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Arizona VIEW STATE →

REGULATORY ACTIVITY:

  • Has posted notice of proposed amendments to its treatment guidelines. In 2012, the Arizona Legislature directed the Industrial Commission of Arizona (the “Commission”) to “develop and implement a process for the use of evidence-based treatment guidelines, where appropriate, to treat injured workers.” See A.R.S. § 23- 1062.03. With significant stakeholder input, the Commission promulgated twelve rules, published in Title 20, Chapter 5, Article 13 of the Arizona Administrative Code (“Article 13” or the “Treatment Guidelines”). Among other things, the Treatment Guidelines:
    • prescribe the use of evidence-based treatment guidelines as a tool to support clinical decision making and quality health care delivery to injured workers within Arizona’s workers’ compensation system;
    • adopted Work Loss Data Institute’s Official Disability Guidelines – Treatment in Workers Compensation (the “Official Disability Guidelines” or “ODG”) as the standard reference for evidence-based medicine;
    • until further action of the Commission, limited the applicability of ODG to the management of chronic pain and the use of opioids for all stages of pain management;
    • outlined an administrative process for the Commission to modify the applicability of ODG;
    • outlined a non-compulsory process for a medical provider or injured worker to seek preauthorization from a payer for medical services or treatment;
    • established an administrative review process to help resolve disputes between medical providers, injured workers, and payers; and
    • outlined procedures for bringing unresolved disputes to the Commission for administrative hearing. In 2017, the Arizona Legislature (in Section 5 of Senate Bill 1332 of the Fifty-Third Legislature, First Regular Session) directed the Commission to “review and determine a process for streamlining the authorization process for treatment that is within the evidence-based treatment guidelines.”
  • The Legislature required the Commission to complete the review process on or before December 31, 2017. Consequently, on June 29, 2017, the Commission directed its Medical Resource Office to: (1) conduct a review of the existing authorization process under the Treatment Guidelines; and (2) make a recommendation to the Commission regarding “streamlining the authorization process for treatment that is within the evidence-based treatment guidelines.” Stakeholders were provided opportunities to offer suggestions and comments regarding streamlining the authorization process, including during a public hearing conducted on August 17, 2017.  At its December 14, 2017 public meeting, the Commission completed its review of the existing authorization process.  Based upon suggestions submitted by interested stakeholders, the Commission approved the following methods for streamlining the Article 13 authorization process: 1. Develop and mandate the use of a Medical Treatment Preauthorization Form with accompanying instructions; and 2. Reduce the time period within which a player must respond to requests for preauthorization or reconsideration from ten business days to seven business days. To view the proposed rules, go to http://apps.azsos.gov/public_services/register/2018/11/04_proposed.pdf.

LEGISLATIVE ACTIONS:

House Bill 2025

The purpose of this bill is to establish regulations regarding rate filings for workers’ compensation insurance. The legislation prohibits an insurer from simultaneously applying a deviation and a schedule rating to the same insured risk. Effective Date February 28, 2018.

Arkansas VIEW STATE →

REGULATORY ACTIVITY:

  • Has published documentation regarding the drug formulary rule that will become effective July 1, 2018.  The documentation published is a copy of the final rule, bullet points and frequently asked questions and answers regarding the rule.  To view the rule and related documents, go to http://www.awcc.state.ar.us/drugformulary.html.

California VIEW STATE →

FEE SCHEDULE NEWS:

  • Medi-Cal rates have been released with an effective date of March 15, 2018. The next update is scheduled for April 15, 2018.
  • 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 2018 changes in the Medicare payment system as required by Labor Code section 5307.1.   The order, which is effective for services on or after April 1, 2018, adopts the Medicare DMEPOS fee schedule second release for calendar year 2018. The next update is expected July 2018.
  • The Division of Workers’ Compensation has posted a new update to the Physician and NCCI Edits data effective April 1, 2018. The next update is scheduled for July 2018.
  • The state has also adopted a new Outpatient and ASC fee schedule with an effective date of April 1, 2018. The next scheduled update is for July 2018.

REGULATORY ACTIVITY:

  • The Division of Workers’ Compensation (DWC) has posted an order adjusting the Ambulance Services section of the Official Medical Fee Schedule (OMFS) to conform to relevant 2018 changes in the Medicare payment system as required by Labor Code section 5307.1.  The order is the second Administrative Director order for the 2018 update to the Ambulance Services Fee Schedule. It adopts an updated public use file for 2018, which was issued on February 14, 2018, by the Centers for Medicare and Medicaid Services. The updated public use file implements legislative provisions of the Bipartisan Budget Act of 2018. The new legislation extends three temporary add-on provisions that would have expired on December 31, 2017. The Administrative Director Order dated February 28, 2018, adopts the updated public use file for services rendered on or after January 1, 2018, and can be found on http://www.dir.ca.gov/DWC/OMFS9904.htm
  • The Division of Workers’ Compensation (DWC) has posted adjustments to the hospital outpatient departments and ambulatory surgical centers section of the official medical fee schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1. The changes took effect March 15, 2018.   The public should take note of the following:
    • Recently added 42 C.F.R. section 419.71, Payment reduction for certain X-ray imaging services, became effective January 1, 2018. The OMFS adopts and incorporates by reference section 419.71, and related payment rules, addressing payment reduction for film X-ray imaging services and computed radiography imaging services.
    • Subdivision (a)(1) of section 9789.32 is corrected by deleting status indicator “Q4” from the table, for services rendered on or after December 15, 2016. Services assigned status indicator “Q4,” clinical laboratory services, are not considered a “supply, drug, device, blood product, or biological.” Thus, subdivision (a)(1) is not applicable to codes assigned status indicator “Q4.”
    • Composite APCs and comprehensive APCs payment rules are added and incorporated by reference by date of service. The adopted clarifying composite APCs and comprehensive APCs payment rules are declaratory of existing regulations.   More information and the adjustments to the hospital outpatient departments and ambulatory surgical centers section of the OMFS can be found at  http://www.dir.ca.gov/DWC/OMFS9904.htm.
  • The Division of Workers’ Compensation (DWC) has posted a correction to the Hospital Outpatient Departments/Ambulatory Surgical Centers portion of the Official Medical Fee Schedule. The correction, reflected in an Administrative Director order, replaces Table A found at Title 8, California Code of Regulations, section 9789.34, with a revised Table A. The order applies to services rendered on or after March 15, 2018.   The Table A replaced by the order inadvertently listed Los Angeles County twice with different county-specific wage indexes and wage-adjusted conversion factors. The correct county-specific wage index for Los Angeles County is 1.2778 and the correct wage-adjusted conversion factor is $94.04. This table is now superseded with a revised table that deletes the incorrect duplicate entry.   The March 15, 2018 effective date remains the same. The order can be found at the http://www.dir.ca.gov/dwc/OMFS9904.htm#6
  • The Division of Workers’ Compensation (DWC) has issued a notice of public hearing to revise the Official Medical Fee Schedule for Physician and Non-Physician Practitioner Services (Physician Fee Schedule), which can be found at California Code of Regulations, title 8, section 9789.12.1 through 9789.19.  The public hearing is scheduled at 10 a.m. on Tuesday, April 17 in the Auditorium of the Elihu Harris State Building, 1515 Clay Street, Oakland 94612. Members of the public may also submit written comments on the proposed amendments until 5 p.m. that day.  The proposed amendments to the physician fee schedule regulations would eliminate the use of the average statewide geographic adjustment factor and adopt Medicare’s MSA based locality-specific geographic adjustment factors, known as the Geographic Practice Cost Indices (GPCIs), which Medicare implemented effective January 1, 2017. Adoption of the new Medicare MSA based locality GPCIs will improve payment allowance accuracy by reflecting the resources required to provide a service according to specific geographic areas. The proposed amendments also make minor clarifying revisions to the regulations.  To view a copy of the proposed regulation, go to http://www.dir.ca.gov/dwc/DWCPropRegs/OMFS-Table-A/OMFS-Table-A.htm.
  • 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: • CMS’ Medicare National Physician Fee Schedule Relative Value File RVU18B April 1, 2018 quarterly update • National Correct Coding Initiative Physician/Practitioner Services CCI Edits April 1, 2018 quarterly update • National Correct Coding Initiative Medically Unlikely Edits April 1, 2018 quarterly update  The order adopting the OMFS adjustments is effective for services rendered on or after April 1, 2018 and can be found on the DWC website.
  • The Department of Industrial Relations (DIR) today issued a progress report on its anti-fraud efforts, including updates on the suspension of 227 medical providers from treating California’s injured workers and the dismissal of 292,000 illegitimate liens with claims valued at over $2.5 billion.   To view a copy of the notice, go to http://www.dir.ca.gov/DIRNews/2018/2018-22.pdf.  To view a copy of the report, go to http://www.dir.ca.gov/Fraud_Prevention/Reports/Anti-Fraud-Report2018.pdf.
  • The Division of Workers’ Compensation (DWC) has posted an order adjusting the Hospital Outpatient Departments and Ambulatory Surgical Centers section of the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1.   The Hospital Outpatient Departments and Ambulatory Surgical Centers fee schedule update Order adopts the following Centers for Medicare & Medicaid Services (CMS) Medicare changes:  • The CMS Medicare Hospital Outpatient Prospective Payment System (OPPS) April 2018 Addendum A [Zip] quarterly update • The CMS Medicare OPPS April 2018 Addendum B [Zip] quarterly update • The CMS Ambulatory Surgical Center Payment System, April 2018 ASC Approved HCPCS Code and Payment Rates [zip], Column A entitled “HCPCS Code” of “Apr 2018 ASC AA” and Column A entitled “HCPCS Code” of “Apr 2018 ASC EE” • Certain sections of the CMS Medicare OPPS April 2018 Integrated Outpatient Code Editor (I/OCE), IntegOCEspecsV19.1 quarterly update. • Section 6 of the CMS April 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS), Change Request (CR) 10515 (revised March 22, 2018), Transmittal R4005CP.  To view the revised fee schedule, go to http://www.dir.ca.gov/dwc/OMFS9904.htm#6

