Arizona VIEW STATE →

REGULATORY ACTIVITY:

• The Industrial Commission of Arizona has adopted the Official Disability Guidelines and Drug Formulary as the standard reference for evidence-based medicine within the context of the Arizona workers' compensation system. Please see the following information on a webinar hosted by ODG by MCG:  Date: Tuesday, May 21, 2019; Time 1:00PM - 2:00PM ET (10:00AM - 11:00AM PT).  For additional information, go to  http://info.mcg.com/webinar-odg-arizona-formulary.html?utm_medium=email&utm_source=marketo&utm_campaign=webinar-invite&.
• Posted notice that the Annual Claims Seminar will be held on August 8-9 at the JW Marriot Camelback INN in Scottsdale Arizona.  Registration will be open soon.
• Under A.R.S. § 23-1065(F), after notice and a hearing, the Commission is authorized to levy an additional one-half percent assessment under A.R.S. § 23-1065(A) if the total annual reserved liabilities of the Special Fund for apportionment under §§ 23-1065(B) and (C) exceed six million dollars.  Please be advised that the Commission will hold a public hearing to gather information concerning this assessment on May 23, 2019, at 1:00 p.m. in the Commissioner’s Conference Room, 3rd Floor, located at 800 West Washington Street, Phoenix, Arizona.  This hearing will be held as part of the Commission’s scheduled meeting for that day.  The record is considered open, and written and oral comments will be accepted until the close of the hearing on May 23, 2019.  At a later date, the Commissioners will discuss and may take action on this assessment.  Written comments may be submitted prior to the hearing c/o Kara Dimas, Executive Secretary, Office of the Commission Director, P.O. Box 19070, Phoenix, Arizona 85005-9070.

LEGISLATIVE ACTIONS:

• House Bill 2137

The Industrial Commission of Arizona (ICA) regulates the workers' compensation insurance industry.  The ICA's responsibilities include occupational safety and health issues, youth employment laws, wage claim dispute resolutions, minimum wage and other labor related issues. The ICA provides workers' compensation coverage for claimants of uninsured employers, insolvent insurance carriers, and self-insured employers.  Additionally, the ICA processes workers’ compensation claims involving workers injured on the job through no-fault of their own. The ICA is funded by an annual assessment on workers' compensation premiums that cannot exceed 3%.  Current law requires employers to secure workers' compensation for their employees either:

1. By obtaining workers' compensation insurance with a licensed insurance carrier; or
2. By furnishing satisfactory proof of financial ability to pay the compensation directly (self-insured) or through a workers' compensation pool (R.S. § 23-961).

Pursuant to A.R.S. § 23-966, the Special Fund assumes liability for all workers’ compensation claims against self-insured employers who fail to pay a workers' compensation claim. The Special Fund will pay medical and compensation benefits to the injured employee. The ICA may levy an assessment on workers' compensation insurance premiums at a rate that is no more than is necessary to keep the Special Fund actuarially sound (A.R.S. § 23-1065).  According to the ICA the current rate is 0%.  This legislation asserts the Special Fund is the successor in interest to all excess insurance policies in effect at the time of an assignment that insure any part of the self-insured employer's financial obligations (Sec. 1). It specifies the recovery rights of the Special Fund are subject to applicable coverage terms and policy limits in the excess policy (Sec. 1). The legislation requires the excess insurer to directly pay the Special Fund for any covered amounts spent (Sec. 1).  It stipulates the Special Fund has a claim against the employer for amounts spent or anticipated to be spent, unless recovered from the excess insurer (Sec. 1).  Effective Date July 29, 2019.

Arkansas VIEW STATE →

LEGISLATIVE ACTIONS:

• House Bill 1850

The enacted legislation is titled The Empower Independent Contractors Act of 2019. The legislation amends portions of Act 4 of 1948 regarding definitions of employee, employment and employment status. The legislation establishes new criteria for determining employment status in determining whether an individual is an employee or independent contractor.  Effective Date August 1, 2019.

California VIEW STATE →

FEE SCHEDULE NEWS:

• The DWC has published a new file for Medi-Cal rates effective April 15, 2019. The next update is expected May 15, 2019.

