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Alaska VIEW STATE →

REGULATORY ACTIVITY:

  • Posted an amended notice of proposed changes relating to rules regarding electronic filing, agency forms, hearings, material adopted by reference, filing notices, second independent medical evaluations, case files, reporting compensation, controversial notices, and employee status. This amended notice extends the date for written public comment and changes the date for in-person public comment. To view the notice, go to https://aws.state.ak.us/OnlinePublicNotices/Notices/View.aspx?id=192301.

Arizona VIEW STATE →

REGULATORY ACTIVITY:

  • Issued a document entitled Frequently Asked Questions RE: Communication Methods in the New Claims System.  To view the document, 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.  Please be advised that the Commission’s prior plan to launch the new Claims System on February 19, 2019, has been delayed.  Barring any further setbacks, the Commission expects to launch the new Claims System in March 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.”

California VIEW STATE →

FEE SCHEDULE NEWS:

  • The DWC has adopted the Medi-Cal rates effective January 15, 2019. The next update is expected February 15, 2019.
  • The Division of Workers’ Compensation (DWC) has posted adjustments to the Hospital Outpatient Departments and Ambulatory Surgical Centers section of the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1 effective February 15, 2019.
  • The Division of Workers’ Compensation (DWC) has posted an order adjusting the Pathology and Clinical Laboratory 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 order is the second Administrative Director order for the January 2019 annual update to the Pathology and Clinical Laboratory Fee Schedule. The Centers for Medicare and Medicaid Services issued a revised 2019 Pathology and Clinical Laboratory Fee Schedule file on January 15, 2019. The revised file corrects various technical errors and supersedes the original file.   The Administrative Director update order dated January 16, 2019 adopting the OMFS adjustment is effective for services rendered on or after January 1, 2019.

REGULATORY ACTIVITY:

  • The Division of Workers’ Compensation (DWC) Administrative Director George Parisotto has issued an Order updating the Medical Treatment Utilization Schedule (MTUS) Drug List effective February 15, 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 Traumatic Brain Injury Guideline
    • New and Revised Drug Recommendations (related to the Traumatic Brain Injury Guideline)
    • Designation of additional drugs as “special fill” eligible, due to treatment recommendation in the Traumatic Brain Injury Guideline

Additional information regarding the MTUS drug formulary may be found on the MTUS Drug Formulary webpage https://www.dir.ca.gov/dwc/MTUS/MTUS-Formulary.html.  To view the notice, go to https://www.dir.ca.gov/dwc/dwc_home_page.htm.

  • The Division of Workers’ Compensation (DWC) has issued a notice of public hearing for proposed evidence-based updates to the Medical Treatment Utilization Schedule (MTUS), which can be found at California Code of Regulations, title 8, section 9792.23.  The public hearing is scheduled for Friday, February 15 at 10 a.m. in the auditorium of the Elihu Harris Building, 1515 Clay Street, Oakland. Members of the public may review and comment on the proposed updates no later than February 15.  The proposed evidence-based updates to the MTUS incorporate by reference the latest published guidelines from American College of Occupational and Environmental Medicine (ACOEM) for the following:
    • Cervical and Thoracic Spine Disorders Guideline (ACOEM October 17, 2018)
    • Elbow Disorders Guideline (ACOEM August 23, 2018)
    • Hand, Wrist, and Forearm Guideline (ACOEM January 7, 2019)
    • Ankle and Foot Disorders Guideline (ACOEM July 16, 2018)
    • Workplace Mental Health: Posttraumatic Stress Disorder and Acute Stress Disorder Guideline (ACOEM December 18, 2018)

The proposed evidence-based updates to the MTUS regulations are exempt from Labor Code sections 5307.3 and 5307.4 and the rulemaking provisions of the Administrative Procedure Act. However, DWC is required under Labor Code section 5307.27 to have a 30-day public comment period, hold a public hearing, respond to all the comments received during the public comment period and publish the order adopting the updates online.  The proposed updates can be viewed at https://www.dir.ca.gov/dwc/DWCPropRegs/MTUS-Evidence-Based-Update/MTUS-Evidence-Based-Update.htm.

