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Alaska VIEW STATE →

REGULATORY ACTIVITY:

Colorado Auto VIEW STATE →

REGULATORY ACTIVITY:

Connecticut VIEW STATE →

REGULATORY ACTIVITY:

  • Published memorandum number 2018-01 regarding the 2018 WCC Hospital and Ambulatory Surgical Center Fee Schedule. To view the memorandum, go to:  http://wcc.state.ct.us/memos/2018/2018-01.htm.
  • Published updated Compensation Review Board (CRB) Calendars.  The calendars were updated on January 8, 2018.  To access the updated calendars, go to: http://wcc.state.ct.us/crb/calendars/calendars.htm.
  • The mileage reimbursement rate for all travel expenses incurred on or after January 1, 2018 has risen to 5 cents per mile. This rate change applies to all claimants, regardless of injury date, and coincides with the federal mileage reimbursement rate pursuant to Section 31-312(a) of the Workers’ Compensation Act. To view current and historic information on reimbursement, go to http://wcc.state.ct.us/gen-info/rec-legis/01-mileage.htm

Delaware VIEW STATE →

FEE SCHEDULE NEWS:

  • The state has adopted their new medical and facility fee schedule with an effective date of January 31, 2018. The next update is scheduled for January 31, 2019.

Florida WC VIEW STATE →

REGULATORY ACTIVITY:

  • Has published adopted rules that become effective January 18, 2018.  The two rules are:
  • Posted notice of proposed rule regarding anti-fraud prevention standards.  The proposed changes are to 69D-2.002, 2.003 and 2.005. The proposed amendments will implement the changes to Section 626.9891, F.S., enacted by Chapter 2017-178, Laws of Florida, establishing uniform anti-fraud prevention standards applicable to all insurers. Section 626.9891, F.S., requires all insurers to establish and maintain an anti-fraud investigation unit, or to contract for such services, and to submit an anti-fraud plan to the Department.  Rule 69D-2.002, F.A.C., adds definitions of the terms “anti-fraud investigative unit,” “Commission,” and “designated anti-fraud unit or division.” Rule 69D-2.003, F.A.C., adopts a form that an insurer can use to comply with the anti-fraud plan filing requirements of Section 626.9891, F.S. Rule 69D-2.005, F.A.C., is amended to reflect statutory changes.   The notice and full text of the proposed rule can be viewed at https://www.flrules.org/gateway/ruleNo.asp?id=69D-2.002.

Idaho VIEW STATE →

REGULATORY ACTIVITY:

  • Posted in the register published on January 3, 2018 notice of action on various rules proposed in 2017.  Notice of Adoption was published for  rules 17.02.04-Administrative Rules of Industrial Commission Under the Workers' Compensation Law benefits; 17.02.07 Procedures to Obtain Compensation; 17.02.08 Miscellaneous Provisions; 17.02.10 Administrative Rules of the Industrial commission Under the Workers' Compensation Law Security for Compensation Insurance Carriers; and 17.02.11 Administrative Rules of the Industrial commission Under the Workers' Compensation Law Security for Compensation Self-Insured Employers.  Also published in the register was notice of vacating proposed rulemaking for 17.02.04 docket no 17-204-1702.

Indiana VIEW STATE →

REGULATORY ACTIVITY:

  • Denial of a Provider Fee Application or refusal to pay a bill from a medical provider for authorized care provided to an injured worker based solely on 631 IAC 1-1-32 (2)(A)(i) is improper.  Provisions in the Indiana Administrative Code are rules authorized by IC 22-3-1-3 to assist the Board in carrying out the Worker’s Compensation Act. Medical providers may go to https://wcbnec03.wcb.state.in.us/jcn.asp available through the Board’s online services to ascertain the name of an injured worker’s employer, worker’s compensation insurance carrier and that carrier’s claim identification number, when available.  No audio or visual recording may be made of any worker’s compensation hearing, conference or proceeding. Social security numbers (SSN) of injured workers must be redacted from all documentation prior to submission to the Board. The Application for Adjustment of Claim is the only exception to this requirement.

