Alabama VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted changes to the Hospital and ASC fee schedules through Addendum 1.

REGULATORY ACTIVITY:

• Published addendum 1 to the 2018 medical fee schedule.  Addendum 1 addresses revisions to the 2018 Ambulatory Surgery Center Fee Schedule and the 2018 Hospital Fee Schedule.  To view a copy of the addendum and revised ASC and Hospital fee schedule, go to https://labor.alabama.gov/wc/2018FeeSchedules.aspx.

Alaska VIEW STATE →

REGULATORY ACTIVITY:

• The State of Alaska Department of Labor and Workforce Development Workers' Compensation Board has scheduled a meeting on May 3-4, 2018.
• The State of Alaska Department of Labor and Workforce Development, Workers' Compensation Division, Medical Services Review Committee will meet June 15, 2018 and July 13 & 27, 2018.

Arizona VIEW STATE →

REGULATORY ACTIVITY:

• On April 26, 2018, the Industrial Commission of Arizona (“Commission”) held its 2018 Fee Schedule hearing as provided in A.R.S. § 23-908(B).  This hearing was held at 1:00 p.m. in the first-floor auditorium of the Commission, which is located at 800 West Washington Street, Phoenix, Arizona.  In addition to public comments received, the Commission also considered a report prepared by Commission staff.  This report is a preliminary document that is intended to serve as a foundational document for discussions that may arise during the hearing process.  To view the recommendations and proposed fee schedule, go to https://www.azica.gov/divisions/medical-resource-office-mro.
• Under A.R.S. § 23-1065(F), after notice and a hearing, the Commission is authorized to levy an additional one-half percent assessment under A.R.S. § 23-1065(A) if the total annual reserved liabilities of the Special Fund for apportionment under §§ 23-1065(B) and (C) exceed six million dollars.  Please be advised that the Commission will hold a public hearing to gather information concerning this assessment on May 17, 2018, at 1:00 p.m. in the Commission’s first floor auditorium located at 800 West Washington Street, Phoenix, Arizona.  This hearing will be held as part of the Commission’s scheduled meeting for that day.  The record is considered open, and written and oral comments will be accepted until the close of the hearing on May 17, 2018.  At a later date, the Commissioners will discuss and may take action on this assessment.  Written comments may be submitted prior to the hearing c/o Kara Dimas, Executive Secretary, Office of the Commission Director, P.O. Box 19070, Phoenix, Arizona 85005-9070.

LEGISLATIVE ACTIONS:

House Bill 2047

The purpose of this bill is to clarify coverage. The legislation adds working members of an LLC who own less than 50% membership interest to the definition of employee.  It allows working members who own more that 50% of an LLC to be deemed as an employee and sets the basis for computing wages and compensation benefits.   It adds working share holders who won less than 50% of the beneficial interest in a corporation to the definition of employee.  It allows working shareholders who own more than 50% of the beneficial interest in a corporation to be deemed as an employee and sets the basis for computing wages and compensation benefits.  Effective Date to Be Determined.

House Bill 2081

The enacted legislation requires an insurance adjuster to keep usual and customary records pertaining to the transactions of an adjuster.  The records must be maintained and made available for inspection for three years immediately after the date of completion of the transaction.  Effective Date to Be Determined.

House Bill 2549

The legislation includes an available opioid assistance and referral call service that is designated by ADHS as an option to be used when a physician must do a consultation regarding the issuance of a prescription that exceeds 90 MMEs per day. The legislation contains a retroactive date of April 26, 2018.   It permits the Arizona Poison Control System to provide statewide opioid assistance and referral resources through a toll-free telephone service. It allows a health professional to issue a prescription that exceeds 90 MMEs if the consulting physician who is board-certified in pain or an opioid call service agrees with the higher dose.  It contains a retroactive date of April 26, 2018.  It clarifies that the 90 MME limitation applies to prescriptions, rather than prescription orders. It exempts prescriptions capped at a 14-day supply that are issued following a surgical procedure from the 90 MME per day limitation.  It contains a retroactive date of April 26, 2018. It clarifies that the 90 MME limit applies to prescriptions that are filled or dispensed outside of a health care institution. It contains a retroactive date of April 26, 2018. The legislation states that a health care institution, private office or clinic must apply to ADHS for licensure as a pain clinic within 60 days of meeting the statutory definition of a pain clinic. It allows a nurse practitioner with advanced pain certification to act as a medical director of a pain clinic. It prohibits a naturopathic physician from dispensing opioids and classifies a violation as unprofessional conduct. The legislation exempts implantable devices dispensed by an allopathic or osteopathic physician, physician assistant, certified nurse midwife or nurse practitioner from the prohibition against dispensing controlled substances.  Effective Date to Be Determined.

Senate Bill 1100

The legislation clarifies that an interested party to a claim can negotiate a settlement of an accepted claim if the period of temporary disability is terminated by a final notice of claim status, award of the ICA or stipulation of the interested parties.  It allows an authorized representative of a carrier, special fund or self-insured employer to sign a settlement.  It requires a settlement to have attached certain information provided by a carrier, special fund or self-insured employer and requires settlements to include specified signed attestations regardless if the employee is represented by counsel.   It adds the following attestations that must be included in a settlement: The settlement amount representing future medical, surgical and hospital benefits; The present value and total amount of future indemnity benefits; The employee's life expectancy and rated age if applicable; The source of the employee's life expectancy; The discount rate used to calculate the present value and total amount of future indemnity benefits; The parties have conducted a search for and taken responsible steps to satisfy any unpaid medical charges; and the settlement was not achieved through coercion, duress, fraud, misrepresentation or undisclosed additional agreements.  The legislation removes the authorization for an ALJ to approve the settlement.  It stipulates an ALJ must approve the settlement if the employee is represented by counsel and certain requirements are met.  It directs an ALJ, if an employee is without counsel, to conduct a hearing and perform a detailed inquiry into the employee's attestations. The inquiry must include: Whether the employee understands the specific right being settled and released; The information, computation and methodology provided by the carrier, special fund or self-insured employer; and the employee's responsibility to protect the interest of other payors and ensure the payment of future treatment costs. It eliminates the requirement when approving a settlement that the ICA consider whether it is in the best interest of the employee based on specified criteria. It permits the ICA to approve a settlement if certain requirements are met. The legislation addresses supportive medical maintenance benefits. It states that any final settlement agreement involving undisputed entitlement to supportive medical maintenance benefits is not valid and enforceable until approved by the ICA.  The legislation permits the ICA to approve a final settlement agreement involving undisputed entitlement to supportive medical maintenance benefits if certain requirements are satisfied. It allows interested parties to a claim to enter into a final settlement and release of a claim for undisputed entitlement to supportive medical maintenance benefits after the period of temporary disability is terminated by a final notice of claim status or award of the ICA.  It directs a carrier, special fund or self-insured employer to submit a summary of all reasonably anticipated future supportive medical maintenance benefits and the projected cost of the benefits for review by the employee. It requires the summary to be included with the final statement agreement filed with the ICA.  The legislation requires all medical conditions subject to the final settlement agreement to be described in the agreement.  The enacted legislation requires the final settlement provisions only apply to future supportive medical maintenance benefits for the described condition.  It directs a carrier, special fund or self-insured employer to inform the attending physician of the approval of a final settlement agreement.  It directs a carrier, special fund or self-insured employer to remain responsible for payment for the treatment not covered by the final agreement unless supportive medical maintenance benefits rendered before the date of the final settlement are disputed or payment for treatment was included.   It asserts the requirements for a final settlement do not prohibit any other settlement. Effective Date to Be Determined.

Senate Bill 1111

The enacted legislation requires a physician who prescribes a schedule II-controlled substance to an employee to comply with statutory requirements relating to controlled substances. It modifies the information a physician must include in an ICA report as follows: Requires the report to contain information regarding the use of a schedule II narcotic or opium-based controlled substance and prescription of any opioid medication.  The report must further include the following:   Documentation regarding a physical examination, substance use risk assessment, and informed consent from the employee for opioid treatment; The frequency of face-to-face follow up visits to reevaluate an employee's continued use of opioids, guidelines for tapering and discontinuing the opioid, and the offering of treatment for opioid dependency or addiction associated with a treatment plan. It removes the provision regarding writing or dispensing an initial prescription order.  It requires a physician to obtain an employee's CSPMP utilization report prior to prescribing the employee an opioid analgesic or benzodiazepine-controlled substance that is listed as schedule II, III, or IV.  A physician must obtain a report at least quarterly while that prescription remains part of the treatment. It allows the insurance carrier, self-insured employer or ICA to request, not more than once every two months, that a physician obtain a CSPMP utilization report regarding an employee.  The enacted legislation clarifies the CSPMP utilization report, rather than the results of an inquiry to the Arizona State Board of Pharmacy is used to determine if the employee is receiving opioids from another provider. It asserts that the insurance carrier or self-insured employer is not liable for any action reasonably necessary to monitor or assess the appropriateness and effectiveness of the employee's opioid use. It allows the ICA to adopt fee reimbursement guidelines for medications dispensed in settings not accessible to the public. The enacted legislation     requires the ICA to review the fee reimbursement guidelines with stakeholders and hold a public hearing by July 1, 2019.  It repeals this requirement on July 1, 2020. It removes the qualification that a physician practice pain management in a change of physician ordered by the ICA. It removes the reporting exemption for medications administered to the employee while receiving inpatient hospital treatment. It modifies the definition of clinically meaningful improvement in function as: A significant improvement in the performance of daily activities or reduction in work restrictions; and a reduction in dependency on continued medical treatment. It eliminates the definition of off-label use. The legislation defines substance use risk assessment as an evaluation of an employee's likelihood for opioid addiction, misuse, diversion or another adverse consequence. It defines a traumatic injury as a physical injury that creates a reasonable risk of death or that causes serious or permanent impairment.  Effective Date to Be Determined.