Colorado VIEW STATE →

REGULATORY ACTIVITY:

Connecticut VIEW STATE →

FEE SCHEDULE NEWS:

  • The 2018 Official Connecticut Fee Schedule for Hospitals and Ambulatory Surgical Centers is being adopted with an effective date of April 1, 2018. The next scheduled update is April 2019.

 

Delaware VIEW STATE →

REGULATORY ACTIVITY:

Delaware Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Published notice that 18 Delaware Administrative Code 303 is being proposed to repeal. Each insurer licensed to write property or casualty insurance in this State, as a supplement to Schedule T of its annual statement, shall submit a report on a form furnished by the Commissioner showing its direct writings and experience, prior to reinsurance, in this State and the United States. All such writings and experience shall be required on a line-by-line basis both for the State and in total, and where appropriate, on a subline-by-subline basis. However, the statute also provides that, "The Commissioner may waive, modify or defer the requirements of this section if he or she determines the information required under this section to be reported is not needed." See 18 Del.C. §526A(h). Regulation 303 implements 18 Del.C. §526A by setting forth the information that is to be reported in the supplement to the statement that property and casualty insurers are required to file annually. The Department has determined that the information required by Regulation 303 is not needed, and has therefore determined to repeal Regulation 303, as permitted by 18 Del.C. §526A(h). To view the proposed rule, go to http://regulations.delaware.gov/register/march2018/proposed/21%20DE%20Reg%20674%2003-01-18.htm.

Florida WC VIEW STATE →

REGULATORY ACTIVITY:

  • Pursuant to a petition to initiate rulemaking, the proposed rules are written to comply with the requirement in section 440.45(4), F.S. that the Office of Judges of Compensation Claims adopt rules setting forth uniform criteria for measuring the performance of the office, including, but not limited to, the number of cases assigned and resolved, the age of pending and resolved cases, timeliness of decisions, extraordinary fee awards, and other data necessary for the judicial nominating commission to review the performance of judges as required in paragraph (2)(c).  The proposed rule provides notice to applicants for the position of judge of compensation claims and for current judges seeking reappointment of the information that will be provided to the statewide nominating commission for consideration of applications for appointment and reappointment. Some of the provisions of the rule apply only to current JCCs seeking reappointment, while other provisions may apply to both current JCCs seeking reappointment and applicants to fill vacancies. To view a copy of the notice and proposed rule, go to https://www.flrules.org/gateway/ruleNo.asp?id=60Q-6.129.
  • The DEPARTMENT OF FINANCIAL SERVICES, Division of Worker's Compensation, and the Three-member Panel announces a public meeting to which all persons are invited.
    • DATE AND TIME: Tuesday, April 10, 2018, 1:00 p.m.
    • PLACE: Room 116, Larson Bldg., 200 E. Gaines St., Tallahassee, Florida

GENERAL SUBJECT MATTER TO BE CONSIDERED: Pursuant to s. 440.13(12), Florida Statutes, the Three-Member Panel will hold a meeting to adopt the 2018 schedules for maximum reimbursement allowances for physicians, hospital inpatient care, hospital outpatient care, and ambulatory surgical centers. Public comment will also be received. A copy of the agenda may be obtained by contacting: The Division of Workers' Compensation will publish the agenda and meeting packet for the Panel's April 10, 2018, meeting on the Division's website under "Notices" (http://www.myfloridacfo.com/Division/WC/noticesRules.htm). Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 5 days before the workshop/meeting by contacting: Vicky Fletcher at (850)413-4185. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice). For more information, you may contact: Theresa Pugh at (850)413-1721.

LEGISLATIVE ACTIONS:

House Bill 1073

The bill modifies several areas regulated by the Department of Financial Services (DFS), including deeming electronic images of all records as original documents as used by the Division of Treasury. The legislation requires that financial literacy be addressed in a foster youth’s transition plan.  It changes the managing general agent license to an appointment and allows a general lines agent to obtain a managing general agent appointment.  It authorizes the Chief Financial Officer to develop the Florida Open Financial Statement System. It clarifies and expanding the circumstances under which a life agent may serve as a trustee or guardian or to act under a power of attorney for the insured. The legislation deems fingerprint submissions to be valid for 48 months for currently licensed individuals seeking additional licensure under Ch. 626, F.S., and for bail bond agents under Ch. 648, F.S.; It reduces the number of insurance policies that can be written each year, with an insurer by an un-appointed agent from 24 to 4.  The legislation eliminates an affidavit requirement for nonresident public and all-lines insurance adjusters.  It clarifies the terms of members of the Florida Fire and Safety Board.  The legislation allows franchisees to operate under the fire equipment dealer license of their parent company.  It modifies the requirements for the firefighter Special Certificate of Compliance.   It makes it mandatory that agency safety coordinators complete the safety coordinator training offered by DFS within one year of being appointed to his or her position.  It requires agencies to report to DFS on their return-to-work and risk management programs.  It requires each agency to communicate with DRM about discrepancies in claims and loss records, and about any inquiries identifying conditions or trends that may lead to claims involving the state; and Allowing DRM to share personal identifying information of individual workers’ compensation claims with its contracted vendors, for the purpose of ascertaining claimant history to investigate the compensability of a claim or to identify and prevent fraud.  Effective Date July 1, 2018.

House Bill 21

The bill addresses opioid abuse by expanding the use of the Prescription Drug Monitoring Program (PDMP), increasing regulation of prescribers and dispensers, amending criminal laws, and making appropriations. The bill limits the prescription for a Schedule II opioid for acute pain to a 3-day supply, or a 7-day supply if deemed medically necessary by the prescriber. The bill excludes pain related to cancer, terminal illness, palliative care, and serious traumatic injury from these prescribing limits. The bill requires regulatory boards within the Department of Health (DOH) to adopt rules establishing guidelines for prescribing controlled substances for acute pain. The bill also requires a health care practitioner to review a patient’s PDMP history before prescribing or dispensing a controlled substance, with exemptions. The bill authorizes a dispensing practitioner who is approved to provide medication-assisted treatment for substance abuse disorders to dispense Schedule II and III substances for such purpose.