  • The Division of Workers’ Compensation (DWC) is now accepting applications for the Qualified Medical Evaluator (QME) examination on April 13. QMEs are independent physicians certified by the DWC Medical Unit to conduct medical evaluations of injured workers. Applications for the QME exam may be downloaded from   https://www.dir.ca.gov/dwc/MedicalUnit/QME_page.html. Applicants may also contact the Medical Unit at 510-286-3700 to request an application via U.S. mail, email or fax. The deadline for filing the exam applications is February 28. For more information, please contact the Medical Unit at 510-286-3700 or by email at QMETest@dir.ca.gov.
  • The Division of Workers’ Compensation (DWC) has posted the 2018 DWC Audit Unit annual report on its website. The Audit Unit annual report provides information on how claims administrators audited by the DWC performed and includes the Administrative Director’s ranking report for audits conducted in calendar year 2017.  The 2018 Audit Unit annual report details the results of audits conducted in 2017 and provides the name and location of each insurer, self-insured employer, and third-party administrator audited during that time. This report to the Legislature summarizes audits conducted in accordance with Labor Code sections 129 and 129.5 to assure that injured workers, and their dependents in the event of their death, are provided with all benefits due them in an expeditious manner. The audit findings, by law, must detail the number of files audited, the number and type of violations cited, and the amount of an undisputed compensation found due and unpaid to the injured worker. The audit findings presented in this report are statistical and do not identify any individual injured worker. The Labor Code provides that contents of the claim files and the Audit Unit working papers are confidential. Performance of insurers, self-insured employers, and third-party administrators subject to profile audit review and full compliance audit is rated in accordance with the performance standards set annually by the Administrative Director. The DWC Administrative Director’s 2018 Audit Ranking Report lists, in ascending order by performance rating, the administrators audited in calendar year 2017.  The Audit Unit report can be found at https://www.dir.ca.gov/dwc/audit.html.

California-Auto VIEW STATE →

REGULATORY ACTIVITY:

  • California Insurance Commissioner Dave Jones has issued new regulations that prohibit the use of gender in private passenger automobile insurance rating in California. The Gender Non-Discrimination in Automobile Insurance Rating Regulation became effective on January 1, 2019. "My priority as Insurance Commissioner is to protect all California consumers, and these regulations ensure that auto insurance rates are based on factors within a driver's control, rather than personal characteristics over which drivers have no control," said Insurance Commissioner Dave Jones. The Commissioner's Gender Non-Discrimination in Automobile Insurance Rating Regulation mandates that all automobile insurance companies operating in California file a revised class plan that eliminates the use of gender as a rating factor.

Colorado VIEW STATE →

REGULATORY ACTIVITY:

Colorado Auto VIEW STATE →

REGULATORY ACTIVITY:

  • The Division is seeking comments on the following proposed draft amended regulation: Draft proposed amended regulation 5-2-12 - Concerning automobile insurance consumer protections. This regulation is being proposed for amendment as changes were identified to improve readability and clarity during the Division's regulatory review process by adding definitions and adding language around consumer notice requirements. The Division has made some changes based on the comments received when this draft regulation was released for informal external review in December of 2018, and those changes are included in this draft being circulated for a second round of external review.  To view the draft regulation, go to https://www.colorado.gov/pacific/dora/draft-regulations-informal-public-comment?utm_medium=email&utm_source=govdelivery.

Connecticut VIEW STATE →

FEE SCHEDULE NEWS:

  • Ambulance rates have been updated as of January 1, 2019. The next expected update to these rates is scheduled for January 2020.

REGULATORY ACTIVITY:

  • Published memorandum number 2018-11 regarding the 2019 WCC Hospital and Ambulatory Surgical Center Fee Schedule. Pursuant to C. G. S. § 31-294d(d) (as amended June 11, 2014) the following will be in effect for the pecuniary liability of the employer for services rendered by a hospital and ambulatory surgical center:
    • The hospital inpatient rate shall be 174% of the Medicare rate payable to that facility.
    • The hospital outpatient and hospital-based ambulatory surgical center rate shall be 210% of the Medicare rate payable to that facility.
    • The non-hospital based ambulatory surgical center rate shall be 195% of the hospital-based outpatient Medicare rate payable in the same CBSA (Core Based Statistical Area).
    • Where there is no Medicare rate for the services in an outpatient hospital setting, the parties shall negotiate the reimbursement rate. If negotiation is not successful, the parties may request a hearing with the Commission; however, treatment shall proceed pending same.

The Workers’ Compensation Commission is working with a vendor to publish the 2019 applicable rates, rules and guidelines for this Fee Schedule. It will be available in advance of the April 1, 2019 effective date. Notice of availability will be published at https://wcc.state.ct.us/.   To view the memorandum, go to https://wcc.state.ct.us/memos/2018/2018-11.htm.

  • The mileage reimbursement rate for all travel expenses incurred on or after January 1, 2019 has risen to $0.58 per mile. This rate change applies to all claimants, regardless of injury date, and coincides with the federal mileage reimbursement rate pursuant to Section 31-312(a) of the Workers’ Compensation Act.

Delaware Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Has posted notice of repeal of 18 Delaware Administrative Code 610 regarding Automobile Premium Consumer Comparison.  The repeal of the rule became effective on January 11, 2019.  A copy of the final action can be viewed at https://insurance.delaware.gov/information/proposedregs/.

District of Columbia VIEW STATE →

REGULATORY ACTIVITY:

Idaho VIEW STATE →

FEE SCHEDULE NEWS:

  • The medical fee schedule has been updated with the 2019 Medicare Physician Relative Value File effective January 1, 2019.