Arizona Auto VIEW STATE →

LEGISLATIVE ACTIONS:

House Bill 3402

Requires an insurance adjuster to keep usual and customary records pertaining to the transactions of the adjuster. Records must be maintained and made available for inspection for three years immediately after the date of completion of the transaction.  Effective Date to Be Determined.

House Bill 2306

The enacted legislation requires ADOT to develop and prescribe standard forms for requesting the release of a vehicle and releasing liability for the removal of property from a towed vehicle by January 1, 2019. The standard vehicle release form must be used beginning January 1, 2019.  Instructs owners, insurance companies, towing companies and other persons requesting the release of a vehicle to present proof of ownership in addition to the standard vehicle release form, beginning January 1, 2019. It directs a towing company to release a towed vehicle to the owner on the day the request for release is provided to the towing company, if conditions are met. The legislation allows the request for release to be emailed or delivered by other electronic means to the towing company. It requires a towing company to: Define a storage day from midnight of one day to midnight of the next day for billing purposes; Provide the detailed billing statement by close of business if the request was made before noon on a business day; Allow the payment of fees and charges to be made in the form of cash, credit card, debit card, insurance company-issued check or money order; Make all fees and charges pursuant to the terms of the applicable contract between the company and the governmental jurisdiction in which the accident occurs; and be open to the public, or available by appointment, to provide current billing statements and release vehicles between 9:00 am and 5:00 pm Monday through Friday, excluding holidays.  A towing company may not accrue storage fees and charges for any day when the lot is closed contrary to this requirement. The enacted statute prohibits a towing company from: Assessing storage fees until the day it provides the billing statement if it failed to provide the statement by the close of business on the day the statement was requested; Imposing additional fees or charges between receiving the request for the release and providing the detailed written statement; Charging more than the amount authorized by the contract or statute for a primary tow; Refusing to release a vehicle after the owner or insurance company presents a request for release and pays the authorized fees and charges; and requiring payment for the removal of personal property that is inside the vehicle if the inspection and removal occurs during normal business hours. It authorizes the registered owner, insurance company or a person designated in writing by the owner, during normal business hours to: Inspect the vehicle at the towing company's storage lot; Report damage to the vehicle, allegedly caused by the towing company, to the towing company at the time of inspection; and remove personal property from the vehicle. The statute permits the towing company to require the owner or insurance company to sign a release of liability for the removal of personal items from a vehicle. It instructs a towing company to tow a vehicle to the closest storage lot designated in the applicable contract after an accident, unless: the owner directs the company to a different location;      there is insufficient capacity in the closest storage lot; or an on-scene officer directs it to be taken to another site. The statute stipulates that all acts of employees or contractors of a towing company within the scope of employment are deemed to be acts of the towing company. It classifies an act or practice in violation of this section as an unlawful practice and authorizes the AG to investigate and take appropriate action against the towing company, including any civil or criminal action, remedy and penalty provided by law. The law classifies failure to release a vehicle on receipt of the request for release and payment of authorized fees and charges as a petty offense for the first violation and a Class 3 misdemeanor (30 days/$500 plus surcharges for individuals, $2,000 plus surcharges for enterprises) for a subsequent violation within 3 years. It stipulates that a lien does not exist in favor of a towing company or storage lot for unpaid towing or storage fees or charges that are incurred.  It asserts that this does not affect the applicability of statute relating to unclaimed vehicles and asserts that the provisions of a contract between a towing company and jurisdiction apply to towing and storage transactions, except as provided in this section. It defines contract and primary tow. It removes the definition of owner. It makes technical and conforming changes. Effective Date to Be Determined.

California VIEW STATE →

FEE SCHEDULE NEWS:

• Medi-Cal rates have been released with an effective date of April 15, 2018. The next update is scheduled for May 15, 2018.
• DWC has posted an order to adjust the pathology and clinical laboratory section of the Official Medical Fee Schedule to conform with changes to the Medicare payment system. The order is effective for services rendered on and after April 1, 2018.

REGULATORY ACTIVITY:

• The Division of Workers’ Compensation (DWC) has posted proposed interpreter fee schedule regulations to its online forum where members of the public may review and comment on the proposals. The draft regulations include:
  • An objective, uniform fee structure based on the federal court system. Higher rates are paid for certified interpreters over provisionally certified, to encourage use of certified interpreters.
  • Reduction in double billing fees for multiple interpretations during the same time slot.
  • Detailed invoice information and billing codes. The independent bill review procedure will be required to quickly resolve disputes over bill amounts.
  • An emphasis on the use of qualified interpreters. Specific documentation of efforts to obtain a certified interpreter is required to ensure that the injured worker is provided with a qualified interpreter.
  • Requirements clarifying the selection and arrangement of interpreters.
  • New credentialing identification requirements. The organizations approved to certify interpreters remains unchanged from the current regulations. For hearings and depositions, an interpreter must be listed as a certified interpreter on either the State Personnel Board or California Courts websites. For medical treatment or medical-legal evaluations, the interpreter must be either certified for hearings and depositions, certified as a medical interpreter by the California Department of Human Resources, or has a current certification or credential in specific languages by either the Certification Commission for Healthcare Interpreters or the National Board of Certification for Medical Interpreters.
• The forum can be found on the DWC forums web page under “current forums.” To view a copy of the regulations, go to http://www.dir.ca.gov/dwc/DWCWCABForum/Interpreter.htm.
• 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 the quarterly changes in the Medicare payment system as required by Labor Code section 5307.1.  The order, dated April 10, is the second Administrative Director order for the April 2018 quarterly update to the Hospital Outpatient Departments and Ambulatory Surgical Centers Fee Schedule. It adopts column A of the April 2 update to CMS’ ASC addendum AA and column A of the April 2 update to CMS’ ASC addendum EE for services rendered on or after April 1, 2018. CMS replaced the March 21 files with April 2 updates.  There are no changes to the HCPCS codes listed in column A of ASC addendum AA and column A of ASC addendum EE from the March 21 files and the April 2 replacement. The Administrative Director update order adopting the OMFS adjustment is effective for services rendered on or after April 1, 2018 and can be found at http://www.dir.ca.gov/dwc/OMFS9904.htm.
• DWC Administrative Director George Parisotto has issued an Order updating the Medical Treatment Utilization Schedule (MTUS) Drug Formulary effective May 15, 2018 pursuant to Labor Code section 5307.29. The Administrative Director’s update Order adopts changes to the MTUS Drug List including the following:
  • Addition and deletion of drugs for treatment of Eye Disorders to coordinate with the updated ACOEM Eye Disorders Guideline which was adopted into the MTUS
  • Designation of “Exempt/Non-Exempt” status for drugs added for treatment of Eye Disorders
  • Designation of “Special Fill” status for drugs added for treatment of Eye Disorders
  • Update of guideline reference symbols for Ankle and Foot Disorders and Eye Disorders
  • Designation of an additional corticosteroid as eligible for the “Special Fill”.
• The updated MTUS Drug List and the Administrative Director Order is posted on the DWC MTUS drug formulary web page. Further updates to the MTUS Drug List will be made on a quarterly, or more frequent, basis.
• The Department of Industrial Relations (DIR) has posted on its Fraud Prevention webpage public documents on which DIR relied in flagging lien claimants as potentially subject to Labor Code section 4615. Labor Code section 4615 places an automatic stay on liens filed by or on behalf of physicians and providers who are criminally charged with certain types of fraud. The automatic stay prevents those liens from being litigated or paid while the prosecution is pending.  DIR flags liens in its Division of Workers’ Compensation’s (DWC’s) Electronic Adjudication Management System (EAMS) as potentially subject to section 4615. A full list of lien claimants with flagged liens is posted online.  The Department of Industrial Relation’s (DIR’s) fraud prevention efforts are posted online, including information on lien consolidations and the Special Adjudication Unit, frequently updated lists for physicians, practitioners, and providers who have been issued notices of suspension and those who have been suspended pursuant to Labor Code §139.21(a)(1).