REGULATORY ACTIVITY:

• 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 Monday, May 6 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 Monday, May 6, 2019. 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:
  • Low Back Disorders Guideline (ACOEM March 7, 2019)
  • Introduction to the Workplace Mental Health Guideline (ACOEM March 13, 2019)

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. To view the proposed updates, go to https://www.dir.ca.gov/dwc/DWCPropRegs/MTUS-Evidence-Based-Updates-April2019/MTUS-Evidence-Based-Updates.htm.

• The Department of Industrial Relations (DIR) and its Division of Workers’ Compensation (DWC) posted a progress report on the department’s Independent Bill Review (IBR) program. IBR is a process used to resolve billing disputes for medical treatment and medical-legal services provided to injured workers. The “2018 Independent Bill Review (IBR) Report: Analysis of 2013-2017 Application Filings” summarizes the activity of an essential component of Senate Bill 863, providing an evaluation of the program during the first five years following its enactment. The report accounts for all applications filed to dispute payments not resolved through Second Bill Review during this time period. Highlights of the report include:
  • The number of IBR applications received averaged 165 filings per month;
  • Seven of 10 decided cases resulted in additional payment for the provider and nearly $12.3 million was awarded in overturned case decisions.

A copy of the progress report is located at https://www.dir.ca.gov/dwc/IBR.htm.

• The Division of Workers’ Compensation (DWC) held a meeting of the  Pharmacy and Therapeutics (P&T) Committee on Wednesday, April 24 from 12:30 to 2:30 p.m. in the Elihu M. Harris State Building, conference room #11 on the second floor, 1515 Clay Street in Oakland. The meeting was open to the public.   The Pharmacy and Therapeutics Committee was established by Assembly Bill No. 1124 (2015) as an advisory body that will consult with the DWC Administrative Director on updates to the Medical Treatment Utilization Schedule (MTUS) drug formulary. The meeting agenda and related materials were posted on the DWC P&T Committee at https://www.dir.ca.gov/dwc/MTUS/MTUS-Pharmacy-and-Therapeutics-Committee.html. DWC welcomes comment from the public on the formulary drug list. All correspondence should be directed to Formulary@dir.ca.gov.

Colorado VIEW STATE →

REGULATORY ACTIVITY:

• Posted notice of rule hearings for rule 2 Workers' Compensation Insurance Premium and Payroll Surcharges, rule 8 Authorized Treating Physician, rule 9 Dispute Resolution and rule 11-4(B)(5) Exchange of Medical records package. The purpose of the hearings is to take comments on proposed rule changes.  The hearing will be held on May 15, 2019 at 10:00 a.m. at 633 17th Street Denver, Colorado. To view the notice of the hearings and proposed rules, go to https://www.colorado.gov/pacific/cdle/workers-compensation-proposed-and-adopted-rules.

LEGISLATIVE ACTIONS:

• House Bill 19-1105

The enacted legislation establishes that an advanced practice nurse with prescriptive authority pursuant to section 12-38-111.6 may receive level I accreditation for purposed of receiving one hundred percent reimbursement under the medical fee schedule established for the Colorado workers’ compensation system.  Effective Date August 2, 2019.

Connecticut VIEW STATE →

REGULATORY ACTIVITY:

• Published the CRB calendar for May 2019.  To view the calendar, go to: https://www.wcc.state.ct.us/crb/calendars/may2019crb.pdf

Georgia VIEW STATE →

LEGISLATIVE ACTIONS:

• Senate Bill 135

The enacted legislation makes changes to certain provisions relating to the workers’ compensation administration and benefits. In regards to the benefits changes the legislation establishes that for injuries on or after July 1, 2013 that are not designated as catastrophic injuries that have the maximum benefit period of 400 weeks will no longer have the 400-week cap in certain circumstances.  The exceptions are for maintenance, repair, revision, replacement or removal of prosthetic device, spinal cord stimulator or intrathecal pump, and durable medical equipment.  Effective Date July 1, 2019.

Idaho VIEW STATE →

REGULATORY ACTIVITY:

• The next meeting of the Commission's Advisory Committee is scheduled to be held May 8, 2019, beginning at 9:00 AM in the Industrial Commission's first-floor conference room, 700 Clearwater Lane, Boise, Idaho.