Illinois VIEW STATE →

REGULATORY ACTIVITY:

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  • All trading partners submitting to the IWCC must submit an updated Trading Partner Document for Release 3.1 before May 17, 2019, or before the start of testing.  Trading partner and EDI vendor testing for IWCC FROI/SROI IAIABC Claims EDI Release 3.1 will begin February 25, 2019 and continue through May 24, 2019.  EDI vendors already submitting XML to at least one R3.1 EDI state at the time of testing are only required to complete connectivity testing requirements.  All other trading partners must complete the entire test plan.  The test plan will be published soon, and an announcement will be sent once it is available. Important Dates:
    • Testing – February 25, 2019, until May 24, 2019
    • Updated Trading Partner Document – due by May 17, 2019
    • Go-Live Date – June 14, 2019
  • The IWCC will regularly update the website to share additional information on this project.  You can also send any questions regarding the implementation to our dedicated EDI e-mail address, WCC.EDI@Illinois.gov.  To view this notice, go to https://www2.illinois.gov/sites/iwcc/news/Pages/news.aspx#iwcc-72.
  • Posted notice of amendment to Rule 50 Ill. Adm. Code 2908 Section 2908.60.  The proposed amendments implement PA 100-1117, which adds the requirement that the Department adopt rules to ensure that health care providers are responsible for supplying only those medical records pertaining to the provider's own claims that are minimally necessary under the federal Health Insurance Portability and Accountability Act of 1996.  Persons who wish to comment on this proposed rulemaking may submit written comments no later than 45 days after the publication of this Notice to: Robert Planthold, Assistant General Counsel Illinois Department of Insurance 122 S. Michigan Ave, Fl. 19 Chicago IL 60603 or Susan Anders Rules Coordinator Illinois Department of Insurance 320 W. Washington St., Fl. 4 Springfield IL 62767.  To view the notice and proposed rule, go to http://www.cyberdriveillinois.com/departments/index/register/home.html.

LEGISLATIVE ACTIONS:

  • House Bill 3452

The enacted legislation amends the Workers' Compensation Act. In provisions concerning required interest payments to providers for unpaid bills, requires such payments to be made by the employer or its insurer to the provider within 30 days (rather than not later than 30 days) after payment of the bill. Provides that if the employer or its insurer fails to pay interest within 30 days after payment of the bill, the provider may bring an action in circuit court for the sole purpose of seeking payment of interest against the employer or its insurer. Provides that the circuit court's jurisdiction shall be limited to enforcing payment of interest as required under a specified provision of the Act. Effective Date January 11, 2019.

Indiana VIEW STATE →

REGULATORY ACTIVITY:

Kentucky VIEW STATE →

REGULATORY ACTIVITY:

  • Posted adopted rules 803 KAR 025:270 and 803 KAR 025:270E Pharmaceutical Formulary and Statement of Emergency.  These rules were adopted December 27, 2018.  The Commissioner of the Kentucky Department of Workers’ Claims (DWC) has promulgated an administrative regulation (803 KAR 25:270) adopting the ODG by MCG Health pharmaceutical formulary for use in the treatment of work-related injuries and occupational disease. The adoption and implementation of a formulary was mandated by House Bill 2 of the 2018 session of the General Assembly.  Drugs listed in the formulary are assigned “Y” or “N” status.  Drugs assigned “Y” status may be dispensed without preauthorization and do not require utilization review. Drugs assigned “N” status require preauthorization.  To view the notice and adopted rules, go to https://labor.ky.gov/comp/Pages/default.aspx. The formulary is available online at odgbymcg.com/state-formulary.   The formulary will take effect as follows:
    • For claims in which the date of injury or last exposure is on or after January 1, 2019, the formulary shall be effective July 1, 2019.
    • For claims in which the date of injury or last exposure is prior to January 1, 2019, the formulary shall be effective:
      • July 1, 2019 for a prescription that is not a refill prescription;
      • January 1, 2020 for a refill prescription of a drug initially prescribed prior to July 1, 2019.

In the coming weeks the DWC will announce and offer a formulary training webinar in conjunction with ODG.  Questions about the formulary regulation may be directed to John Mann at 502-782-4532 or JohnW.Mann@ky.gov.  Support and training is also available through the ODG Helpdesk at 800488-5548 or online at odghelp@mcg.com.

Maryland VIEW STATE →

REGULATORY ACTIVITY:

  • Effective January 1, 2019, the 2019 mileage reimbursement rate increases to $0.58 per mile.
  • Attorneys are required, pursuant to COMAR 14.09.01.09, to keep their contact information current with the Commission. Online Services subscribed Attorneys will maintain or update their contact information via their User Profile page. If an attorney is changing law firms, he or she must contact the Commission at 410-864-5280.

Medicare VIEW STATE →

FEE SCHEDULE NEWS:

  • Clinical Laboratory – CMS has released an updated 2019 clinical laboratory fee schedule file effective January 1, 2019. 

Michigan VIEW STATE →

FEE SCHEDULE NEWS:

  • The state has adopted a new Health Care Services Rules and Fee Schedule with an effective date of January 8, 2019.

