Alaska VIEW STATE →

REGULATORY ACTIVITY:

• The Alaska Department of Labor and Workforce Development and the Alaska Workers’ Compensation Board propose to adopt regulation changes in Title 8 of the Alaska Administrative Code, dealing with electronic filing, agency forms, hearings, material adopted by reference, filing notices, second independent medical evaluations, case files, reporting compensation, controversial notices, and employee status, including the following:

(1)  8 AAC 45.020 is proposed to be changed as follows: Amend procedures relating to filing a document.

(2) 8 AAC 45.025 is proposed to be changed as follows: Amend the regulation to reference the correct agency mailing address and clarify where agency forms may be obtained.

(3) 8 AAC 45.060 is proposed to be changed as follows: Amend procedures relating to filing and serving a document.

(4) 8 AAC 45.070 is proposed to be changed as follows: Clarify hearing procedures.

(5) 8 AAC 45.083 is proposed to be repealed and readopted as follows: Update fee schedule material adopted by reference.

(6) 8 AAC 45.085 is proposed to be changed as follows: Amend procedures relating to filing a document.

(7) 8 AAC 45.092 is proposed to be changed as follows: Amend procedures relating to the second independent medical evaluation process.

(8) 8 AAC 45.110 is proposed to be changed as follows: Clarify hearing procedures.

(9) 8 AAC 45.134 is proposed to be repealed: Change how compensation may be offset.

(10) 8 AAC 45.136 is proposed to be repealed and readopted as follows: Change the procedures for reporting compensation.

(11) 8 AAC 45.182 is proposed to be changed as follows: Clarify controversial notice filing procedures.

(12) 8 AAC 45.890 is proposed to be repealed: Remove regulatory definition of employee status.

• Written comments were accepted until January 3, 2019. Oral comments may be submitted at a hearing to be held on January 10, 2019, in Room 208, 3301 Eagle St., Anchorage, Alaska 99503. Public comment will be heard from 10:15am to 11:15am and might be extended to accommodate those present before 10:15am who did not have an opportunity to comment. You may submit written questions relevant to the proposed action to the Department of Labor and Workforce Development, Division of Workers’ Compensation at P.O. Box 115512, Juneau, AK 99811-5512 or by electronic mail at workerscompregs@alaska.gov. The questions must be received at least 10 days before the end of the public comment period. The Department of Labor and Workforce Development, Division of Workers’ Compensation will aggregate its response to substantially similar questions and make the questions and responses available on the Alaska Online Public Notice System and the Division of Workers’ Compensation’s website. A copy of the proposed regulation changes and the material proposed for adoption by reference is available on the Alaska Online Public Notice System and by contacting Alexis Newman at (907) 465-6059 or alexis.newman@alaska.gov. After the public comment period ends, the Department of Labor and Workforce Development and the Workers’ Compensation Board will either adopt the proposed regulation changes or other provisions dealing with the same subject, without further notice, or decide to take no action. The language of the final regulation may be different from that of the proposed regulation. You should comment during the time allowed if your interests could be affected.
• As required by AS 44.62.245, the Department of Labor and Workforce Development and the Alaska Workers’ Compensation Board give notice that the following amended versions of material adopted by reference in 8 AAC 45.083, under authority of AS 23.30.098, and dealing with fees for medical treatment and services, is in effect: International Classification of Diseases, 2019 edition, valid October 1, 2018 through September 30, 2019, published by the American Medical Association. A copy of the above material is available for public review at Department of Labor and Workforce Development, Division of Workers’ Compensation at 1111 W 8th St., Suite 305 Juneau, Alaska 99811. The effective date for the amended versions of the material described above is October 1, 2018. For more information, please contact Marie Marx, Department of Labor and Workforce Development, Division of Workers’ Compensation at 1111 W 8th St., Suite 305 Juneau, Alaska 99811, (907) 465-2790.

Arizona VIEW STATE →

REGULATORY ACTIVITY:

• Published a letter from the Commissioner regarding Directed Care in Arizona Workers' Compensation Claims. In part the letter stated, "The Industrial Commission of Arizona continues to receive complaints about entities that are directing care in violation of the Arizona Workers' Compensation Act.  Please be advised that the only entities authorized to direct care in Arizona are private self-insured employers.  Employees of insured employers and public self-insured entities have the right to choose their own medical providers.   To view the letter, go to https://www.azica.gov/news-and-events.
• The Industrial Commission of Arizona's plan to replace the Claims Division's 27-year-old, COBOL-based mainframe computer system is nearing completion. Barring any development setbacks, the Commission is planning to launch the new Claims System on February 19, 2019. The new Salesforce-based system will feature automated workflow capabilities, enhanced analytics, superior document management, and a dynamic web-based portal for interested parties - known as the "ICA Community."  To review the complete text of the announcement, go to https://www.azica.gov/news-and-events.
• The new Claims System will require interested parties (i.e., carriers, employers, claimants, and legal representatives) to select a "preferred communication method" for Claims and/or ALJ communications. Each interested party will have an ICA Community "administrator account" that contains the party's "preferred communication method." Interested parties will be able to choose from three options:
  • S. Mail (at a single designated mailing address);
  • Electronic fax (at a single designated fax number); or
  • Secured File Transfer Protocol ("SFTP") (at a designated SFTP destination).
• S. Mail (at the address on file with the Commission) will be the default option when no alternative communication method is selected. Please note that encrypted e-mail (both inbound and outbound) and Phoenix-office pickup will not be available after the new Claims System is launched. The Commission has posted a "Request and Agreement for Alternative Service and Waiver of A.A.C. R20-5-158(B)" ("Request and Agreement") form on the Commission's website (click for link). Interested Parties may use the Request and Agreement form to select a preferred communication method and designate a mailing address or fax number in advance of the launch of the new Claims System. Please note that each distinct carrier and self-insured employer will need to complete a separate Request and Agreement form. This means that carriers or employers with multiple subsidiaries will need to complete a Request and Agreement for each applicable legal entity. Completion of the Request and Agreement form will allow the Commission to populate ICA Community administrator accounts with selected communication methods in advance of System launch. Interested parties that do not complete this process by January 31, 2019, will default to service by U.S. Mail until an alternative method of communication is selected in the ICA Community. Please be advised that, after the new Claims System is launched, the Commission will no longer address or direct Claims and/or ALJ communications to third-party administrators. See Substantive Policy Statement: Notification of Parties in Workers' Compensation Matters, effective February 19, 2019, available at https://www.azica.gov/substantive-policies-directory-other-adosh. Management of third-party administrators will be the responsibility of carriers and self-insured employers. Although the Commission will no longer address or direct Claims and/or ALJ communications to third-party administrators, carriers and self-insured employers will be permitted to direct their communications to a third-party administrator by designating the third-party administrator's mailing address, fax number, or SFTP destination. For example, if a carrier elects to receive communications by U.S. Mail or electronic fax, the carrier can input a third-party administrator's mailing address or fax number in lieu of the carrier's mailing address or fax number. Carriers and self-insured employers, however, will be limited to a single preferred communication method and a single destination address, fax number, or SFTP destination. Carriers and self-insured employers that utilize multiple third-party administrators will be responsible for managing the distribution of communications to third-party administrators responsible for claim processing functions. Carriers and self-insured employers who choose to direct communications to a third-party administrator will be solely responsible for updating the preferred communication method and designated destination if/when a third-party administrator relationship changes. To further assist impacted stakeholders with these changes, the Commission is preparing a series of FAQs related to these changes, which will shortly be posted to the Commission's website (azica.gov). Additionally, the Commission is planning a series of WebEx conference calls to further discuss the upcoming changes and answer stakeholder questions. The content of each WebEx will be similar, so it is not necessary to participate in all three WebEx sessions. The WebEx schedule and registration instructions are below:
  • WebEx : January 17, 2019 at 10:00 a.m. (Arizona Time) 
• Further questions regarding the new Claims System and the content of this letter may be directed to Claims Manager, Ruby Tate, at Ruby.Tate@azica.gov. PIO Contact, Name: Trevor Laky, Title: Chief of Legislative Affairs and Public Information Officer, Phone: 602-542-4478, Email address: trevor.laky@azica.gov