The bill requires all pain management clinics that claim an exemption from statutory registration requirements to obtain a certificate of exemption by January 1, 2019. Currently, pharmacies only report dispensing controlled substances listed in Schedule II, III, and IV to the PDMP. The bill expands the reporting requirement to include certain Schedule V substances. The bill authorizes direct access to the PDMP for employees of certain federal agencies who prescribe or dispense controlled substances, and indirect access for district medical examiners under certain conditions. The bill authorizes DOH to share and exchange PDMP data with other states if certain conditions are met and authorizes the PDMP to interface with practitioner electronic health record systems. Chapter 893, F.S., the “Florida Comprehensive Drug Abuse Prevention and Control Act,” classifies controlled substances into five schedules, based on the substance’s “potential for abuse” and whether the substance has a currently accepted medical use. The bill aligns the state schedule of drugs with the federal schedule of drugs. The bill also makes it a crime to possess, purchase, deliver, or sell a tableting machine, encapsulating machine, or controlled substance counterfeiting material for the purpose of illegally manufacturing controlled substances. The bill increases the level of offense from a third-degree felony to a second-degree felony for intentionally prescribing medically unnecessary controlled substances, or medically unnecessary amounts of controlled substances. The bill has an insignificant, positive fiscal impact on DOH from savings from pain management clinic investigations; a positive indeterminate impact on prison beds; and a possible positive, indeterminate fiscal impact on local governments.  For Fiscal Year 201819, the bill appropriates $27,035,532 in nonrecurring funds from the Federal Grants Trust Fund for substance abuse treatment and other services; $26,500,000 in recurring funds from the General Revenue Fund for substance abuse treatment and upgrades to the PDMP, and $117,700 in nonrecurring funds from the General Revenue Fund for upgrades to the PDMP.  Effective Date July 1, 2018.

Senate Bill 376

The enacted legislation revises the standards for determining compensability of employment-related posttraumatic stress disorder (PTSD) under workers’ compensation for first responders, which includes volunteers or employees engaged as law enforcement officers, firefighters, emergency medical technicians, and paramedics. The bill allows first responders that meet certain conditions to access indemnity and medical benefits for PTSD without an accompanying physical injury. Current law provides only medical benefits for a mental or nervous injury without an accompanying physical injury and requires the first responder to incur a compensable physical injury to receive indemnity benefits for a mental or nervous injury. The legislation specifies that benefits do not require a physical injury and are not subject to certain apportionment or limitations. Effective Date October 1, 2018.

Idaho VIEW STATE →

REGULATORY ACTIVITY:

  • The Industrial Commission Claims and Benefits department conducts compliance audits of insurers and their designated in-state adjusters. Periodic audits are performed to ensure insurer and self-insured employers are in compliance with claims adjusting requirements as required by Statute and Rule. To view the guidelines, go to https://iic.idaho.gov/insurance/Audit_Guidelines_v1_040118.pdf.

LEGISLATIVE ACTIONS:

House Bill 366

The enacted legislation would amend Section 72-205, Idaho Code, adding language that would require a postsecondary institution to cover a student through the institution's workers' compensation policy, if the employer the student is placed with does not cover the student through its policy. The definition of "work experience student" includes work-study students of Idaho's public higher education institutions. Adult students, when employed by an institution or placed in an off-campus work experience, are covered as employees by the employer's workers' compensation coverage. The existing language requires the postsecondary institution to include the student in its policy, even if the employer has already covered the student through its workers' compensation policy.  Effective Date July 1, 2018

Indiana VIEW STATE →

LEGISLATIVE ACTIONS:

Senate Bill 290

The enacted legislation establishes a time frame for the payment of compensation under a settlement agreement, a permanent partial impairment agreement, and an award of compensation ordered by a single hearing member of the Worker's Compensation Board (board).  It provides that an employer that fails to make a timely payment is subject to a civil penalty.  It requires an employer that has mobile or remote employees to convey information about worker's compensation coverage to the employer's employees in an electronic format or in the same manner as the employer conveys other employment related information. It allows the electronic filing of certain documents with the board.  The legislation provides that a permanently, totally disabled worker must reapply to the second injury fund for a wage replacement benefit every three years instead of every 150 weeks.  It requires the reporting of workplace injuries needing medical attention beyond first aid instead of injuries causing an absence from work for more than one day. It provides that reporting requirements for workplace injuries are intended to be consistent with the recording requirements set out in the United States Occupational Safety and Health Administration's regulations. It changes from $50 per employee to $100 per day the civil penalty for an employer's failure to provide proof of worker's compensation coverage. The legislation revises the definition of employer to include corporations, limited liability companies, limited liability partnerships, and other entities that have common control and ownership. It establishes the assigned risk plan (plan) administered by the Worker's Compensation Rating Bureau (bureau). It provides that the plan may be substantially modified or eliminated only as the General Assembly provides by statute. The bill removes the requirement for representation in the management of the bureau by stock companies and nonstock companies. The legislation urges the Legislative Council to assign to an appropriate interim study committee the task of studying increases to the benefit schedules for worker's compensation and occupational diseases compensation.  Effective Date July 1, 2018.

Senate Bill 369

The legislation, except during a medical emergency, prohibits workers' compensation and occupational disease compensation reimbursement for drugs specified in the ODG Workers' Compensation Drug Formulary Appendix A published by MCG Health as "N" drugs. It permits a prescribing physician to request to prescribe an "N" drug. It provides that, if the employer approves the request, the prescribing physician may prescribe the "N" drug. It provides that, if the employer does not approve the request, the employer shall: (1) shall send the request to a third party that is certified by the Utilization Review Accreditation Commission to make a determination concerning the request; and (2) notify the prescribing physician and the employee of the third party's determination not more than five business days after receiving the request. The enacted legislation also provides that, if the third party's determination is to deny the request, the employer shall notify the prescribing physician and the employee, and the employee may apply to the Worker's Compensation Board for a final determination concerning the third party's determination. It provides that, if the employer fails to notify the physician and the employee of the third party's determination, the prescribing physician's request is considered approved, and reimbursement of the "N" drug is authorized.  Effective Date July 1, 2018.

Iowa VIEW STATE →

REGULATORY ACTIVITY:

  • Important Electronic Data Interchange (EDI) Claims Updates: New R3.1 EDI Claims Release Requirement Tables and Trading Partner Profile Registration Now Available.  To access, click HERE.

Kansas VIEW STATE →

REGULATORY ACTIVITY:

  • Published notice of revised Maximum Weekly Benefits and revised Minimum Weekly Survivors Benefit for July 1, 2017- June30, 2018.  The revised Maximum Weekly Benefits is $631.00.  The revised Minimum Weekly Survivors Benefit is $421.00.

Kentucky VIEW STATE →

FEE SCHEDULE NEWS:

  • A new Hospital Fee Schedule has been adopted with an effective date of April 1, 2018. The next scheduled update is expected April 2019.

LEGISLATIVE ACTIONS:

House Bill 220

The enacted legislation creates a new section of KRS Chapter 336 establishing the criteria under which a marketplace contractor is not deemed to be an employer of a marketplace platform; amend to add additional requirements to be considered a marketplace platform; amend to include additional exclusions to the section.  Effective Date June 30, 2018.

Louisiana VIEW STATE →

REGULATORY ACTIVITY:

  • Published in the March State Register notice of intent to amend certain portions of the Louisiana Administrative Code, Title 40, Labor and Employment, Part III, Workers’ Compensation Second Injury Board, Chapter 5 regarding forms.  This Rule is promulgated by the authority vested in the director of the Office of Workers’ Compensation found in R.S. 23:1291 and R.S. 23:1378(A). To view the notice of intent and proposed rule, go to http://www.doa.la.gov/Pages/osr/reg/Regs2018.aspx and click on the March Icon.

Maine VIEW STATE →

LEGISLATIVE ACTIONS:

Legislative Document 1030

The enacted legislation requires that a naturopathic doctor be entitled to the same benefits and right to treat as any other licensed physician providing services under the terms of coverage included in any insurance policy providing health benefits.  Effective Date January 1, 2019.