Kentucky Auto VIEW STATE →

REGULATORY ACTIVITY:

Louisiana Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Issued Bulletin 2018-01 which rescinds Bulletin 2011-04 and Bulletin 2012-02. All surplus lines insurers, brokers, producers, and policyholders independently procuring surplus lines insurance are hereby given notice that Bulletin No.  2011-04, issued on December 29, 2011, and Bulletin No.  2012-02, issued on June 14, 2012, are rescinded.  To view the bulletin go to: https://ldi.la.gov/docs/default-source/documents/legaldocs/bulletins/bul2018-02-cur-licensingcontactsupdate
  • Published notice in the state register regarding a proposed rule. In accordance with R.S. 49:950 et seq., the Administrative Procedure Act, and through the authority granted under R.S. 22:1 and 22:11, et seq., the Department of Insurance has adopted Regulation 109 to implement the provisions of Act 154 of the 2017 Regular Session of the Louisiana Legislature, specifically R.S. 22:821(B)(3)  and 22:1546(B)(1)(a),  in  addition  to  22:1547(C)(1),  22:255, 22:1545,  22:1554,  22:1558,  22:1563,  22:1671,  22:1694, 22:1808.8  and  22:1922  which  provide  for  the  licensing  of insurance  producers,  claims  adjusters,  public  adjusters, insurance  consultants  and  the  licensing  of  business  entities as insurance producers. To view the notice, go to: https://ldi.la.gov/docs/default-source/documents/legaldocs/regulations/reg109-cur-produceradjusterandr.
  • Issued Bulletin 2018-02 regarding licensing contacts update. The purpose of Bulletin 2018-02 is to inform all risk bearing entities of the requirements of Act 10 of the 2017 Regular Session of the Louisiana Legislature. Beginning January 1, 2018, all risk bearing entities must provide accurate contact information to the Commissioner and shall annually certify via electronic means the accuracy of the name, mailing address, phone number, and electronic mail address of individuals appointed as their respective contact representative. Additionally, Act 10 of the 2017 Regular Session requires risk bearing entities to inform the Commissioner within thirty days of any change in the information required by Act 10 of the 2017 Regular Session of the Louisiana Legislature. You may find a list of "risk bearing entities" in La. R.S. 22:48. To view a copy of the bulletin, go to: https://ldi.la.gov/docs/default-source/documents/legaldocs/bulletins/bul2018-02-cur-licensingcontactsupdate.

Maryland VIEW STATE →

REGULATORY ACTIVITY:

  • Published the calendar year 2018 benefits rate information.
  • Legal practitioners:  In an effort to reduce the volume of rejected settlements at the intake stage, the Commission is requesting that attorneys carefully review all settlements and ensure that they are accurate and completed properly prior to submitting them. Common errors seen are missing signatures, incorrect insurer, wrong claim number or date of accident. Also, please be sure to answer ALL questions on the Settlement Worksheet. If you have any questions, please contact the Settlement Intake section at 410-864-5364 or email obowman@wcc.state.md.us.
  • Updating courtroom Audio/Visual equipment—new requirements to play videos:  “The Commission is in the process of replacing current televisions in the courtrooms with modern flat-screen televisions. We are also began replacing the DVD/VCR players with Peerless-AV PeerAir HDS300 Pro Wireless AV Multi-Display Systems. This new technology will allow the Commission to better adapt to changing technology and video formats. All media will be played from your laptop computer. You will connect your computer to the Peerless system via either HDMI or VGA cable and the Peerless system will display your computer on the flat-screen for viewing. A laptop with software to play your video(s) is required for the videos to be played on the courtroom television. The Peerless system does not contain a “player;” it is simply transmitting your computer display to the television; for example, video files on a USB drive will be plugged into your computer to be played. Please make sure any files you intend to show will play correctly on your computer. HDMI and VGA cables, as well as Thunderbolt Mini Display Port DP convertors for Apple laptops, will be provided by the Commission. We are rolling out this new technology in phases and web notices will post as equipment is replaced in each site. As of January 26, 2018, the equipment at each site is as follows: Peerless system (connect your laptop to the courtroom television to play videos) – Abingdon; DVD/VCR (videos must be on DVD or VHS tape to play on the courtroom television) - Baltimore, Beltsville. Cambridge, Frederick, LaPlata. “
  • A copy of all petitions for judicial review must be served on the Worker’s Compensation Commission, in accordance with Labor and Employment Article, § 9-737, Annotated Code of Maryland, and the Maryland Rules, 7-201, and 7-202(d) (2). For more information please visit http://www.dsd.state.md.us/comar/comarhtml/14/14.09.11.01.htm