California VIEW STATE →

FEE SCHEDULE NEWS:

• The Division of Workers’ Compensation (DWC) has posted an order adjusting the Physician Services/Non-Physician Practitioner Services section of the Official Medical Fee Schedule (OMFS) to conform to relevant 2019 changes in the Medicare payment system as required by Labor Code section 5307.1. The Administrative Director update order adopting the OMFS adjustments effective for services rendered on or after January 1, 2019, can be found at the DWC website’s https://www.dir.ca.gov/dwc/OMFS9904.htm#7.  The next update is expected in April 2019.
• The Division of Workers’ Compensation (DWC) has posted an order adjusting the Ambulance Services section of the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1. The update order is effective for services rendered on or after January 1, 2019 and can be found at the DWC website’s https://www.dir.ca.gov/dwc/OMFS9904.htm.  The next update is expected January 2020.
• The DWC has adopted a new DMEPOS fee schedule to conform with the changes in the Medicare payment system effective January 1, 2019. The next update is expected in April 2019.
• The DWC has adopted the Medi-Cal rates effective December 15, 2018. The next update is expected January 15, 2019.

REGULATORY ACTIVITY:

• The Division of Workers’ Compensation Announces 2019 Profile Audit Review and Full Compliance Audit Performance: Labor Code sections 129 and 129.5 require the Audit and Enforcement Unit of the Division of Workers’ Compensation (DWC) to conduct a profile audit review (PAR) for all adjusting locations of California workers’ compensation claims at least once every five years. Performance of the adjusting locations is measured in five areas of claims administration:
  • The payment of accrued and undisputed indemnity;
  • The late first payment of temporary disability / first notice of salary continuation;
  • The late first payment of permanent disability and death benefits;
  • The late subsequent indemnity payments;
  • The provision of notices with Qualified Medical Evaluator/Agreed Medical Evaluator advice.
• DWC annually establishes profile audit review and full compliance audit (FCA) standards in accordance with Labor Code sections 129(b)(1) and (2) and California Code of Regulations, title 8 (8 C.C.R.), section 10107.1. The 2019 standards are based on the audit results of calendar years 2015 through 2017.
• Performance standards for 2019

The PAR performance standard for audits conducted in 2019 is 1.36133. Audit subjects with PAR performance ratings of 1.36133 or lower will be required to pay any unpaid compensation, but no administrative penalties will be assessed. If an audit subject’s PAR performance rating is 1.36134 or higher, the audit will expand to a FCA, and an additional sample of indemnity claims will be audited. The FCA performance standard for audits conducted in 2019 is 1.66166. Audit subjects with an FCA performance rating of 1.66166 or less will be required to pay any unpaid compensation and administrative penalties will be assessed for all violations involving unpaid and late paid compensation. If an audit subject’s full compliance audit performance rating is 1.66167 or higher, an additional sample of denied claims as well as the expanded sample of indemnity claims will be audited. Penalties will be assessed for all violations as appropriate pursuant to 8 C.C.R. sections 10111 through 10111.2.

• Severity Rate standard for 2019

The Severity Rate standard for 2019 is $104.97.  More information on the performance standards that will be in use for the profile audit reviews and full compliance audits during calendar year 2019 will be posted on the DWC Audit and Enforcement Unit https://www.dir.ca.gov/dwc/audit.html.

• Posted notice to all insurers authorized to transact workers' compensation in California regarding Fiscal Year 2018/2019 Assessments for: Workers’ Compensation Administration Revolving Fund (WCARF) • Uninsured Employers Benefits Trust Fund (UEBTF) • Subsequent Injuries Benefits Trust Fund (SIBTF) • Occupational Safety and Health Fund (OSHF) • Labor Enforcement and Compliance Fund (LECF) • Workers’ Compensation Fraud Account (FRAUD). To view the notice, go to https://www.dir.ca.gov/dwc/dwc_home_page.htm.
• NOTICE IS HEREBY GIVEN that the Acting Di- rector (“Director”) of the Department of Industrial Relations (“Department”) proposes to add a new section 15203.11 and to amend sections 15203.2 and 15251 of Title 8 of the California Code of Regulations, for purposes of implementing recent amendments to Labor Code Section 3702.2(a). Those amendments require the Director to obtain detailed information needed to evaluate the administrative costs, expenditures, solvency, and performance of public self−insured employer workers’ compensation programs. The Director also proposes to make non-substantive changes to section 15430 to bring that section into conformity with other recent statutory and regulatory amendments. To view the notice, go to https://oal.ca.gov/december-2018-notice-registers/.
• The Office of Self-Insurance Plans (OSIP) has posted proposed regulations that will require self-insured public entities to file annual reports providing demographic, claim and financial data regarding their workers’ compensation programs. The proposed regulations, mandated by Governor Edmund G. Brown Jr.’s 2012 workers’ compensation reforms, will allow for greater transparency of the solvency and viability of self-insured workers’ compensation programs and the true liabilities of public entities. As specified by Labor Code section 3702.2(a), the changes would require public entities to report portions of their financial statements pertaining to workers’ compensation liabilities. Public entities would also be required to provide aggregate information as a point of reference for other public entities. The proposed regulations were developed in accordance with the recommendations of a 2014 report conducted by the Commission on Health and Safety and Workers’ Compensation, Examination of California Public Sector Self-Insurance Workers’ Compensation Program. The notice and text of the regulations can be found on the proposed regulations web page. A public hearing on the proposed regulations has been scheduled for 10 a.m. January 23, 2019, in Room 11 at the Elihu M. Harris State Building, 1515 Clay Street, Oakland, 94612. To view a copy of the notice, go to https://www.dir.ca.gov/dwc/dwc_home_page.htm.  To view a copy of the proposed rules, go to https://www.dir.ca.gov/osip/rulemaking/osip_rulemaking_proposed.html.
• The Division of Workers’ Compensation (DWC) has posted a draft of amendments to the physician reporting and utilization review regulations on its online forum, and invites members of the public to review and provide comment. The proposed changes, which will update the treating physician reporting requirement and implement the provisions of Senate Bill 1160, are intended to: Expedite appropriate evidence-based medical treatment for injured workers; Increase meaningful communication between treating physicians and utilization review physicians, and Improve the overall quality of utilization review services in workers’ compensation.
• The proposed regulatory amendments will be made pursuant to the rulemaking provisions of the Administrative Procedure Act. To view a copy of the notice, go to https://www.dir.ca.gov/dwc/dwc_home_page.htm.  To view a copy  of the forum documentation on this proposal, go to https://www.dir.ca.gov/dwc/DWCWCABForum/UR-Regulations.htm.
• The Division of Workers’ Compensation (DWC) is announcing the increase of the mileage rate for medical and medical-legal travel expenses by 3.5 cents to 58 cents per mile effective January 1, 2019. This rate must be paid for travel on or after January 1, 2019 regardless of the date of injury. Labor Code Section 4600, in conjunction with Government Code Section 19820 and the Department of Personnel Administration regulations, establishes the rate payable for mileage reimbursement for medical and medical-legal expenses and ties it to the Internal Revenue Service (IRS).  IRS bulletin Number IR-2018-251 dated December 14, 2018 announced the rate increase. The updated mileage reimbursement form is posted on the DWC website.