LEGISLATIVE ACTIONS:

• Senate Bill 1028

This bill identifies Post Traumatic Stress Disorder (PTSD) otherwise known as Post Traumatic Stress Injury (PTSI) as an occupational injury that affects Idaho's First Responders. Under current law, a mental injury must be accompanied by a physical injury. This changes the current statue that if a First Responder has "clear and convincing" evidence of a physiological injury, the treatment would be handled through workers’ compensation. The provision of this act shall be null, void, and of no force and effect on and after July 1, 2023. Effective Date July 1, 2019.

Illinois VIEW STATE →

REGULATORY ACTIVITY:

• Zone 2 Arbitrator Douglas McCarthy was recently appointed to the position of Commissioner of the Illinois Workers' Compensation Commission. His appointment to Commissioner became effective on March 15 2019.  The dockets in Urbana, Springfield and Quincy that were previously assigned to Commissioner McCarthy will be designated as "TBA1" until a permanent replacement is named.  Until a new arbitrator is assigned all settlement contracts can be sent to either Arbitrator Hemenway or Arbitrator Pulia for review and / or approval. Their addresses are as follows:

Arbitrator   Hemenway      Arbitrator Pulia

PO Box 648                          PO Box 8117

Lincoln, IL 62656               Westchester, IL 60154

312/859-9592                      312/465-3977

Motions and other correspondence for the Quincy call on April 3rd and the Springfield call on May 21st are to be sent to Arbitrator Hemenway. Motions and other correspondence for the Urbana call on June 12th are to be sent to Arbitrator Pulia.

• Zone 4 Arbitrator Barbara Flores was recently appointed to the position of Commissioner of the Illinois Workers' Compensation Commission. Her appointment to Commissioner became effective on March 15 2019. The dockets in New Lenox, Kankakee and Ottawa that were previously assigned to Commissioner Flores will be designated as "TBA2" until a permanent replacement is named.
• Until a new arbitrator is assigned all settlement contracts can be sent to either Arbitrator Dollison or Arbitrator Erbacci for review and / or approval. Their addresses are as follows:

Arbitrator Dollison                      Arbitrator Erbacci

1448 E. 52nd Street #436          2615 N. Drury Lane

Chicago, IL 60615-4122             Arlington Heights, IL 60004

312/465-3978                               312/590-3462

• Motions and other correspondence for the New Lenox status call on April 1st are to be sent to Arbitrator Dollison. Motions and other correspondence for the Ottawa status call on May 23rd and the Kankakee status call June 17th are to be sent to Arbitrator Erbacci.
• All trading partners submitting to the IWCC must submit an updated Trading Partner Agreement for Release 3.1 before May 17, 2019, or before the start of testing.  Trading partner and EDI vendor testing for FROI/SROI EDI Claims 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. Trading Partner Documents: Illinois R3.1 Trading Partner Agreement; Illinois R3.1 Implementation Guide (Updated 4/15/2019); Illinois R3.1 Testing Requirements Plan (Updated 2/25/2019); Illinois R3.1 Test Feedback Request List; Illinois R3.1 FAQs (Updated 4/15/2019) .  To view the information, go to https://www2.illinois.gov/sites/iwcc/Pages/EDIImplimentation.aspx.

Indiana VIEW STATE →

REGULATORY ACTIVITY:

• Posted notice of intent to readopt rules in anticipation of IC 4-22-2.5-2, providing that an administrative rule adopted under IC 4-22-2 expires January 1 of the seventh year after the year in which the rule takes effect unless the rule contains an earlier expiration date. Effective 30 days after filing with the Publisher. Overview: Rules to be readopted without changes are as follows: 631 IAC 1 workers’ compensation.  To view this notice, go to http://www.in.gov/legislative/iac/irtoc.htm?id=1.5&hdate=20190327&ldate=20190327.
• The ODG Drug Formulary training webinar is now available to download. To view the available information, go to http://info.mcg.com/odg-webinar-on-demand-indiana-formulary.html.

Iowa VIEW STATE →

LEGISLATIVE ACTIONS:

• Senate File 507

The legislation established an additional condition regarding injuries to a person at work.  The statute now provides that personal injuries due to idiopathic or unexplained falls from a level surface on the same level surface do not arise out of and in the course of employment and are not compensable under the workers’ compensation statutes.  Effective Date July 1, 2019.