REGULATORY ACTIVITY:

  • The Bureau of Labor Market Information & Strategic Initiatives has reported the state average weekly wage as of June 30, 2018 is $1,022.92. In accordance with Section 418.355(2) of the Workers' Disability Compensation Act, the 2019 maximum weekly benefit based on 90% of the state average weekly wage is $921.00. Thus, the 2019 Weekly Benefit Tables are republished to show the State Average Weekly Wage and corresponding maximum benefit rate.  The 2019 calculation program should be available shortly and will be promptly posted. It is the expectation of the Workers’ Compensation Agency that claims administrators possess the appropriate knowledge of the Workers’ Disability Compensation Act to properly pay claims in accordance with statutory requirements.  To view this notice, go to https://www.michigan.gov/wca/0,4682,7-191--485866--,00.html.
  • The Department of Technology, Management and Budget has advised that the mileage rate increased to $0.58 per mile for 2019.
  • Published notice that the 2018 Health Care Services Rules and Fee Schedule became effective on January 8, 2019.  The 2018 Health Care Services Rules and Fee Schedule are effective Jan. 8, 2019, and will replace the current 2017 fee schedule. The updated rules, manual, and fee schedule worksheets are posted, and are based on 2018 source documents such as the 2018 October release CMS Physicians Fee Schedule, as well as 2018 CPT® and HCPCS® Level II procedure codes.  Some highlights of the updated rule language include:
    • Updated source document listings and conversion factor.
    • New definition and rule language regarding Telemedicine services.

Montana VIEW STATE →

REGULATORY ACTIVITY:

Nebraska VIEW STATE →

REGULATORY ACTIVITY:

  • Effective Jan. 1, 2019, the mileage rate will become $0.58 per mile for travel to seek medical treatment or while participating in a vocational rehabilitation plan. This conforms to the reimbursement rate paid to State of Nebraska employees.
  • A recording of the recent Nebraska Workers’ Compensation Court Electronic Data Interchange Release 3.1 informational webinar is now available for online viewing.  To view the webinar, go to https://nwccedi.info/news.

Nevada VIEW STATE →

REGULATORY ACTIVITY:

  • Effective January 1, 2019, the standard mileage reimbursement rate for transportation costs incurred while using a private vehicle while traveling on official State business has increased from $0.545 per mile to $0.58 per mile. Per NAC 616C.150, reimbursement for the cost of transportation for an injured employee, under appropriate conditions, must be computed at a rate equal to the mileage allowance for State employees.

New Mexico VIEW STATE →

REGULATORY ACTIVITY:

  • There is a new general deliver email address set up specifically for inquiries and claims to be filed with the New Mexico Uninsured Employer Fund, or “UEF.”  Please send all correspondence regarding pending or future claims to: WCA-UEF@state.nm.us.

New York VIEW STATE →

FEE SCHEDULE NEWS:

  • A new EAPG data set was released with an effective date of January 1, 2019. The next update is expected in April 2019.

REGULATORY ACTIVITY:

  • The Workers' Compensation Board posted notice of two rule adoptions: Fees for Medical Testimony and Medical Fee Schedules.  To view the notice of adoption, go to https://docs.dos.ny.gov/info/register/2018/december26/toc.html.
  • Published bulletin 046-1136 titled Changes to eClaims Process for Section 21-a and Claims Paid Without Liability.  To view the bulletin, go to http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1136.jsp.
  • Issued a press release regarding addition of a new, free tool for state-of-the-art virtual hearings. New York State Workers' Compensation Board Chair Clarissa M. Rodriguez today announced the Board has launched a new tool that makes it even easier for injured workers, attorneys and other participants to attend workers' compensation hearings remotely. The Board's virtual hearings, a first-in-the-nation initiative, give injured workers a way to move the claim process forward without having to travel many miles for a hearing that may last only minutes, which is especially beneficial depending on the extent of their injuries. The Board is now offering an app that may further improve the user experience for those attending virtual hearings. The WCB VHC app is free in the iOS App Store and does not require users to install any additional software on their mobile device. It employs a simple interface that guides the user from sign on, to the virtual waiting room, and finally to the video hearing once a Judge calls the case. "The feedback we've received about virtual hearings has been overwhelmingly positive, and now we're making it even better with an easy-to-use app," Board Chair Rodriquez said. "This will help injured workers not just here in New York, but in other parts of the country as well, by removing the burden of travel, which can be treacherous this time of year." In addition to added convenience for injured workers, the new app may be particularly helpful for attorneys and licensed representatives who attend hearings regularly because it saves sign-on profile information, allowing users to log in faster. Users can also remove a hearing from their schedule if information was entered incorrectly or if they are no longer appearing for a case. Parties using the app can still use other apps or features on their mobile devices while waiting for their hearing to be called. A notification will automatically alert them when it's time to join a hearing, even if they're in another app or their screen is off. The New York State Workers' Compensation Board developed virtual hearings in partnership with the Office of Information Technology Services to give all parties involved the option of using a smart phone, tablet or computer to attend hearings. This is the first high definition, all access system for legal hearings in the nation, where multiple users in different locations log in once and then move from one hearing to another. Virtual hearings are entirely optional though, and parties can always choose to attend in-person if they prefer.  "The app release is just one more example of how the Board is committed to growing and improving the workers' compensation system," Board Chair Rodriguez said. "With virtual hearings, this new app and other recent initiatives, we're also demonstrating that we're a 'new and improved' Board – one that's better for workers and better for business." Virtual hearings were first tested in the Capital District Office in Menands in November 2017 and are now available at all Board locations except Newburgh and Allegany. More information on virtual hearings and the new virtual hearings app, including instructional videos and other training materials, is at wcb.ny.gov/virtual-hearings. To access the app in the iOS App Store, visit bit.ly/VHCApp.  To view the press release, go to http://www.wcb.ny.gov/content/main/PressRe/virtual-hearings-app-press-release.jsp.