California-Auto VIEW STATE →

REGULATORY ACTIVITY:

• Issued Bulletin 2018-4 Notification of Fee Increase Effective March 3, 2019.In accordance with Insurance Code Section 12978, this provides notification that the California Department of Insurance is increasing fees by 10 percent for all insurance producers, bail agents, insurance adjusters, and insurers operating in the State of California effective March 3, 2019. As an example, an insurance agent or broker will see an increase of $18 for each biennial license or renewal, which amounts to $9 per year. To view the bulletin, go to https://www.insurance.ca.gov/0250-insurers/0300-insurers/0200-bulletins/bulletin-notices-commiss-opinion/Bulletin2018-4.cfm.

Colorado VIEW STATE →

FEE SCHEDULE NEWS:

• Published a newer version of the 2019 Medical Fee Schedule on its web site. The newest version dated December 26, 2018 replaces the previous versions published.  The next update to the fee schedule is expected in January 2020.

REGULATORY ACTIVITY:

• Has adopted Rule 17 Exhibit 2: Traumatic Brain Injury that becomes effective January 30, 2019. To view the adopted rule, go to https://www.colorado.gov/pacific/cdle/workers-compensation-proposed-and-adopted-rules.
• Posted notice of a rules hearing for a proposed rule regarding the Colorado Uninsured Employer Fund. 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 Colorado Uninsured Employers Fund Rules, 7 C.C.R. 1106-1 as described below.  The Colorado Uninsured Employer Board has the authority to promulgate rules pursuant to the Colorado Uninsured Employers Act as set forth in section §8-67-107.  Date and Time of Hearing: February 5, 2019 9:30 a.m.  Place of Hearing: 633 17th Street Denver, CO.   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:

• Posted Notice of Request for Comments on proposed amended regulation 5-2-12 concerning automobile insurance consumer protections. To view the notice, go to https://www.colorado.gov/pacific/dora/draft-regulations-informal-public-comment.

Connecticut VIEW STATE →

REGULATORY ACTIVITY:

• Pursuant to Section 31-280b, Chairman Stephen M. Morelli has appointed Commissioners Peter C. Mlynarczyk and David W. Schoolcraft to sit as panel members on appeals before the Compensation Review Board for the calendar year beginning January 1, 2019.

Florida WC VIEW STATE →

REGULATORY ACTIVITY:

• Posted a notice of correction in the November 29, 2018 register. Notice is hereby given that the following correction has been made to the proposed rule in Vol. 44 No. 217, November 6, 2018 issue of the Florida Administrative Register. The correction has been made to update the Notice with statutorily required information. Summary of statement of estimated regulatory costs and legislative ratification is deleted in full and is replaced by the following: The Agency has determined that Rule 69L-7.020, F.A.C. will have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has been prepared by the Agency. The Agency has determined that the proposed Rule 69L-7.020, F.A.C. is expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: The Department conducted a SERC analysis of the proposed rule utilizing a cost analysis of estimated regulatory costs prepared by the National Council on Compensation Insurance, Inc. (NCCI). NCCI’s cost analysis of proposed Rule 69L-7.020, F.A.C., indicates that the proposed rule will result in an estimated overall increase in Florida workers’ compensation system costs of 0.1% (+$4M). The Agency has determined that Rule 69L-7.100, F.A.C. will have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has been prepared by the Agency. The Agency has also determined that the proposed Rule 69L-7.100, F.A.C. is expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: The Department conducted a SERC analysis of the proposed rule utilizing a cost analysis of estimated regulatory costs prepared by NCCI. NCCI’s cost analysis of proposed Rule 69L-7.100, F.A.C., indicates that the proposed rule will result in an estimated overall increase in Florida workers’ compensation system costs of 1.5% (+$66M).  To view the notice, go to https://www.flrules.org/gateway/ruleNo.asp?id=69L-7.020.
• The Florida Department of Economic Opportunity has determined the statewide average weekly wage paid by employers’ subject to the Florida Reemployment Assistance Program Law to be $939.41 for the four calendar quarters ending June 30, 2018. Section 440.12(2), Florida Statutes (2018), expressly provides that, for injuries occurring on or after August 1, 1979, the weekly compensation rate shall be equal to 100 percent of the statewide average weekly wage, adjusted to the nearest dollar, and that the average weekly wage determined by the Department of Economic Opportunity for the four calendar quarters ending each June 30 shall be used in determining the maximum weekly compensation rate with respect to injuries occurring in the calendar year immediately following. Accordingly, the maximum weekly compensation rate for work-related injuries and illnesses occurring on or after January 1, 2019, shall be $939.00. To view the bulletin, go to https://www.myfloridacfo.com/Division/WC/bulletins.htm.

Georgia VIEW STATE →

REGULATORY ACTIVITY:

• Effective December 1, 2018 the SSN/BTN numbers will be removed from the Board’s forms, ICMS II and database. You will no longer have to request a BTN to file a WC-1 or WC-14. You can file them via ICMS II or EDI. The new revision of the Board forms reflecting the removal of the SSN/BTN and any other changes will be available on the website on December 1, 2018.
• Effective January 1, 2019, the filing of a Form WC-1 will be required in all claims, including all “medical only” claims. Penalties will be assessed if parties fail to timely file a WC-1 after January 1, 2019, pursuant to the provisions of O.C.G.A. §§ 34-9-12(a), 34-9-18 and Board Rules.

Hawaii No-Fault VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted the Medicare 2019 version effective January 1, 2019. The next update is expected January 2020.
• The state has adopted a new Ambulance fee schedule effective January 1, 2019. The next update is expected January 2020.

Hawaii WC VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted a new fee schedule effective January 1, 2019. The next update is expected January 2020.

REGULATORY ACTIVITY:

• Posted the 2019 Maximum weekly wage base and benefit amount. To view the posting, go to http://labor.hawaii.gov/dcd/news/2019-maximum-weekly-wage-base-and-benefit-amount/.