Maryland VIEW STATE →

REGULATORY ACTIVITY:

  • The Commission is in the process of replacing the televisions in the courtrooms with flat-screen televisions. We will also be 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 now 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 then display your computer on the flat-screen television 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 a mechanism to transmit your computer display to the television. Files on a USB drive will need to 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 the scheduled install dates for the Peerless system by location is as follows:
    • Peerless system available (connect your laptop to the courtroom television to play videos)
    • Abingdon – January 26, 2018
    • Baltimore – February 28, 2018
    • Frederick – March 16, 2018
    • Beltsville – March 22, 2018
    • Cambridge – March 27, 2018
    • LaPlata – March 29, 2018
  • Posted notice of Adoption of rules:  Subtitle 09 WORKERS' COMPENSATION COMMISSION: 09.01 General Administrative; 14.09.02 Requirements for Filing and Amending Claims; 14.09.02 Requirements for Filing and Amending Claims; 14.09.04 Legal Representation and Fees; 14.09.07 Vocational Rehabilitation Practitioners; 14.09.08 Guide of Medical and Surgical Fees; 14.09.10 Settlements and Lump Sum Payments; 14.09.12 Responsibilities of Insurers; and 14.09.13 Individual Employer Self-Insurer. The adopted rules become effective March 12, 2018. To view the notice, go to http://www.dsd.state.md.us/MDR/4505/Assembled.htm#_Toc507421397.  To review a copy of the rules as proposed, go to http://www.wcc.state.md.us/Adjud_Claims/Reg_Changes.html.
  • Notice to Attorneys: Pursuant to COMAR 14.09.04.01(B), an attorney wishing to practice before the Commission SHALL register for WFMS Online Services http://www.wcc.state.md.us/WFMS/Atty_req.html in accordance with COMAR 14.09.01.09. The new Regulation is effective on March 12, 2018. All attorneys not currently registered with WFMS Online Services must register with the Commission immediately. Pursuant to COMAR 14.09.02.02 (A), claims by represented claimants SHALL be filed electronically through the WFMS. Attorneys must begin filing claims through WFMS effective March 12, 2018.  Effective immediately, new attorney registrations will no longer require a registration fee.  See the Attorney Registration page for more.
  • Revised Form – Claimant’s Consent to Pay Fees and Costs (H-44 Revised 03/2018) - The form has been revised to reflect the changes to COMAR 14.09.04.02 and 14.09.04.03, which are effective March 12, 2018. A fillable PDF form is available on the website. The PDF-fillable form may be found on the Forms and Instructions page. We do not accept form filing via email/attachment or fax. Please begin using the new form immediately. To view the form, go to http://www.wcc.state.md.us/PDF/PDF_Forms/H44_fill.pdf.
  • Revised Form – Request to Strike Appearance of Counsel (C-25R Revised 03/2018) - The form has been revised to reflect the changes to COMAR 14.09.04.01, which are effective as of March 12, 2018.

The revised form, Notice to Withdraw Appearance, is available for Online Services subscribers only as an online form. A fillable PDF form is available on the website for the use by of non-subscribers only. The PDF-fillable form may be found on the Forms and Instructions page. We do not accept form filing via email/attachment or fax. Please begin using the new form immediately.  To view the form, go to http://www.wcc.state.md.us/PDF/PDF_Forms/eReqStrike.pdf

  • Pursuant to COMAR 14.09.04.01(B), an attorney wishing to practice before the Commission SHALL register for WFMS Online Services http://www.wcc.state.md.us/WFMS/Atty_req.html in accordance with COMAR 14.09.01.09. The new Regulation is effective on March 12, 2018. All attorneys not currently registered with WFMS Online Services must register with the Commission immediately. Pursuant to COMAR 14.09.02.02 (A), claims by represented claimants SHALL be filed electronically through the WFMS. Attorneys must begin filing claims through WFMS effective March 12, 2018.  Effective immediately, new attorney registrations will no longer require a registration fee.  To find more information, go to http://www.wcc.state.md.us/Adjud_Claims/Atty_Reg.html
  • Mobile device/smartphone apps for the NCCI Online Workers' Compensation Coverage Verification Service (CVS) http://www.wcc.state.md.us/WFMS/Online_CVS.html will be unsupported effective May 2018.  Mobile users will access the site via their smartphone/tablet web browser.  You can create a shortcut to the CVS on your device's home screen. To create the short-cut: open a browser on your device, enter ewccv.com/cvs and add the shortcut to your phone’s home screen.
  • The Partner’s Status As A Covered Employee Form IC-04 has been posted to the Commission website at  http://www.wcc.state.md.us/Gen_Info/ICR.html#Forms0.  Forms section. The form is to be used for a partner(s) to indicate his/her intention regarding being a covered employee pursuant to § 9-219 of the Labor and Employment Article.

Massachusetts VIEW STATE →

REGULATORY ACTIVITY:

The proposed amendments to 130 CMR 405.000 allow Community Health Centers to provide chiropractor services on site or by referral. The proposed amendments to 130 CMR 441.000 allow chiropractor services to occur in CHCs, instead of only a chiropractor's office. The proposed amendments align terminology and practice protocol with industry standards.  In addition, 130 CMR 441.000 is being amended to permit more than 20 office visits or chiropractic manipulative treatments per calendar year, or any combination of office visits and chiropractic manipulative treatments, exceeding a total of 20 per calendar year, with prior authorization for all visits or treatments more than 20 in the calendar year.  To view a copy of the proposed rules, go to https://www.mass.gov/service-details

/masshealth-proposed-regulations-and-public-notices.

  • Published emergency adoption of Dental Services Regulation.  To view the notice and adopted rule, go to https://www.mass.gov/service-details/masshealth-proposed-regulations-and-public-notices.
  • Published administrative bulletin 18-05 regarding 101 CMR 701.00: community Hospital Reinvestment Trust Fund Payments and Funding effective March 28, 2018.  To view the bulletin, go to https://www.mass.gov/lists/2018-eohhs-administrative-bulletins.
  • Posted notice of proposed amends 101 CMR 343.00 Hospice Services. 101 CMR 343.00 governs payment rates for hospice services provided to publicly aided individuals by governmental units. The proposed amendments to 101 CMR 343.00 update the rates of payment for hospice services provided by MassHealth providers, in accordance with M.G.L. c. 118E, § 13D, which requires EOHHS to establish rates for health care services to be paid by governmental units. Additionally, the Centers for Medicare and Medicaid Services (CMS) annually set the minimum rates for Medicaid Hospice services, which are to be effective on October 1 of each year, and which EOHHS uses as the base rates. EOHHS has reviewed CMS' Hospice Wage Index and Payment Rate Update for Federal FY 2018 and has applied CMS methodology to the previous rate period for MassHealth Hospice rates. The percentage change in individual rates between the previous rate period ending September 30, 2017 and this rate period range from -2.7% to 1.56%, with the overall change in rates being approximately -0.15%. The proposed regulation is planned to go into effect no sooner than July 27, 2018. However, pursuant to 101 CMR 343.04(3)(b), the rates for hospice services were updated via administrative bulletin on December 6, 2017, and in accordance with CMS required changes to these rates. The expected annual fiscal impact for MassHealth is an increase of approximately $28,130. There is no fiscal impact on cities and towns.  To view the notice, go to http://www.sec.state.ma.us/spr/sprpub/032318f.pdf.  To view a copy of the proposed regulation, go to  https://www.mass.gov/files/documents/2018/03/09/101-cmr-343-proposed-redline.pdf.
  • Published Bulletin 18-06 regarding dental services effective January 1, 2018; Bulletin 18-07 regarding DME effective January 1, 2018; Bulletin 18-08 regarding DME effective March 1, 2018; and Bulletin 18-09 regarding new HCPCS codes effective March 1, 2018.  To view the bulletins, go to https://www.mass.gov/lists/2018-eohhs-administrative-bulletins.