Colorado VIEW STATE →

REGULATORY ACTIVITY:

• Posted notice of Hearing regarding rule 2: Workers' Compensation Insurance Premium and Payroll Surcharges.   Notice is given of a public hearing to afford all interested persons an opportunity to be heard prior to the adoption of proposed amendments to the Workers’ Compensation Rules of Procedure, 7 C.C.R. 1101-3 as described below.  The Director of the Division of Workers’ Compensation has the authority to promulgate rules pursuant to the Workers’ Compensation Act as set forth in section §8-47-107.  To view the notice and proposed rule, go to https://www.colorado.gov/pacific/cdle/workers-compensation-proposed-and-adopted-rules.
• Posted notice of hearing regarding rule 7: Life Expectancy Table.  Notice is given of a public hearing to afford all interested persons an opportunity to be heard prior to the adoption of proposed amendments to the Workers’ Compensation Rules of Procedure, 7 C.C.R. 1101-3 as described below.  The Director of the Division of Workers’ Compensation has the authority to promulgate rules pursuant to the Workers’ Compensation Act as set forth in section §8-47-107.  To view the notice and proposed rule go to https://www.colorado.gov/pacific/cdle/workers-compensation-proposed-and-adopted-rules.

Colorado Auto VIEW STATE →

REGULATORY ACTIVITY:

• Reminder Property and Casualty rule 3 CCR 702-5 regarding disclosure requirements for private passenger automobile policies became effective April 1. 2018. The purpose of this regulation is to interpret and implement the provisions of §§ 10-4-111(1) and (5) and 10-4-636, of the Colorado Revised Statutes, to provide summary disclosure requirements and the summary disclosure form for private passenger automobile insurance. The purpose of this regulation is to interpret and implement the provisions of §§ 10-4-111(1) and (5) and 10-4-636, of the Colorado Revised Statutes, to provide summary disclosure requirements and the summary disclosure form for private passenger automobile insurance. To view information regarding this rule, go to https://www.sos.state.co.us/CCR/eDocketDetails.do?trackingNum=2017-00411.

Florida No-Fault VIEW STATE →

LEGISLATIVE ACTIONS:

House Bill 533

The Unfair Insurance Trade Practices Act provides an extensive list of unfair methods of competition and unfair or deceptive acts prohibited in the business of insurance. Among these is a prohibition on an insurer refusing to insure anyone solely because they have not bought the following services related to the ownership and use of a motor vehicle: Towing service; Procuring group coverage from an insurer for bail and arrest bonds or for accidental death and dismemberment; Emergency service; Procuring prepaid legal services, or providing reimbursement for legal services; Offering assistance in locating or recovering stolen or missing motor vehicles; or Paying emergency living and transportation expenses of the owner of a motor vehicle related to a damaged motor vehicle.  The bill allows a property and casualty insurer to condition the sale of insurance on the purchase of motor vehicle services if such services are purchased from a membership organization that is affiliated with the property and casualty insurer. The property and casualty insurer and its affiliated membership organization must have been affiliated on January 1, 2018. Effective Date July 1, 2018.

Florida WC VIEW STATE →

REGULATORY ACTIVITY:

• Posted notice to repeal Rule No 69D-2.004 Insurer Anti-Fraud Plans. The relevant provisions of Rule 69D-2.004, F.A.C., regarding insurer anti-fraud plans, were recently moved to Rule 69D-2.003, F.A.C. Rule 69D-2.004, F.A.C., is no longer necessary and is being repealed.  To view the posted notice, go to https://www.flrules.org/gateway/ruleNo.asp?id=69D-2.004.
• Posted notice of development of rulemaking regarding rule number 64K-1.008 Electronic Health Recording System Integration.  The purpose and intent of the rule is to provide the process for approved entities to connect electronic health record keeping systems to the Prescription Drug Monitoring Program system. To view the notice, go to https://www.flrules.org/gateway/ruleNo.asp?id=64K-1.008.
• Proposed amendments to rule 69L-6.025 Conditional Release of Stop-Work Order and Periodic Payment Agreement. The proposed amendment to paragraph 69L-6.025(4)(b), F.A.C., will allow employers an additional opportunity to remain compliant with their payment agreement schedules by increasing the number of times the Department will rescind an Order Reinstating Stop-Work Order from two to three in any one case. The proposed amendment to subsection 69L-6.025(7), F.A.C., will allow employers who have made at least three-monthly payments of the agreed amount to enter into a new payment agreement in lieu of making six monthly payments. Reducing the number of payments required from six to three will shorten the timeframe for entering into a new payment agreement. The proposed amendment also clarifies that these payments must be based on the employer’s current payment agreement schedule. The proposed amendment to subsection 69L-6.025(8), F.A.C., further clarifies that the Department will only enter into one payment agreement for the recently served penalty. This verifies that the employer can only have one payment agreement and it must be based on the last served penalty. The proposed amendment to subsection 69L-6.025(10), F.A.C., will require employers who have been issued a Stop-Work Order or Order of Penalty Assessment to provide address changes to the Department. To view the proposed rule, go to https://www.flrules.org/gateway/ruleNo.asp?id=69L-6.025.
• A public meeting for proposed rule 69L-6.025 is scheduled on May 17, 2018 EST in room 102 Hartman Building, 2012 Capital Circle, Tallahassee, Florida.

Georgia VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted a new Medical, Hospital and Dental fee schedule with an effective date of April 1, 2018.

REGULATORY ACTIVITY:

• Published the State Board of Workers' Compensation fee schedule effective April 1, 2018. To view a copy of the adopted fee schedule, go to https://sbwc.georgia.gov/medical-and-dental-fee-schedules.

Idaho VIEW STATE →

REGULATORY ACTIVITY:

• Posted updates the EDI Claims Release 3.0 regarding updates to EDI Requirement Tables (Version2.1).  To view the updates, go to https://iicedi.info/requirements.

Indiana VIEW STATE →

REGULATORY ACTIVITY:

• The Board will be implementing a new protocol for submitting “C” claim settlement documents in the near future.  The legal environment surrounding Indiana worker’s compensation cases is changing.  We are seeing many more settlements.  Fewer cases are resolved through hearings.  Therefore, once we have the internal processes in place, documents submitted for approval in “C” claims will go to the respective Single Hearing Members. Please disregard any documentation you may have seen, as the Board has not finalized anything in this regard.
• The Board will be transitioning to EDI Version 3.1 on 1/1/2019. You can see more information at http://www.in.gov/wcb/2586.htm.Indiana Worker's Compensation Board (INWCB) will be implementing electronic reporting of workers’ compensation first reports of injury (FROI) and subsequent reports of injury (SROI).  Electronic reporting will be required for all trading partners:  insurers, self-insured employers, and claim administrators.  Mandatory implementation is planned for January 1, 2019. Electronic reporting will be via Electronic Data Interchange (EDI) transactions using the Claims 3.1 reporting standards adopted by the International Association of Industrial Accident Boards and Commissions (IAIABC).  Additional information on the IAIABC EDI transactions for FROI and SROI can be found online at the IAIABC website, http://www.iaiabc.org.The INWCB has contracted with ISO's Workers Compensation Solutions division, to manage its FROI and SROI EDI reporting.  ISO will be administering registration of trading partners, testing, data collection and submission of EDI data to the State. INWCB will provide an enhanced EDI Website that will be available early June 2018.
• New Nurse Case Manager Guidelines can be found at http://www.in.gov/wcb/2585.htm.

