Alaska VIEW STATE →

REGULATORY ACTIVITY:

• NOTICE OF PUBLIC MEETING:  The Alaska Workers' Compensation Board will conduct a full board meeting, October 4-5, 2018. This meeting is open to the public and will begin at 9:00am. The meeting will be held at the following location: Department of Labor Building; 3301 Eagle Street; Hearing Room 208; Anchorage, Alaska. The agenda consists of the regular business of the Workers' Compensation Board and Division, consisting of, but not limited to discussion of issues pertaining to the Alaska Workers’ Compensation Act, and approval of potential changes to regulations.  The Board will also conduct other business as necessary and useful. A copy of the proposed agenda is attached.  Public comment will be taken in person or telephonically from 10:15AM to 11:15AM on October 4, 2018 and might be extended to accommodate those present before 10:15AM who did not have an opportunity to comment.  To view the notice, go to https://aws.state.ak.us/OnlinePublicNotices/Notices/View.aspx?id=191145.

LEGISLATIVE ACTIONS:

• House Bill 79

An act relating to workers' compensation; repealing the second injury fund upon satisfaction of claims; relating to service fees and civil penalties for the workers' safety programs and the workers' compensation program; relating to the liability of specified officers and members of specified business entities for payment of workers' compensation benefits and civil penalties; relating to civil penalties for underinsuring or failing to insure or provide security for workers' compensation liability; relating to preauthorization and timely payment for medical treatment and services provided to injured employees; relating to incorporation of reference materials in workers' compensation regulations; relating to proceedings before the Workers' Compensation Board; providing for methods of payment for workers' compensation benefits; relating to the workers' compensation benefits guaranty fund authority to claim a lien; excluding independent contractors from workers' compensation coverage; establishing the circumstances under which certain nonemployee executive corporate officers and members of limited liability companies may obtain workers' compensation coverage; relating to the duties of injured employees to report income or work; relating to misclassification of employees and deceptive leasing; defining 'employee'; relating to the Workers' Compensation Board's approval of attorney fees in a settlement agreement; and providing for an effective date.. Effective Date August 27,2018.

Arizona VIEW STATE →

REGULATORY ACTIVITY:

• Posted a reminder that the Commission is updating their treatment guidelines.  The updated guidelines become effective October 1, 2018.  A summary of the updated guidelines and an FAQ regarding the changes can be viewed at https://www.azica.gov/resources/medical-provider.

Arkansas VIEW STATE →

REGULATORY ACTIVITY:

• The Commission issued an update to Advisory 2000-1 Revised, announcing that the maximum rates for 2019 will be $695.00 for Total Disability and $521.00 for Permanent Partial Disability.
• The Commission also issued an update to Advisory 2007-1 Revised, announcing that the threshold at which the Death and Permanent Total Disability Trust Fund will assume payments of benefits for injuries resulting in permanent total disability or death will be $225,875 for 2019 (through June 30, 2019).
  • To view the advisories, go to http://www.awcc.state.ar.us/advind.html.

• The insurance department issued the final regulation Rule 118 regarding Pharmacy Benefits Managers.  The regulation became effective August 27, 2018. To view the final regulation, go to  https://insurance.arkansas.gov/pages/industry-regulation/legal/finalized-rules/.

California VIEW STATE →

FEE SCHEDULE NEWS:

• The DWC has adopted the Medi-Cal rates effective September 15, 2018. The next update is expected October 15, 2018.
• The DWC has adopted new changes to the Physician Fee Schedule effective October 1, 2018. The next update is expected January 1, 2019.
• The DWC adopted changes to the Outpatient and ASC Fee Schedule effective October 1, 2018. The next update is expected January 1, 2019.

REGULATORY ACTIVITY:

• The Division of Workers’ Compensation (DWC) has posted the 2017 ethics advisory committee's annual report on its website. The workers' compensation ethics advisory committee is a state committee independent from the DWC, that is charged with reviewing and monitoring complaints of misconduct filed against workers' compensation administrative law judges.  The ethics advisory committee is required to make a public report each year summarizing activities in the previous calendar year. To view the report, go to https://www.dir.ca.gov/dwc/ethrpt17.pdf
• The Division of Workers’ Compensation’s (DWC) Administrative Director George Parisotto has issued an Order updating the Medical Treatment Utilization Schedule (MTUS) Drug List effective October 1, 2018 pursuant to Labor Code section 5307.29. The Administrative Director’s update Order adopts changes to the MTUS Drug List, based on the American College of Occupational and Environmental Medicine (ACOEM) Practice Guidelines, including the following:
  • Addition of drugs addressed in the Chronic Pain Guideline and Opioids Guideline
  • New, Revised, and Deleted Drug Recommendations (related primarily to the Chronic Pain Guideline, and the Opioids Guideline)

  The updated MTUS Drug List v. 3, the Administrative Director’s Order and the formulary regulations can be accessed 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.  To view the updated drug list, go to https://www.dir.ca.gov/dwc/MTUS/MTUS-Formulary-Orders.html.

• The Department of Industrial Relations (DIR) and its Division of Workers’ Compensation (DWC) posted a progress report on the department’s Independent Medical Review (IMR) program.

IMR is the medical dispute resolution process that uses medical expertise to obtain consistent, evidence-based decisions and is one of the most important components of Senate Bill 863, Governor Edmund G. Brown Jr.’s landmark 2012 workers’ compensation reform.  “This shows that Independent Medical Review – which replaced a system where injured workers had to wait for medical treatment while disputes were litigated – continues to provide a timely, efficient process for resolving treatment disputes and supporting appropriate care,” said George Parisotto, DWC Administrative Director. “For the last few years, DIR and DWC have worked to reduce the average number of days to complete IMR decisions. We continue with the ongoing efforts to enhance the program, including Medical Treatment Utilization Schedule updates, adopting the drug formulary and posting public copies of more than 660,000 IMR final determinations.”  Highlights of the report include:

• • The monthly average length of time to issue an IMR determination after the receipt of all medical records ranged from 10 days to 14 days, as compared to a high of 24 days in 2016.
  • An average of 14,350 IMR decisions were issued each month in 2017.
  • The number of eligible applications increased for the fifth consecutive year.
  • Case decisions continue to be similar when comparing several demographic categories, including the injured workers’ date of injury, their representation status, and the geographic region of their residence.
  • Similar to prior years, over 40 percent of treatment requests sent for IMR are for pharmaceuticals, with three of every ten pharmaceutical requests for opioids.
  • Guidelines contained in the Medical Treatment Utilization Schedule continue to be the primary resource for the determination of medical necessity.

To view the report, go to https://www.dir.ca.gov/dwc/IMR.htm.

• The Division of Workers’ Compensation (DWC) normally posts the weekly updated Medi-Cal pharmaceutical fee data file each Wednesday.  On Wednesday, September 5, 2018, DWC posted the weekly pharmaceutical fee data file received from the Department of Health Care Services (DHCS).  On Thursday, September 6, 2018, DHCS notified DWC that a corrected file had been issued and DWC posted the corrected file to the website and to the FTP server. While there appear to be relatively few changes to less than 100 out of over 700,000 records, DWC advises anyone who downloaded the weekly pharmaceutical data file posted on September 5th to download the corrected file from the website or collect the file from the FTP server.  In addition, anyone who used the online pharmaceutical calculator on September 5 or 6 should run the calculation again to ensure the result received is consistent with the updated file.
• The Division of Workers’ Compensation (DWC) had the first Pharmacy and Therapeutics Committee meeting on Wednesday, September 26 from 12:30 to 3:30 p.m. in the Elihu M. Harris State Building, conference room #1 on the second floor, 1515 Clay Street in Oakland. The Pharmacy and Therapeutics Committee was established by Assembly Bill No. 1124 (2015) as an advisory body that will consult with the DWC Administrative Director on updates to the Medical Treatment Utilization Schedule (MTUS) drug formulary.