North Carolina VIEW STATE →

FEE SCHEDULE NEWS:

  • The state has published an update to their Professional, DME and Laboratory Fee Schedule with an effective date of January 1, 2019.

REGULATORY ACTIVITY:

  • Governor Roy Cooper has nominated James C. Gillen for appointment as a Commissioner to the North Carolina Industrial Commission, pending confirmation by the North Carolina General Assembly. Deputy Commissioner Gillen will continue to serve in his current position until his confirmation process is complete, and he has been sworn in.
  • On January 17, 2019, the Industrial Commission formally adopted changes to rules governing claims brought pursuant to the State Tort Claims Act. The rules as adopted by the Commission are available athttp://www.ic.nc.gov/news.html#hot. The Rules Review Commission will consider the rules at its February meeting.

North Dakota VIEW STATE →

FEE SCHEDULE NEWS:

  • WSI has released updates to the following fee schedules with an effective date of January 1, 2019: Ambulance, Anesthesia, APC, Ambulatory Surgical Center, Durable Medical Equipment, Inpatient Hospital, Clinical Laboratory, Medical Provider Fee Schedule, Outpatient Hospital and Physician Drugs. The next expected update to the fee schedules is April 1, 2019.

REGULATORY ACTIVITY:

  • Effective for dates of service on and after January 1, 2019, WSI has implemented a new code, W0420, for a provider to bill when instructing an injured worker on the use of a TENS unit. The W0420 code replaces code 64550 (Application of surface neurostimulator), which was deleted from the Current Procedural Terminology (CPT®) codebook for 2019. When a provider bills a W0420 code, WSI requires written documentation regarding instruction on the TENS unit to accompany the bill. The reimbursement amount for W0420 in 2019 is $20.00. Reimbursement for WSI for TENS instruction is in addition to any reimbursement offered by the TENS supplier. The following is a reminder of the standard process involving the prescription for a TENS unit: The treating provider submits an Electro Medical Device Certification Request (M5) form, along with a prescription for a TENS unit to WSI. WSI reviews the request for medical necessity. If the request is approved, CPR Medical coordinates mailing of the TENS unit to the appropriate party, i.e. rendering provider or directly to the injured worker. WSI reimburses CPR Medical for the TENS unit. CPR Medical may offer a voucher to the rendering provider to instruct the injured worker on use of the TENS unit. To view this notice, go to http://www.workforcesafety.com/news/news-item/change-in-billing-for-instruction-on-the-use-of-a-transcutaneous-neurostimulator-tens-unit.

Ohio VIEW STATE →

REGULATORY ACTIVITY:

Oklahoma VIEW STATE →

REGULATORY ACTIVITY:

  • The Workers' Compensation Commission is considering amendments to its administrative rules. The Notices of Rulemaking Intent, Rule Impact Statements, and Proposed Permanent Rules are available on the Commission's website at https://ok.gov/wcc/Legal/Governing_Documents_/index.html. If you would like to submit comments to the commission regarding the proposed rules, you may email them to rules@wcc.ok.gov through February 15, 2019. A public hearing will be held at 2:30 p.m., Friday, March 1, 2019, in Commission Chambers on the 2nd floor of the Denver Davison Building, Oklahoma City, OK. Interested parties must sign in at the door. 

Oregon VIEW STATE →

REGULATORY ACTIVITY:

  • Published an update to the December 2018 issue of WCB Case News and Notes.  To view the updated issue, go to http://www.oregon.gov/wcb/Pages/news-notes.aspx.
  • Released the 2017 Oregon Occupational Injury & Illness Survey Combined Report.  To view the report the report, go to https://www.oregon.gov/dcbs/reports/Documents/boli-stats/occ-sum/18-2081.pdf .
  • Posted notice of proposed rulemaking hearing regarding the establishment of Oregon Prescription Drug Transparency Program, reporting requirements, fees, civil penalties.  The affected rules are OAR836-053-0473, 836-200-0500, 836-200-0505, 836-200-0510, 836-200-0515, 836-200-0520, 836-200-0525, 836-200-0530, 836-200-0535, 836-200-0540, 836-200-0545, 836-200-0550, 836-200-0555, 836-200-0560 . The Prescription Drug Price Transparency Act (2018 Oregon House Bill 4005, enrolled at 2018 Oregon Laws, Chapter 7) directs the Department of Consumer and Business Services (DCBS) to establish a reporting program for prescription drug manufacturers and health insurance carriers to increase the transparency of prescription drug pricing in Oregon. This program will be known as the Oregon Prescription Drug Price Transparency program. The law directs DCBS to engage in rulemaking to define key terms and timelines, and empowers DCBS to establish fees, adopt a schedule of civil penalties for violations and adopt any other rules necessary for carrying out the provisions of Section 2 of the law. The proposed rule establishes:
    • Definitions for key terms including “new prescription drug,” “net annual increase,” “one month supply” and “course of treatment” that clarify the circumstances when a report is required;
    • Form, manner and content requirements for reports from drug manufacturers;
    • DCBS’s supervisory expectations of participating drug manufacturers, including good faith standards;
    • Timelines for DCBS to request additional information relating to drug manufacturer reports, and for manufacturers’ responses;
    • DCBS’s process for adjudicating trade secret claims from drug manufacturers;
    • Timelines for DCBS to make drug manufacturer reports publicly available, subject to applicable trade secret  exemptions;
    • DCBS’s process for receiving notices from consumers about prescription drug price increases;
    • Establishing an annual $400 fee for drug manufacturers, as well as an additional surcharge fee for manufacturers that file reports with DCBS;
    • Adopting a schedule of civil penalties for drug manufacturer violations; and
    • Requirements for information on drug pricing to be provided by health insurance carriers in rate filings.

The proposed rules are necessary to ensure that the program is administered in a fair and equal manner for all participating drug manufacturers and health insurance carriers, to minimize the administrative burden and cost of the program for the state and the industry, and to achieve the program’s purpose of providing notice and disclosure of information relating to the cost and pricing of prescription drugs in order to provide accountability for prescription drug pricing

  • Published revised Bulletin 112 Reimbursement of injured workers' travel, food, and lodging and accompanying form 3921.  To view the revised bulletin, go to https://wcd.oregon.gov/forms/Pages/bulletins.aspx.
  • Published permanent administrative order ID 1-2019 Chapter 836 Insurance Regulation regarding update to adoption of the valuation manual for principle-based reserving. The effective date is January 1, 2019.
  • In accordance with ORS 183.405, the Board is conducting its “five-year” review of OAR 438-011-0055, which prescribes the procedures to be followed by a “paying agency” in issuing a “third party election” letter.  The Board has already requested/received written comments from members of the advisory committee regarding this rule, as well as parties/practitioners who offered comments during the initial rulemaking process.  (Copies of those responses will be posted on the Board’s website.) To further assist the Members in conducting their review of this rule, they are seeking written comment from the public.  Any such comments should be directed to Kayleen Atkins, WCB’s Executive Assistant, at 2601 25th St, SE, Ste. 150, Salem, OR 97302, kayleen.r.atkins@oregon.gov, or via fax at (503)373-1684.  The deadline for these written comments is February 28, 2019.  Those written comments, which will also be posted on the Board’s website, should address the following questions:
    • Did the rule achieve its intended effect?
    • Was the anticipated fiscal impact of the rule underestimated or overestimated?  (See Board’s “Statement of Need and Fiscal Impact” dated June 28, 2013.)
    • Have any subsequent changes in the law required that the rule be repealed or amended?
    • Is there a continued need for the rule?
    • What impacts has the rule had on small business?

Oregon-Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Issued bulletin DFR 2019-01 replacing Insurance Division Bulletin 96-5 regarding use of corporate and assumed business names by insurers.  The bulletin was issued January 7, 2019.  The purpose of this bulletin is to clarify the requirements and procedures relating to the use of corporate and assumed business names by insurers. For purposes of this bulletin, "insurers" includes health care service contractors. Questions about these issues have arisen from insurers in connection with: Recommendations contained in market conduct examinations, and “ Changes in ownership of insurers.  To access the bulletin, go to https://dfr.oregon.gov/laws-rules/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 January 1, 2019.  The next expected update is for April 2019.