Medicare VIEW STATE →

FEE SCHEDULE NEWS:

  • Physician – CMS has adopted a new Physician module with an effective date of April 1, 2018.  The next expected update is July 1, 2018.
  • ASP Drugs - CMS has updated the ASP Drug rates with an effective date of April 1, 2018. The next expected update is July 1, 2018.
  • DMEPOS – CMS has adopted a new DMEPOS module with an effective date of April 1, 2018. The next expected update is July 1, 2018.
  • ASC – CMS has posted a new ASC module with an effective date of April 1, 2018. The next expected update is July 1, 2018.
  • Outpatient – CMS has posted a new Outpatient module with an effective date of April 1, 2018.  The next expected update is July 1, 2018.

Michigan VIEW STATE →

FEE SCHEDULE NEWS:

  • The state has adopted the 2017 Michigan Workers’ Compensation Health Care Services Manual with an effective date of March 15, 2018.

REGULATORY ACTIVITY:

  • Published the 2017 Health Care Services Rules and Fee Schedule which became effective March 15, 2018 to replace the current 2016 fee schedule. The updated rules, manual, and fee schedule worksheets are posted, and are based on 2017 source documents such as the 2017 October release CMS Physicians Fee Schedule, as well as 2017 CPT® and HCPCS Level II procedure codes.  Some highlights of the updated rule language include:
    • Updated laboratory procedure codes for drug testing, drug screening and drug confirmation testing.
    • Revised language for reimbursement of dispensed medication.
    • New billing and reimbursement rules for air ambulances.

Please feel free to contact the Agency with any questions or comments on our toll-free line at 1-888-396-5041.

To view the document, go to https://www.michigan.gov/wca/0,4682,7-191--463225--,00.html.

Michigan Auto VIEW STATE →

REGULATORY ACTIVITY:

Mississippi VIEW STATE →

REGULATORY ACTIVITY:

  • April settlement schedule changes: Please be advised that the Mississippi Workers’ Compensation Commission will not be processing walk-in settlement approvals on the following days (due to the Annual Educational Conference):  TUESDAY, APRIL 17 or WEDNESDAY, APRIL 18.

Mississippi Auto VIEW STATE →

REGULATORY ACTIVITY:

Montana VIEW STATE →

REGULATORY ACTIVITY:

  • Posted notice of a hearing regarding the 2018 Workers' Compensation Proposed Fee Schedule.  The hearing is scheduled on April 20, 2018 at 10:00 A.M. in the Beck Building 2nd Floor Conference Rooms A & B at 1805 Prospect Avenue in Helena Mt.  To view the proposed fee schedule, go to https://mtwc.optum.com/overview.aspx.  The proposed effective date is July 1, 2018.
  • Posted notice of public hearing on proposed amendment to rule 24-29-335 regarding the workers' compensation facility service rules and rates and conversion factors.  The hearing will be held on April 20, 2018, at 10:00 a.m. The Department of Labor and Industry will hold a public hearing in conference rooms A and B of the Beck Building, 1805 Prospect Avenue, Helena, Montana, to consider the proposed amendment of the above-stated rules.

Nevada Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Posted notice of intent to amend Chapter 686 A of the Nevada Administrative Code. A regulation relating to insurance; requiring certain information to be included in certain agreements for consultation or related advice; requiring a copy of certain agreements for consultation or related advice to be made available for audit; authorizing certain persons to charge and collect a fee for providing consultation or related advice concerning individual health benefit plans; requiring an agreement for consultation or related advice concerning individual health benefit plans to contain certain information; revising references to insurance agents and brokers; and providing other matters properly relating thereto.  To view the proposed regulation, go to  https://www.leg.state.nv.us/Register/2018Register/R001-18P.pdf

New Jersey No-Fault VIEW STATE →

REGULATORY ACTIVITY:

New York VIEW STATE →

FEE SCHEDULE NEWS:

  • The state has adopted a new DME fee schedule effective April 1, 2018.

REGULATORY ACTIVITY:

North Carolina VIEW STATE →

REGULATORY ACTIVITY:

  • Notice is hereby given in accordance with G.S. 150B-21.2 that the North Carolina Industrial Commission intends to adopt the rules cited as 04 NCAC 10M .0101-.0103, .0201-.0203, .0301, .0401, and .0501. This proposed rule amendment was also published on January 16, 2018 in Volume 32, Issue 14, of the North Carolina Register at Page 1334-1339, available at http://www.oah.state.nc.us/rules/register/Volume%2032%20Issue%2014%20January%2016,%202018.pdf.    Proposed Effective Date:  May 1, 2018. Oral comments on the proposed rule amendment may be made at the Public Hearing before the Industrial Commission: Date:  March 2, 2018 Time:  2:30 p.m. Location:  Room 240, 2nd Floor, Department of Insurance, Albemarle Building, 325 North Salisbury Street, Raleigh, NC 27603. To view the rules as proposed, go to http://www.ic.nc.gov/Proposed10M.Notice-011618.pdf.  To view a copy of the rules as proposed, go to http://www.oah.state.nc.us/rules/register/Volume%2032%20Issue%2014%20January%2016,%202018.pdf.
  • Effective March 12, 2018, the Deputy Commissioners’ section will no longer send docketing notices via fax. To continue to receive docketing notices, please opt in to the new e-mail list by e-mailing docketing.notice.opt.in.out@ic.nc.gov with a list of e-mail addresses to add to our contact list. Additionally, docketing reports will continue to be posted at http://www.ic.nc.gov and can be found under “Sections” – “Deputy Commissioners” – “Master List of Cases for Docketing.”
  • The Commission will convene to deliberate and vote on a proposed amendment to 04 NCAC 10A .0107 and the proposed adoption of nine rules to be cited in 04 NCAC 10M.  The meeting was held at 1:00 p.m. on Tuesday, March 20, 2018, in the Industrial Commission Hearing Room, Room 2173, on the second floor of the Dobbs Building, 430 North Salisbury Street, Raleigh, North Carolina 27603. This meeting is held pursuant to Chapter 143 of the North Carolina General Statutes. Accordingly, there will be no opportunity for public comment. To view more information regarding the proposed rule change to 04 NCAC 10A.0107, go to http://www.ic.nc.gov/proposed10A0107Notice-011618.pdf.  For more information regarding proposed rules for the utilization of opioids, related prescriptions, and pain management, go to http://www.ic.nc.gov/Proposed10M.Notice-011618.pdf.
  • Effective April 2, 2018, the Deputy Commissioners’ section will no longer send calendars and uniform pre-trial orders via fax. Deputy Commissioners shall serve calendars and uniform pre-trial orders to represented parties via e-mail. If an attorney’s e-mail address is unknown or if a party is appearing pro se, mail or certified mail will be used in lieu of e-mail. If you would like to ensure the Commission has record of your email address, you may e-mail dockets@ic.nc.gov.

North Dakota VIEW STATE →

FEE SCHEDULE NEWS:

  • The state has adopted quarterly fee schedule updates with an effective date of April 1, 2018. The next scheduled update is expected in July 2018.

REGULATORY ACTIVITY:

  • Published a notice regarding services not reimbursable by WSI.  WSI does not provide reimbursement for services considered unnecessary to treat or diagnose a compensable work injury.  This includes services generally considered preventive.  Below are some examples of the services billed to WSI in error. Services unnecessary to treat a work injury may include:
    • Treatment for communicable diseases (e.g. common cold),
    • Treatment for seasonal disorders (e.g. allergies), and
    • Treatment for pre-existing conditions (e.g. diabetes).
    • Services generally considered preventive: Flu vaccine, Mammogram and Pap smear.

There are circumstances in which a provider may render one or more of these services concurrently with the treatment of a work injury.  If this should occur, a provider should not bill WSI for the services unrelated to the work injury.  For these services, it is appropriate for a provider to pursue direct reimbursement from the patient or other insurance.