Massachusetts VIEW STATE →

REGULATORY ACTIVITY:

  • Published notice of public hearing for rules 101 CMR 316.00 Surgery and Anesthesia; 101 CMR 317.00 Medicine, and 101 CMR 318.00 Radiology.
  • Pursuant to the authority of M.G.L. c. 118E and in accordance with M.G.L. c. 30A, a public hearing was held at 9:30 a.m. on Tuesday, January 23, 2018, in the First Floor Conference Room, 100 Hancock Street, Quincy, MA 02171, relative to the adoption of amendments to: 101 CMR 345.00: Temporary Nursing Services. M.G.L. c. 118E, § 13D, requires the Executive Office of Health and Human Services (EOHHS) to annually establish by regulation the limit for the rates for services provided by temporary nursing agencies registered with the Department of Public Health (DPH) to licensed hospitals and nursing facilities. The proposed amendments to 101 CMR 345.00 are in accordance with this statutory requirement. The proposed amendments establish the rate limits for temporary nursing agency services for each geographic region as purchased by hospitals and nursing facilities effective May 1, 2018. The rate limits were developed through analysis of 2014 cost data provided by facilities for the wage component, and 2014 cost data provided by temporary nursing agencies for the administrative component and profit factor, and include rates for registered nurses, licensed practical nurses, and certified nursing assistants. The rate limits include an allowance for wages, payroll taxes, and fringe benefits, in accordance with statutory requirements. The wages incorporate a cost adjustment factor (CAF) of 6.18% based on the Massachusetts consumer price index and incorporate an adjustment to the shift differentials by a CAF of 5.84% for hospitals based on Massachusetts Hospital Association Hospital Salary Survey for 2015, and a CAF of 5.52% for nursing facilities based on Massachusetts Senior Care Association Annual Employment Survey for 2015. The final regional hourly rate limits for hospitals and nursing facilities were determined by combining the median wages with an administrative component of 35.43% and profit factor of 5.31%, as derived from cost data.
  • Published Bulletin 18-2 regarding 101 CMR 206.00 Standard Payments to Nursing Facilities.  To view the bulletin, go to : http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/adminbull-2017/ab-18-02.pdf
  • Published bulletin 18-03 regarding rule 101 CMR 512.00 Nursing Facility User Fees: Offset Procedures for Non-Payment of User Fees. The bulletin has a retro effective date of January 26, 2018.  To view a copy of the bulletin, go to: http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/adminbull-2017/ab-18-03.pdf.

Michigan Auto VIEW STATE →

REGULATORY ACTIVITY:

Minnesota VIEW STATE →

REGULATORY ACTIVITY:

  • The Minnesota Department of Labor and Industry is considering amendments to Minnesota Rules 5220.1400 through 5220.1700 concerning vocational rehabilitation. A draft of the possible amendments was recently added and can be accessed from the workers' compensation rulemaking docket webpage in "Minnesota Rules, Chapter 5220; Workers' compensation vocational rehabilitation". A copy of the notice can be viewed at: http://www.dli.mn.gov/RulemakingWC.asp. To view the rule, go to: dli.mn.gov/Pdf?docket/5220draft1410-1700.pdf.

Minnesota-Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Issued Bulletin 2018-1 regarding market analysis, disaster planning, preparedness and response.  This bulletin is directed to all property and casualty insurers licensed in the state of Minnesota.  To view the bulletin go to  http://mn.gov/commerce-stat/pdfs/bulletin-2018-1.pdf.