• The Division of Workers’ Compensation (DWC) will hold a public meeting on Wednesday, October 17 to discuss the structure of a new medical-legal fee schedule for the workers’ compensation system. This fee schedule is used to compensate physicians for examinations and reports that decide issues of compensability for work-related injuries. DWC posted a notice of pre-rulemaking proposed amendments to the current medical-legal fee schedule in an open forum on May 3 and received an overwhelming response by the workers’ compensation community, with most respondents requesting an overhaul of the entire medical-legal fee schedule.  The October meeting is intended to respond to this input and develop next steps for revising the fee schedule.  DWC seeks input from stakeholders who will be affected by the final version of the medical-legal fee schedule. The Division is particularly interested in:

• • Determining the best format for the new fee schedule to offer optimum benefit for QMEs, AMEs, Injured Workers, Employers, Medical Management Organizations and Carriers;
  • Identifying any possible obstacles to that process; and
  • Identifying representatives to participate in small pre-rulemaking meetings to further develop the best format for the new medical-legal fee schedule.

The public meeting is scheduled for Wednesday, October 17 at 10 a.m. in the auditorium of the Elihu Harris Building, 1515 Clay Street, Oakland.  Meeting attendees will be allowed up to three minutes to express their ideas on changes to the fee schedule. Written comments can also be submitted at the public meeting, emailed to DWCRules@dir.ca.gov, or mailed to:

Division of Workers’ Compensation

P.O. Box 420603

San Francisco, CA 94142

Attn: Medical-Legal Fee Schedule Forum

To view the notice and additional information, go to https://www.dir.ca.gov/dwc/DWCWCABForum/1.asp

• The Division of Workers’ Compensation (DWC) has posted proposed amendments to the Pharmaceutical Fee Schedule to its online forum where members of the public may review and comment on the proposal. Under the California Labor Code, the fee schedule for pharmaceuticals is based primarily upon the Medi-Cal pharmacy payment system. Medi-Cal is now implementing a revised payment methodology approved by the Centers for Medicare and Medicaid Services (CMS). Background information on the Medi-Cal changes can be reviewed on the Department of Health Care Services (DHCS) Pharmacy Reimbursement Project web page. Due to requirements of federal law, the DHCS will implement Medi-Cal pharmacy fee schedule changes retroactively to April 1, 2017. For workers’ compensation, fee schedule changes will not be retroactive; the draft regulations propose that the new methodology become effective for pharmaceuticals dispensed on or after January 1, 2019. The following regulation changes are proposed to implement Labor Code section 5307.1 and to align the fee schedule with the new Medi-Cal system:

• • Elimination of the Average Wholesale Price (AWP) minus 17 percent as a benchmark for the drug ingredient;
  • Revised methodology for payment of the drug ingredient, which sets the maximum at the lower of the following:
    • National Drug Acquisition Cost (NADAC) or Wholesale Acquisition Cost (WAC) for drugs lacking a NADAC price;
    • Federal Upper Limit;
    • Maximum Allowable Ingredient Cost (MAIC);
    • Usual and Customary Charge;
  • Adoption of the revised two-tier Medi-Cal dispensing fee structure for pharmacies (which increases the dispensing fee from the current $7.25 to $10.05, or to $13.20 for those pharmacies listed by Medi-Cal as eligible for the higher fee);
  • Rules addressing fees for compounded drugs and repackaged drugs.

The forum can be found on the DWC forums web page under “current forums.”  Comments will be accepted on the forum until Monday, October 8.

• The Division of Workers’ Compensation (DWC) has adopted amendments to the Official Medical Fee Schedule (OMFS) for Physician and Non-Physician Practitioner Services (California Code of Regulations, title 8, section 9789.12.1 through 9789.19.1) to replace the average statewide geographic adjustment factor with local geographic adjustment factors as of January 1.  The locality-specific geographic adjustment factors, known as the Geographic Practice Cost Index (GPCI), was implemented by Medicare in January 2017 as part of its Metropolitan Statistical Area (MSA) program. Adoption of the Medicare MSA-based locality GPCIs will improve payment allowance accuracy by reflecting the resources required to provide a service according to specific regions. The amendments also make minor clarifying revisions to the regulations. DWC submitted a request to the California Office of Administrative Law to file the amended regulations with the Secretary of State and have them published in the California Code of Regulations. The regulations can be found on the DWC  Further information and adjustments to the Physician section of the OMFS can be found on the DWC’s OMFS web page.

LEGISLATIVE ACTIONS:

• Assembly Bill 1749

This bill would provide that whenever any peace officer is injured, dies, or is disabled from performing his duties as a peace officer by reason of engaging in the apprehension or attempted apprehension of law violators or suspected law violators within or out of the state, or protection or preservation of life or property within or out of the state, or the preservation of the peace anywhere in this state, but is not at the time acting under the immediate direction of his employer, he or his dependents shall be accorded by his employer all of the same benefits the peace officer or his dependents would have received had that peace officer been acting under the immediate direction of his employer. The bill would provide that this provision is declaratory of existing law. Effective Date January 1, 2019.

• Senate Bill 880

Existing law prohibits a person or entity, other than physicians or attorneys, from advertising, printing, displaying, publishing, distributing, or broadcasting in any manner a statement concerning services or benefits to be provided to an injured worker, which is paid for by that person or entity that is false, misleading, or deceptive. Violation of these provisions is a misdemeanor punishable by incarceration in the county jail for not more than one year, or by a fine not exceeding $10,000, or by both that imprisonment and fine. This bill would make technical, non-substantive changes to the above provision and would delete an obsolete provision. Effective Date January 1, 2019.

Colorado VIEW STATE →

FEE SCHEDULE NEWS:

• The Division has adopted the new regulations for the Medical and Hospital fee schedule effective January 1, 2019. The next expected update is for January 2020.

REGULATORY ACTIVITY:

• The Division has adopted Rule 11: Division Independent Medical Examination, Rule 16 Utilization Standards, Rule 18 Medical Fee Schedule and 2018 Exhibits to the Medical Fee Schedule.  All of the rules become effective on January 1, 2019.  To view the adopted rules, go to https://www.colorado.gov/pacific/cdle/workers-compensation-proposed-and-adopted-rules.
• Posted notice of a rule hearing regarding the Colorado Uninsured Employer Fund.  To view the notice and rule, go to https://www.colorado.gov/pacific/cdle/workers-compensation-proposed-and-adopted-rules. 

Delaware VIEW STATE →

LEGISLATIVE ACTIONS:

• House Bill 318

This bill updates the Delaware Insurance Guaranty Association (DIGA) Act to more closely align it with the National Association of Insurance Commissioners (NAIC) and National Conference of Insurance Guaranty Funds (NCIGF) Model Acts. DIGA in a non-profit association, established under Chapter 42, Title 18 of the Delaware Code as a safety net to protect residents of this state when a covered property and casualty claim arises from an insolvency of a member insurance company. DIGA is fully funded by assessments levied on member insurance companies and remaining assets from insolvent insurance companies. Section 1 clarifies the types of insurance that do not fall under this chapter. Section 2 clarifies the definition of what is excluded from the definition of a “covered claim” and adds “ocean maritime insurance” to this chapter. Section 3 provides for an increase in the maximum amount of covered claims from $300,000 to $500,000 (workers compensation coverage remains unlimited) and specifies when the Association would be relieved of any obligation to defend an insured on a covered claim. Section 3 permits procedures to be established for DIGA to retrieve net worth information from an insured, with consequences if the information is not provided in a timely basis. Section 3 also provides DIGA with the ability to bring an action against any third-party administrator or other party who refuses to release information related to an insolvent company interfering with DIGA’s ability to carry out its duties. Section 3 also provides DIGA with the authority, subject to approval by the Commissioner, to provide claims-handling services to any “run-off insurer” provided the Association expenses related thereto are fully reimbursed. Section 4 renames § 4212 (formerly non-duplication of recovery) and clarifies that all other insurance coverage (excluding Medicare) is primary to DIGA coverage. Section 5 removes unnecessary language regarding the Board of Director’s functions in relation to making recommendations on the status of member insurers. Section 6 provides the Board of Directors the right to request financial and other information from the liquidator, receiver, or statutory successor of an insolvent insurer covered by this chapter.  Effective Date July 17, 2018.