Kansas VIEW STATE →

REGULATORY ACTIVITY:

• The Director of Workers’ Compensation for the State of Kansas is accepting applications for one membership on the Workers’ Compensation Board. In order to be considered by the nominating committee, each applicant shall be an attorney regularly admitted to practice law in Kansas for a period of at least seven (7) years with at least five (5) years experience practicing law in the area of workers’ compensation and shall have engaged in the active practice of law during such period as a lawyer, judge of a court of record or any court in Kansas or a full-time teacher of law in an accredited law school, or any combination of such types of practice.

Kentucky VIEW STATE →

REGULATORY ACTIVITY:

• Posted in the state register notice regarding a regulation that applies to the benefits provided in KRS 342.020 and for which the employer’s responsibility for payment is limited to 780 weeks. This administrative regulation establishes the process by which the department will notify the employee of the right to file an application to continue the benefits provided by KRS 342.020, the method by which the employee is to make application, and the process by which an administrative law judge will determine and order a continuation of benefits for an additional time beyond the original period. To view the notice, go to https://legislature.ky.gov/Law/kar/Pages/Registers.aspx.
• Published the minutes of the March 28, 2019 Regulatory Advisory Committee meeting.  To view the minutes, go to https://labor.ky.gov/comp/Pages/default.aspx

LEGISLATIVE ACTIONS:

• House Bill 64

The enacted legislation amends the pharmacy statute to permit a pharmacist to dispense a prescription refill in the amount equal to the standard unit of dispensing for the drug without authorization by the prescribing practitioner in emergency situations in which such authorization may not be readily or easily obtained. The pharmacist may dispense up to a 72-hour supply of maintenance medication.  The legislation makes an exception to the 72-hour supply if the standard unit of dispensing for the drug exceeds  a 72-hour supply; the pharmacist dispenses a supply of the drug that is equal to the standard unit of dispensing and the drug is used for insulin therapy or treatment of chronic respiratory diseases.  Effective Date April 26, 2019.

• Senate Bill 126

The legislation is administrative in nature making a number of technical changes to a number of state agencies. No material changes were made that affect workers’ compensation.  Effective Date July 1, 2019.

Kentucky Auto VIEW STATE →

LEGISLATIVE ACTIONS:

• House Bill 151

The legislation is enacted to establish a range of criminal penalties resulting from conviction of insurance fraud. The legislation requires certain Kentucky health professional boards to report suspected insurance fraud to the Department of Insurance's Division of Insurance Fraud Investigation and to require the boards to provide information requested by the insurance commissioner. It requires the Department of Kentucky State Police to redact vehicle accident reports provided to news-gathering organizations; provide an exception to redaction for up to three reports per day. It creates a new section of Subtitle 39 of KRS Chapter 304 to prohibit physician self-referrals of health care services for which payment may be made from basic reparations benefits provided under the Motor Vehicle Reparations Act. It incorporates exceptions provided in federal law. It requires refund of amounts collected in violation of section. It amends KRS 304.99-060 to establish civil penalties for violation of Section 4 of the Act. It amends KRS 311.597 to deem violation of Section 4 or 5 of the Act by a physician "dishonorable, unethical, or unprofessional conduct." Effective Date July 27, 2019.

Maryland VIEW STATE →

REGULATORY ACTIVITY:

• Maryland posted notice of final action regarding Subtitle 09 WORKERS’ COMPENSATION COMMISSION. Notice of Final Action: [19-025-F] : On March 14, 2019, the Workers’ Compensation Commission adopted amendments to: (1) Regulation .04 under COMAR 14.09.02 Requirements for Filing and Amending Claims; (2) Regulation .02 under COMAR 14.09.03 Hearing Procedures; (3) Regulation .03 under COMAR 14.09.04 Legal Representation and Fees; and (4) The chapter heading COMAR 14.09.07 Vocational Rehabilitation. This action, which was proposed for adoption in 46:2 Md. R. 79—80 (January 18, 2019), has been adopted as proposed.  Effective Date: April 8, 2019. R. KARL AUMANN Chairman Workers’ Compensation Commission.  To view the notice, go to http://www.dsd.state.md.us/MDR/4607/Assembled.htm#_Toc4493874

LEGISLATIVE ACTIONS:

• House Bill 60

The enacted legislation is administrative in nature. The Maryland Department of Labor is the successor of DLLR; previous names and titles have the same meaning as the new names and titles in all laws, executive orders, rules, regulations, policies, or documents created by a State official, employee, or unit. The bill does not affect (1) the terms of office of members of any board, commission, office, department, agency, or other unit; (2) the status of any transaction or employment entered into or existing before the bill’s effective date; (3) any right, duty, or interest flowing from a statute amended by the bill; or (4) the continuity of any board, commission, office, department, agency, or other unit and related matters. Letterhead, business cards, and other documents bearing the new name may not be used until the materials bearing the previous name have been used. The publisher of the Annotated Code of Maryland must change cross references and terminology throughout the code. Effective Date July 1, 2019.