Mississippi VIEW STATE →

REGULATORY ACTIVITY:

  • Adopted amendments to rules 20 Miss. Admin. Code Chapter 1, 1.1, 1.15, 2.1 and 2.25. The rules are effective January 1, 2018.  To view the rules, go to: http://www.sos.ms.gov/adminsearch/ACProposed/00023078b.pdf.
  • Announced a change in their EDI requirements table.  The requirement for DN 0025 Industry code has changed for the FROI 00 and 04 to “MC” (Mandatory/Conditional). To allow for any programming change that may be necessary, the effective date is June 29, 2018. If you already have this data, please begin to send it in as soon as possible. Please see MS FROI Data Element Requirement table below.  To view the requirements table, go to:  https://mwcc.ms.gov/#/electronicDataInterchange.
  • The Mississippi Attorney Transmittal Online System (ATOS) became mandatory on January 1, 2018.  To register go to: https://www.mwcc.ms.gov/atos/#/register.

Missouri VIEW STATE →

REGULATORY ACTIVITY:

Nebraska VIEW STATE →

REGULATORY ACTIVITY:

  • The court's revised Rules of Procedure document is available in portable document format (pdf). Amendments to the court's non-adjudicatory Rules 26 and 47 and Addendum 2 were adopted at a Dec. 13, 2017 public meeting. To view the rules, go to: http://www.wcc.ne.gov/legal/statutes.aspx#rules
  • Effective Jan. 1, 2018, the mileage rate will become 54.5 cents per mile for travel to seek medical treatment or while participating in a vocational rehabilitation plan. This conforms to the reimbursement rate paid to State of Nebraska employees.
  • The court's revised Rules of Procedure are now available in portable document format (pdf). Amendments to the court's adjudicatory Rule 15 were adopted at a Dec. 13, 2017 public meeting and were approved by the Nebraska Supreme Court on Jan. 17, 2018. Amendments to the court's non-adjudicatory Rules 26, 47, and Addendum 2 were adopted at a Dec. 13, 2017 public meeting. To view the adopted rule amendments, go to https://www.wcc.ne.gov/legal/statutes.aspx.  To view a copy of the complete rules of procedure as revised go to: https://www.wcc.ne.gov/publications/rules.pdf.

Nevada VIEW STATE →

FEE SCHEDULE NEWS:

  • The Division of Industrial Relations of the Department of Business and Industry in Nevada has revised their fee schedule to use the most recent editions of the Relative Value for Physicians, Relative Value Guide of Anesthesiologists, Medicare’s current reimbursement for HCPCS codes K and L, ASC Hospital Outpatient Group List 2016 and the Nevada Specific Codes with an effective date of February 1, 2018. The next expected update is scheduled for February 1, 2019.

New Jersey No-Fault VIEW STATE →

REGULATORY ACTIVITY:

LEGISLATIVE ACTIONS:

  • Assembly Bill 3402
  • The enacted legislation mandates that auto insurance payers of medical bills must be able to accept the bills electronically from the providers. All providers must submit medical bills electronically if they submit more than 25 bills monthly.  The legislation requires the use of the ASC X12 005010 format. The legislation became effective January 16, 2018 and all parties subject to the legislation must comply no later than September 16, 2019.  Effective Date January 16, 2018.

New York VIEW STATE →

REGULATORY ACTIVITY:

  • Posted proposed rule regarding an option to Self-Insure the Jockey Fund.