• House Bill 408

This bill amends the Workers’ Compensation Act to include a provision permitting Industrial Accident Board hearing notices and decisions to be sent by secure email with an electronic receipt in lieu of certified mail. This will save money for the State and time for the parties and their attorneys. Effective Date July 17, 2018.

Florida WC VIEW STATE →

REGULATORY ACTIVITY:

• Posted the following notice to amend 69L-5.217: “Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 44 No. 166, August 24, 2018 issue of the Florida Administrative Register. These changes are being made to address written comments received within 21 days after publication of the notice of hearing and to provide clarification when calculating the civil penalties and fines by deleting outdated application of the rule text.  To view the notice, go to https://www.flrules.org/gateway/View_Notice.asp?id=20855599.”
• Florida posted notice of a rule workshop regarding new rule 69L-3.009, Florida Administrative Code to be held on Thursday, October 4, 2018, 9:00 a.m. (eastern) in Room 102, Hartman Building, 2012 Capital Circle SE, Tallahassee, FL. A new rule is being introduced due to the passage of CS/CS/SB 376, which added subsections (5) and (6) to section 112.1815, Florida Statutes (F.S.). Section 112.1815(5)(f), F.S., requires the Department of Financial Services to adopt rules specifying injuries qualifying as grievous bodily harm of a nature that shocks the conscience.  To view the notice and proposed rule, go to https://www.flrules.org/gateway/View_Notice.asp?id=20904972.

Hawaii WC VIEW STATE →

REGULATORY ACTIVITY:

• The Form HC-5 Employee Notification to Employer for Calendar Year 2019 is available.  To view the form, go to http://labor.hawaii.gov/dcd/forms/.

Idaho VIEW STATE →

FEE SCHEDULE NEWS:

• The division has posted Table 5, List of FY19 MS-DRGs, Relative Weights effective October 1, 2018. The next update is expected October 2, 2019.

Illinois VIEW STATE →

REGULATORY ACTIVITY:

• Effective September 2018, the Waukegan Status Calls will be held in the new Jury Assembly Room in the Criminal Courts Tower. The arbitration hearings will continue to be held in the Lake County Courthouse but will move from room D-300 on the third floor to room C-200 on the second floor.  Please note that the Waukegan hearing dates for October and December of 2018 have been revised.  The October trial cycle will begin with the Status Call on Friday, October 19th in the new Jury Assembly Room in the Criminal Courts Tower. Hearings will be held in room C-200 of the Lake County Courthouse on October 22nd, 23rd, 24th, 25th, 29th, 30th, and 31st.The December trial cycle will begin with the Status Call on Friday, December 14th in the new Jury Assembly Room in the Criminal Courts Tower. Hearing will be held in room C-200 of the Lake County Courthouse on December 17th, 18th, 19th and 20th. The Status Call and trial dates for September and November have not changed.
• Governor Rauner reappointed the following Arbitrators for the Illinois Workers' Compensation Commission: Maria S. Bocanegra, Paul V. Cellini, Stephen J. Friedman, Jessica A. Hegarty, Gerald A. Granada, Jeffrey B. Huebsch, Nancy H. Lindsay, Christine Marie Ori, Maureen H. Pulia, Melinda M. Rowe-Sullivan, and Douglas S. Stephenson.
• The Village of New Lenox has informed the IWCC that the Village Hall will be closing early on Friday, November 9th for an employee function. The Village has requested that the IWCC complete all judicial activities for that day no later than 11:00 AM. Please keep this in mind when completing your schedules.
• Published a revised table of Trauma Centers by Region.  To view the revised table, go to dph.illinois.gov/topics-services/emergency-preparedness-response/ems/trauma-program/centersByReg.

LEGISLATIVE ACTIONS:

• House Bill 4650

Amends the Illinois Controlled Substance Act. In a provision allowing pharmacists to authorize a designee to consult the Prescription Monitoring Program on their behalf, defines "pharmacist" to include, but be not limited to, a pharmacist associated with a health maintenance organization or a Medicaid managed care entity providing services under the Illinois Public Aid Code. Amends the Illinois Controlled Substances Act. Provides that any pharmacist feedback, including grades, ratings, or written or verbal statements, in opposition to a clinical decision that the prescription of a controlled substance is not medically necessary shall not be the basis of any adverse action, evaluation, or any other type of negative credentialing, contracting, licensure, or employment action taken against a prescriber or dispenser. In a provision allowing pharmacists to authorize a designee to consult the Prescription Monitoring Program on their behalf, defines "pharmacist" to include a clinical pharmacist employed by and designated by a Medicaid Managed Care Organization providing services under the Illinois Public Aid Code under a contract with the Department of Health and Family Services for the sole purpose of clinical review of services provided to persons covered by the entity under the contract to determine compliance with the Act (in the introduced bill, defines "pharmacist" to include, but be not limited to, a pharmacist associated with a health maintenance organization or a Medicaid managed care entity providing services under the Illinois Public Aid Code). Provides that a managed care entity pharmacist shall notify prescribers of review activities.  Deletes language providing pharmacist feedback, including grades, ratings, or written or verbal statements, in opposition to a clinical decision that the prescription of a controlled substance is not medically necessary shall not be the basis of any adverse action, evaluation, or any other type of negative credentialing, contracting, licensure, or employment action taken against a prescriber or dispenser.  Effective Date August 21, 2018.

Indiana VIEW STATE →

REGULATORY ACTIVITY:

• Paper settlements documents will no longer be accepted by the Board.  Those sent in or dropped off will be destroyed and the parties informed by phone or e-mail to submit the Agreement and Order as a PDF according to the Checklist and Procedure documents found here(and Attached). Documents will not be marked Received until processed through the electronic system.  Please know the Board will continue to improve this process as comments are received and notice will always be given through this format and notices on the website.

Iowa VIEW STATE →

REGULATORY ACTIVITY:

• The Workers’ Compensation Commissioner proposes to amend Chapter 2, “General Provisions,” Chapter 3, “Forms,” Chapter 4, “Contested Cases,” Chapter 5, “Declaratory Orders,” Chapter 10, “Informal Dispute Resolution Procedures,” and Chapter 11, “Electronic Data Interchange (EDI),” Iowa Administrative Code.  This rule making implements, in whole or in part, Iowa Code sections 26, 85.27, 86.8, 86.13, 86.18, 86.24, 86.40 and 87.22These proposed amendments will facilitate the electronic filing of claims and EDI information with the agency.  To view the notice and proposed rule, go to https://www.legis.iowa.gov/law/administrativeRules. 
• On August 29, 2018, the Division of Workers’ Compensation published in the Iowa Administrative Bulletin a Notice of Intended Action concerning rules for the Workers’ Compensation Electronic System (WCES). The link to the Iowa Administrative Bulletin is: https://www.legis.iowa.gov/docs/aco/bulletin/08-29-2018.pdf. Written or oral comments were accepted by the Division no later than 4:30 p.m. on September 18, 2018.
• The following was published:

NOTICE OF DELAY FOR START OF THE WORKERS’ COMPENSATION ELECTRONIC FILING, CASE MANAGEMENT, HEARING SCHEDULING AND EDI SYSTEM (WCES).

