by a professional licensed to prescribe or dispense them. Examples include acetylfentanyl, a lethal opioid, and newly emerged synthetic recreational drugs. The rule also establishes benchmark dosages for certain drugs to provide a baseline for use by prosecutors to seek enhanced penalties for possession .of higher quantities of the drug. The rule simplifies some language for clarity.  Persons Affected: Law enforcement, physicians prescribing stimulants, depressants and narcotics, individuals taking prescribed drugs, individuals in possession of regulated drugs and retail establishments that sell certain synthetic substances that are harmful or dangerous.  Hearing date: 03-31-2017 09:00 AM. Location: Vermont Department of Health, Room 3B. Address: 108 Cherry Street, Burlington, VT, 05402.  Comments can be submitted to Shayla Livingston Agency: Department of Health Address: 108 Cherry Street, Burlington, VT, 05402
  • Telephone: 802-863-7280; Fax: 802-951-1275; Email: vdhrules@vermont.gov Comments are due by April 7, 2017
• 17P008
  • Title: Rule for Medication-Assisted Treatment for Opioid Dependence. Type: Standard. Status: Proposed
  • Agency: Department of Health.  Legal Authority: 3 V.S.A. § 801(b) (11) and Section 14 Act 195 (2013).
  • Summary: This rulemaking expands capacity for the treatment of opioid dependence by allowing advanced practice registered nurses and physician's assistants to prescribe buprenorphine to individuals requiring and seeking treatment for opioid dependence. The rule also increases the number of patients a physician may treat from 100 to 275. Persons Affected: Individuals with opioid addiction and their families, physician's assistants, advance practice registered nurses, physicians, Opioid Treatment Programs, Vermont Department of Health, substance abuse treatment professionals, preferred providers, Vermont's designated agencies, and insurers. Hearing date: 03-31-2017 02:00 PM. Location: Vermont Department of Health, Room 3B. Address: 108 Cherry Street, Burlington, VT, 05402. Comments can be submitted to Shayla Livingston Agency: Department of Health Address: 108 Cherry Street, Burlington, VT, 05402
  • Telephone: 802-863-7280; Fax: 802-951-1275; Email: vdhrules@vermont.gov Comments are due by April 7, 2017.

Virginia VIEW STATE →

REGULATORY ACTIVITY:

• Posted an updated Medical Fee Schedule Project Timeline.
• Virginia has published the maximum compensation rate; minimum compensation rate and COLA rate that will become effective on July 1, 2017.  The maximum compensation rate will be $1,043.0.  The minimum compensation rate will be $260.7.  The COLA rate will be 2.05%.

LEGISLATIVE ACTIONS:

• House Bill 1571
  The enacted legislation provides that the pecuniary liability of an employer for a medical service provided for the treatment of a traumatic injury or serious burn includes liability for any professional service rendered during the dates of service of the admission or transfer to a Level I or Level II trauma center or to a burn center, as applicable. The measure increases the initial charge outlier threshold, which under the stop-loss feature allows hospitals to receive payments or reimbursements that exceed the fee schedule amount for certain claims, from 150 percent of the maximum fee for the service set forth in the applicable fee schedule to 300 percent of such amount. The measure allows the Workers' Compensation Commission to adjust the charge outlier threshold percentage; under existing law, it is allowed only to decrease the percentage. The measure also (i) expands the definition of codes, as used in the provision directing the Commission to establish fee schedules for scheduled medical services, to include revenue codes, which are defined in the bill; (ii) clarifies the definition of "HCPCS codes"; (iii) directs the Commission to use the regulatory advisory panel on all matters involving or related to the fee schedule as deemed necessary by the Commission; (iv) adds a definition of "new type of technology"; and (v) extends the deadline by which the regulatory advisory panel is required to meet, review, and make recommendations to the Commission from July 1, 2017, to July 1, 2018. The bill contains an emergency clause. Effective Date: March 13, 2017.
• House Bill 1659 and Senate Bill 1175
  The enacted legislation requires that any arbitration proceeding regarding the exercise of an employer's right of subrogation to an employee's claim against a third party shall be limited solely to arbitrating the amount and validity of the employer's lien and shall not affect the employee's rights in any way. Such arbitration shall not be held unless (i) any contested expenses remaining have been submitted to the Virginia Workers' Compensation Commission (the Commission) for a determination of their validity and the Commission has made such determination of validity prior to the commencement of the arbitration; (ii) prior to the commencement of such arbitration the employer has provided the injured employee and his attorney, if any, with an itemization of the expenses associated with the lien that is the subject of the arbitration; (iii) upon receipt of the itemization of the lien, the employee shall have 21 days to provide a written objection to any expenses included in the lien to the employer, and if the employee does not do so any objections to the lien to be arbitrated shall be deemed waived; and (iv) the employer shall have 14 days after receipt of the written objection to notify the employee of any contested expenses that the employer does not agree to remove from the lien, and if the employer does not do so any itemized expense objected to by the employee shall be deemed withdrawn and not included in the arbitration. Effective Date: July 1, 2017.
• Senate Bill 904
  The enacted legislation provides an exception from the prohibition against carrying a weapon into courthouses in the Commonwealth for a commissioner or deputy commissioner of the Workers' Compensation Commission while in the conduct of official duties. Effective Date: July 1, 2017.
• Senate Bill 1201
  The enacted legislation authorizes the Workers' Compensation Commission to require an employer to provide funds for the purchase of a suitably equipped automobile for an incapacitated employee if it finds that it is medically necessary and that modification to the employee's automobile are not technically feasible or will cost more than the funds available for a replacement automobile. The total of the costs of the automobile and of any bedside lifts, adjustable beds, and modification of the employee's principal home are limited to $42,000, which is the amount of the existing cap on expenses for modifications to the injured employee's automobile and home. Effective Date: July 1, 2017.