North Carolina VIEW STATE →

REGULATORY ACTIVITY:

  • Beginning January 2, 2018, workers’ compensation Opinions and Awards will be served via e-mail to the attorney of record. Certified mail will only be used to provide notice when an attorney’s e-mail address is unknown or when the party is appearing pro se. These changes are in response to N.C. Sess. Law 2017-57, Sec. 15.17’s amendments to N.C. Gen. Stat. § 97-86 and are designed to realize cost savings and institute a more efficient method for providing notice.
  • Has posted notice of amendment to existing rules and new rules.
  • The Commission posted notice regarding proposed changes to the Computation of Time and Notice by the Commission, Rule 04 NCAC 10A .0107, including the public hearing date and the written comment period for the proposed rule amendment.  The Commission will hold a public hearing on Friday, March 2, 2018, at 10:30 a.m. in Room 240, 2nd Floor, Department of Insurance, Albemarle Building, 325 North Salisbury Street, Raleigh, NC 27603. The Commission will also accept written comments on the proposed rule through March 19, 2018
  • The Commission posted notice regarding nine proposed rules for the utilization of opioids, related medications, and pain management treatment in workers’ compensation claims. This notice includes information on the public hearing and the written comment period for the rules proposed for adoption.  The Commission will hold a public hearing on Friday, March 2, 2018, at 2:30 p.m. in Room 240, 2nd Floor, Department of Insurance, Albemarle Building, 325 North Salisbury Street, Raleigh, NC 27603. The Commission will also accept written comments on the proposed rule through March 19, 2018.

Ohio VIEW STATE →

FEE SCHEDULE NEWS:

  • A new Inpatient fee schedule effective February 1, 2018 has been published.  The next expected update to the Inpatient schedule will be February 2019.

REGULATORY ACTIVITY:

  • Has posted notice of a packet of rules being considered for review:

-Package Title: BWC Fee Schedule Rules -Rule Numbers: 4123-6-08 Bureau fee schedule. 4123-6-21.3 Outpatient medication formulary. 4123-6-37.2 Payment of hospital outpatient services. 4123-6-37.3 Payment of ambulatory surgical center services.

Oklahoma VIEW STATE →

REGULATORY ACTIVITY:

  • Has posted Notice of intent to amend Title 810 Oklahoma Workers' Compensation Commission Chapter 10 Practice and Procedure rule and Chapter 25. Pursuant to 85A O.S. §101, the Commission is required to implement an electronic data interchange (EDI) system. The Commission permanent rules, now in effect, establish a mandatory EDI implementation date of January 1, 2018. Numerous entities have requested additional time to implement and test a new EDI system. The Commission has also learned that the International Association of Industrial Accident Board and Commissions (IAIABC) Release 3.1 standards will be released in August 2018.The proposed revisions change the mandatory EDI implementation date from January 1, 2018 to September 1, 2018. The proposed delay in EDI implementation will accommodate those requesting additional time to implement EDI and will allow the Commission to adopt the most recent standards.  A public hearing will be held at 1:30 p.m. on Tuesday, February 20, 2018 in Commission Chambers on the 2nd floor of the Denver N. Davison Building, 1915 N. Stiles Avenue, Oklahoma City, Oklahoma.  The proposed rule can be viewed HERE
  • Is accepting comments to proposed permanent rules through February 16, 2018. The proposed rules are Chapter 1 General Information, Chapter 10 Practice and Procedures and Chapter 25 Workers' Compensation Insurance and Self Insurance.  The proposed rules can be viewed at https://ok.gov/wcc/documents/Proposed%20Permanent%20Rules%20for%20posting%201-16-18.pdf.
  • Published an alert regarding Commission rulemaking and form revisions. This alert is issued to inform that the Workers' Compensation Commission is in the process of promulgating Permanent Rules and revising its forms. A copy of the Commission’s proposed rules and forms are available to view on the Commission's website at https://ok.gov/wcc/Legal/Governing_Documents_/index.html.  Rules changes are summarized in the respective Notices of Rulemaking Intent found at the same link.  Forms revisions include changes consistent with the Commission’s current rules and statutes, adoption of a new CC-Form 50 Medical Interlocutory Order Request form in accordance with 85A O.S., § 50(I) and O.A.C. 810:15-5-4, and repeal of obsolete forms (CC-Form 211 and Subject Line Authorization form). If you have any comments you would like to submit to the Commission regarding the proposed rules or changes to its forms, you may email them to rules@wcc.ok.gov through Friday, February 16, 2018. A public hearing will be held at 1:30 p.m., Tuesday, February 20, 2018, in Commission Chambers on the 2nd floor of the Denver Davison Building, Oklahoma City, OK.  To view the alert, go to:  https://ok.gov/wcc/documents/Alert%20Regarding%20Commission%20Rulemaking%20%20%26%20Forms%201-17-18.pdf.
  • Proposed amendments to rules and forms. Comments for the proposed rules and forms will be accepted through February 16, 2018. Rules to be amendment are Chapter 1; Chapter 10; and Chapter 25. A substantial number of forms are proposed to being changes. The forms being proposed are:
    • Proposed CC-Form-2
    • Proposed CC-Form-2A Extension
    • Proposed CC-Form-2A
    • Proposed CC-Form-3
    • Proposed CC-Form-3A
    • Proposed CC-Form-3B
    • Proposed CC-Form-3C
    • Proposed CC-Form-3F
    • Proposed CC-Form-4
    • Proposed CC-Form-5
    • Proposed CC-Form-9
    • Proposed CC-Form-10
    • Proposed CC-Form-10A
    • Proposed CC-Form-10C
    • Proposed CC-Form-13
    • Proposed CC-Form-20
    • Proposed CC-Form-36
    • Proposed CC-Form-40
    • Proposed CC-Form-50
    • Proposed CC-Form-71
    • Proposed CC-Form-93
    • Proposed CC-Form-99
    • Proposed CC-Form-100
    • Proposed CC-Form-300
    • Proposed CC-Form-A
    • Proposed CC-Form-M
    • Proposed CC-Form-V
    • Proposed CC-Joint Petition
    • Proposed Death Claim Settlement Order
    • Proposed Form-SI Employer Permit
    • Proposed Form-SI Group Permit
    • Proposed Form-SI-TPA Permit
    • Proposed JP-APPENDIX
    • Proposed MFDR Form 10M
    • Proposed MFDR Form 19
    • Proposed WC Premium Tax Report Form
  • To view the rules and forms being proposed, go to: https://ok.gov/wcc/Legal/Governing_Documents_/index.html