Kentucky VIEW STATE →

LEGISLATIVE ACTIONS:

House Bill 2

The legislation amends KRS 342.020 to establish that, only for workers’ compensation insurance claims resulting in an award of permanent total disability or resulting from injuries listed in subsection (9) (amputation of a limb, loss of hearing, or loss of vision), the employer’s obligation to pay benefits continues so long as the employee is disabled, regardless of the duration of the employee’s income benefits. For permanent partial disability claims not involving a subsection (9) injury, the employer’s obligation to pay benefits would extend for 780 weeks from date of injury or date of last exposure; thereafter, benefits would continue so long as the employee demonstrates, and an administrative law judge determines that continued medical treatment is reasonably necessary and is related to the work injury or occupational disease. The bill would require the commissioner notify an employee of the right to apply for continued benefits and the employee to file an application for continued benefits 75 days before the end of the 780-week benefit period.  If an employee fails to apply for continued benefits or a judge determines benefits are not reasonably necessary or not related to the work injury or occupational disease the employer’s obligation to pay medical benefits would cease permanently at the end of 780 weeks (15 years).  Section 1 would limit the number of urine screenings an employer would be obligated to pay for.  The legislation allows waiver of utilization review under identified circumstances; prohibit a provider charging a fee for an initial copy of medical records for the worker or their attorney; require development or adoption of a pharmaceutical formulary and promulgation of regulations to implement the formulary.  The legislation deems no interest due on delayed payment of income payments if the delay was caused by the employee.  The legislation limits the time to reopen a claim to 4 years after the original award or order becomes final and non-appealable. The legislation bars a claim based on cumulative trauma injury unless notice was given to the employer and unless application for adjustment of claim has been made to the commissioner within 5 years after the last exposure to the cumulative trauma. It limits liability for compensation for occupational disease to the last employer where the employee was exposed to the hazard for a minimum of 1 year; require the payment obligor to pay for medical evaluation of an employee claiming pulmonary dysfunction unless the employee has failed to provide spirometric evidence, in which case the employee must pay 50% of the evaluation cost. HB 2 GA would extend the deadline for filing a claim for compensation due to the following cancers to 20 years from the last injurious exposure:  bladder cancer; brain cancer; colon cancer; non-Hodgkin's lymphoma, kidney cancer, liver cancer, lymphatic or hematopoietic cancer, prostate cancer, testicular cancer, skin cancer, cervical cancer, and breast cancer.  The legislation establishes new maximum limits on employee and employer attorneys’ fees.  It establishes that an employer is not liable for compensation where an employee’s injury is due to voluntary ingestion of prescribed or nonprescribed substances that caused disturbance of mental or physical capacity, or willful intention of an employee to injure or kill himself or another.  The legislation allows employers through their insurers and self-insured/employer to recover a pro-rata share of its subrogation lien (indemnity and medical benefits) when an employee recovers a judgment against a third party for the employee’s injuries that includes indemnity and medical benefits.   It increases the percentage of Kentucky’s average weekly wage that may be paid as an income benefit; change the age limit on benefits to 67 years (or 2 years after injury, whichever is later); income benefits to dependents would likewise cease when the employee would have reached age 67 or 2 years after injury or exposure; offset income benefit payable to certain injured employees by the amount the employee would have paid in taxes or the amount paid for temporary light duty; terminate income benefits for temporary total disability to a professional athlete when their contract expires if they’ve been released to return to employment for which they’ve trained or have experience. The legislation requires employment for one year prior to filing a claim for hearing loss.  Effective Date July 1, 2018.

House Bill 388

The legislation amends KRS 342.001 to establish that, for policies issued after January 1, 2019 that include a deductible, the special fund premium assessment would be calculated by the “deductible program adjustment” method, defined as “a method of calculating premiums and premiums received on a gross basis for any schedule rating modifications, debits, or credits as if the deductible contract is not being used to calculate coverage.” This provision is intended as guidance on, and transparency of, the premium assessment base for deductible policies. It requires, beginning January 1, 2020 all premium assessments, including those payable by self-insured employers and state and political subdivision (including city and county government) employers, be remitted to the funding commission electronically by the 30th day following the end of each quarter.  It amends KRS 342.1223(2)(b) to delete the term “non-dividend-paying” from the description of equity securities. It amends KRS 342.1231 to reduce the time period within which the funding commission may mail a notice of assessment to an assessment payer (insurance company) from 7 to 5 years, after which time the assessment would be barred. It requires an insurance carrier pay a refund owed an insured within 60 days of notice by the funding commission that the refund is owed. If the refund is unpaid on the due date a 1.5% late penalty shall be owed by the insurance carrier.  Effective Date July 1, 2018.

Louisiana VIEW STATE →

REGULATORY ACTIVITY:

• Notice: When a medication has been previously approved, an LWC-WC-1010 shall not be required for any subsequent refills or new prescriptions of the previously approved medication within a six (6) month period.

Maine VIEW STATE →

REGULATORY ACTIVITY:

• The Workers’ Compensation Board has scheduled a public hearing on May 8, 2018 at 10:00 a.m. for proposed amendments to Rule Chapters 1-9, 12-16, and 18. The deadline for written comments is May 18, 2018 at 5:00 p.m. For more information, go to http://www.maine.gov/wcb/Departments/legaldivision/proposed.html.
• Published the following notice in the state register:

AGENCY: 90-350 - Workers’ Compensation Board (WCB)
CHAPTER NUMBER AND TITLE: Ch. 1-9, 12-16, 18
PROPOSED RULE NUMBERS: 2018-P050 thru P064
BRIEF SUMMARY: The proposed changes define terms, prescribe forms and clarify procedures regarding the processing and payment of workers’ compensation claims.
DETAILED SUMMARY: The following is a summary of the major changes:
Ch. 1 §1-A: Provide a means for employees to give notice of a claim in cases where the employer is out of business and the insurer is unknown.
Ch. 1 §5(1)(A)(3): Defines when 401(k) matching funds are considered fringe benefits.
Ch. 1 §5(2)(C): Allow a one-time adjustment, by filing a modification form, to an estimated average weekly wage.
Ch. 1 §11: Establishes process for meeting with the Maine Insurance Guaranty Association as required by 39-A MRS §153(9).
Ch. 2: Permanent impairment and benefit extension sections are simplified and the process for notifying employees of the right to request extensions of benefits pursuant to §213(1) is clarified.
Ch. 3 §1-A: Clarifies medical only First Reports of Injury must be sent to an employer’s insurance company.
Ch. 4: Clarifies eligibility to serve as an independent medical examiner and the procedure for requesting/paying for an independent medical examination.
Ch. 5: Procedures are clarified and new medical releases are proposed to ensure appropriate medical records can be received in a timely manner.
Ch. 6: Vocational rehabilitation rules have been rewritten to provide needed clarity.
Ch. 8 §11: Provides additional basis to reduce or discontinue benefits pursuant to 39-A MRS §205(9)(A).
Ch. 9: Requires use or benefit release form approved by Social Security Administration and permits employers/insurers to notify employees near the age of 62 of the obligation to inform employer/insurer of application for and receipt of old age Social Security benefits.
Ch. 12: Reorganized in a more logical manner. Also clarifies timeframe for requesting medical examinations prior to hearing and adds requirement that employees provide to employers reports generated by health care providers who attend examinations under 39-A MRS §207.
Ch. 13: Clarifies procedures before the Appellate Division.
PUBLIC HEARING: May 8, 2018, 10:00 a.m., Workers' Compensation Board, Central Office, 442 Civic Center Drive, Suite 100, Augusta, Maine
COMMENT DEADLINE: May 18, 2018
CONTACT PERSON FOR THIS FILING / SMALL BUSINESS IMPACT INFORMATION / WCB RULEMAKING LIAISON: John C. Rohde; 27 State House Station, Augusta, ME 04333. Telephone: (207) 287-7096. Email: John.Rohde@Maine.gov .
FINANCIAL IMPACT ON MUNICIPALITIES OR COUNTIES: N/A
STATUTORY AUTHORITY FOR THIS RULE: 39-A MRS §152(2)
SUBSTANTIVE STATE OR FEDERAL LAW BEING IMPLEMENTED (if different):
WCB WEBSITE: www.maine.gov/wcb.

Maryland VIEW STATE →

REGULATORY ACTIVITY:

• Updated Form – Stipulation of Parties and Award of Compensation WCC form H-34 (04/2018) has been changed. The revised form is available on our Forms and Instructions page as a fillable PDF. Please begin using the new form immediately.  To view the form, go to http://www.wcc.state.md.us/Adjud_Claims/Forms.html#settlement.
• Changes to the Online Employee Claim:  You can now check the status of your online employee claim.  A new tab is added to the "Start a Claim" and "Complete a Claim" options.  "Check Form Status" allows you to check the status of any claim started for 45 days after initiated.  If the claim submission is approved, you can also obtain the WCC Claim number in the results.

LEGISLATIVE ACTIONS:

House Bill 814 and Senate Bill 403

This bill expands to all local boards of education the authority to waive the requirement that a participating employer reimburse the local board for the cost of workers’ compensation insurance coverage provided to students placed in unpaid work-based learning experiences.  Effective Date October 1, 2018.

House Bill 1592 and Senate Bill 851

This bill requires the membership of the Maryland Jockey Injury Compensation Fund, Inc. (jockey fund) to consist of each licensed owner and trainer of a thoroughbred horse who is subject to an assessment.  When a jockey is injured or killed while live thoroughbred racing or training if the principal earnings of the jockey are based on money earned as a jockey during live racing and not as an exercise rider, the jockey fund is the employer responsible for providing workers’ compensation benefits.  Other provisions related to applications for benefits and actions against the licensed owner or trainer are repealed.  Effective Date October 1, 2018.