The Division of Workers’ Compensation is announcing a delay in the roll-out of WCES, the new electronic filing, case management, hearing scheduling and EDI system for workers’ compensation, WCES.

The Division had planned to Go-Live on December 3, 2018.  It has been determined it is not possible to thoroughly test the system before December 3, 2018. The Division was advised to delay the Go-Live date until we can be confident WCES has been thoroughly tested. A new Go-Live date for WCES has not been determined. Work will not stop on this project and the Division will publish a revised Go-Live date once we have agreement among the vendors and the Division. The delay in the go-live date applies to both filing in contested claims as well as EDI.  EDI filers will continue to file using EDI Release 2.0 until WCES goes live and then will switch to EDI Release 3.1. Claimants, employers and insurance carriers will continue to file paper documents in contested claims until WCES goes live.  The process for scheduling hearings will also remain as it is currently until WCES goes live. This bulletin is in regard to USE OF THE LATEST DIVISION OF WORKERS’ COMPENSATION FORMS.

A number of parties have not been using the most current forms from the Division’s web site. Specifically, the Compromise Settlement form 14-0025 (revised August 2018) is not being used by many parties. Please use the most recent form when filing with the Division as required by Iowa Admin. Code r. 876-3.1(2018).

Kansas VIEW STATE →

REGULATORY ACTIVITY:

• A public hearing was held on September 14, 2018 pursuant to HB 2280. The purpose of the hearing was to consult and solicit information from individuals and entities that may be affected by the proposed changes to the Workers’ Compensation 2019 Schedule of Medical Fees.

Kentucky VIEW STATE →

REGULATORY ACTIVITY:

• Posted notice of proposed amendments for 803 KAR 50:010 Hearings, Procedure; deposition and 803 KAR 30:010 Special Fund Assessments in the September register of the state of Kentucky.  To view a copy of the proposed amendments, go to http://www.lrc.ky.gov/kar/contents/registers/registers.htm.
• Published the following notice regarding potential violation of certificates for companies certified for medical bill audit review: The Department of Workers’ Claims (DWC) has discovered that some Medical Bill Audit (MBA) plans that are approved and certified through DWC are utilizing other vendors to further review and, at times, improperly reduce a statement for services from a provider.  These other entities do not have an MBA plan on file with DWC and are, therefore, not approved to perform medical bill audits. The term “Medical Bill Audit” is defined as the review of medical bills for services which have been provided to assure compliance with the adopted fee schedules.  803 KAR 25:190 Section 1 (4). When an MBA Plan Administrator submits a Medical Bill Audit plan to the Department of Workers’ Claims for certification, the plan is reviewed to ensure that all regulations and criteria are satisfied.  The Commissioner will approve the application only if the plan appropriately documents the policies and procedures to be followed and other required criteria. If approved, the plan will remain effective for four years.  The plan may have contracts with a provider to allow a lesser fee than the fee schedule.  The Commissioner approves only the plan as submitted and expects that the applicant is completing the reviews and not utilizing other entities to complete reviews.  A Statement for Services billed on a HCFA 1500 must be reimbursed by applying the Schedule of Fee for Physicians. A Statement for Services billed on a UB04 must be reimbursed by applying the assigned cost to charge ratio for that facility.  The total charges (including implants) are multiplied by the assigned cost to charge ratio for the correct reimbursement.  A Medical Bill Audit vendor is required, per Section 1 (4) cited above, to assure that charges for services billed comply with the adopted Hospital Fee Schedule and, therefore, the cost-to-charge ratio. The reduction of a medical bill which is inconsistent with the pertinent regulation is unauthorized, inappropriate and puts at risk the certification of the vendor performing MBA services.

Maine VIEW STATE →

FEE SCHEDULE NEWS:

• Maine has adopted a new Inpatient Fee schedule effective October 1, 2018. The next update is expected October 2019.

REGULATORY ACTIVITY:

• In accordance with 39-A M.R.S.A.  Section 209-A, the first part of the annual update has been completed. The IP Facility Fee Schedule/Appendix III has been updated for dates of discharge on or after 10-1-18. Questions or concerns regarding the annual update may be addressed to Barriere@maine.gov.  To view the notice, go to https://www.maine.gov/wcb/index.html.

Maryland VIEW STATE →

REGULATORY ACTIVITY:

• Online Services subscribers: our new PDF Document Viewer is now implemented.  Helpful web browser info is located on the WFMS Online Services Help & Support page. For additional information, go to http://www.wcc.state.md.us/WFMS/WFMS_Updates.html#PDF_Viewer.

Massachusetts VIEW STATE →

REGULATORY ACTIVITY:

• Issued an update to Bulletin 18-6 101 CMR 314.00: Dental Services Effective January 1, 2018- updated August 24, 2018. Under the authority of 101 CMR 314.01(5) and (6), the Executive Office of Health and Human Services (EOHHS) has added 18 codes, deleted three codes, cross-walked three codes, and revised 16 procedure code descriptions, as specified in the Current Dental Terminology (CDT) 2018 set by the American Dental Association for the calendar year 2018.   The 10 new codes in this bulletin that require pricing are reimbursed at individual consideration (I.C.). Rates listed in this administrative bulletin are applicable until EOHHS issues revised rates, provided that the listed rates shall continue in effect following promulgation of 101 CMR 314.00, effective February 15, 2018. The deleted codes are no longer available for use for dates of service after December 31, 2017. There is no change in the rates for the sixteen codes with revised descriptions.  To view the bulletin, go to https://www.mass.gov/lists/2018-eohhs-administrative-bulletins.
• Pursuant to the authority of M.G.L. c. 118E and in accordance with M.G.L. c. 30A, a public hearing will be held on Monday, October 15, 2018, at 10:00 a.m. in the First Floor Conference Room, 100 Hancock Street, Quincy, MA relative to the adoption of amendments to:  01 CMR 318.00:  Radiology  Proposed amendments to 101 CMR 318.00 update the payment rates used by state governmental units for the technical component (TC) of certain magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) services, as well as one computed tomography (CT) service (referred to collectively as “MRI/MRA services” or “MRI/MRA service codes”) delivered to publicly-aided individuals by eligible providers under the regulation. To view a copy of the notice, proposed rule and proposed service codes, go to https://www.mass.gov/service-details/executive-office-of-health-and-human-services-public-hearings.

Medicare VIEW STATE →

FEE SCHEDULE NEWS:

• Physician – CMS has posted new updates with an effective date of October 1, 2018. The next expected update is set for January 1, 2019.
• HCPCS – CMS has published new HCPCS updates with an effective date of October 1, 2018. The next update is expected on January 1, 2019.
• DMEPOS – There are no changes to the DMEPOS Fee Schedule files for the October 2018 update. The next update is expected on January 1, 2019.
• CCI/MUE Edits – CMS has adopted new updates to the CCI and MUE data sets with an effective date of October 1, 2018. The next update is expected on January 1, 2019.
• ASP Drugs – CMS has posted new updates to the ASP Drugs module with an effective date of October 1, 2018. The next update is expected on January 1, 2019.
• OPPS – CMS has posted new updates with an effective date of October 1, 2018. The next expected update is set of January 1, 2019.
• ASC – CMS has published a new ASC module with an effective date of October 1, 2018. The next update is expected on January 1, 2019.