Oregon VIEW STATE →

REGULATORY ACTIVITY:

Pennsylvania WC VIEW STATE →

REGULATORY ACTIVITY:

  • Based upon the Statewide Average Weekly Wage, as determined by the Department of Labor and Industry for the fiscal year ending June 30, 2017, the maximum compensation payable under sections 105.1 and 105.2 of the Workers' Compensation Act (77 P.S. §§ 1 and 25.2) shall be $1,025 per week for injuries occurring on and after January 1, 2018. For purposes of calculating the update to payments for medical treatment rendered on and after January 1, 2018, the percentage increase in the Statewide Average Weekly Wage is 3.0%.

South Carolina VIEW STATE →

REGULATORY ACTIVITY:

  • Pursuant to Reg. 67-1605(E)(5) the Net Present Value (NPV) Tables for 101 through 500 weeks are calculated at the yield-to-maturity rate of the Five-Year U. S. Treasury Note reported by the Federal Reserve on the first business day following January 1. The regulation further states the discount rate shall not exceed six percent or be less than two percent.  The Five-Year Treasury published by the Federal Reserve on January 2nd, 2018 was 2.25%. Therefore, the Net Present Value Table for weeks one through 100 shall be calculated using a discount rate of two percent (2%).  The Net Present Value Table for weeks 101 through 500 shall be calculated using a discount rate of two and one-fourth (2.25%) percent.  The present value of the commutable weeks shall be determined based on the present value tables in effect on the date of the award or settlement. This notice may be viewed HERE
  • Issued notice of mandatory workers' compensation LCM Filings and Second Injury Fund Assessments. The notice was filed on January 30, 2018. To view the notice, go to https://doi.sc.gov/DocumentCenter/View/10632

Tennessee VIEW STATE →

FEE SCHEDULE NEWS:

  • The Tennessee Labor and Workforce Development has made revisions to Rule 0800-02-17 Rules for Medical Payments, Rule 0800-02-18 Medical Fee Schedule and Rule 0800-02-19 Inpatient Hospital Fee Schedule that become effective on February 25, 2018.  Most notable is the adoption of the Medicare Home Health PPS for the reimbursement of home health services and updated inpatient hospital per diem rates.