Illinois VIEW STATE →

FEE SCHEDULE NEWS:

• The medical and facility fee schedules have been updated with an effective date of January 1, 2019. The next update is expected in January 2020.

REGULATORY ACTIVITY:

• The IWCC has secured a new location in Urbana where the Arbitration Status Call, Arbitration Hearings and Review Hearings will be held. The new location is at the Lincoln Square Mall just a few short blocks from the current location at the Urbana Civic Center. The new hearing site will become available for the January 2019 trial cycle and is located on the lower level of the Lincoln Square Mall. The mall address is 201 Lincoln Square, Urbana, IL 61801.

Indiana VIEW STATE →

REGULATORY ACTIVITY:

• Posted an emergency rule from the Indiana Board of Pharmacy. The rule temporarily amends 856 IAC 2-2-6 to add drug compounds to Schedule V. Statutory authority: IC 25-26-13-4.1. Effective 30 days after filing with the Publisher. The rule was filed on November 21, 2018 and became effective December 21, 2018. To view a copy of this emergency rule, go to http://www.in.gov/legislative/iac/20181128-IR-856180516ERA.xml.html.

Kansas VIEW STATE →

REGULATORY ACTIVITY:

• The KDOL Workers’ Compensation Division launched the Online System for Claims Administration Research/Regulation (OSCAR) on Nov. 30, 2018. OSCAR is a comprehensive digitization program intended to improve customer service; reduce administrative costs; increase operational efficiency and effectiveness and improve data quality and integrity. Planning and implementation for the OSCAR program was completed over a four-year time-span which included in-depth research in the areas of electronic transactions, Web access and digital storage. At launch, all interaction with the KDOL, Workers’ Compensation Division will be conducted using the OSCAR system. Attorneys representing claimants, employers, insurers, claims administrators and third-party administrators are required to have an OSCAR account. OSCAR is expected to reduce paper waste, expedite workflows and improve transparency. To access the OSCAR system, go to oscar.dol.ks.gov.
• Posted notice of a public hearing to be held on February 15, 2019, regarding the revision of fee schedule in K.S.A. 51-9-7 as authorized by K.S.A. 44-510i. The Director is to adjust the fees at least biennially to ensure the Medical fees paid as a result of a workers’ compensation injury are current, reasonable and fair. To view the notice, go to http://www.kssos.org/pubs/pubs_kansas_register.asp.
• The state apologizes for any inconvenience as it continues to update issues with the OSCAR system. If you are able to make your case filings in OSCAR, please continue. If you are having issues making your filings with OSCAR, you may temporarily file by mailing or faxing your paper work to the division. Please attach your contact information in the event that staff has questions.

Mail to: Work Comp/OSCAR Submission, 401 SW Topeka Blvd., Topeka, KS 66603, Fax: (785) 296-8580, Include cover sheet marked: Work Comp/OSCAR Submission.

Kentucky VIEW STATE →

REGULATORY ACTIVITY:

• Settlement agreements must be submitted electronically beginning Jan. 1, 2019. As previously announced, as of Jan. 1, 2019, all Settlement Agreements (Form 110) must be submitted electronically through LMS. The Department of Workers' Compensation (DWC) will not accept nor process paper Settlement Agreements after Jan. 1, 2019. To access the PowerPoint presentation regarding the process for submission of Settlement Agreements electronically please go to the 'Forms, Documents, Publications, and Reports' tab on the DWC website and type in the words “settlement agreements” in the keyword search bar.  The first option will be titled “Electronic Submission of Settlement Agreements PowerPoint.”  Open that document for a detailed explanation of the process of electronic submission of Settlement Agreements in claims assigned to ALJs and pre-litigation/post-litigation Settlement Agreements.  For further assistance, please contact the DWC at Laborkywclms.technicalsupport@ky.gov. Additional information is available at http://labor.kentucky.gov/workersclaims. Department of Workers' Claims is located at 657 Chamberlin Ave, Frankfort, KY 40601. Other questions concerning Department of Workers' Claims can be addressed by calling (502) 564-5550.

Louisiana VIEW STATE →

REGULATORY ACTIVITY:

• The Louisiana Workers' Compensation Educational Conference will be held January 16-18, 2019 at the Hilton New Orleans Riverside.

Maine VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted changes to the physician, outpatient and ASC facility fee schedule with an effective date of January 1, 2019. The next medical fee schedule update is expected in January 2020.

REGULATORY ACTIVITY:

• Published in the state register notice of adoption of Chapter 5 Medical Fees, Reimbursement Levels and Reporting requirements. The effective date of the adopted rule is January 1, 2019. To view the adopted rule, go to http://www.maine.gov/wcb/Departments/legaldivision/proposed.html.

Maryland VIEW STATE →

REGULATORY ACTIVITY:

• The 2019 calendar for the Maryland workers' compensation commission maximum rate of benefits is posted. To view the document, go to http://www.wcc.state.md.us/Adjud_Claims/Comp_Rates.html. In accordance with Section 9-604 of the Labor and Employment Article, which authorizes the computation of Awards to the next highest dollar when the standard computation formula results in an uneven amount, the following are maximum benefits for death and disability for injuries occurring on and after January 1, 2019.
  • Temporary total disability: Two-thirds of the employee’s Average Weekly Wage not to exceed 100% of the State Average Weekly Wage or $1,116.00.
  • Permanent total disability: Two-thirds of the employee’s Average Weekly Wage not to exceed 100% of the State Average Weekly Wage or $1,116.00.
  • Permanent partial disability: For awards for a period less than 75 weeks for events occurring on or after January 1, 2000 but before January 1, 2009, compensation is to be paid at the rate of thirty-three and one-third per centum of the employee’s Average Weekly Wage, not to exceed $114.00.
  • The minor disability category does not apply to certain public safety employees. See LE 9-628(a).
• Posted notice of appointment of two new Commissioners, Allan Kittleman and Howard Metz to the Commission. Allan H. Kittleman, Commissioner - On November 28, 2018 Governor Larry Hogan announced the appointment of Allan H. Kittleman to the Maryland Workers’ Compensation Commission. Commissioner Kittleman graduated with honors from the University of Maryland School of Law with a J.D. in 1988. He received his bachelor's degree in political science from the University of Maryland, Baltimore County in 1981. After receiving his J.D. degree, he joined Smith, Somerville & Case. In 1991, he joined Herwig & Humphreys where he became a partner. Subsequently, he became “of counsel” at Godwin, Erlandson, Vernon and Daney. Throughout his 25 years in legal practice, Commissioner Kittleman concentrated his practice in the defense of workers’ compensation claims in Maryland and the District of Columbia. Commissioner Kittleman also previously served on the Howard County Council (1998-2004), in the Maryland State Senate (2004-2014) and as the Howard County Executive (2014-2018). Howard L. Metz, Commissioner - On November 28, 2018 Governor Larry Hogan announced the appointment of Howard L. Metz to the Maryland Workers’ Compensation Commission. Commissioner Metz graduated from the State University of New Jersey School of Law in 1985. He received his bachelor's degree from The American University in 1982. Mr. Metz has over 30 years of experience in workers’ compensation and as a litigation attorney representing clients in trials before the Maryland Circuit and District Courts and U.S. District Court including courts in Pennsylvania and New Jersey. He has briefed and argued cases before the Maryland Court of Appeals, Court of Special Appeals and U.S. Court of Appeals for the Fourth Circuit. In addition to practicing before the Maryland Workers' Compensation Commission, Mr. Metz has appeared before the Social Security Administration and other State and Federal Agencies. He has been a court appointed mediator for the Circuit Court for Frederick County since 2000 and for the Circuit Court for Washington County since 2008. He frequently lectures and is a continuing legal education instruction in the areas of Workers’ Compensation law and mediation practice.
• Posted new materials to the Medical Fee Guide Information page for calendar year 2019. To view the newly posted material, go to http://www.wcc.state.md.us/MFG/Medical_Fee_Schedule.html.  The posted material include Maryland Specific Conversion Factor (MSCF)/Percentage Multiplier Information Medical Services and Treatment Reimbursement Rates, Ambulatory Surgery Centers Reimbursement Rates, Anesthesiology Base Units and Calculation, Orthopedic/Neurological Surgical CPT Codes and CPT Codes not valued by CMS.