Maryland-Auto VIEW STATE →

REGULATORY ACTIVITY:

• Posted proposed amendments to Title31 Subtitle 15 Unfair Trade Practices Chapter 09 Automobile Liability Insurance.  The proposed regulation can be viewed at http://insurance.maryland.gov/Pages/newscenter/RegulatoryActivity.aspx.
  Comments on the proposed rule will be closed on April 30, 2018.

LEGISLATIVE ACTIONS:

House Bill 1161 and Senate 856 This bill repeals the Uninsured Motorist Education and Enforcement Fund (UMEEF) within the Motor Vehicle Administration (MVA) and establishes UMEEF in the Maryland Automobile Insurance Fund (MAIF).  The bill establishes another Program to Incentivize and Enable Uninsured Vehicle Owners to Be Insured; however, the new program must be administered by MAIF (instead of MVA).  Uninsured motorist penalties collected through the program are retained by MAIF.  The bill requires MVA to notify MAIF in a certain manner when it receives notice that a vehicle has become uninsured.  Effective Date  July 1, 2018. 

Massachusetts VIEW STATE →

REGULATORY ACTIVITY:

• The Executive Office of Health and Human Services and the Department of Industrial Accidents held a listening session to hear comments from the public regarding rates of payment for workers’ compensation claims pursuant to M.G.L. c. 152, §13(1), and related regulations. This listening session was held to gather information from interested parties to help inform the Executive Office of Health and Human Services in its determination of rates of payment for workers’ compensation claims in accordance with M.G.L. c. 118E, §13D. The agencies were seeking information from medical providers, insurers, claimants, and other interested stakeholders regarding the workers’ compensation rates and how they affect workers’ compensation coverage, consumer access, and quality of care. Additionally, the agencies provided general information regarding the rate review and regulatory promulgation process. The listening session took place in the conference room #3 at 1 Ashburton Place, 21st floor, Boston, MA, on Wednesday, April 11, 2018, from 1:00 p.m. to 3:00 p.m.
• Published Administrative Bulletin 18-12 regarding 101 CMR 334.00 Prostheses, Prosthetic Devices and Orthotic Devices; HCPCS Updates and Corrections.  To view a copy of the bulletin, go to https://www.mass.gov/lists/2018-eohhs-administrative-bulletins.
• The Executive Office of Health and Human Services (EOHHS) and the Department of Industrial Accidents (DIA) have initiated a review of the reimbursement rates for treatment of work-related injuries and claims pursuant to G.L. c. 152, § 13(1), and related regulations. The rates will be reviewed and established in accordance with M.G.L. c. 118E, § 13D.
• Issued Administrative Bulletin 18-15 regarding CMR 322.00: Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment; Rate Updates for Certain Absorbent Products Subject to a Preferred Supplier Agreement. The rates in this bulletin became effective April 15, 2018.  Under the authority of 101 CMR 322.00, the Executive Office of Health and Human Services (EOHHS) is issuing this bulletin to establish differential rates for certain products. Specifically, pursuant to 101 CMR 322.01(6)(b), EOHHS has the authority to establish differential rates via Administrative Bulletin for durable medical equipment or medical supplies subject to a preferred supplier agreement or agreements between a manufacturer and a governmental unit or units.  To view the bulletin, go to https://www.mass.gov/lists/2018-eohhs-administrative-bulletins.

Medicare VIEW STATE →

FEE SCHEDULE NEWS:

• Outpatient and Inpatient PSF Files – CMS has published new versions of the outpatient and inpatient PSF filed with an effective date of April 1, 2018. The next expected update is July 1, 2018.

Minnesota VIEW STATE →

REGULATORY ACTIVITY:

• The Department of Labor and Industry has posted a Notice of Intent to Adopt Rules Without a Public Hearing Unless 25 or More Persons Request a Hearing, and Notice of Hearing if 25 or More Requests for Hearing Are Received.  The commissioner of the Minnesota Department of Labor and Industry (DLI) intends to adopt rules governing Workers' Compensation Vocational Rehabilitation Fees, Minnesota Rules, Part 5220.1900.  Please see the Dual Notice:  Notice of Intent to Adopt Rules Without a Public Hearing Unless 25 or More Persons Request a Hearing, and Notice of Hearing if 25 or More Requests for Hearing Are Received (Dual Notice), which is available at dli.mn.gov/Pdf/docket/5220_1900_dualnotice.pdf. The Dual Notice provides details about the rulemaking process, including how to submit comments and how to request a hearing via the agency contact person. A copy of the proposed rules is available at www.dli.mn.gov/Pdf/docket/5220_1900_proposedappvdrules.pdf.
• Published notice in the state register of proposed rule.  The proposed rules are amendments to the rules governing fees for vocational rehabilitation services provided to injured workers. Specifically, the proposed rules eliminate the fee reduction for lengthy and costly rehabilitation plans and adjust the maximum hourly rate for qualified rehabilitation consultant (QRC) services so that total QRC costs remain neutral as of the effective date of the rules. The proposed rules also increase the hourly limit on QRC services when a person other than the QRC is providing job development or job placement services. Next, the proposed rules provide clarity to rehabilitation providers and insurers about billing and payment for certain types of services and activities. Finally, the rules reference penalty authority that exists under the workers’ compensation statutes for an insurer’s failure to timely pay or deny a rehabilitation provider’s bill.  The statutory authority to adopt the proposed rules is Minnesota Statutes 2016, section 176.102, subdivision 2(a), which grants the commissioner of DLI the authority to adopt rules regarding rehabilitation fees, and Minnesota Statutes 2016, section 176.83, subdivisions 1 & 2, which grant the commissioner the authority to adopt “rules necessary to implement and administer section 176.102” and adopt, amend, or repeal rules to carry out the provisions.

Nebraska VIEW STATE →

REGULATORY ACTIVITY:

• Posted an announcement that Lorra O'Banion has been named Nebraska Workers' Compensation Court General Counsel. The appointment became effective on April 2, 2018.
• The Nebraska Workers' Compensation Court will be transitioning from IAIABC Claims Release 1 to IAIABC Claims Release 3.1 standard for electronic reporting of Workers' Compensation Injury and Payments.  A copy of the notice can be viewed at https://www.wcc.ne.gov/news/nwcc_news.aspx.

LEGISLATIVE ACTIONS:

Legislative Bill 953

The enacted legislation requires the Workers’ Compensation Court to approve a lump-sum settlement in cases in which (a) the employee at the time of settlement is eligible for Medicare, is a Medicare beneficiary, or has a reasonable expectation of becoming eligible for Medicare within 30 months; or (b) if medical, surgical, or hospital expenses incurred for treatment of the injury will not be fully paid as part of the settlement, if the employee’s attorney affirms that the settlement is in conformity with the compensation schedule and for the best interests of the employee or his or her dependents, under all the circumstances. It also addresses a recent Workers’ Compensation Court’s decision regarding the enforceability of late payment penalties. Currently, Neb. Rev. Stat. § 48-139(4) permits a fifty percent penalty for late payments to the employee, but the Workers' Compensation Court has found that the employee has already waived his or her rights to enforce this. LB 953 corrects this issue by making the entry of an order of dismissal a prerequisite to the discharge of a defendant from liability.  Effective Date July 18, 2018.

Legislative Bill 957

The legislation provides for certain payments by direct deposit, prepaid card, or similar electronic payment system.  It defines terms to harmonize provisions; and to repeal the original section. Effective Date July 18, 2018.

New-Hampshire-Auto VIEW STATE →

REGULATORY ACTIVITY:

• Published notice of a requirement for licensed insurers to complete a 2017 Line of Business Survey.  To view the survey, go to https://www.nh.gov/insurance/media/bulletins/2018/index.htm.

New Mexico VIEW STATE →

REGULATORY ACTIVITY:

• The IME Provider Selection Committee organized pursuant to § 52-1-1.2. D. is revising its list of health care providers who are authorized to conduct independent medical examinations (IMEs).  This list includes one applicant to be considered during the June 2018 IME Committee meeting.  The list can be found on the Health Care Providers page. Written public comment on any health care provider being considered for inclusion or continuation on the list of authorized IME providers will be accepted from May 1, 2018, through close of business on May 31, 2018. In making its decisions, the “Committee shall, to the greatest extent possible, designate only health care providers whose judgments are respected, or not objected to, by recognized representatives of both employer and worker interests and whose judgments are not perceived to favor any particular interest group.” To provide written public comment, please contact the Workers’ Compensation Administration’s Medical Cost Containment Bureau, PO Box 27198, Albuquerque, NM 87125-7198, phone (505) 841-6811, fax (505) 841-6078.