Medicare VIEW STATE →

FEE SCHEDULE NEWS:

• DMEPOS – CMS has reposted updates to the January 1 and April 1, 2019 DMEPOS module.

Minnesota VIEW STATE →

REGULATORY ACTIVITY:

• Published the March edition of the Compact Newsletter.  To view the newsletter, go to http://www.dli.mn.gov/business/workers-compensation/work-comp-compact-newsletter?utm_medium=email&utm_source=govdelivery.

Mississippi VIEW STATE →

REGULATORY ACTIVITY:

• The 2019 Fee Schedule has been filed with the SOS. The state conducted oral proceedings concerning the rule change on 4/18/19 at 10 am in Hearing Room C.  To view the notice, go to https://mwcc.ms.gov/#/home.

Montana VIEW STATE →

REGULATORY ACTIVITY:

• Posted notice of public hearing regarding amendments to treatment guidelines. The rule proposed to be amended is as follows, stricken matter interlined, new matter underlined: 24.29.1611 UTILIZATION AND TREATMENT GUIDELINES

(1) through (1)(c) remain the same. (d)  for medical services provided January 1, 2017 through December 31, 2017: "Montana Utilization and Treatment Guidelines, 4th edition, 2016"; and (e)  for medical services provided on or after January 1, 2018 through June 30, 2019: "Montana Utilization and Treatment Guidelines, 5th edition, 2017."; and (f) for medical services provided on or after July 1, 2019:  "Montana Utilization and Treatment Guidelines, 6th edition, 2019." (2) through (2)(b) remain the same. (c)  Thoracic Outlet Syndrome; (d) remains the same. (e)  Chronic Regional Pain Syndrome Disorder; (f) through (i) remain the same. (j) Cumulative Trauma Conditions. (3) The utilization and treatment guidelines adopted in (1) are to be read in conjunction with the Centers for Disease Control publications: (a)  "CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016"; and (b)  2018 edition of "Implementing the CDC Guideline for Prescribing Opioids for Chronic Pain." (3) remains the same but is renumbered (4). (4) (5)  All insurers shall routinely and regularly review claims to ensure that care is consistent with the Montana Guidelines adopted by reference in (1) and (6) (7). (5) and (6) remain the same but are renumbered (6) and (7). REASON: There is reasonable necessity to amend ARM 24.29.1611 in order to incorporate updated medical guidelines that appropriately reflect the state of the art for medical treatment and utilization for workers' compensation purposes.

4. Copies of the proposed 2019 publication identified as the proposed "Montana Utilization and Treatment Guidelines, 6th edition, 2019" is available and can be accessed at http://erd.dli.mt.gov/work-comp-claims/medical-regulations. Copies of the Centers for Disease Control publications proposed to be incorporated by reference can be accessed at:  https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fmmwr%2Fvolumes%2F65%2Frr%2Frr6501e1er.htm and https://www.cdc.gov/drugoverdose/pdf/prescribing/CDC-DUIP-QualityImprovementAndCareCoordination-508.pdf.
5. A printed version of the proposed 2019 publication is also available by contacting Celeste Ackerman at the address, e-mail, or telephone numbers listed in paragraph 2 of this notice.
6. Concerned persons may present their data, views, or arguments either orally or in writing at the hearing. Written data, views, or arguments may also be submitted to Celeste Ackerman, Employment Relations Division, P.O. Box 8011, Helena, MT 59604-8011; fax (406) 444-4140; or e-mail to celeste.ackerman@mt.gov, and must be received no later than 5:00 p.m., on April 26, 2019.  To view the notice, go to http://www.mtrules.org/gateway/ShowNoticeFile.asp?TID=9064.