Michigan VIEW STATE →

REGULATORY ACTIVITY:

• Published the following to all interested parties regarding request for workers' compensation records: “Please be advised, in accordance with section 6 of the Freedom of Information Act (FOIA), MCL 15236, the Department of Licensing and Regulatory Affairs (LARA) has appointed a FOIA Coordinator. As part of the implementation, all requests for Workers’ Compensation Agency documents will now be directed to the central LARA FOIA Office for processing. This model centralizes the LARA’s FOIA responsibilities enhancing efficiency through a single point of entry for customer requests and provides resource efficiency by relieving the agency of several FOIA compliance tasks. This process improvement will further allow the agency to focus their resources on research, retrieval, and review/redacting of potentially responsive public records.  Thus, we are advising that as a result of the procedural changes noted above, and to ensure our continued compliance with FOIA guidelines, customers may notice an adjustment in responsive determinations to their requests. Finally, it should be noted that subpoenas will continue to be processed directly by the Workers’ Compensation Agency. Should you have any questions regarding this announcement please do not hesitate to contact me directly at (517) 284-8901or by email at longm1@michigan.gov.   
• Since 2006, all Agency-approved vocational rehabilitation providers have been required to utilize Form WC-500, “Vocational Rehabilitation Provider Professional Disclosure Statement” at the outset of each vocational rehabilitation case, not including wage earning capacity evaluations. This policy remains in place with the introduction of the updated form. Vocational counselors providing services to Michigan’s injured workers are expected to adhere to the Code of Professional Ethics for Rehabilitation Counselors.  The issues outlined in the disclosure statement uphold the requirements of Section A.3 of the Code.  Overall, Form WC-500 is meant to assist with establishing trust, enhancing transparent communication, and building rapport at the start of the counseling relationship.  It also serves as protection for you and your client during the counseling relationship and is frankly just part of professional practice. As before, if your client is not supportive of signing the document, please note this on the form and sign in your designated location to note that the discussion took place, and that informational brochures were provided.  And finally, recognize that you may need to review this document with your client at various times throughout the counseling relationship.  

Minnesota VIEW STATE →

FEE SCHEDULE NEWS:

• The Minnesota Department of Labor and Industry has adopted a new Outpatient Hospital Fee Schedule with an effective date of October 1, 2018. Some of newly adopted regulations are:
  • The Hospital Outpatient Fee Schedule (HOFS) applies to all outpatient hospital services with the exception of hospitals designated by Medicare as Critical Access Hospital (CAH).
  • Reimbursement for outpatient services is divided into two categories. Non-Critical Access Hospitals with 100 or fewer licensed beds and hospitals with greater than 100 licensed beds.
  • The HOFS for outpatient surgical, emergency room and clinic services is based on Medicare’s Hospital Outpatient Prospective Payment System (OPPS) Addenda A and B in addition to corresponding code “status indicators”.
  • If the bill includes a charge where the Status Indicator = “J1” or “J2”, then reimbursement is made at the value listed within the HOFS.
  • If the bill does not include a charge where the Status Indicator = “J1” or “J2”, and if the service is covered, charge is to be paid based upon the relative value fee schedule. If the service is not covered under the relative value fee schedule, then reimbursement is made at 85% of the hospital’s usual and customary charge.

REGULATORY ACTIVITY:

• A new August/September edition of COMPACTis now available at dli.mn.gov/business/workers-compensation/work-comp-compact-newsletter.

Nevada VIEW STATE →

REGULATORY ACTIVITY:

• The Fall Edition of the Workers’ Compensation Chronicle Newsletter has been published. Highlights of this newsletter include:
  • 2018 Workers' Compensation Educational Conference
  • Adjuster Licensing
  • Holiday Office Closures
  • Training Schedule
  • Annual PT Checks Coming Soon
  • Benefit Penalties
  • Reporting Reminders

To view the publication, go to http://dir.nv.gov/WCS/Home/.

• The Division of Industrial Relations, Department of Business and Industry, State of Nevada (the “Division”), will conduct a public hearing to amend NAC 61 6C.502, to comply with NRS 61 6C.495, as amended by Section 9 of Assembly Bill 458, Chapter 216, Statutes of Nevada 2017, at page 1167. This regulation deletes the actuarial annuity table for the calculation of lump-sum permanent partial disability (“LS PPD”) payments in accordance with the requirements of NRS 616C.495(5), as amended, and repeals NAC 616C.498 which has become unnecessary based on the amendment of NRS 616C.495(1).

New Jersey WC VIEW STATE →

REGULATORY ACTIVITY:

• Posted notice of a public hearing on Tuesday September 25, 2018 at 10:00 a.m. at the New Jersey Department of Labor and Workforce Development at John Fitch Plaza 12th Floor Large Conference Room, Trenton New Jersey. The proposed amendments to N.J.A.C. 12:235-1.6 would establish the 2019 maximum workers' compensation benefit rates for temporary disability, permanent total disability, permanent partial disability, and dependency under the Workers' Compensation Law. Because a 60-day comment period has been provided in this notice of proposal, this notice is excerpted from the rulemaking calendar requirement pursuant to N.J.A.C. 1:30-3.3(a)5.  The proposed amendment would increase the Maximum workers’ compensation benefit rate from $903.00 per week to $921.00 per week.

New Mexico VIEW STATE →

REGULATORY ACTIVITY:

• The 2018 New Mexico Workers' Compensation Administration's 2018 Annual Report is available online for browsing and for download.  To view the annual report, go to https://workerscomp.nm.gov/NMWCA-Publications.

New York VIEW STATE →

REGULATORY ACTIVITY:

• Issued bulletin subject number 046-1099:  The provisions of the World Trade Center Registry legislation signed by Governor Andrew M. Cuomo on September 11, 2016, have been extended to September 11, 2022. The extension keeps the World Trade Center Registry open until September 11, 2022; extends the deadline period for filing the Registration of Participation in World Trade Center Rescue, Recovery and/or Clean-up Operations (Form WTC-12) to September 11, 2022; and directs the Board to reconsider claims previously disallowed under §§ 18 or 28 with dates of disablement between September 11, 2015 and September 11, 2017. To view the bulletin, go to http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1099.jsp.

North Carolina VIEW STATE →

REGULATORY ACTIVITY:

• Notice of Proposed Rulemaking: 11 NCAC 23A Group 2 Rules and 11 NCAC 23B Rules: To view the notice regarding two proposed adoptions and nine amendments for rules governing workers’ compensation claims, as well as two amendments and one repeal for rules governing State tort claims, go to http://www.ic.nc.gov/proposedGroup2Rules.html . The notice includes the text of the proposed rules, the public hearing time, and information on how to submit public comments.
• Published in the state register on September 17, 2018 notice regarding proposed rules by the North Carolina Workers' Compensation Commission. On its own initiative, the Industrial Commission ("Commission”) conducted an internal review of its workers’ compensation rules and sought informal stakeholder feedback on rules in 11 NCAC  23A.  The proposed adoptions and amendments reflect changes necessary to clarify the rules, provide for increased efficiency, or update the rules to current reflect practices.  The Commission also conducted an internal review of its rules governing State tort claims.  The proposed amendments to 11 NCAC 23B reflect changes necessary to clarify the rules, provide for increased efficiency, or update the rules to reflect current practices.  The Commission proposes to repeal Rule 11 NCAC  23B .0207 because the necessary contents of the rule are proposed to be added to Rule 11 NCAC 23B .0206.  Comments may be submitted to:  Ashley B. Snyder, 1233 Mail Service Center, Raleigh, NC 27699-1233; phone (919)807-2524; email snyder@ic.nc.gov.   Comment period ends: November 16, 2018.  To view the notice, go to https://www.oah.state.nc.us/rules/register/.
• To improve efficiency and enhance customer service, the Industrial Commission has established goals designed to update and improve the Industrial Commission’s public-facing technology. In the coming years, the Commission will embrace technological advances, which will improve efficiency and enhance customer service for attorneys, parties, and other stakeholders. Most importantly, the Industrial Commission will implement a 21st-century case management system, making it easier for our stakeholders to file documents and track the status of their pending cases. Using state-of-the-art modalities, this plan will improve the Commission’s current practices to be more responsive to the public’s needs. Updates on Chairman Allen’s 20/20 Technology Initiative will be posted on the Industrial Commission’s website and the Industrial Commission’s Twitter account, @IC_NC_GOV.
• On September 18, 2018, Superior Court Judge Paul Ridgeway signed an order affirming the December 14, 2015 Declaratory Ruling of the North Carolina Industrial Commission, ending years long litigation.  At the root of the lawsuit was Session Law 2013-410, Section 33, which instructed the Industrial Commission to amend its medical fee schedule to tie reimbursement rates to Medicare values. The purpose of the reform was to bring medical costs in the workers’ compensation system more in line with the national average.   As a result of these significant changes, medical costs in the workers’ compensation system have been controlled and better balanced.  In fact, since the valid Medicare-based medical fee schedule took effect on April 1, 2015, average workers’ compensation insurance rates have decreased each year, dropping by 8.3 percent in 2016 and 12.5 percent in 2017.  Recently, on August 29, 2018, the North Carolina Rate Bureau proposed a 17.2 percent decrease to the average workers’ compensation insurance rate.