New York VIEW STATE →

REGULATORY ACTIVITY:

• Published notice that the emergency rule regarding the option to self-insure the jockey fund has been permanently adopted. To view the notice, go to https://docs.dos.ny.gov/info/register/2018/april4/toc.html.
• Published Bulletin 046-1048 regarding revised medical authorization request forms. The following medical authorization forms have been revised to include a place for providers to include their National Provider Information (NPI) number. The forms also expand the certification area by adding a space for more than one fax number or email address. This will allow providers to indicate that the request for authorization was submitted to a second fax number or email address in addition to the designated fax number or email address found on the Board's website. Providers who search the Board's website but cannot locate the designated fax number or email address should check the box "designated contact information not available."  To view a copy of the bulletin, go to http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1048.jsp.
  • Attending Doctor's Request for Authorization and Carrier's Response (Form C-4AUTH),
  • Attending Doctor's Request for Optional Prior Approval and Carrier's/Employer's Response (Form MG-1),
  • Continuation to Form MG-1, Attending Doctor's Request for Optional Prior Approval (Form MG-1.1),
  • Attending Doctor's Request for Approval of Variance and Carrier's Response (Form MG-2), and
  • Continuation to Form MG-2, Attending Doctor's Request for Approval of Variance (Form MG-2.1)

The Chair proposed the adoption of Part 441 of 12 NYCRR and amendment of Section 440.2 of 12 NYCRR to establish a drug formulary that includes high-quality and cost-effective pre-authorized medication. The Notice of Proposed Rule Making was published in the December 27, 2017, edition of the State Register. Comments on the proposed rule were accepted for 60 days after publication.  For more information regarding these proposed regulations, contact Heather M. MacMaster, Deputy General Counsel, Workers' Compensation Board, 328 State Street, Schenectady, New York 12305-2318, telephone: (518) 486-9564, e-mail: regulations@wcb.ny.gov.  To view a copy of the related documents, go to http://www.wcb.ny.gov/drug-formulary-regulation/.

• Issued bulletin subject number 046-1058 regarding proposals to improve medical care for injured workers. To increase provider participation in the workers' compensation system and improve injured workers' access to timely, quality medical care, the Workers' Compensation Board (Board) is proposing an increase to provider fees and adoption of the universal CMS-1500 form to reduce administrative burden, among other measures. Access to quality medical care for injured workers is of utmost importance for a healthy workers' compensation system. When an injured worker has ready access to medical treatment, the worker heals and is restored to function more quickly and completely. This benefits not only the worker, but the employer as well. Today the Board announces a multipronged approach to address provider concerns around participating in the workers' compensation system and expand injured workers' access to medical care.
  • Proposal to Increase Medical Fees for All Medical Providers The Board's current medical fee schedule has remained relatively unchanged since 1996 and remains a significant obstacle to attracting new providers and retaining existing ones. Therefore, the Board will be advancing a regulatory proposal in June to raise provider fees; this will be effective for services provided on or after October 1, 2018. The proposal will include an overall statewide fee increase for all provider types, with additional increases for certain specialty provider groups that have an extreme shortage of authorized providers. These new fees will ensure providers in New York are receiving fair and reasonable reimbursement for prompt, quality treatment to our injured workers.
  • Proposal to Reduce Paperwork Providers have indicated that the unique paperwork requirements in the workers' compensation system result in significant additional administrative costs. Therefore, the Board will be consolidating and eliminating forms, including converting to the use of the CMS-1500 form. The CMS-1500 is the universal claim form used by medical providers to bill health insurers. Careful review and discussion with different stakeholders confirms that the CMS-1500 is easy to use and provides the necessary information. The Board proposes replacing the current Board treatment forms (C-4 and C-4.2, and equivalent OT/PT and PS forms) with the CMS-1500. As the CMS-1500 is already used by medical providers and insurance carriers to process claims, the Board anticipates an easy transition to the CMS-1500 and will be working towards a January 1, 2019, implementation date.
  • Other Enhancements to Improve Access to Quality Medical Care The Board is also committed to other improvements that will increase access to quality medical care and reduce administrative burdens. Medical Portal. The first phase of the Medical Portal, an important Business Process Re-engineering initiative, will be coming this year. This electronic medical portal will allow providers to quickly and easily identify whether their course of treatment is consistent with the Board's medical treatment guidelines and, if not, advise them that a variance is needed. The Medical Portal is an important step toward an easy-to-use, paperless system. Access to Different Medical Providers The Board is also exploring options that will increase access to medical care providers. This will afford injured workers access to expanded provider types and medical providers flexibility in the delivery of medical care. Governor Cuomo continues to support a comprehensive legislative solution that expands the types of providers that may treat injured workers. Currently only physicians, chiropractors, podiatrists, and psychologists can be authorized. The proposed legislation would amend the Workers' Compensation law to conform with the Education law by permitting medical providers who are licensed in New York State to become authorized, opening participation to nurse practitioners, physician's assistants, licensed clinical social workers, and other providers. In most instances, injured workers would be able to seek treatment for their workers' compensation illness and injuries with the same providers they use for non-work-related illness and injuries. The proposals announced today come in direct response to claimants' challenges in finding treating providers, and concerns from health care providers around low fees and complexity that keep some from participating. By addressing these concerns and bringing more providers into the workers' compensation system, injured workers can more readily access the care they need. To review the bulletin, go to http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1058.jsp.
• The maximum weekly benefit rate for workers’ compensation claimants is two-thirds of the New York State average weekly wage for the previous calendar year, as determined by the New York State Department of Labor (Workers’ Compensation Law §§ 2(16);15(6)). The Department of Labor reported to the Superintendent of the Department of Financial Services that the New York State average weekly wage for 2017 was $1,357.11. Accordingly, the maximum weekly benefit rate is $904.74 for compensable lost time for workers' compensation claims with dates of accident during the period from July 1, 2018 through June 30, 2019.

North Carolina VIEW STATE →

REGULATORY ACTIVITY:

• On November 21, 2017, by a unanimous decision, the Court of Appeals issued an Opinion reversing the August 9, 2016 Decision of Superior Court Judge Paul Ridgeway and remanding the case for entry of an order affirming the Industrial Commission’s December 14, 2015 Declaratory Ruling. The Court of Appeals held that the ambulatory surgery center provisions of the workers’ compensation medical fee schedule that became effective April 1, 2015 were promulgated in accordance with the Administrative Procedure Act and are valid retroactively and prospectively. Please click here to read that decision. On April 6, 2018, the North Carolina Supreme Court denied Surgical Care Affiliates’ request for a Petition for Discretionary Review. This leaves in place the November 2017 Court of Appeals decision in favor of the Industrial Commission. Rule 04 NCAC 10J .0103, effective April 1, 2015, continues to be the effective fee schedule for ambulatory surgery centers.
• Posted copy of letter sent to the North Carolina Rules Review Commission requesting exemption request regarding industrial commission's rules subject to the current round of periodic review of existing rules.  To view the letter, go to http://www.ic.nc.gov/news.html#hot. 
•  tp://www.ic.nc.gov/news.html#hotws.html" \nd transact public business. The tentative agenda is as follows:
  • Discuss the internal review committees’ reports on the Workers’ Compensation Rules and the Tort Claims Rules and consider potential future rulemaking.
  • Consider potential additional rulemaking related to the Opioid Utilization Rules.
  • Review the draft Companion Guide to the Opioid Utilization Rules.
  • Address other administrative matters, including approving the minutes from the March 20, 2018 Commissioners Meeting.
• On April 19, 2018, the Rules Review Commission approved nine rules adopted by the Industrial Commission for the utilization of opioids, related prescriptions, and pain management treatment in workers’ compensation claims. Six of the nine rules were approved with technical corrections. Please click here to view the nine approved rules. No letters of objection were received. Therefore, these rules went into effect on May 1, 2018. To view the rules, go to  http://www.ic.nc.gov/news.html#hot.
• On April 19, 2018, the Rules Review Commission approved the rule amendment with technical corrections to Rule 04 NCAC 10A .0107. Please click here to view an annotated version of the approved rule showing all amendments. No letters of objection were received. Therefore, this rule as amended is effective as of May 1, 2018. To view the rule, go to http://www.ic.nc.gov/news.html#hot.

Ohio VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted a new fee schedule for Outpatient and Ambulatory Surgical Services effective on and after May 1, 2018.  The next update is expected in May 2019.

Ohio-Auto VIEW STATE →

REGULATORY ACTIVITY:

• Issued bulletin 2018-02 regarding Pharmacy Benefits-Prohibited Practices.  To view the bulletin, go to http://www.insurance.ohio.gov/Legal/Bulletins/Pages/BulletinIndex.aspx.

Oregon VIEW STATE →

REGULATORY ACTIVITY:

• 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.
• 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.

Pennsylvania WC VIEW STATE →

REGULATORY ACTIVITY:

• Published an updated fee schedule memo. To view the memo, go to http://www.dli.pa.gov/Businesses/Compensation/WC/HCSR/MedFeeReview/Fee%20Schedule/Pages/default.aspx.