Medicare VIEW STATE →

FEE SCHEDULE NEWS:

• Physician – CMS has posted new updates to the National Physician Fee Schedule Relative Value File effective January 1, 2019. The next expected update is April 1, 2019.
• OPPS – CMS has released new updates to the hospital outpatient fee schedule with an effective date of January 1, 2019. The next expected update is April 2019.
• ASC – CMS has released a new update to the ASC fee schedule with an effective date of January 1, 2019. The next expected update is April 2019.
• DMEPOS – CMS has posted a new DMEPOS module with an effective date of January 1, 2019.  The next expected update is in April 2019. 
• Clinical Laboratory – CMS has released the 2019 clinical laboratory fee schedule with an effective date of January 1, 2019.  The next expected update is in January 2020.

Michigan VIEW STATE →

REGULATORY ACTIVITY:

• Posted notice that the 2019 weekly benefit table is now available. The state average weekly wage and maximum weekly rate should be available in a few weeks and will be posted at that time. To view the announcement, go to https://www.michigan.gov/wca/0,4682,7-191--484378--,00.html.

Nebraska VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted a new medical fee schedule and new Inpatient DRG/Trauma hospital rates with an effective date of January 1, 2019. The next update is expected in January 2020.

REGULATORY ACTIVITY:

• Effective January 1, 2019, the maximum weekly income benefit under the Nebraska Workers’ Compensation Act increased to $855.00. This amount applies to work-related injuries and illnesses occurring on or after January 1, 2019.
• Has published Fiscal Year 2018 Case Summaries. To access the summaries, go to https://www.wcc.ne.gov/legal-practice-statutes-and-rules/appellate-court-decisions.
• Amendments to Rules 26, 47, and 50 were adopted at a public meeting on December 20, 2018.  Rule 26 became effective January 1, 2019. Rules 47 and 50 became effective December 20, 2018. Adopted amendments to Rule 2 became effective only upon review and approval of the Nebraska Supreme Court. To view the adopted rules, go to https://www.wcc.ne.gov/home/public-hearings-and-public-meetings.

Nevada VIEW STATE →

REGULATORY ACTIVITY:

• Guarantee Insurance Company On November 27, 2017 the Second Judicial Circuit Court in Leon County, Florida found Guarantee Insurance Company to be insolvent and Issued an Order of Liquidation. The Florida Department of Financial Services (Department) is the court appointed Receiver of Guarantee Insurance Company. All policyholders are hereby advised to secure replacement coverage immediately, as all Guarantee Insurance Company policies were cancelled effective December 27, 2017. The Order of Liquidation has established a claim filing deadline of May 28, 2018. Pursuant to Nevada Revised Statutes, claims cannot be filed with the Nevada Insurance Guaranty Association more than 18 months after the date of the order of Liquidation or after the final date set by the court or whichever is earlier. It should also be noted that pursuant to N.R.S. 687A.020, the Nevada Insurance Guaranty Association cannot cover Surety claims. All policyholders, former policyholders, and claimants having outstanding, unsettled claims against Guarantee Insurance Company should immediately contact: Nevada Insurance Guaranty Association 3821 W. Charleston Blvd., Suite 100 Las Vegas, NV 89102 Phone: (702) 368-0607 Toll Free: (800) 964-7882 Fax: (702) 368-2455 Email: service@nviga-pc.org Website: nviga-pc.org.
• Issued the winter edition of the Nevada Workers' Compensation Chronicle. To view the publication, go to http://dir.nv.gov/WCS/Home/ and click on "Current Newsletter".

Nevada Auto VIEW STATE →

REGULATORY ACTIVITY:

• Issued Bulletin 18-006 regarding third party administrators due date for filing annual reports. In part the bulletin states: "Pursuant to NRS 8528(1), not later than 90 days after the expiration of the fiscal year of the TPA, or within such other period as the Commissioner may allow, each holder of a certificate of registration as a TPA shall file with the Commissioner an annual report for that fiscal year. This provision was enacted during the 2015 Legislative session, revising the prior due date of July 1 of each year".  To view the bulletin, go to http://doi.nv.gov/News_Notices/Bulletins/Bulletin_18-006/.

New Jersey WC VIEW STATE →

REGULATORY ACTIVITY:

• Published the schedule of disabilities and maximum benefits exclusive of amputation and enucleation that became effective on January 1, 2019. To view the benefit table, go to https://www.nj.gov/labor/wc/wc_index.html.

New Mexico VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted new hospital and healthcare provider fee schedules effective January 1, 2019. The next expected update is in January 2020.
• The Gross Tax Receipts schedule has been updated for the period of January 1 through June 30^th .  The next expected update is in July 2019.

REGULATORY ACTIVITY:

• Albuquerque, N.M. December 17, 2018 – New Mexico Workers’ Compensation Administration (WCA) Director Darin A. Childers has stepped down from his post and is returning to the private practice of law in Albuquerque. His resignation is effective today. Childers served as WCA Director for five years, officially taking the leadership role on Dec. 2, 2013. He began his service with the agency as General Counsel in June 2011. Until New Mexico Governor-elect Michelle Lujan Grisham appoints a replacement, current Executive Deputy Director Verily Jones will serve as acting director.