• Proposed updates to the Montana Professional and Facility Fee Schedules have been filed with the Secretary of State. The public hearing will be May 6th, 2019 at 10:00 am.  The hearing will be at the Beck Building, 1805 Prospect Avenue, Helena, MT, conference room A/B on the 2nd floor.  The proposed changes will be effective July 1, 2019. The Department has completed the review and update of the Facility and Professional Fee Schedules.  The proposed updates have been posted on https://mtwc.optum.com/feeSchedule.aspx (professional fee) and http://erd.dli.mt.gov/work-comp-claims/medical-regulations/montana-facility-fee-schedule (facility fee).

LEGISLATIVE ACTIONS:

• Senate Bill 160

The enacted legislation established presumptive coverage for firefighters under workers’ compensation for certain diseases associated with firefighting and providing conditions.  The legislation provides a rebuttal option for insurers. In addition, the legislation provides opt-in choice for volunteer firefighting entities. The presumption applies to certain diseases when the firefighter has a set number of years of service as a firefighter. Effective Date July 1, 2019.

Nebraska VIEW STATE →

REGULATORY ACTIVITY:

• On April 11, 2019 the Workers' Compensation Court adopted amendments to Rules 2, 3, 47 and addendum 2.  Rule 47 and Addendum 2 became effective April 11, 2019.  Adopted amendments to Rules 2 and 3 will become effective only upon review and approval of the Nebraska Supreme Court. To view this notice, go to https://www.wcc.ne.gov/home/court-news.

Nevada VIEW STATE →

REGULATORY ACTIVITY:

• Workers’ Compensation Medical Training Classes were held on April 17, 2019  at 9:30 am – 11:30 am. This class details the process for verifying workers’ compensation insurance coverage and how to use available tools to expedite that process.
• Reminder the Workers' Compensation Insurer and TPA reporting is due May 6, 2019.  To view additional information regarding the report, go to http://dir.nv.gov/WCS/Insurer-TPA_Reporting/.

New Hampshire VIEW STATE →

REGULATORY ACTIVITY:

• Please be advised that the New Hampshire Department of Labor has submitted the proposed rule dealing with regulation and licensing of 3rd party administrators for approval to the Joint Legislative Committee on Administrative Rules. The public hearing for the proposed rules will be held at the New Hampshire Department of Labor on Thursday May 2, 2019 at 2 pm.  To view the notice, go to https://www.nh.gov/labor/index.htm.

LEGISLATIVE ACTIONS:

• House Bill 285

The enacted legislation provides that for workers’ compensation rate filings that a filing and any supporting information not considered proprietary pursuant to RSA 412:16, II shall be open to public inspection upon approval of the filing. Effective Date June 22, 2019.

New Jersey WC VIEW STATE →

REGULATORY ACTIVITY:

• The law day was held on Wednesday, May 1, 2019 1:30-4:00 pm.  The Division presented courses at the Workers' Compensation courts statewide on permanent total disability: law, practices and methods 1.5 hours and ethics 1 hour. Written seminar materials were provided on site.  To find additional information regarding law day, go to https://www.nj.gov/labor/wc/legal/seminar.html#2019_LAWDAY

New Mexico VIEW STATE →

REGULATORY ACTIVITY:

• The next Advisory Council meeting is scheduled for Thursday, June 20 at 1:30 p.m. at the main office, 2410 Centre SE, Albuquerque.

LEGISLATIVE ACTIONS:

• House Bill 324

The enacted legislation provides a presumption for posttraumatic stress disorder diagnosed by a physician or psychologist that results in physical impairment, primary or secondary mental impairment or death for purposes of workers’ compensation claims. This added condition to presumption is for firefighters.   Effective Date June 14, 2019.

• House Bill 539

The enacted legislation is not specific workers’ compensation legislation but is general legislation affecting the licensing of social workers.  The legislation clarifies licensure requirements and allows for telesupervision  and telehealth.  The act also allows for electronic examinations.  Effective Date June 14, 2019.