  • Published a notice regarding expectations for presumptive drug screens and definitive drug testing.  WSI has expectations for presumptive drug screening and definitive testing, based on adopted medical guidelines. Reimbursement for these drug tests is dependent upon a provider’s compliance with these expectations. Non-compliance with the expectations may affect the reimbursement of other medical services.  Drug screens and testing are important to the claim management process as they are helpful in evaluating the following: Worker is taking prescribed medications that are at or below therapeutic or toxic levels (therapeutic drug monitoring); or Worker is taking prescribed controlled substance medications; or Worker is taking non-prescribed or illicit drugs. The two main methods of drug testing include initial qualitative (presumptive) screenings and confirmatory quantitative (definitive) testing. Presumptive screenings are either laboratory-based or point of collection (POC) testing, and drugs are reported as only either present or absent. Definitive tests are highly sensitive and specific to a particular drug(s) or class of drugs. There are many limitations of presumptive drug screenings, which necessitate the use of definitive testing for certain circumstances. The Work Loss Data Institute’s Official Disability Guidelines (ODG), adopted by WSI, details the following on when to perform definitive testing: “When the POC screen is appropriate for the prescribed drugs without evidence of non-prescribed substances, confirmation is generally not required.  Confirmation should be sought for (1) all samples testing negative for prescribed drugs, (2) all samples positive for non-prescribed opioids and (3) all samples positive for illicit drugs.” It is WSI’s expectation that a provider will perform presumptive screening when medically necessary and prior to any definitive testing. In addition, WSI expects definitive testing on all samples positive for non-prescribed opioids and all samples positive for illicit drugs. Failure, neglect, or refusal to respond to requests by WSI for drug testing may result in the denial of reimbursement for medical services provided. See North Dakota Administrative Code § 92-01-02-31.5(c). WSI follows CMS standards for the billing of drug screens and testing services.  A provider may bill one presumptive drug screening code (CPT 80305-80307) per day. In the event of a positive presumptive drug screen, a provider may bill one definitive drug testing code (CPT G0480-G0483) per day.
  • Has published new reimbursement schedules that become effective April 1, 2018.  The published documents are for APC, Ambulatory Surgical Center, Durable Medical Equipment, Medical Provider Fee Schedule, Outpatient Hospital and Physician Drug.  To view the published documents, go to https://www.workforcesafety.com/WSI/billingfeeschedule/FeeSchedule/FeeSchedule

Ohio VIEW STATE →

REGULATORY ACTIVITY:

Oregon VIEW STATE →

FEE SCHEDULE NEWS:

  • The Workers’ Compensation Division has adopted a new Hospital and Physician fee schedule effective April 1, 2018. The next update is scheduled for April 2019.

REGULATORY ACTIVITY:

  • The Workers’ Compensation Division recently issued a temporary rule that reflects the Court of Appeal’s decision in Chu v. SAIF 290 Or App 194 (2018). The Court found parts of OAR 436-120-0147 to be inconsistent with statute, and specifically that a worker’s regular employment at the time of injury includes all jobs held at the time of injury, not just the job where the injury occurred.  The effective date of the rules was Feb. 23, 2018. Temporary rules may only remain in effect for 180 days, so we must adopt “permanent” rules to replace them before they expire on Aug. 21, 2018. We welcome your ideas for agenda topics, and you may use the form located on our website at http://wcd.oregon.gov/laws/Documents/5141_final_pdf_form.pdf. Please submit your topic ideas by March 23, so we have time to complete research before the advisory committee meets. New topics submitted close to the time of the meeting or at the meeting may not be included on the agenda but will be discussed if time allows or held over for future consideration.

Meeting Information

Please RSVP if you will join us - to my attention, fred.h.bruyns@oregon.gov; do not reply directly to this listserv message. Options for attendance include in-person, by phone, or via the computer using GoToMeeting™.
Date: April 30, 2018, Time: 1:30 p.m. Pacific Daylight Savings Time, Location (if you plan to attend in person): Durham Plaza, 16760 SW Upper Boones Ferry Rd, Ste 200   Tigard, Oregon, in the OSHA PFO Training Room, Dial-in number: To be announced, GoToMeeting™ Access Code: To be announced

  • Published notice of correction to bulletin 111 Computation of temporary disability, permanent disability, and death benefits based on Oregon's state average weekly wage. This bulletin provides updated benefit rates based on the Oregon average weekly wage for 2017.  The Workers’ Compensation Division is issuing this corrected Bulletin 111 to clarify the method of calculating death benefits to children. This corrected bulletin replaces Bulletin No. 111 dated Dec. 12, 2017, in its entirety.  The division also published the associated form 5332. To view the corrected bulletin, go to http://wcd.oregon.gov/forms/Pages/bulletins.aspx.  To view a copy of the form, go to http://wcd.oregon.gov/forms/Pages/forms.aspx
  • Updated News and Case Notes with the publication of the February 2018 Edition.  To view the February Edition, go to http://www.oregon.gov/wcb/Pages/news-notes.aspx.

The Workers’ Compensation Division has posted final (permanent) rules:

Each document linked above includes a summary of rule changes that are effective April 1, 2018. Summaries of          testimony and the agency’s responses are posted as well for OAR 436-001 & OAR 436-009, 010, and 015.

  • Oregon has revised bulletin 285 and form 2839 regarding a request for a hearing. This bulletin provides the form to use to request a hearing on a matter within the director’s jurisdiction. The Workers’ Compensation Division made a few minor updates to the bulletin and form, but the requirements for requesting a hearing have not changed. This bulletin replaces Bulletin 285 dated Nov. 21, 2012. To view a copy of the bulletin, go to http://wcd.oregon.gov/Bulletins/bul_285.pdf.  To view a copy of the form, go to http://wcd.oregon.gov//forms/pages/forms.aspx?f=2839.
  • Published Bulletin 290 regarding Hospital fee schedule — adjusted cost-to-charge ratios for Oregon and out-of-state hospitals. This bulletin provides updated adjusted cost-to-charge ratios. Apply these ratios to hospital inpatient and outpatient services according to ORS 656.248 and OAR 436-009-0020. This bulletin replaces Bulletin 290 issued March 14, 2017.  The new ratios become effective April 1, 2018.  To view the bulletin, go to http://wcd.oregon.gov/forms/Pages/bulletins.aspx.
  • Oregon published Revised Bulletin 124, "Forms for vocational assistance to injured worker, cost-of-living matrix, and fee schedule," is available online. To view the bulletin and forms, go to http://wcd.oregon.gov/Bulletins/bul_124.pdf (Bulletin 124); http://wcd.oregon.gov/WCDForms/1081.doc (Form 1081); http://wcd.oregon.gov/WCDForms/1083.doc (Form 1083); and http://wcd.oregon.gov/WCDForms/2800.doc (Form 2800).
  • Oregon published an industry notice today regarding attorney fees issued by the director. The Workers’ Compensation Division wants to ensure you are aware of upcoming changes in the division’s processes regarding attorney fees.  The rules related to attorney fees awarded by the director are in OAR chapter 436, division 001, rules 0400 through 0440. The rules have been amended, and the new rules to go into effect April 1, 2018. Under amended OAR 436-001-0400(2), if time devoted is a factor in determining the amount of the fee, the attorney should submit a statement of the numbers of hours spent on the case. The division’s reviewer may request the attorney to submit additional information to support or clarify the statement of hours. If the attorney does not submit a statement of hours or other information as requested before an order is issued, the reviewer will presume the attorney spent one to two hours on the case. The reviewer will not solicit a statement of hours, and the Medical Resolution Team (MRT) will no longer provide a courtesy contact 72-hours before issuing an order. We encourage practitioners to become familiar with the division’s attorney fee rules. You can access the new rules at http://wcd.oregon.gov/laws/Pages/index.aspx.  If you have questions about this notice, contact the legal issues coordinator at 503-947-7723. To view the notice, go to http://wcd.oregon.gov/Pages/industry-notices.aspx.
  • Oregon has posted note of amendments to Rule OAR 436-050 Employer/Insurer Coverage Responsibility and OAR 436-180 Worker Leasing.  A public meeting is scheduled for April 24, 2018 at 9:00 a.m. in Room B of the Labor and Industries Building at 350 Winter Street, Salem Oregon.  To view the notice and proposed rule, go to http://wcd.oregon.gov/laws/Pages/proposed-rules.aspx.