New York VIEW STATE →

REGULATORY ACTIVITY:

• Issued Bulletin Subject No. 046-1119 regarding appeals, inventory and forms. The Board announces that the number of undecided workers’ compensation appeals continues to decline. As of November 1, 2018, there were only 3,927 applications for administrative review waiting to be decided, and 92% were decided in less than six months. The prompt processing of appeals aids both workers and employers by quickly making benefits and treatments available and lowering litigation costs. The Board continues to strive to resolve all appeals in less than six months. When parties properly complete the Application for Board Review or Application for Reconsideration/Full Board Review, it aids the responding party in identifying the exact issues, grounds and evidence used in support of the application and crafting a timely and effective rebuttal. A complete application or rebuttal also aids the Board in timely and effectively reviewing the application or rebuttal so the appeal is resolved quickly. To aid parties in properly completing applications and rebuttals, and to eliminate any possible confusion, the Board has revised the Application for Board Review (Form RB-89), Rebuttal of Application for Board Review (Form RB-89.1), Application for Reconsideration/Full Board Review (Form RB-89.2), and Rebuttal of Application for Reconsideration/Full Board Review (Form RB-89.3) to add clarifying information to the instructions.
• Item 15 of Form RB-89 and Item 16 of Form RB-89.1 have been clarified to state that the date when the objection or exception was interposed must be listed. 12 NYCRR 300.13(b)(2)(ii)
• Forms RB-89.2 and RB-89.3 have been revised to clarify that the forms are not coversheets but the actual Application for Reconsideration/Full Board Review and Rebuttal of Application for Reconsideration/Full Board Review.
• Finally, to provide additional support to all parties, the Board has prepared a Guidance Document on the Proper Application of Board Rule 300.13. The document sets forth the existing rules and the correct completion of Items 11 through 15 on Form RB-89, and Items 13 through 15 on Form RB-89.2. A companion document titled, Supplement: Decisional Examples, provides examples, item by item, as to how these rules are applied. The Board will continue to accept the prior version of the form (01-18) until February 1, 2019. After that date, any prior version of the application form shall not be considered to be in the format prescribed by the Chair and will be subject to denial of review. To view a copy of the bulletin, go to http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1119.jsp.
• Issued bulletin subject number 046-1121 on December 3, 3018 regarding updated independent medical examiner list. IMEs were notified that they were required to register with the Board by November 30, 2018, to maintain their authorization. They were advised that failure to register by this deadline would be deemed a refusal to provide information concerning authorization per Workers’ Compensation law section 13-d(2)(f), and that their authorization to perform independent medical examinations in the New York State workers’ compensation system would be rescinded on a contingent basis until they complete their registration. Independent medical examination reports or testimony from IMEs who failed to register by November 30, 2018, will be valid for examinations performed on or before November 30, 2018, but will be invalid for examinations performed after November 30, 2018. To reinstate their authorization to perform independent medical examinations, unregistered IMEs must register with the Board. A list of unregistered IMEs is available on the Board’s website. To find an authorized, registered health care provider or IME, use the Health Care Provider and IME Search on the Board’s website. For questions regarding the IME registration process, please contact the Medical Director’s Office at (800) 781-2362, option 6.  To view the bulletin, go to http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1121.jsp.
• Issued bulletin subject number 046-1123 regarding the eCase document upload feature. The Board has added a document upload feature to its eCase application that will enable users to upload documents directly to the electronic case folder to use as evidence at scheduled hearings. Purpose: The eCase document upload feature enables the parties in a hearing and the Workers' Compensation Law Judge to see vital evidence that will be used at hearings. The document upload feature is not a means to submit or process claim documents. The uploaded documents are for the purposes of the hearing only and will not be otherwise processed by the Board. Any documents uploaded that are not eligible to be uploaded or which are mislabeled, will not be processed by claims examiners before or after the hearing. The claims examiner will not be able to assist with mislabeled or improperly uploaded documents. Intended Users: The intended users of the eCase document upload feature are attorneys (both claimant and insurance carriers), insurers, third party administrators, self-insured employers, and claimants. IME entities and employers do not have access to the document upload functionality.  To view the bulletin, go to http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1123.jsp.

New York No-Fault VIEW STATE →

REGULATORY ACTIVITY:

• Proposed 9th amendment to Insurance Regulation 68-C (11 NYCRR65-3) Regulations Implementing the Comprehensive Motor Vehicle Insurance Reparations Act - Claims for Personal Injury Protection Benefits. Comments on the proposed rule will close on January 14, 2019. To view the notice and proposed rule, go to https://www.dfs.ny.gov/insurance/rproindx.htm.

North Carolina VIEW STATE →

REGULATORY ACTIVITY:

• On November 19, 2018, the Industrial Commission formally adopted changes to the "Group 2" Workers’ Compensation Rules and Tort Rules. The Group 2 Rules as adopted by the Commission are available at http://www.ic.nc.gov/news.html#hot. Amendments made in response to public comments are highlighted. The Rules Review Commission considered the proposed changes at its December meeting. Additionally, the Commission adopted changes to the Public Safety Employees’ Death Benefits Act Rules under N.C. Gen. Stat. § 150B-21.5(a). The amendments reflect the title of the Act being changed from the Law Enforcement Officers’, Firemen’s, Rescue Squad Workers’ and Civil Air Patrol Members’ Death Benefits Act to the Public Safety Employees’ Death Benefits Act. The Rules Review Commission also considered these proposed amendments at its December meeting. The proposed changes are available at ic.nc.gov/news.html#hot.
• On November 15, 2018, the Rules Review Commission ("RRC") approved amendments to Rules 11 NCAC 23A .0101, .0102, .0103, .0108, .0302, .0411, .0503, .0602, .0603, .0608, .0609A, .0610, and .0611. The RRC also approved the repeal of Rule 11 NCAC 23A .0618. For the convenience of the Commission’s stakeholders, an overview of the substantive changes is available. To view the rule changes and summary of changes, go to http://www.ic.nc.gov/news.html#hot.  The changes went into effect December 1, 2018.
• On December 13, 2018, the Rules Review Commission approved all proposed changes to the "Group 2" Workers’ Compensation Rules and the Public Safety Employees’ Death Benefits Act Rules as adopted by the Industrial Commission. The changes became effective January 1, 2019. On the same day, the Rules Review Commission approved proposed changes to rules governing the State Tort Claims Act. However, the Tort Rules received more than ten letters of objection. As a result, the rules are subject to legislative review pursuant to N.C. Gen. Stat. § 150B-21.3. To view this notice, go to http://www.ic.nc.gov/news.html#hot.

North Dakota VIEW STATE →

REGULATORY ACTIVITY:

• WSI recently published an article about the Advanced Beneficiary Notice (ABN) process. After receiving several follow-up questions from providers about the article, WSI is providing further clarification.  To view the published clarification, go to http://www.workforcesafety.com/news/news-item/clarification-on-previous-advanced-beneficiary-notice-abn-article.
• Effective January 1, 2019, WSI will implement fee schedule changes. To view the notice and a summary of the changes, go to http://www.workforcesafety.com/news/news-item/updated-fee-schedule-effective-january-1-2019.  To view the complete set of fee schedules for North Dakota, go to  http://www.workforcesafety.com/WSI/billingfeeschedule/FeeSchedule/FeeSchedule

Ohio VIEW STATE →

FEE SCHEDULE NEWS:

• A new medical fee schedule has been adopted with an effective date of January 1, 2019. The next expected update for the medical fee schedule is in January 2020.

REGULATORY ACTIVITY:

• Posted a notice of the Bureau of Workers' Compensation intent to consider for review rule 4123-6-08 the Bureau fee schedule for the purpose of amending the rule. To view the notice, go to https://www.bwc.ohio.gov/basics/guidedtour/generalinfo/OACInReview.asp.
• Posted a notice of the Bureau of Workers' Compensation intent to consider for review rule 4123-3-01 Bureau claims procedure rule. To view the notice, go to https://www.bwc.ohio.gov/basics/guidedtour/generalinfo/OACInReview.asp.
• Posted a notice of the Bureau of Workers' Compensation intent to consider for review rule 4123-6-33 Lumbar fusion surgery, HBAI and medical treatment reimbursement request. To view the notice, go to https://www.bwc.ohio.gov/basics/guidedtour/generalinfo/OACInReview.asp.