Washington VIEW STATE →

FEE SCHEDULE NEWS:

• The state has released and update to their fee schedule adding 16 new HCPCS codes/fees for Non- Facility and Facility effective April 1, 2017.  To view the payment and billing manual go to:
  http://www.lni.wa.gov/ClaimsIns/Providers/Billing/FeeSched/2016/policy2016.asp.  The next update to the fee schedule is expected to become effective July 1, 2017.

REGULATORY ACTIVITY:

• Washington has published proposed rule language for Prescription Drug Program & Interchangeable Biologics (Chapter 296-20 WAC, Medical Aid Rules). The purpose of this rulemaking is to update Chapter 296-20 WAC, Medical Aid Rules. This rulemaking will amend rules that are now inconsistent with Engrossed Senate Bill 5935 (Chapter 242, Laws of 2015), a new law related to interchangeable biologics, and new rule language from the Washington State Health Care Authority (HCA) related to the Washington State Prescription Drug Program (PDP). The proposed language will also incorporate by reference the provisions of the therapeutic interchange in HCA’s WAC 182-50-200. The proposed rule language will accomplish the following: - WAC 296-20-03011 will be amended to include new content regarding “interchangeable biologics” that is explicitly and specifically dictated by ESB 5935, now codified in statute in RCW 69.41.110. - Definitions in WAC 296-20-01002 will be amended to be consistent with recently amended definitions by the HCA regarding Washington State’s PDP. HCA definitions will be adopted without material change. - Language in WAC 296-20-03011 also will incorporate by reference the HCA’s rules for therapeutic alternatives and the therapeutic interchange. This will allow the department’s rules on this program to be consistent with HCA language now and for future HCA amendments.

Wyoming VIEW STATE →

REGULATORY ACTIVITY:

• Wyoming Worker's Compensation has partnered with Corvel Corporation for prescription benefit management, effective March 1, 2017.
• Wyoming has published new ACP Guidelines for Nonradicular Low Back Pain.
• Wyoming Workers’ Compensation has received concerns regarding the recent, unexpected change in reimbursement for pharmacy services. “We are currently working with both the Wyoming Pharmacy Association and our vendor Corvel/CVS Caremark to resolve this issue. The goal is to re- establish a price model that is fair and balanced to all parties; Wyoming pharmacies and the employers in the state of Wyoming, who ultimately pay the premiums. To that end, we have set a series of three meetings across the state where we will meet with pharmacy representatives in a collegial, problem solving approach. Please feel free to join us at one of these meetings and help us identify a solution. The meetings are: •  March 28th at the Riverton Workforce Center,  422 E. Fremont Avenue at 11:00 am •  March 31st at the Sheridan Workforce Center, 247 Grinnell Plaza, Suite 200 at 9:00 am •  March 31st at the Casper Labor Standards Conference Room, 851 Werner Court,  at 12:30 pm.  In the interim, we will reimburse transactions as per the Wyoming Workers’ Compensation Rules & Regulations, CHAPTER 9 – FEE SCHEDULES, Section 6. Fees for Pharmacy Items. (a)  Pharmaceuticals shall be reimbursed at the lower of: (i) Average Wholesale Price (AWP) minus 10% plus a $5.00 dispensing fee; or (ii) The provider’s usual and customary charge. In no case shall any provider bill for charges greater than those charged to the general public for like services. The Division reserves the right to review such charges and reimburse at the usual and customary rate if a discrepancy is found.  Please forward any questions or concerns to Rae Anne White RN, Nurse District Manager at 307-777-8219 or Fax 307-777-8724. “

LEGISLATIVE ACTIONS:

• House Bill 84
  The enacted legislation relates to labor and employment; providing for the discretionary recovery of delinquent worker's compensation payments by civil action; providing for the recovery of delinquent payments through installment agreements as specified; modifying the interest rate for delinquent premium. Effective Date: July 1, 2017.
• House Bill 111
  The enacted legislation relates to worker's compensation; providing that county governments or county governmental entities may establish a collective system for managing worker's compensation claims and benefits; requiring rulemaking. Effective Date: July 1, 2017.
• Senate File 89
  The enacted legislation relates to labor and employment; providing for a rebuttable presumption of disabilities for firefighters; listing subject diseases; providing eligibility for specified benefits to which the presumption applies; outlining criteria for presumptions; providing rulemaking authority; specifying applicability; and providing for an effective date. Effective Date: March 3, 2017.
• Senate File 167
  This bill amends the statute providing discounts to the workers’ compensation rates paid by employers. It increases the discount an employer receives for participating in an approved drug and alcohol testing program from five percent (5%) to ten percent (10%), and increases the total of all discounts an employer can receive from twenty-five percent (25%) to thirty percent (30%). The bill provides for an out-of-state employer beginning new operations in Wyoming to receive an experience modification rating based on the employer's out of state operations. This rating affects how much the employer's workers’ compensation rate will be based on its claim history. The bill allows the Department of Workforce Services to require out-of-state employers to submit any necessary information for the purpose of determining the employer's experience modification rating. The Department is authorized to promulgate rules for this purpose. The bill requires the Department of Workforce Services to establish a workers’ compensation premium credit for employers who made all required workers’ compensation payments for calendar year 2016. This credit will be in an amount determined by the Department and can be used by employers towards their premium obligations between July 1 and December 31, 2017. The Department will implement the premium credit through its rulemaking authority under W.S. 27-14-201(q). Effective Date:  July 1, 2017.