LEGISLATIVE ACTIONS:

House Bill 4058

The legislation changes criteria for private nonprofit corporation to be licensed as property services contractor. Exempts property services contractors from requirement to submit to Bureau of Labor of Industries copies of all payroll records when labor contractor pays employees directly. Specifies when initial and continuing training of employees must occur. Excludes employees of contractor from definition of property services contractor. Requires applicant for property services contractor to submit names and addresses of those responsible for fulfilling obligations.  Provides property services contractors with flexibility in areas of license examination and for self-certifying vehicle insurance. Requires employer to provide pay and time records within 45 days of employee's request.  Allows civil action to be commenced against property services contractor on or after July 1, 2018. Effective Date July 1, 2018.

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, 2018.  The next expected update is for July 1, 2018.

Rhode Island Auto VIEW STATE →

REGULATORY ACTIVITY:

South Carolina VIEW STATE →

FEE SCHEDULE NEWS:

  • The Division of Workers’ Compensation has adopted a new medical fee schedule effective April 1, 2018.

REGULATORY ACTIVITY:

  • Posted on its web site a copy of the State Auditor's Report of the Workers' Compensation Commission.  To view the report, click HERE
  • At the Business Meeting on March 19, 2018, the Commission approved changes to the Medical Services Provider Manual (MSPM). The changes included approving a Conversion Factor of $50 and adopting the 2018 CMS CPT/HCPCS codes. In August 2017 the Commission approved the annual update the MSPM approving a Conversion Factor of $50 and the use of the CMS 2017 CPT/HICPCS codes. At that time, the stakeholders recommended the MSPM be updated to utilize the most recent Relative Values established by the Center for Medicare and Medicaid Studies (CMS). The Commission directed the consultants to calculate several Conversion Factors and their respective financial impact on the system using the 2018 Relative Values; claims medical data in terms of frequency and amount paid to the provider reported to NCCI for the calendar year 2016, and the 10% limit imposed by Act 183 in 2012.  The effective date of the updated MSPM is April 1, 2018. To view additional information regarding the manual, go to http://www.wcc.sc.gov/insurance/Pages/MedicalServicesDivision.aspx.
  • Published a summary of the Commission's business meeting on March 19, 2018.  To view the summary, go to http://www.wcc.sc.gov/Pages/default.aspx.

South-Carolina-Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Has re-published bulletin 2017-03 reminding auto insurers writing automobile business of new laws becoming effective in 2018.  The purpose of this Bulletin is to notify insurers writing automobile insurance policies of the recent enactment of Act No. 89, which includes amendments that are applicable to automobile insurance coverage issued or renewed on or after November 19, 2018.  To view the bulletin, go to http://doi.sc.gov/civicalerts.aspx?AID=112.  

Tennessee VIEW STATE →

REGULATORY ACTIVITY:

  • Tennessee has posted notice a hearing for a new rule set. The proposed new rule is 0800-02-27 Adjuster and Adjusting Entity Certification Program. The general purposes of this program are to assure that employees sustaining an injury arising out of and in the scope of employment are treated fairly and to assure that workers' compensation claims are handled in an appropriate and uniform manner.  This chapter and the rules within apply to all adjusting entities and adjusters subject to the provisions of the Tennessee workers' compensation Law who choose to participate in the adjusting entity certification program or adjuster certification program, respectively.  The projected effective date of the rule is May 31, 2018.  To view a copy of the notice and the rule, go to http://publications.tnsosfiles.com/rules_filings/03-01-18.pdf.
  • Posted notice of proposed amendments to rule 0800-02-01 General Rules of the Workers' Compensation Program. This chapter shall apply to all employees, employers, adjusting entities, and providers of services related to workers' compensation claims subject to the Tennessee Workers' Compensation Law. To view a copy of the notice and rule, go to http://publications.tnsosfiles.com/rules_filings/03-02-18.pdf.

LEGISLATIVE ACTIONS:

House Bill 1651

The enacted legislation extends the Bureau of Workers’ Compensation for 6 additional years through June 30, 2024.  Effective Date March 16, 2018.

Texas VIEW STATE →

FEE SCHEDULE NEWS:

  • The Division has adopted a new Home Health and Dental fee schedule for April 2018. The next update is expected in July 2018.

REGULATORY ACTIVITY:

  • The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) has made an additional amendment to new plain language notice PLN-3b.  The amendment provides insurance carriers with an option to communicate to injured employees when they are making a reasonable assessment of impairment rating pursuant to Labor Code §408.121(c).  This additional language does not need to be included on the PLN-3b when an insurance carrier is not making a reasonable assessment.   TDI-DWC notes that Labor Code §408.0041(f) requires an insurance carrier to pay benefits based on the designated doctor’s opinion during the pendency of any dispute, unless otherwise ordered by the commissioner. Insurance carriers must begin using revised plain language notices PLN-1, PLN-2, and PLN-4 through PLN-12 on March 1, 2018.  To allow time for system participants to implement the latest amendment, insurance carriers must begin using the PLN-3a, PLN-3b, and PLN-3c on April 1, 2018. The finalized PLNs are available on the TDI-DWC website at tdi.texas.gov/forms/form20plain.html.  Insurance carriers may choose to continue using the existing plain language notices or to begin using the revised notices until the effective date. If you have any questions, please contact Emily McCoy at Emily.McCoy@tdi.texas.gov.
  • Posted notice of proposed Telemedicine Rules in the state register.  To view the posting in the register, go to http://www.sos.state.tx.us/texreg/archive/March22018/Proposed%20Rules/28.INSURANCE.html#35.
  • Published the Workers' Compensation Research and Evaluation Group FY 2018 Research Agenda.  To view the agenda, go to http://www.tdi.texas.gov/wc/rules/documents/regagenda18m.pdf.
  • The Texas Department of Insurance, Division of Workers' Compensation, pursuant to the authority and direction given under the Texas Workers' Compensation Act (Texas Labor Code, §401.023), has determined that any interest or discount provided for in the Act shall be at the rate of 5.58 percent. This rate is computed by using the treasury constant maturity rate for one-year treasury bills {2.08 percent) issued by the United States Government, as published by the Federal Reserve Board for March 171 2018 {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, 2018 through June 30, 2018.

Texas Auto VIEW STATE →

REGULATORY ACTIVITY:

  • The Texas Department of Insurance proposes amendments to 28 TAC §§801, 19.1003, 19.1004, 19.1013, 19.1016, 19.1019, and 19.1310, and new §§19.803 - 19.810, concerning licensing and continuing education requirements of insurance professionals, including agents, adjusters, public insurance adjusters, managing general agents, risk managers, and home office salaried employees. The amendments and new sections are necessary to implement Senate Bill 876, 84th Legislature, Regular Session (2015), which amends Insurance Code Title 13, relating to licensing and continuing education requirements; and SB 807, 84th Legislature, Regular Session (2015) and SB 1307, 84th Legislature, Regular Session (2015), which amend Occupations Code Chapter 55, relating to licensing of military service members, military veterans, and military spouses. Additionally, TDI has proposed amendments to §§19.801, 19.1003, 19.1004, 19.1013, 19.1016, 19.1019, and 19.1310 to reflect current TDI style guidelines. Amendments to §§19.801, 19.1003, 19.1004, 19.1013, 19.1016, 19.1019, and 19.1310, and new §§19.804 - 19.810 implement changes made by SB 876 to the licensing and continuing education requirements of insurance professionals, including agents, adjusters, public insurance adjusters, managing general agents, risk managers, and home office salaried employees. Amendments to existing §§19.801, 19.1003, 19.1004, 19.1013, 19.1016, 19.1019, and 19.1310 also modernize existing requirements, including allowing for increased use of electronic payment transactions. The amendments also update statutory references resulting from the non-substantive revision of statutes enacted in SB 1324, 78th Legislature, Regular Session (2003).
  • New §19.803 implements changes made by SB 807 and SB 1307 to Occupations Code Chapter 55, relating to licensing of military service members, military veterans, and military spouses. In accordance with Chapter 55 of the Occupations Code, §19.803 provides for extensions of time to complete continuing education, reciprocal licensing, and waiver of the examination requirement. To view the proposed rule, go to http://www.sos.state.tx.us/texreg/archive/March92018/Proposed%20Rules/28.INSURANCE.html#65.