North Dakota VIEW STATE →

FEE SCHEDULE NEWS:

• The following WSI fee schedules have been updated as of October 1, 2018: APC, Ambulatory Surgery, Clinical Lab, Physician, Outpatient Hospital and Physician Drug Module. The next update is expected January 2019.

REGULATORY ACTIVITY:

• To establish claim and medical bill liability, WSI requires a provider submit a specific diagnosis code reflective of the injury treated. This requirement aligns with General Coding Guidelines (4) and (18), published in the ICD-10-CM Official Guidelines for Coding and Reporting. These General Coding Guidelines indicate: "Specific diagnosis codes should be reported when they are supported by the available medical record documentation and clinical knowledge of the patient’s health condition…. Diagnosis codes describing symptoms and signs are acceptable for reporting only when the provider has not established a related, definitive (confirmed) diagnosis.” WSI most commonly encounters improper diagnosis coding when a provider assigns a standalone diagnosis code of “pain”, and the medical record indicates a more specific diagnosis is available. While pain may be a relevant sign or symptom resulting from a work injury, it is not a specific condition for which WSI accepts liability. Consequently, receipt of a service coded with “pain” as the only diagnosis may result in a prolonged claim adjudication timeframe as well as a bill reimbursement denial. The following is an example of reporting a diagnosis with the highest level of specificity: WSI receives a medical bill with attached documentation for an initial visit following a work injury. The worker was lifting a box when they felt something pull in their lower back, followed by aches and pains. The signs and symptoms reported in the medical record include muscle swelling over the lumbar region. The diagnosis indicated in the medical record and reported on the medical bill is M54.5 for lumbar pain. A more appropriate diagnosis, based on the evidence in the medical record, would be S39.012 for a low back strain.
• It has come to our attention that fraudulent checks using our name are being mailed in FedEx packages, falsely representing payment from Workforce Safety & Insurance, (WSI).  Typically, WSI does not mail checks via FedEx.  If you have received a check from WSI in a FedEx envelope, the check is likely a fake check.  If you want to clarify if a check you received from WSI is valid, you may call WSI Customer Service at 1-800-777-5033.  The bulk of these payments are being sent to pay for online purchases. The check payment total is significantly more than the purchase price of the item you are selling, and the buyer requests you to send the excess funds back to them or they will have someone stop by and pick them up. Your bank may accept these checks when you deposit them.  However, when the check is presented to the issuing bank, it will be declined and returned to your bank.  At that time, your bank will make you responsible for the funds if the check you deposited is a fake check. WSI is not affiliated with these checks.
• WSI has expanded the EDI billing options available through iHCFA to include facility charges (UB-04/837i). Prior to this, WSI had implemented the electronic submission of professional charges (CMS 1500/837p) only.  For both types of billing (837p and 837i), submission through iHCFA is available at no cost to the provider.
• iHCFA is a specialized clearinghouse that facilitates the electronic submission of bills, medical reports, and supporting documents to workers' compensation payers.  Use of this billing option provides several benefits not accessible for paper billing, including automated attachment of a medical record to a bill, confirmation reports of bill receipt, and improved bill payment timeframes.

iHCFA provides the following options for submitting medical bills electronically:

• Direct connection with WSI for medical bill and documentation submission
• Online claim form interface, including documentation attachment
• Indirect connection with a provider’s existing clearinghouse, dependent on the clearinghouse’s ability to meet certain technical requirements

A provider interested in submitting EDI medical bills must register with both WSI and iHCFA.

• To register with WSI, complete the Payee Registration and Substitute W-9 form and fax to 888-786-8695.
  • This step is applicable for a new or existing billing provider who wishes to begin EDI billing.
  • A provider must complete this form for each business NPI billed to WSI.
  • Alternatively, a provider may submit the form for one business NPI and include an attachment. The attachment must provide the details requested on the form for each additional NPI.
• To register with iHCFA, or for additional information, contact iHCFA at 973-795-1641 (option 2)

Oklahoma VIEW STATE →

REGULATORY ACTIVITY:

• Reposted in the state register the emergency adoption of Title 810 Chapter 1, Chapter 10, and Chapter 25 of the workers' compensation commission's administrative rules. The emergency rules will remain in effect until September 14, 2019.  To view the rules, go to https://www.sos.ok.gov/oar/online/viewRegister.aspx?vol=35&num=24

Oregon VIEW STATE →

REGULATORY ACTIVITY:

• Each year, the Department of Consumer and Business Services adopts by rule the workers’ compensation premium assessment rate that is paid by employers to fund workers’ compensation and workplace safety and health programs. The rule also adopts the rate for an additional amount that is collected from all self-insured employers and self-insured employer groups to fund the Self-Insured Employers Adjustment Reserve and the Self-Insured Employer Group Adjustment Reserve. These funds ensure worker benefits are available in the event of a financial failure of a self-insured employer or self-insured employer group. Before recommending the 2019 rate, the department must analyze financial data and review and authorize a proposed workers' compensation pure premium rate filing by the National Council on Compensation Insurance. The proposed premium assessment rate for 2019 is expected to be announced by mid-September. Additional assessments to fund the Self-Insured Employer Adjustment Reserve and Self-Insured Employer Group Adjustment Reserve are also expected to remain unchanged. These are preliminary rates and are subject to change during the rulemaking process. This rulemaking will adopt the assessment rates that will be in effect from Jan. 1, 2019, to Dec. 31, 2019.  A hearing on the proposed workers' compensation premium assessment rates will be held at 3 p.m. on Thursday, Sept. 20, 2018, in Room F (Basement) of the Labor & Industries Building, 350 Winter St. NE, Salem, Oregon. Written testimony will be accepted through 5 p.m. Thursday, Sept. 27, 2018 by the Director's Office of the Department of Consumer and Business Services, 350 Winter St. NE, P.O. Box 14480, Salem, OR 97309-0405.  To view the notice and supporting documentation, go to https://www.oregon.gov/dcbs/cost/Pages/rulemaking.aspx.
• Published revised bulletin 112 regarding reimbursement of injured workers' travel, food and lodging.  The revised lodging and meal rates become effective October 1, 2018.  The revised private vehicle mileage rate becomes effective January 1, 2018.  This bulletin provides Form 3921, “Request for Reimbursement of Expenses,” and the rates injured workers are reimbursed for travel, food, and lodging costs as directed by Oregon Administrative Rule (OAR) 436-009-0025.  The Workers’ Compensation Division is updating this bulletin and Form 3921 to update the lodging and meal rates, effective Oct. 1, 2018, through Sept. 30, 2019. The private vehicle mileage rate, effective Jan. 1, 2018, remains the same as previously published. This bulletin replaces Bulletin No. 112 dated Jan. 5, 2018. Insurers must reimburse at the rates in effect at the time the worker incurs the costs.  To view the bulletin and associated forms, go to https://wcd.oregon.gov/forms/Pages/bulletins.aspx.
• Issued revised Bulletin 237 regarding Workers' Compensation Insurer's Report. This bulletin provides a revised Form 1502 and describes Form 1502 reporting requirements under Oregon Administrative Rules (OAR) 436-060-0011. Insurers must use Form 1502 to report claim status and activity to the Workers' Compensation Division. This bulletin replaces Bulletin 237 issued Jan. 25, 2010. This form must be in exclusive use by March 1, 2019.  To view the bulletin, go to https://wcd.oregon.gov/forms/Pages/bulletins.aspx.
• In a recently issued notice of proposed rulemaking hearing, the Workers' Compensation Division announced that the proposed assessment rate would be published by the middle of September.  In a news release dated Sept. 10, 2018, the department announced that the proposed 2019 WBF assessment rate is 2.4 cents per hour worked, a decrease of 0.4 cents from the current rate of 2.8 cents per hour. Please review also Exhibit 1, "Workers' Benefit Fund Assessment Recommendation for CY 2019 “attached. The news release also explained that the average cost of workers' compensation insurance coverage in 2019 will go down.