Oklahoma VIEW STATE →

FEE SCHEDULE NEWS:

• New DMEPOS and Ambulance rates in accordance with CMS have been adopted with an effective date of January 1, 2019.

REGULATORY ACTIVITY:

• Effective January 1, 2019, the Internal Revenue Service has announced an increase in the mileage reimbursement rate from $.545 to $.58 per mile. (See IR-2018-251, Issued 12/14/2018).  The new rate applies to mileage incurred on or after January 1, 2019.

Oregon VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted the new 2019 CPT and HCPCS codes for their medical fee schedule with an effective date of January 1, 2019. The next expected update to the medical fee schedule is in April 2019.

REGULATORY ACTIVITY:

• Published an industrial which provides information pertaining to the submission of self-insured employer and employer group claim-loss data, also known as the annual report of losses. To view the notice, go to https://wcd.oregon.gov/Pages/industry-notices.aspx.
• The Quarterly Fatality Report for the third quarter 2018 (7/01/2018-10/31/2018) is now available. In both 2017 and 2018 DCBS received notification of ten fatalities accepted for workers’ compensation benefits during the 3rd quarter. The Quarterly Fatality Report presents compensable fatalities grouped by industry. The previous year’s counts are included for comparison. Please note the 2018 data are preliminary until the final count is released in the spring of next year.
• Issued Revised Bulletin 209 regarding report of losses, instructions and guidelines. This bulletin explains reporting requirements under Oregon Administrative Rule (OAR) 436 -050-0175(3), which requires all self-insured employers to submit claim loss data to the department for calculation of annual experience rating modifications, security deposits, and retrospective rating plan adjustments. This bulletin replaces Bulletin 209 issued Dec. 4, 2017. In 2019, self-insured employers’ reporting threshold for individual claims, established by the National Council on Compensation Insurance (NCCI) split point, will increase to $17,000. Included with the update bulletin are revisions to forms 2808, 2809, 2810, and 2937.  To view bulletin, go to https://wcd.oregon.gov/forms/Pages/bulletins.aspx.
• Issued Revised Bulletin 316 regarding claims processing administrative cost factor. This revised bulletin notifies insurers and self-insured employers of the 2019 claim processing administrative cost factor. The Workers’ Compensation Division (division) applies this factor to approved reimbursements for supplemental disability benefits and certain claim costs. The factor is calculated under Oregon Administrative Rule (OAR) 436- 050-0180. This bulletin replaces Bulletin 316 issued Dec. 4, 2017.  The claim processing administrative cost factor for calendar year 2019 is 22.78 percent. To view the bulletin, go to https://wcd.oregon.gov/forms/Pages/bulletins.aspx.
• Posted notice of temporary changes to Oregon Rule OAR 436-009 Oregon Medical Fee and Payment Rules regarding the adoption of new medical billing codes for 2019. The adopted rule becomes effective January 1, 2019 and remains effective through June 29, 2019.  To view the notice and adopted rules, go to https://wcd.oregon.gov/laws/Pages/new-rules.aspx.

South Carolina VIEW STATE →

REGULATORY ACTIVITY:

• Published a summary of the full Commission business meeting held on November 26, 2018. To view a copy of the summary, go to https://wcc.sc.gov/news/2018-11/full-commission-business-meeting-summary-november-26-2018.
• At the Business Meeting on December 17, 2018, the Commission approved the maximum weekly compensation rate at $845.74 for injuries arising on and after January 1, 2019. The South Carolina Department of Employment and Workforce certified the average weekly wage July 1, 2017 through June 30, 2018. As provided in Title 42 of the SC Code of Laws, 1976 the maximum weekly compensation rate equals 66⅔% of an individual’s average weekly wage, not to exceed the average weekly wage in this State for the preceding fiscal year as determined by the South Carolina Department of Employment and Workforce.  For additional information about this notice contact: Gary M. Cannon Executive Director 803.737.5744 gcannon@wcc.sc.gov.

South-Carolina-Auto VIEW STATE →

REGULATORY ACTIVITY:

• Bulletin Number 2018-13; To: All Insurers Transacting Private Passenger Automobile Insurance Business in South Carolina; From:  Raymond G. Farmer; Director of Insurance; Re:  FYI 9’s Uninsured Motorist Distribution (2017’s Marker Share); Date:  December 18, 2018: South Carolina law provides that South Carolina drivers seeking to drive uninsured must pay annually a fee of Five Hundred Fifty dollars ($550) for the privilege of operating an uninsured vehicle on South Carolina highways or a Three Hundred Dollar ($300) reinstatement fee.   See, e.g., S.C.  Code Ann.  56-10-510 (Supp.  2015).    These fees are deposited into the Uninsured Motorist Fund ("Fund”) to be disbursed   in accordance with§§ 38-77-151 through 38-77-155. Section 3 8-77-155 states that the Director of Insurance shall distribute monies annually from the Fund among the several insurers writing motor vehicle bodily injury and property damage liability insurance on motor vehicles registered in this state. Your company   may receive a check representing its portion of the uninsured motorist distribution based upon its 2017 market   share.    This amount was calculated pursuant   to the requirements of §38-77-155.   The purpose of the Fund is to reduce the cost of uninsured motorist insurance coverage.   Therefore, the method used to account for these funds must be consistent with the purpose set forth in § 3 8- 77-154.   Accounting for these funds as other income should be done in accordance with NAIC statutory guidance. Please do not hesitate to contact Mia Mills, Accountant/Fiscal Analyst III, at (803) 737-6111 or via E-mail at mmills@doi.sc.gov if you have any questions  or concerns  about the amount of this year's distribution.  To view the bulletin, go tohttp://doi.sc.gov/civicalerts.aspx?AID=184.

Tennessee VIEW STATE →

REGULATORY ACTIVITY:

• A public rule-making hearing will be held regarding the amended rules for the Medical Fee Schedule. The hearing will be held at 220 French Landing Drive, Nashville in the TOSHA Hearing Room on January 17, 2019.  To view the amended rules, go to https://www.tn.gov/workforce/injuries-at-work/bwc-newsroom/2018/12/19/rule-making-hearing-for-medical-fee-schedule.html.