South Carolina VIEW STATE →

REGULATORY ACTIVITY:

  • The net present value tables have been updated as of January 3, 2019.  To view the announcement and tables, go to https://wcc.sc.gov/news/2019-01/net-present-value-tables-updated-january-2019.
  • Has published a new mileage reimbursement rate effective January 1, 2019. Regulation 67-1601 A (1) provides the expenses incurred for travel to receive medical attention which shall be reimbursed to the claimant are mileage to and from a place of medical attention which is more than five miles away from home in accordance with the amount allowed state employees for mileage.  The state employee mileage rate is based upon the standard business mileage rate established by the Internal Revenue Service. Effective January 1, 2019 the reimbursement rate for state employee mileage is 58 cents per mile. This represents a three and half per mile increase from the 2018 rate of $0.545 per mile. Therefore, effective January 1, 2019, the new mileage reimbursement rate to and from a place of medical attention is $0.58 per mile.  To view the notice and the new rate, go to https://wcc.sc.gov/news/2018-12/new-mileage-rate-effective-january-1-2019.
  • Published the agenda and meeting materials for the January 22, 2019 meeting of the commissioners.  To view the notice and agenda, go to https://wcc.sc.gov/news.
  • At the Business Meeting on January 22, 2019, the Commissioners received a draft of the Proposed 2019 Medical Services Provider Manual (MSPM).  The effective date of the revised MSPM is April 1, 2019. The Commission is soliciting comments from interested parties, which will be considered at the Business Meeting February 19, 2019. Please submit comments on the proposed changes by email to Amy Proveaux at aproveaux@wcc.sc.gov no later than February 10. The Commission will consider final approval at the Business Meeting on March 18, 2019.  To view the notice and proposed changes, go to https://wcc.sc.gov/news/2019-01/proposed-changes-2019-medical-services-provider-manual.

South Dakota VIEW STATE →

REGULATORY ACTIVITY:

Texas VIEW STATE →

FEE SCHEDULE NEWS:

  • New Home Health and Dental modules have been adopted with an effective date of January 1, 2019. The next update is expected in April 2019.

REGULATORY ACTIVITY:

  • 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 6.16 percent. The rate shall be effective January 1, 2019, through March 31, 2019.  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 December 17, 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 December 20, 2018.
  • Texas adoption amendments to 28 TAC §§7, 116.11, 133.308, 140.1, 140.8, 141.2, 142.2 - 142.5, 142.7, 142.8, 142.10 - 142.16, 142.18, 142.20, 143.1 - 143.5, 152.3, 152.6, and new §140. On December 17, 2018, Commissioner of Workers’ Compensation Cassie Brown adopted amendments to the above-referenced sections of Title 28, Part 2 of the Texas Administrative Code (TAC).  The commissioner also adopted new 28 TAC §140.9.  The adoption was filed with the Office of the Secretary of State on December 18, 2018.  These rules took effect on January 7, 2019.  The rules will apply to all activity in a proceeding that occurs on or after the effective date.  The adoption was published in the January 4, 2019, issue of the Texas Register and may be viewed on the Secretary of State website at http://www.sos.state.tx.us/texreg/index.shtml.  A courtesy copy of the adoption is available on the Texas Department of Insurance website at https://www.tdi.texas.gov/wc/rules/2018rules.html.  To view a copy of the notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.
  • On December 14, 2018, Commissioner of Workers' Compensation Cassie Brown adopted amendments to 28 Texas Administrative Code (TAC) Chapter 114, Self-Insurance. The adopted amendments to 28 TAC §§1-114.15 and a new §114.16 were filed with the Office of the Secretary of State on December 17, 2018, and were published in the January 4, 2019, issue of the Texas Register. The adopted amendments may be viewed on the Secretary of State’s website at ww.sos.state.tx.us/texreg/index.shtml. A courtesy copy of the adoption is available on the Texas Department of Insurance (TDI) website at www.tdi.texas.gov/wc/rules/2018rules.html. The amendments to 28 TAC Chapter 114 implement House Bill (HB) 1989, 85th Legislature, Regular Session, by amending the definition of certified self-insurer, describing the TDI endorsement of the standard workers’ compensation policy required to withdraw from self-insurance with an insuring agreement, and providing the standards required of an insurance carrier seeking to assume workers’ compensation liabilities from a certified self-insurer withdrawing with an insuring agreement. The adopted new section also includes an affirmation of the commissioner’s discretion to review previously approved certified self-insurer withdrawals and, notwithstanding 28 TAC §114.4, modify the security deposit obligations.   To view the notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.
  • On December 20, 2018, Commissioner of Workers' Compensation Cassie Brown adopted amendments to 28 Texas Administrative Code (TAC) §148.17, Special Provisions for Sanctions. The amendments were filed with the Office of the Secretary of State on December 20, 2018, and were published in the January 11, 2019, issue of the Texas Register. The adopted amendments may be viewed on the Secretary of State’s website at sos.state.tx.us/texreg/index.shtml. A courtesy copy of the adoption is available on the Texas Department of Insurance website at www.tdi.texas.gov/wc/rules/2018rules.html. The amendments to 28 TAC §148.17:
    • Retitle and amend the rule to apply to all administrative sanctions, including monetary penalties.
    • Delete the requirement for paying the penalty or posting a bond in order to seek judicial review.
    • Provide for other forms of payment of penalties, as approved by DWC.

These went into effect January 9, 2019.  To view the notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.