Hearing information:

Sept. 20, 2018, 4 p.m.

350 Winter Street NE, Room F (basement)

Salem, Oregon 97301

Send written comments to:

Email – fred.h.bruyns@oregon.gov

Fred Bruyns, rules coordinator

Workers’ Compensation Division

350 Winter Street NE (for courier or in-person delivery)

PO Box 14480, Salem, OR 97309-0405

Fax – 503-947-7514

The public may also listen to the hearing or testify by telephone: Dial-in number is 1-213-787-0529; Access code is 9221262#.  The closing date for written comments was Sept. 27, 2018, 5 p.m.

• The MAC agenda for October 19 has been issued. If you have questions, please contact Cara Filsinger, 503-947-7582or cara.l.filsinger@oregon.gov .
• Has published notice of a public hearing regarding proposed rules OAR 436-050, Employer/Insurer Coverage Responsibility and OAR 436-080, Noncomplying Employers.  A public rulemaking hearing is scheduled: Oct.22, 2018, 11m. Labor & Industries Building, 350 Winter Street NE, Room F, Salem, Oregon , Teleconference dial-in number - 1-213-787-0529; Access code is 9221262#. Written comments will be accepted through (and including) Oct. 29, 2018. Send written comments to:

Email: fred.h.bruyns@oregon.gov Regular mail: Fred Bruyns, rules coordinator, Workers’ Compensation Division, PO Box 14480, Salem, OR 97309-0405 Courier or personal delivery: 350 Winter Street NE, Salem, Oregon Fax – 503-947-7514To view the proposed rules, go to https://wcd.oregon.gov/laws/Pages/proposed-rules.aspx.

• The Workers’ Compensation Division has published an industry notice, "Application of OAR 436-060-0025(3)through (7)," https://wcd.oregon.gov/IndustryNotices/09-21-18-IN-wage%20calculation.pdf This notice provides a discussion of Oregon Administrative Rule (OAR) 436-060-0025(3)through (7) and examples for insurers and self-insured employers. It is intended to apply to the wage calculation for dates of injury on or after Feb. 21, 2018. If you have questions about this notice, contact Audit Manager Barbara Belcher at 503-947-7687or barbara.belcher@oregon.gov.  To view the notice, go to  https://wcd.oregon.gov/Pages/industry-notices.aspx.
• Bulletin 380, Retroactive Program benefits effective Oct. 1, 2018, is now available online: https://wcd.oregon.gov/Bulletins/bul_380.pdf. Retroactive Program benefits effective Oct. 1, 2018.  This bulletin notifies insurers of: 1. The annual increase in Retroactive Program benefits, and 2.  The methods used to calculate these benefits and determine the amount of Retroactive Program reimbursement. The Retroactive Program benefit is an additional amount paid to eligible workers or their beneficiaries when benefit levels are lower than what is currently being paid for like injuries. Program recipients are primarily beneficiaries of workers who suffered fatal injuries and workers previously determined to have a permanent total disability. To view the bulletin, go to https://wcd.oregon.gov/forms/Pages/bulletins.aspx.

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 October 1, 2018. The next update is expected in January 1, 2019.

Rhode Island VIEW STATE →

REGULATORY ACTIVITY:

• Published Information Letter 18-5 regarding maximum compensation rate. In accordance with Section 28-33-17 of the Rhode Island Workers’ Compensation Act, the Maximum Total Disability Weekly Compensation Rate is $1,253.00 for injuries occurring on or after October 1, 2018. To view the information letter, go to http://www.dlt.ri.gov/wc/infoletters.htm.

South Carolina VIEW STATE →

REGULATORY ACTIVITY:

• The department of insurance published bulletin 218-09 regarding cyber security event reporting form.  To view the bulletin, go to http://doi.sc.gov/civicalerts.aspx?AID=168.

South-Carolina-Auto VIEW STATE →

REGULATORY ACTIVITY:

• Published bulletin number 2018-10 regarding notice of unusual circumstances/catastrophe insurance declaration for South Carolina due to Hurricane Florence for the purposes of licensing temporary adjusters and motor vehicle physical damage appraisers.  To view the bulletin, go to http://doi.sc.gov/civicalerts.aspx?AID=170.

Texas VIEW STATE →

FEE SCHEDULE NEWS:

• A new update to Texas Home Health and Dental Codes has been adopted with an effective date of September 1, 2018.

REGULATORY ACTIVITY:

• The Texas Department of Insurance, Division of Workers' Compensation (DWC) is accepting public comments on proposed amendments to 28 TAC and the proposed adoption of 28 TAC §114.16. The proposed amendments to and new rule in Chapter 114 implement House Bill (HB) 1989 of the 85th legislative session. HB 1989 amended Texas Labor Code §407.045 to add §407.045(a-1) which provides that an adequate program required for withdrawal from certified self-insurance includes a program in which all workers’ compensation obligations have been insured or reinsured with an authorized insurer. Proposed 28 TAC §114.2(b)(3) amends the definition of certified self-insurer (CSI) to exclude CSIs that have withdrawn with an insuring agreement pursuant to Labor Code §407.045(a-1). New rule 28 TAC §114.16, regarding withdrawals from self-insurance, defines the elements of an insuring agreement and the standards required of an insurance carrier seeking to assume workers’ compensation liabilities from a CSI withdrawing with an insuring agreement; and, allows the commissioner to review and approve modifications of previously approved withdrawals from self-insurance, including security deposit modifications. There are also non-substantive amendments throughout Chapter 114 to enhance clarity and to update the rule to reflect current regulatory structure, and agency drafting style.  To view the Notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.  To view the rules go to https://www.tdi.texas.gov/wc/rules/2018rules.html.
• The Texas Department of Insurance, Division of Workers' Compensation has determined that any interest or discount provided for in the Texas Workers' Compensation Act shall be at the rate of 6.06 percent. The rate shall be effective October 1, 2018, through December 31, 2018.  The rate is computed by using the treasury constant maturity rate for one-year treasury bills issued by the United States Government, as published by the Federal Reserve Board for September 16, 2018, plus 3.5 percent. Texas Labor Code §401.023. For more information regarding calculation of the Discount Rate and Interest Rate, contact CompConnection at 800-252-7031, option 3. Issued in Austin, Texas, on September 21, 2018.
• The workers’ compensation state average weekly wage for dates of injury from October 1, 2018, through September 30, 2019, is set at $937.70. The maximum weekly benefit rates for workers’ compensation income benefits is set at $938 and the minimum weekly benefit rate is set at $141 for that period. The maximum and minimum weekly benefit rates for dates of injury from October 1, 2017, through September 30, 2018, were $913 and $137 respectively. In accordance with Texas Labor Code §408.047, the workers’ compensation state average weekly wage is equal to 88 percent of the average weekly wage in covered employment as computed each year by the Texas Workforce Commission under Labor Code §207.002(c). A table showing maximum and minimum weekly benefit amounts for injuries that occurred on or after January 1, 1991, is available on the Texas Department of Insurance website.