Texas VIEW STATE →

REGULATORY ACTIVITY:

• Issued the Biennial Report of the Texas Department of Insurance to the 86th Legislature - Division of Workers' Compensation. To view this notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.
• Issued notice regarding adoption of the 28 Texas Administrative Code Section 132.7.The Texas Department of Insurance, Division of Workers' Compensation (DWC) has adopted an amendment to 28 TAC §132.7, relating to duration of death benefits for an eligible spouse. The amendment aligns §132.7 with Texas Labor Code §408.183, as amended by House Bill (HB) 2119 of the 85th Legislature. HB 2119 amended Labor Code §408.183 to allow eligible spouses of first responders to remain eligible for death benefits for life after remarrying, if the first responder died as a result of an injury in the course and scope of employment or while providing services as a volunteer, regardless of the date on which the death of the first responder occurred.  The change to §408.183 applies only to eligible spouses who remarried on or after September 1, 2017.  Amended §132.7(f) deletes the words, “This subsection only applies to claims based on a compensable injury that occurs on or after September 1, 2015,” and adds the following words and new language, “This subsection applies to: (1) eligible spouses who remarry on or after September 1, 2017; and (2) eligible spouses who remarried between September 1, 2015, and August 31, 2017, if the claim is based on a compensable injury that occurred on or after September 1, 2015.”   The amendment does not alter the distribution of death benefits under §132.11 or the redistribution of death benefits under §132.12. If there is an eligible child or grandchild and an eligible spouse, death benefits continue to be divided between the beneficiaries, with half paid to the eligible spouse and half paid in equal shares to the eligible children.  The adoption was published in the December 14, 2018, issue of the Texas Register and will be available at www.sos.state.tx.us/texreg/index.shtml once published. A courtesy copy will also be available on the TDI website at tdi.texas.gov/wc/rules/2018rules.html.
• The commissioner of workers’ compensation adopts the following Fiscal Year 2019 Research Agenda for the Workers’ Compensation Research and Evaluation Group (REG):
  • Completion and publication of the thirteenth edition of the Workers’ Compensation Health Care Network Report Card (required in 2019 under Texas Insurance Code §1305.502(a)-(d) and Texas Labor Code §405.0025(b)).
  • An update of return-to-work outcomes for injured employees in the Texas workers’ compensation system (Labor Code §405.0025(a)(4)).
  • An annual update of medical costs and utilization in the Texas workers’ compensation system, including an analysis on the impact of the Texas pharmacy closed formulary on compounded drugs (Labor Code §405.0025(a)(5)).
  • A baseline evaluation of medical services provided through telemedicine in the Texas workers’ compensation system, including medical utilization and costs of Medicare-approved services (Labor Code §405.0025(a)(5)).
• Under Labor Code §405.0025, the REG is charged with conducting professional studies and research related to:
  • 1) the delivery of benefits;
  • 2) litigation and controversy related to workers’ compensation;
  • 3) insurance rates and ratemaking procedures;
  • 4) rehabilitation and reemployment of injured employees;
  • 5) the quality and cost of medical benefits;
  • 6) employer participation in the workers’ compensation system;
  • 7) employment health and safety issues; and
  • 8) other matters relevant to the cost, quality, and operational effectiveness of the workers’ compensation system.

To view the notice, go to  https://www.tdi.texas.gov/alert/whatsnew/index.html.  

• The Texas Department of Insurance, Division of Workers' Compensation (DWC) has released the 2018 Insurance Carrier Performance Based Oversight (PBO) assessment. For 2018, insurance carriers were assessed on their performance for timeliness in the following categories: paying initial temporary income benefits; processing initial medical bills; processing requests for reconsideration of medical bills; submitting initial payment data by electronic data interchange (EDI); and submitting medical bill processing data by EDI. DWC reviewed 121 insurance carriers with the following results: 55 had scores placing them in the high performer tier, 65 were in the average performer tier, and one had a score placing them in the poor performer tier. The 2018 PBO assessment results and a list of the insurance carriers that were reviewed are posted on the Texas Department of Insurance (TDI) website at: tdi.texas.gov/wc/pbo/pboresults.html. If an insurance carrier is not listed, it was not assessed in 2018; however, no insurance carrier in the Texas workers' compensation system is exempt from compliance with the Texas Labor Code and DWC rules.  More information on PBO and the 2018 assessment is available on the TDI website at www.tdi.texas.gov/wc/pbo/icpbo.html. DWC will assess health care providers separately in 2019. To view the above information, go to https://www.tdi.texas.gov/news/2018/dwc12122018.html.

Utah WC VIEW STATE →

REGULATORY ACTIVITY:

• The Utah Labor Commission held an Open Meeting on December 13, 2018 (Thursday) at 9:00 am to discuss changes to rule R612-300 Medical Care in Workers Compensation claims. The purpose for this change was to adopt, with modifications, the Optum 2018 Essential Resource-=Based Relative Value Schedule (RBRVS), 2018 1st Quarter Update and to adjust the conversion factors regarding certain medical specialties.

Virginia VIEW STATE →

REGULATORY ACTIVITY:

• Announced the release of a new claim form effective December 14, 2018. To view this announcement, go to http://www.vwc.state.va.us/news/New-Claim-Form.

Washington VIEW STATE →

FEE SCHEDULE NEWS:

• The Department of Labor & Industries has adopted new 2019 codes for the medical and ASC fee schedules effective January 1, 2019. A new fee schedule update is expected in July 2019.

REGULATORY ACTIVITY:

• Effective 01/01/2019, the payment policy for job modifications and pre-job modifications is being removed from Chapter 18: Modifications: Home, Job and Vehicle and can now be found in the updated Chapter 30: Vocational Services. Please see the PDF of Chapter 30 in this table.  To view the information, go to https://lni.wa.gov/ClaimsIns/Providers/Billing/FeeSched/2018/Updates2018.asp?utm_medium=email&utm_source=govdelivery.
• The state adopted the Adjuster licensing special education criteria rule (R 2018-14) on November 29, 2018. The rule takes effect on January 1, 2019. The rule will create new, and amend existing, sections of WAC 284-17-123 to clarify the special education condition found in RCW 48.17.380(3)(d) for an adjuster license candidate. For more information, including the adopted rule (CR-103P) and the concise explanatory statement, 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=.
• The Washington State Department of Labor & Industries announces changes to the Outpatient Drug Formulary and Selected Preferred Drug List effective January 1, 2019. The changes for the outpatient drug formulary are available at http://www.lni.wa.gov/ClaimsIns/Files/Providers/DrugFormulary.pdf?utm_medium=email&utm_source=govdelivery. The selected preferred drug list is available at http://www.lni.wa.gov/ClaimsIns/Files/Providers/SelectedPDLforworkers.pdf?utm_medium=email&utm_source=govdelivery.
• The Department of Labor & Industries has posted new CPT® and HCPCS codes effective January 1, 2019. Deleted codes effective December 31, 2018 are also posted. To view the updates, go to https://www.lni.wa.gov/ClaimsIns/Providers/Billing/FeeSched/2018/Updates2018.asp.
• Posted notice that the state is considering an increase to the RBRVS conversion factor, the anesthesia conversion factor, and the maximum daily caps for physical and occupational therapy for July 2019. To view a copy of the notice, go to https://www.lni.wa.gov/ClaimsIns/Rules/New/Proposed/default.asp?RuleID=268&utm_medium=email&utm_source=govdelivery.

West Virginia VIEW STATE →

REGULATORY ACTIVITY:

• Issued Information Letter 201 in November of 2018. The letter is in regards to letters of exemption from workers' compensation insurance coverage. To view the letter, go to http://www.wvinsurance.gov/Resources/Informational-Letters.
• Published the 2019 Workers' Compensation Benefits Calendar.  To view the calendar, go to https://www.wvinsurance.gov/Workers-Compensation.