  • On December 20, 2018, Commissioner of Workers’ Compensation Cassie Brown adopted with changes amendments to 28 Texas Administrative Code (TAC) §180.8, Notices of Violation; Notices of Hearing; Default Judgments and 28 TAC §180.26, Criteria for Imposing, Recommending and Determining Sanctions; Other Remedies. The adopted amendments were filed with the Office of the Secretary of State on December 27, 2018, and were published in the January 11, 2019, issue of the Texas Register at sos.state.tx.us/texreg/index.shtml. A courtesy copy is available on the TDI website at www.tdi.texas.gov/wc/rules/2018rules.html.  To view the notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.
  • On November 16, 2018, the Texas Department of Insurance, Division of Workers’ Compensation (DWC) solicited input from workers’ compensation system participants regarding a potential category for the 2019 Medical Quality Review Annual Audit Plan (Annual Plan). DWC appreciates the input provided by system participants. All comments were carefully considered and discussed. The Commissioner of Workers’ Compensation Cassie Brown approved the Annual Audit Plan on January 11, 2019, as proposed. The Annual Plan sets the priorities for the Medical Quality Review Panel (MQRP) audits during the upcoming year per Section IV of the Annual Plan. This includes the scope, methodology, selection criteria, and program area responsibilities described in the Medical Quality Review Process (Process).  Information about the Process and the Annual Plan is available on the TDI website at tdi.texas.gov/wc/hcprovider/medadvisor.html. All medical quality reviews initiated on or after January 1, 2019, will be performed in accordance with the approved Process.
    If you have any questions regarding this memo, contact Mary Landrum at 512-804-4814 or mary.landrum@tdi.texas.gov.   To view the notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.  To view the audit plan, go to https://www.tdi.texas.gov/wc/hcprovider/medadvisor.html.

Utah WC VIEW STATE →

FEE SCHEDULE NEWS:

  • The state adopted changes to their physician fee schedule rates with an effective date of January 1, 2019. The next update is expected in January 2020.

Vermont VIEW STATE →

REGULATORY ACTIVITY:

  • Effective January 1, 2019 the Workers’ Compensation mileage reimbursement rate increased from $0.545 to $0.58 per mile.  The mileage reimbursement rate as determined by Rule 4.1310 is for mileage traveled for medical treatment, to attend an employer’s independent medical examination or attend a vocational rehabilitation meeting.  The rate is the rate that is in effect for classified state employees.

Virginia VIEW STATE →

REGULATORY ACTIVITY:

Virginia Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Issued a number of administrative orders:
    • AO 12067: Effective December 1, 2018 (new business) and January 1, 2019 (renewal business) - AIPSO Filing No. VA 18-02 Personal Auto Rate Filing - This filing includes a rate increase of 6.8% overall.
    • AO 12068:  Effective December 1, 2018 (new business) and (renewal business) - AIPSO Filing No. VA 18-10 Section 35 of the Plan Manual for Personal Lines Auto amended to introduce a new alternate procedure for the selection of a representative to serve on the Board when the American Insurance Association (AIA), Property Casualty Insurers Association of America (PCI) or the Nonaffiliated Insurance Companies (NAF) are unable to appoint one or more subscriber companies to serve.
    • AO 12069: Effective January 1, 2019 (new business) and February 1, 2019 (renewal business) - AIPSO Filing No. VA 18-07 Commercial Auto Rate Filing - This filing includes a rate increase of 0.8% overall.
    • AO 12070: Effective January 1, 2019 (new business) and (renewal business) - AIPSO Filing No. VA 18-08 Section 2 of the Plan Manual for Personal Lines Auto amended to introduce language that would limit the eligibility for physical damage coverage to vehicles with an original cost new of $75,000 or less.
    • AO 12072: Effective January 1, 2019 (new business) and January 1, 2019 (renewal business) - AIPSO Filing No. VA 18-09 revised Administrative Section 18 and Commercial Auto Physical Damage Rate Tables of the manual to limit the eligibility for physical damage coverage to vehicles with an original cost new of $75,000 or less.

To view the above referenced administrative orders, go to https://www.scc.virginia.gov/boi/adminords/2018.aspx.

Washington VIEW STATE →

REGULATORY ACTIVITY:

  • Published rule proposal regarding Acupuncture (CR-102). The purpose of this proposed rulemaking is to allow the department and self-insurers to pay for acupuncture as specified in WAC 296-23-238. When this rule is effective, the Acupuncture medical coverage decision’s approved conditions will only list “low back pain related to an accepted condition on the claim.” Other conditions may be considered at a later date based on the best available scientific and clinical evidence. In addition, the proposed rules will allow Acupuncturists, including East Asian Medicine Practitioners (EAMPs), to treat injured workers. EAMPs have 15 different treatment modalities within their scope of practice (RCW 18.06.010). These proposed rule changes will only apply to acupuncture.  A hearing on the proposed rule will be held on February 5, 2019 at 1:00 pm at L & I Headquarters 7273 Linderson Way SW, Room S118 in Tumwater WA.  To view the notice and proposed rule, go to https://www.lni.wa.gov/LawRule/WhatsNew/Proposed/default.asp?RuleID=434.



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