Utah No-Fault VIEW STATE →

REGULATORY ACTIVITY:

• Issued bulletin 2018-14 regarding premium increases prohibited for certain claims or inquiries.  To view the bulletin, go to https://insurance.utah.gov/consumer/legal-resources/bulletins.

Vermont VIEW STATE →

REGULATORY ACTIVITY:

• Announces that registration is now open for the October training conference. In order to be re-licensed to adjust Vermont workers’ compensation claims, adjusters must receive continuing education credit by attending Vermont Department of Labor sponsored trainings. The dates for the conference will be October 25 & 26, 2018. The conference will be held at the Hilton Hotel, Burlington, Vermont. The seminars begin at 12:30 p.m. on Thursday the 25th and conclude at noon on Friday the 26th. Registration begins at 11:00 a.m. on Thursday, the 25th. Please note the times for the conference and make certain that travel arrangements do not conflict with the start and end times. Attendees must be present for the whole conference for continuing education credit. To make hotel reservations call the Hilton Burlington’s Central Reservations line at 1-800-445-8667 and mention the special rate code of VT DOL WC Adjusters to get the group rate.
• Posted that the final proposed rules regarding Vermont Workers' Compensation Vocational Rehabilitation have been filed with the Secretary of State's Office and the Legislative Committee on Administrative Rules.  The rules are tentatively on the Legislative Committee on Administrative Rule agenda October 18th.  To view the final proposed rule, go to http://labor.vermont.gov/legal-information/proposed-rules/.

Virginia VIEW STATE →

REGULATORY ACTIVITY:

• Published the Virginia Workers' Compensation 2017 Annual Report.  To view the report, go to http://www.vwc.state.va.us/news/2017-VWC-Annual-Report.

Washington VIEW STATE →

REGULATORY ACTIVITY:

• The Washington State Department of Labor & Industries announces changes to the Outpatient Drug Formulary and Selected Preferred Drug List effective October 1, 2018. The changes are available for review in the online Outpatient Drug Formulary PDF document.
• Posted notice of proposed amendments to Workers' Compensation Self-Insurance Rules and regulations Chapter 296-15 WAC.  The purpose of this proposal is to update Chapter 296-15 WAC, Workers’ Compensation Self-Insurance Rules and Regulations. The existing rules are outdated and lead to inefficient processes for workers, employers and the Department. The goals of the proposed rules are to create more focused intervention and adjudication for the Department, establish more efficient lines of communication for workers, and ensure greater certainty for employers. Also included in the rule changes are language clarifications, as well as a change to WAC 296-15-4316 that will bring it back into alignment with statute regarding the termination of time loss benefits when Option 2 is selected.  To view the notice and proposed rule, go to http://www.lni.wa.gov/LawRule/WhatsNew/Proposed/default.asp?RuleID=263.
• Washington Coverage Decision: The Washington State Department of Labor & Industries has updated the coverage decision on pharmacogenomic testing according to a recent Health Technology Clinical Committee coverage determination. Effective November 1, 2018, pharmacogenomic testing for patients being treated with oral anticoagulants is not a covered benefit.   For additional information, go to http://www.lni.wa.gov/ClaimsIns/Providers/TreatingPatients/ByCondition/Pharmacogenomic.asp?utm_medium=email&utm_source=govdelivery.
• Washington Coverage Decision: The Washington State Department of Labor & Industries has adopted a new Health Technology Clinical Committee coverage determination about surgery for lumbar radiculopathy/sciatica, effective November 1, 2018.

Lumbar radiculopathy is a clinical syndrome characterized by radiating leg pain, with or without motor weakness, and sensory disturbances in a myotomal or dermatomal distribution. The objective of treatment for radiculopathy is symptom relief through nonsurgical management, or surgical intervention to decompress the affected nerve. Coverage decision: Covered with conditions (Effective date: November 1, 2018).   Authorization requirements

  For additional information, go to http://www.lni.wa.gov/ClaimsIns/Providers/TreatingPatients/ByCondition/LumbarRadiculopathySciatica.asp?utm_medium=email&utm_source=govdelivery.

Washington-Auto VIEW STATE →

REGULATORY ACTIVITY:

• The office of Insurance Commissioner has withdrawn the notice to start rulemaking (CR-101 on the clarifying adjuster licensing requirement rule 2017-04.  The proposed rule is being withdrawn because the broad language in RCW 48.17.010(1) that defines "Adjuster" will not allow the state to narrowly identify the rule of adjusting in insurance claims.
• Posted notice of consideration of rulemaking R 2018-14 creating new and amending some existing section of WAC 284-17-123 to clarify the special education condition found in RCW 48.17.380(3)(d) for adjuster license candidates.  Comments are due by October 15, 2018.  Send comments to rulescoordinator@oci.wa.gov .  To view the proposed documentation, go to https://www.insurance.wa.gov/adjuster-licensing-special-education-criteria-r-2018-14?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=.

West Virginia VIEW STATE →

REGULATORY ACTIVITY:

• Published the Assigned Risk Rates by Class that become effective November 2018. West Virginia employers are under a statutory obligation to maintain workers’ compensation insurance.  Generally, employers in West Virginia can purchase workers’ compensation coverage through one of over 270 insurance companies that are currently providing workers’ compensation insurance to West Virginia employers.    However, if an employer is unable to obtain workers’ compensation coverage through the voluntary market they can obtain coverage through the Residual Market, also known as the “Assigned Risk Plan” (the “Plan”).  The Assigned Risk Plan provides West Virginia employers with a means for obtaining workers’ compensation coverage when it cannot be obtained in the voluntary insurance market.  To view the Assigned Risk Rates effective November 1, go to http://www.wvinsurance.gov/Workers-Compensation. 
• Published the Workers' compensation Loss Cost Effective November 1, 2018.  The workers’ compensation class advisory loss costs are actuarially determined by the National Council on Compensation Insurance, Inc. (NCCI), West Virginia’s statistical rating agent. The loss costs will become effective November 1, 2018 for all classifications.  Advisory Loss Costs do not include a carrier’s Loss Cost Multiplier (LCM), which is a factor that increases the loss costs to recover administrative expenses and business operations. The final rate will be the class loss cost multiplied by the carrier loss cost multiplier.  Payroll fluctuations and allocations, classification assignments, experience rating modifications, credit/debit programs and additional policy endorsements will all contribute to the final written premium due for each policy. These factors, as well as all surcharges, are not reflected in the loss cost amounts. The per capita classes (0908 and 0913) show a loss cost based on the number of employees reported for those classes rather than the payroll reported. Example: An employer reports 3 domestic workers for class 0913. The annual premium (not including the LCM and other policy components) would be calculated as follows: 3 X $182.00 = $546.00 annual written premium.  To view Workers' Compensation Loss Cost effective November 1, go to http://www.wvinsurance.gov/Workers-Compensation.

Wisconsin VIEW STATE →

FEE SCHEDULE NEWS:

• The certified radiology database has been updated with an effective date of July 1, 2018. The next update is scheduled for January 1, 2019.