REGULATORY ACTIVITY:

Texas VIEW STATE →

REGULATORY ACTIVITY:

  • DWC Finalizes the Medical Quality Review CY 2018 Annual Audit Plan. To view the plan, go to: http://www.tdi.texas.gov/wc/hcprovider/medadvisor.html
  • The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) is accepting public comments on proposed rules to amend 28 Texas Administrative Code (TAC) §§500, 134.530, and 134.540. Proposed amendments to §134.500 will exclude all prescription drugs created through compounding.  Proposed amendments to §§134.530 and 134.540 will require preauthorization of these drugs for claims subject to and not subject to certified networks. The proposed rule change does not prohibit the use of compounded drugs for injured employees when medically necessary; however, it does require that the medical necessity be determined prior to dispensing these drugs. To view the proposed rule, go to: http://www.tdi.texas.gov/wc/rules/2018rules.html
  • Published in the state register that the Texas Department of Insurance, Division of Workers' Compensation (division) proposes to amend 28 Texas Administrative Code (TAC) §134.500, Definitions; and proposes conforming amendments to 28 TAC §134.530, Requirements for Use of the Closed Formulary for Claims Not Subject to Certified Networks; and 28 TAC §134.540, Requirements for Use of the Closed Formulary for Claims Subject to Certified Networks. The proposed changes amend the definition of the closed formulary to exclude any prescription drug created through compounding, and to require preauthorization for all prescription drugs created through compounding.  The Texas Department of Insurance, Division of Workers' Compensation (division) proposes to amend 28 Texas Administrative Code (TAC) §134.500, Definitions; and proposes conforming amendments to 28 TAC §134.530, Requirements for Use of the Closed Formulary for Claims Not Subject to Certified Networks; and 28 TAC §134.540, Requirements for Use of the Closed Formulary for Claims Subject to Certified Networks. The proposed changes amend the definition of the closed formulary to exclude any prescription drug created through compounding, and to require preauthorization for all prescription drugs created through compounding.  To view the posting in the register go to http://www.sos.state.tx.us/texreg/archive/January192018/Proposed%20Rules/28.INSURANCE.html#26. 
  • Posted notice of informal rule posting regarding amendments to 28 TAC §134.230, and §134.600 concerning Return to Work Rehabilitation Programs and Preauthorization, Concurrent Utilization Review, and Voluntary Certification of Health Care.  To view the notice, go to: HTTP.  To view the rule go to: file:///D:/State%20Regulations/Texas/2018%20Proposed%20Rules/Texas%20Proposed%20drcarf0118.pdf.

  • The Texas Department of Insurance, Division of Workers’ Compensation (TDI‐DWC) is accepting comments on the proposed Fiscal Year 2018 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 §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.

  • Under Texas Labor Code §405.0025, the REG is charged with conducting professional  studies and research related to:  1) the delivery of benefits; 2) litigation and controversy  related to workers’ compensation; 3) insurance rates and ratemaking procedures; 4)  rehabilitation and reemployment of injured employees; 5) the quality and cost of medical  benefits; 6) employer participation in the workers’ compensation system; 7) employment  health and safety issues; and 8) other matters relevant to the cost, quality, and operational  effectiveness of the workers’ compensation system. 

    If you wish to comment on the proposed Fiscal Year 2018 research agenda or request a public hearing, you must do so in writing no later than 5 p.m. CST on Tuesday, February 20, 2018.  A hearing request must be on a separate page from any written comments.  The Texas Department  of Insurance Division of Workers’ Compensation requires two copies of your comments or hearing request.  Send one copy by mail to:  Maria Jimenez Office of General Counsel MS – 15 Texas Department of Insurance, Division of Workers’ Compensation 7551 Metro Center Drive, Suite 100 Austin, Texas 78744 – 1645 or by email to rulecomments@tdi.texas.gov.   Send the other copy by mail to:  D.C. Campbell Director of the Workers’ Compensation Research and Evaluation Group Texas Department of Insurance Mail Code 107‐WC P.O. Box 149104 Austin, Texas 78714‐9104.  To view a copy of the proposed research agenda, go to: http://www.tdi.texas.gov/wc/regulation/roc/documents/agendafy18pro.pdf