Utah WC VIEW STATE →

REGULATORY ACTIVITY:

  • Posted notice of proposed rule. The purpose of this rule change is to correct a typographical error in the rule text. The anesthesiology conversion factors were approved by the Workers' Compensation Advisory Council at $62, and not $65 as stated in the current rule text. To view a copy of the notice and proposed rule, go to https://rules.utah.gov/publicat/bull_pdf/2018/b20180301.pdf.

LEGISLATIVE ACTIONS:

House Bill 127

This enacted legislation amends portions of the Controlled Substance Database Act. This legislation changes the requirements for checking the controlled substance database.  It delays enforcement of the requirements in this bill to check the controlled substance database. The legislation modifies the authority of the Division of Occupational and Professional Licensing to review the controlled substance database to identify any prescriber who may be overprescribing opioids.  The legislation grants the Division of Occupational and Professional Licensing the authority to provide education or training to certain prescribers and to take other enforcement action.  The legislation modifies enforcement provisions.  Effective Date July 8, 2018.

House Bill 288

This legislation enacts provisions related to claiming workers' compensation benefits.  It makes it unlawful for an employer to interfere with an employee's ability to seek workers' compensation benefits or retaliate against an employee for seeking workers' compensation benefits.  The legislation provides penalties for violating a provision of this bill. Effective Date July 8, 2018.

Senate Bill 14

The enacted legislation modifies provisions relating to the Industrial Accident Restricted Account.  The legislation eliminates language that provides for a repeal of provisions related to the Industrial Accident Restricted Account.  Effective Date July 8, 2018.

Senate Bill 40

This bill modifies provisions related to workers' compensation disability benefits.  It modifies the calculation of benefits paid to one or more dependents of an employee with a disability under the Workers' Compensation Act.  Effective Date July 1, 2018.

Senate Bill 64

This legislation amends provisions of the Workers' Compensation Act related to health care providers. The legislation modifies the membership of the workers' compensation advisory council.  It amends a required report to the Business and Labor Interim Committee.  The legislation authorizes the Labor Commission to use funds from the Industrial Accident Restricted Account for specific purposes.  The enacted legislation addresses the rate at which certain workers' compensation carriers and self-insured employers must reimburse a hospital for covered medical services. The legislation allows carriers or self-insurers to reimburse hospitals through a contract between the entities.  In lieu of a contract, payment shall be made to hospitals in a county of the first, second or third class at 75% of the billed hospital fees for the covered services provided. If the hospital is in a county of the fourth, fifth or sixth class at 85% of the billed hospital fees for the covered medical services.   Effective Date July 8, 2018.

Senate Bill 75

The enacted legislation modifies provisions of the Utah Labor Code.  The legislation defines certified mail as a method of mailing by any carrier that is accompanied by proof of delivery.  It modifies the mailing requirements under Title 34A, Utah Labor Code. The legislation provides the circumstances under which the Division of Industrial Accidents may waive or reduce a penalty against an employer for conducting business without securing workers' compensation benefits for the employer's employees. The waiver includes noncoverage was less than 180 days and no injury were reported to the division during the period of noncompliance.  Effective Date July 8, 2018.

Senate Bill 92

This bill modifies provisions of the Workers' Compensation Act related to attorney fees.  The enacted legislation provides that to the extent allowed by court rule, an employee may be awarded reasonable attorney fees in an adjudication of a workers' compensation claim where only medical benefits are at issue. Effective Date July 8, 2018.

Virginia VIEW STATE →

LEGISLATIVE ACTIONS:

House Bill 82

The enacted legislation repeals an enactment clause that provides that the maximum tax rate that may be assessed on insurance carriers or self-insured employers for the purpose of funding workers' compensation benefits that are awarded against uninsured employers from the Uninsured Employer's Fund will revert from 0.5 percent to 0.25 percent on July 1, 2018. Repealing the enactment will maintain the maximum rate at its current level of 0.5 percent. Effective Date July 1, 2018.

House Bill 117

The enacted legislation provides that the commissioners of the Workers' Compensation Commission, for purposes of constituting a quorum, shall include any deputy commissioner or retired commissioner who is appointed or recalled, respectively, to fill a vacancy on the Commission. Effective Date July 1, 2018.

House Bill 531

The enacted legislation removes the provision that prevents the Workers' Compensation Commission from aggregating proof of coverage information filed with the Commission by an insurance carrier or rate service organization on behalf of an employer with the proof of coverage information filed by or on behalf of other employers. Effective Date July 1, 2018.

House Bill 558

The enacted legislation clarifies that the "medical community," when referring to providers of medical services rendered under the Virginia Workers' Compensation Act outside of the Commonwealth, shall be determined by the zip code of the principal place of business of the employer if located in the Commonwealth. If the employer's principal place of business is not in the Commonwealth, then it shall be determined by the zip code of the location where the Workers' Compensation Commission would conduct its hearing regarding a dispute concerning the medical services.  Effective Date July 1, 2018.

Washington VIEW STATE →

REGULATORY ACTIVITY:

  • Published notice of policy statement changes regarding resolution and settlement authority, payment for smoking cessation products for spinal fusion candidates and payment for tobacco cessation products for surgical candidates.  To view published notice, go to http://lawfilesext.leg.wa.gov/law/wsr/2018/05/18-05-038.htm. 
  • The department is proposing rulemaking to amend the current public records fee schedule in WAS 296-06-120, legislation passed in 2017 that amended RCW 42.56.120 which governs agency charges to requestors for providing copies of public records.  To view the proposed notice and rule, go to http://lawfilesext.leg.wa.gov/law/wsr/2018/05/18-05-084.htm

LEGISLATIVE ACTIONS:

House Bill 1723

The enacted legislation states that there exists a prima facie presumption, with regard to United States department of energy Hanford site workers who are covered under the state industrial insurance act, that the following are occupational diseases: Respiratory disease; heart problems, experienced within seventy-two hours of exposure to fumes, toxic substances, or chemicals at the site; cancer; beryllium sensitization, and acute and chronic beryllium disease; and neurological disease. Effective Date June 7, 2018.

West Virginia VIEW STATE →

LEGISLATIVE ACTIONS:

House Bill 82

The enacted legislation amends and reenacts §23-4-1 of the Code of West Virginia, 1931, as amended, relating to whom Workers’ Compensation Fund is disbursed; including rebuttable presumptions for certain injuries and diseases for professional firefighters; setting eligibility criteria for rebuttable presumptions; setting expiration of rebuttable presumption regarding leukemia, lymphoma, or multiple myeloma arising out of, and in the course of, employment as a firefighter on July 1, 2023, absent legislative action to the contrary; and eliminating outdated and obsolete language.  Effective Date June 7, 2018.

Wisconsin VIEW STATE →

FEE SCHEDULE NEWS:

  • The hospital radiology database has been published with a retroactive effective date of January 1, 2018. The next update is expected in July 2018.

REGULATORY ACTIVITY:

Wyoming VIEW STATE →

LEGISLATIVE ACTIONS:

House Bill 9

The enacted legislation relates to the Department of Workforce Service. The legislation removes specified department of workforce services reporting requirements.  The two repealed reports are:  Annual report to the Legislature about anticipated deficiencies in employer contributions for specified employees to the worker's compensation account; and  Annual report to the Joint Minerals, Business and Economic Development Interim Committee about the workplace safety contract program.   Effective Date March 9, 2018.

House Bill 10

The enacted legislation relates to worker's compensation. The enacted legislation specifies applicability of other states' worker's compensation laws in situations of reciprocity. It requires recognition of Wyoming's worker's compensation coverage in a nonresident employer's home state before Wyoming will recognize that nonresident employer's home state worker's compensation coverage in Wyoming.  Effective Date July 1, 2018.



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