Rhode Island VIEW STATE →

REGULATORY ACTIVITY:

• Published information letter 18-01 regarding 2018 cost of living increase notification.  Rhode Island General Law Sections 28-33-17(f)(1), Weekly Compensation for Total Incapacity, 28-33-18.3(b)(1), Continuation of Benefits – Partial Incapacity and 28-3730, Cost of Living Increase, provide for annual benefit increases to certain classes of employees.  By the statutes listed above, the increases to these employees shall be by an amount equal to the total percentage increase in the (CPI-W) Consumer Price Index, United States city average for urban wage earners and clerical workers as formulated and computed by the Bureau of Labor Statistics of the United States Department of Labor for the period of March 1 to February 28 each year.  The Cost of Living Increase for 2018 will be 2.3 %.  Effective May 10, 2018, weekly benefits paid to these employees should be increased 2.3%.  By statute, increases shall be paid by insurers and employers without further order of the court.  Late payment of the increase may result in the assessment of a 20% penalty on the unpaid amount. To view the information letter, go tohttp://www.dlt.ri.gov/wc/infoletters.htm.

Rhode Island Auto VIEW STATE →

REGULATORY ACTIVITY:

• Published Bulletin 2018-7 regarding Auto Body Labor Rate Survey- Insurers and Groups which Must Participate in2018 Survey. Published with the survey were two excel spreadsheets listing the entities that must respond to the survey.  To view the bulletin and spreadsheets, go to http://www.dbr.ri.gov/news/insurance.php.

South Carolina VIEW STATE →

REGULATORY ACTIVITY:

• Posted the Agenda of the April 16 business meeting along with materials to be presented to the Commissioners at the business meeting.  To view the agenda, go to http://www.wcc.sc.gov/Pages/default.aspx.
• Posted notice that the report of the April 16 business meeting is now available.  To view the report, go to http://www.wcc.sc.gov/Pages/default.aspx.

South Dakota VIEW STATE →

REGULATORY ACTIVITY:

• Posted notice to replace and correct the previous notice published pertaining to rules in Chapter 47:03:05. The date for the public hearing and the comment period have been amended as stated below. The Division of Labor and Management will hold a public hearing in the Sharpe Conference Room, Missouri River Plaza, 123 W. Missouri Avenue, Pierre, South Dakota, on May 14, 2018 at 2:00 p.m., to consider the adoption and amendment of proposed rules to the following:  Chapter 47:03:05. The effect of the rules is to revise the workers' compensation fee schedule.
• Posted the following is the state register: Department of Labor and Regulation:  Division of Labor and Management: (April 18, 2018) intends to amend rules to revise the workers compensation fee schedule.  The general authority for these rules, as cited by the agency, is SDCL § 62-7-8.  A public hearing will be held in the Sharpe Conference Room, Missouri River Plaza, 123 West Missouri Avenue, Pierre, South Dakota, on May 14, 2018, at 2:00 p.m. CT. Copies of the proposed rules may be obtained without charge from and written comments sent to South Dakota Division of Labor and Management, 123 W. Missouri Avenue, Pierre, SD 57501. Electronic copies are available by email to mallori.barnett@state.sd.us, and Online at https://rules.sd.gov or http://dlr.sd.gov/workers_compensation/aspx. The comment period will remain open for ten days following the public hearing and will close on May 19, 2018. This hearing is being held in a physically accessible place. Persons who have special needs for which the Division can make arrangements are asked to call (605) 773-3681 at least 48 hours before the public hearing.

South-Dakota-Auto VIEW STATE →

REGULATORY ACTIVITY:

• Published bulletin 18-01 regarding defense of Liability and Professional Liability Products.  To view the bulletin, go to https://dlr.sd.gov/insurance/laws.aspx#bulletins.

Tennessee VIEW STATE →

LEGISLATIVE ACTIONS:

House Bill 2304

The enacted legislation amends the workers’ compensation statute regarding attorney fees.  Effective Date April 18, 2018.

Senate Bill 1615

Deletes the requirement that every workers’ compensation insurer that provides insurance for Tennessee workers’ compensation claims or self-insured employers maintain a claims office or contract with a claims adjuster located within the State of Tennessee. Effective Date April 12, 2018.

Senate Bill 2141

The Workers' Compensation Law does not presently apply to farm or agricultural laborers and employers of those laborers. This bill authorizes employers of farm or agricultural laborers to accept the Workers' Compensation Law by purchasing a workers' compensation insurance policy, and to withdraw that acceptance by canceling or not renewing the policy and providing notice to the employees. Effective Date April 2, 2018.

Texas VIEW STATE →

REGULATORY ACTIVITY:

• The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) seeks input on the development of an Opioids Plan-Based Audit (Plan-Based Audit) to evaluate the appropriateness of a health care provider’s decision-making and record-keeping that supports prescribing opioids for each treatment plan tailored to a specific injured employee. The Plan-Based Audit sets the scope, methodology, selection criteria, and program area responsibilities according to the Medical Quality Review Process. A copy of the proposed Opioid Plan-Based Audit is available on the TDI website at tdi.texas.gov/wc/hcprovider/medadvisor.html. The Opioid Plan-Based Audit is a part of the approved CY 2018 Medical Quality Review Annual Audit Plan, which is available on the TDI website at www.tdi.texas.gov/wc/hcprovider/documents/auditplan18.pdf .  If you have any questions, contact Mary Landrum at 512-804-4814 or Mary.Landrum@tdi.texas.gov.
• Commissioner of Workers' Compensation Ryan Brannan adopted amended 28 Texas Administrative Code (TAC) §§ 105, 112.101, 112.102, 112.201, 112.202, 130.101, 130.102, and 136.1, and repealed 28 TAC §130.10 and §136.2 to align the Texas Department of Insurance, Division of Workers’ Compensation (division) rules with recent statutory amendments in House Bill 2112, 85th Legislative Session, Regular Session, which became effective on June 9, 2017.  The adoptions will be published in the April 6, 2018, issue of the Texas Register and available at www.sos.state.tx.us/texreg/index.shtml once published. A courtesy copy of the adopted rules will also be available on the division website at www.tdi.texas.gov/wc/rules/2018rules.html.  The division is posting finalized versions of several forms simultaneously with this rule, including the DWC Form081, Agreement Between General Contractor and Subcontractor to Provide Workers’ Compensation Insurance; the DWC Form-082, Agreement for Motor Carriers and Owner Operators; the DWC Form-083, Agreement for Certain Building and Construction Workers; the DWC Form-084, Exception to Application of Joint Agreement for Certain Building and Construction Workers; and, the DWC Form-085, Agreement Between General Contractor and Subcontractor to Establish Independent Relationship.  In addition, in response to public comment, the division is posting a new Spanish version of DWC Form-084.  Also, the division is removing the DWC Form-065, Application for Inclusion on Registry of Private Providers of Vocational Rehabilitation Services, and the DWC Form-020, Insurance Carrier’s Notice of Coverage/Cancellation/non-Renewal of Coverage, from the division website. Additional information and the forms are available on the division website at: www.tdi.texas.gov/forms/form20.html.  To view the entire notice, go to http://www.tdi.texas.gov/alert/whatsnew/index.html. To view the rules, go to http://www.tdi.texas.gov/wc/rules/2018rules.html.
• Texas Workers' Compensation Commissioner Ryan Brannan has informed Gov. Greg Abbott that he will step down from his position effective May 1. Commissioner Brannan was appointed to the Texas Department of Insurance’s, Division of Workers’ Compensation (DWC) in August 2014 by Governor Rick Perry and reappointed twice by Governor Abbott. Governor Abbott may appoint an individual to fulfill the existing term, which expires February 1, 2019.
• Posted notice of an informal posting regarding amendments to 28 Texas Administrative Code (TAC) §§7, 116.11, 133.308, 140.1, 140.8, 141.2, 142.2, 142.3, 142.7, 142.8, 142.10, 142.11, 142.12, 142.13, 142.14, 142.16, 142.18, 142.20, 143.1, 143.2, 143.3, 143.4, 143.5, 152.3, 152.6 and new §140.9.  To view the notice, go to http://www.tdi.texas.gov/alert/whatsnew/index.html.  To view the rules, to http://www.tdi.texas.gov/wc/rules/drafts.html.
• The Commissioner of Workers’ Compensation has adopted the procedure for evaluating designated doctor performance effective immediately. The evaluation procedure provides for a review of the quality of designated doctor decisions, as required by law. The Texas Department of Insurance, Division of Workers’ Compensation (DWC) may take necessary action to deny renewal of a designated doctor's certification based on the integrity of these decisions. The evaluation procedure will also help DWC increase training and testing quality by identifying areas for Designated Doctor performance improvement. Information about the evaluation procedure, including selection criteria, is available at tdi.texas.gov/wc/hcprovider/medadvisor.html.  If you have questions, contact Mary Landrum at 512-804-4814 or Mary.Landrum@tdi.texas.gov. For media inquiries, contact DWC Communications at 512-804-4208 or DWCCommunications@tdi.texas.gov.   To view additional information regarding the review, go to www.tdi.texas.gov/wc/hcprovider/medadvisor.html#ddpr.
• On March 29, 2018, Commissioner of Workers’ Compensation Ryan Brannan adopted amended 28 Texas Administrative Code §§134.500, regarding Definitions; 134.530, regarding Requirements for Use of the Closed Formulary for Claims Not Subject to Certified Networks; and 134.540, regarding Requirements for Use of the Closed Formulary for Claims Subject to Certified Networks.  The adoption was filed with the Office of the Secretary of State on April 2, 2018.  The adoption will be published in the April 13, 2018 issue of the Texas Register and may be viewed on the on the Secretary of State website at sos.state.tx.us/texreg/index.shtml.  A courtesy copy of the adoption is available on the Texas Department of Insurance website at www.tdi.texas.gov/wc/rules/2018rules.html.   The adopted amendments to §134.500 will exclude from the closed formulary all prescription drugs created through compounding prescribed and dispensed on or after July 1, 2018.  The adopted amendments to §§134.530 and 134.540 will require preauthorization of these drugs for claims subject to and not subject to certified networks.  The rule change does not prohibit the use of compounded drugs for injured employees when medically necessary; however, it does require that medical necessity be determined prior to prescribing and dispensing these drugs on or after July 1, 2018.  Prescriptions for compounded drugs not requiring preauthorization that are written before July 1, 2018, and refills for those prescriptions, will not be impacted by this rule change.
• The Texas Department of Insurance, Division of Workers' Compensation (division) is accepting public comments on a proposed rule to amend 28 Texas Administrative Code (TAC) §129.5.   If you want to comment on the proposal, submit your written comments by 5:00 p.m. Central time on May 21, 2018. A request for a public hearing must be sent separately from your written comments. Send written comments or hearing requests by email to Rulecomments@tdi.texas.gov or by mail to:  Texas Department of Insurance, Division of Workers' Compensation Maria Jimenez Workers' Compensation Counsel MS – 4D 7551 Metro Center Drive, Suite 100 Austin, Texas 78744-1645.  If a hearing is held, TDI-DWC will consider written comments and public testimony presented at the hearing.  The proposal will be published in the April 20, 2018 issue of the Texas Register and will be available at sos.state.tx.us/texreg/index.shtml once published. A courtesy copy will also be available on the TDI website at www.tdi.texas.gov/wc/rules/2018rules.html.  The amendment conforms the division’s rules to legislation passed during the 85th legislative session (House Bill 2546, effective June 9, 2017). Amended §129.5 allows a delegated health care practitioner authorized under Labor Code §408.025 to complete, sign, and file a work status report.  Amended §129.5 also allows an injured employee to receive a work status report by electronic transmission, if the injured employee agrees to receive the report by electronic transmission. In accordance with §133.20(e)(2), a medical bill must be submitted in the name of the licensed health care provider that provided the health care or that provided direct supervision of an unlicensed individual who provided the health care.  If an authorized physician assistant completes and signs a work status report in accordance with proposed Rule §129.5, the physician assistant should be listed as the rendering provider on the medical bill. To view the proposed rule, go to http://www.tdi.texas.gov/wc/rules/2018rules.html.
• Posted notice of adoption of rule 133.30 regarding telemedicine and telehealth services.  Commissioner of Workers' Compensation Ryan Brannan adopted new 28 Texas Administrative Code §133.30, regarding Telemedicine Services and Telehealth Services. The adoption will be published in the April 27, 2018 issue of the Texas Register and may be viewed on the Secretary of State website at http://www.sos.state.tx.us/texreg/index.shtml once published. A courtesy copy of the adoption is available on the division’s website at https://www.tdi.texas.gov/wc/rules/2018rules.html.
  New §133.30 expands access to telemedicine services in the Texas workers’ compensation system by allowing health care providers to bill and be reimbursed for telemedicine or telehealth services regardless of where the injured employee is located at the time the services are delivered. Health care providers must follow applicable Medicare payment policies and billing provisions found throughout Chapter 133 and 134 of division rules when billing for telemedicine or telehealth services.  New §133.30 is applicable to telemedicine and telehealth services provided on or after September 1, 2018. A list of services billable under Medicare payment policies may be found at https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes.html.  To view the rule, go to https://www.tdi.texas.gov/wc/rules/2018rules.html.

Virginia VIEW STATE →

REGULATORY ACTIVITY:

• Published an updated Medical Fee Schedule Project Timeline.  To view the updated timeline, go to vwc.state.va.us/sites/default/files/documents/Medical-Fee-Schedule-Project-Timeline_0.pdf.
• Effective July 1, 2018 the maximum compensation rate will be $1,082.00, and the minimum compensation rate will be $270.50.  Effective October 1, 2018 the COLA rage will be 2.15%.

Washington VIEW STATE →

REGULATORY ACTIVITY:

• Workers' Compensation Self-Insurance Rules and Regulations (Chapter 296-15 WAC). The purpose of this rulemaking is to update Chapter 296-15 WAC, Workers’ Compensation Self-Insurance Rules and Regulations. The existing rules are outdated and have been a point of concern for both business and labor. An advisory workgroup of business and labor representatives has worked with the department to formulate modernized rule concepts for consideration by the broader communities. The key objectives of this rulemaking effort include: better communication to workers; greater certainty for employers; and reduced re-adjudication and strengthened regulation by the department that better aligns with statutory mandate.  To view a copy of the pre-proposal, go to lni.wa.gov/LawRule/WhatsNew/Proposed/default.asp?RuleID=263.

LEGISLATIVE ACTIONS:

House Bill 1336

The legislation Exempts from social security offset requirements, workers who applied to receive social security retirement benefits before the date of their injury and workers receiving social security benefits before their injury. Effective Date June 7, 2018.

Senate Bill 6214

The legislation exempts certain firefighters, law enforcement officers, and emergency medical technicians from a rule of the department of labor and industries that claims based on mental conditions or mental disabilities caused by stress do not fall within the definition of occupational disease. Provides a prima facie presumption, with regard to certain firefighters, law enforcement officers, and emergency medical technicians who are covered under the state industrial insurance act, that posttraumatic stress disorder is an occupational disease.  Effective Date June 7, 2018.

Senate Bill 6245

The enacted legislation centralizes and consolidates the procurement of spoken language interpreter services and expands the use of language access providers. It authorizes the department of social and health services, the department of children, youth, and families, and the state health care authority to purchase interpreter services on behalf of limited English-speaking applicants and recipients of public assistance. Authorizes the department of labor and industries to purchase interpreter services for medical and vocational providers authorized to provide services to limited English speaking injured workers or crime victims. Requires the department of social and health services, the department of children, youth, and families, the state health care authority, and the department of labor and industries, no later than September 1, 2020, to purchase in-person spoken language interpreter services directly from language access providers, and/or through limited contracts with scheduling and coordinating delivery organizations. Requires the department of enterprise services, upon the expiration of a contract in effect on the effective date of this section, but no later than September 1, 2020, to develop and implement a model that all state agencies must use to procure spoken language interpreter services by purchasing directly from language access providers and/or through contracts with scheduling and coordinating entities. Effective Date June 7, 2018.

Senate Bill 6393

The enacted legislation revises the state industrial insurance act to authorize the department of labor and industries to use a different assumption for annual investment returns for the reserve funds for self-insured and state fund pension claims. Effective Date June 7, 2018.

Wisconsin VIEW STATE →

REGULATORY ACTIVITY:

• Has published the WC Advisory Council Meeting Minutes for council meetings held on 10/4/2017, 10/13/2017, and 12/12/2017.  To view a copy of the minutes, go to https://dwd.wisconsin.gov/wc/councils/wcac/wcac_minutes.htm.
• Published the Workers' Compensation Advisory Council Meeting Minutes for the meeting of February 5, 2018 in draft form.  To view the meeting minutes draft form, go to https://dwd.wisconsin.gov/wc/councils/wcac/wcac_minutes.htm. 

LEGISLATIVE ACTIONS:

Assembly Bill 877 The enacted legislation relates to: disclosures to the commissioner of insurance and other changes to the insurance laws, extending the time limit for emergency rule procedures, providing an exemption from emergency rule-making procedures, and granting rule-making authority.  Effective Date April 17, 2018.

Wyoming VIEW STATE →

LEGISLATIVE ACTIONS:

Senate File 6

The enacted legislation exempts real estate professionals from coverage as specified.   Effective Date July 1, 2018.