  • Has published notice in the state register of proposed changes to 28 TAC Section 110.15 Requires Notices of Coverage; TAC Section 101, 112.102, 112.201, and 112,202 Scope of Liability for Compensation; TAC section 130.10, 130.101 and 130.102 Impairment and Supplemental Income Benefits; TAC 136.1 and 136.2 Benefits Vocational Rehabilitation.  To view a copy of the notices published, go to http://www.sos.state.tx.us/texreg/sos/index.html.
  • Has posted notice that the division has finalized the Lumbar Spine Magnetic Resonance Imaging (MRI) Plan-Based Audit.  On November 20, 2017, The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) solicited and received constructive input from workers’ compensation system participants on the proposed Lumbar Spine Magnetic Resonance Imaging (MRI) Plan-Based Audit (Plan-Based Audit).  TDI-DWC appreciates the input provided by system participants.  All comments were carefully considered and discussed.  The Commissioner of Workers’ Compensation W. Ryan Brannan, approved the Plan-Based Audit on January 23, 2018.  All medical quality reviews initiated on or after January 1, 2018, will follow the approved Medical Quality Review Process (Process) in effect.  The Process and Plan-Based Audit are posted on the TDI website at:  tdi.texas.gov/wc/hcprovider/medadvisor.html.  If you have any questions regarding this memo, contact Mary Landrum at 512-804-4814 or Mary.Landrum@tdi.texas.gov. To view a copy of the notice, go to:  http://www.tdi.texas.gov/wc/hcprovider/documents/mriaudit0118m.pdf

Utah No-Fault VIEW STATE →

FEE SCHEDULE NEWS:

  • The state has adopted a new fee schedule with an effective date of January 1, 2018. The next expected update is expected in January 2020.

Utah WC VIEW STATE →

REGULATORY ACTIVITY:

  • Proposed a new rule R982-800 regarding the Utah Data Research Center.  The purpose of this proposed rule is to set forth procedures governing the submission of data research requests to the Utah Data Research Center (Center), to establish criteria for how the Center will prioritize the data research requests it receives, and to set minimum standards for the information that must be included in a data research request.

Vermont VIEW STATE →

REGULATORY ACTIVITY:

West Virginia VIEW STATE →

REGULATORY ACTIVITY:

  • Pursuant to West Virginia Code§ 23-4-8(d) and (e), workers' compensation claimants are entitled to reimbursement for among other things, mileage driven “in connection with medical examinations, appointments and treatments, including appointments with the claimant's authorized treating physician."  Under§ 23-4-8(e), the reimbursement rate for mileage payable to a workers’ compensation claimant is equal to the rate determined by the West Virginia Department of Administration’s Purchasing Division Travel Rules for State employees.  In accordance with the West Virginia State Travel Rules, the state's mileage reimbursement rate for privately-owned vehicles adheres to the rate set by the United States General Services Administration ("GSA"). The State Travel Management Office of the West Virginia Department of Administration's Purchasing Division has announced that effective January 1, 2018, the state mileage reimbursement rate has increased to $0.545 per mile.  Accordingly, the West Virginia Offices of the Insurance Commissioner is issuing a notice to advise all private carriers, self-insured employers, and third-party administrators responsible for the administration of workers’ compensation claims in West Virginia that the rate of reimbursement to claimants for mileage driven under the provisions of West Virginia Code § 23-4-8(d) and (e) is also adjusted to $0.545 per mile, effective January 1, 2018.  Any questions regarding this notice should be directed to the OIC's Legal Division at (304) 558-0401 or legal@wvinsurance.gov.
  • Has published the 2017 claims data template for Self-Insureds. To view the template, go to: http://www.wvinsurance.gov/Home.aspx.



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