New York VIEW STATE →

FEE SCHEDULE NEWS:

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

REGULATORY ACTIVITY:

• New York provided a quick update to let you know that the CMS-1500 project is moving forward, and that the Workers’ Compensation Board will inform you when the implementation phase of the project will begin. The Board recently released an onboarding guide for XML Submission Partners (clearinghouses) to prepare for testing in late April 2019. Check here to see the status of XML Submission Partners with whom you currently partner. We also want to take this opportunity to clarify whether a payer can reject a medical bill/report received prior to the employer’s notice of the underlying injury. They cannot. Since the medical report must be filed within 48 hours of the first medical exam, the first medical report could be filed before the employer notifies the payer that there has been a workplace injury, and so before the payer submits the FROI. Please stay tuned for additional updates, and monitor the CMS-1500 section of the Board’s website for the latest information, including updates about phase one of the project, upcoming training and the most recent FAQs. If you have any questions, please email CMS1500@wcb.ny.gov.
• Published Bulletin Subject Number 046-1048 regarding revised medical request authorization forms. The revised forms include:  Attending Doctor's Request for Authorization and Carrier's Response (Form C-4AUTH), Attending Doctor's Request for Optional Prior Approval and Carrier's/Employer's Response (Form MG-1), Continuation to Form MG-1, Attending Doctor's Request for Optional Prior Approval (Form MG-1.1), Attending Doctor's Request for Approval of Variance and Carrier's Response (Form MG-2), and Continuation to Form MG-2, Attending Doctor's Request for Approval of Variance (Form MG-2.1). To view the bulletin, go to http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1048.jsp.
• The Rating Board will hold the 2019 New York State Workers’ Compensation Forum at Convene, 730 Third Avenue, New York, New York, on Thursday, September 12, 2019 (“Forum”).  The Forum will be immediately preceded by the 2019 Annual Meeting of the Rating Board membership. The Forum is an annual event hosted by the Rating Board to bring the New York State workers’ compensation community together and provide marketplace insight through the release and presentation of the 2019 State of the System Report and New York State focused research studies.  For a fuller understanding of the types of presentations made at the Forum, please visit http://www.nycirb.org/forums.php to view the 2018 Forum presentations and download the corresponding reports and studies.
• New York issued the following notice. Insurance carriers have the option of paying benefits on a workers’ compensation claim without liability if they are unsure of their liability for a claim. The provisions of Workers’ Compensation Law (WCL) Section 21-a enable an insurance carrier to take up to a year (365 days) to determine whether to accept or deny a claim, as long as the insurance carrier continues to make timely benefit payments on the claim and notifies the claimant and the Board that these payments are made without liability.  Avoid Losing 21-a Status; Insurance carriers may lose their status of without liability if they do any of the following: Provide Notice of Objection to Payment of a Bill for Treatment; Provided (Form C-8.1B) stating treatment provided was not causally related to the compensable injury, or stating that the claim is controverted when there is no controversy (FROI/SROI-04) present in the case; and Fail to continue payments consistent with the claimant's treating provider's medical reports, including reducing payments based on an Independent Medical Examination (IME). This information has been updated on the eClaims section of the Board's website in addition to the Insurers, Representatives and Self-Insured Employers sections. On January 18, 2019, the Board issued a Subject Number announcing changes to the eClaims process for Section 21-a and Claims Paid Without Liability.  Questions?  Contact Claims@wcb.ny.gov.
• The New York State Workers' Compensation Board (Board) has prepared a third revision to the proposed NYS Workers' Compensation Drug Formulary (Formulary) originally announced in Subject Number 046-1012, Board Announces Draft Regulations for New York State Pharmacy Formulary on December 28, 2017. The proposed revision was in the April 17, 2019, State Register, and the Board will accept comments for 30 days. The revised proposed regulations are also available on the Board's website. The Board encourages the public, injured workers, employers, self-insured employers, insurance carriers, third-party administrators, attorneys, medical providers, and labor and business organizations to provide comment. Please submit your comments on or before May 17, 2019, to regulations@wcb.ny.gov. The Board will evaluate all comments received and will consider necessary revisions as the process advances. To review the revised proposed regulation, go to http://www.wcb.ny.gov/drug-formulary-regulation/.
• The Chair of the New York State Workers' Compensation Board adopted a revised Pharmacy Fee Schedule on April 17, 2019. The amended Pharmacy Fee Schedule updates the methodology for calculating fees for pharmaceuticals and the reporting of rebates from pharmaceutical manufacturers to insurers and employers. The amended Pharmacy Fee Schedule will take effect for all prescriptions filled (both new and refills) on or after October 1, 2019. The adopted regulations providing the updated methodology is available on the Board's website. To view the revised pharmacy fee schedule, go to http://www.wcb.ny.gov/content/main/wclaws/PharmacyFeeSchedule/PharmacyFeeSchedule.jsp.

North Carolina VIEW STATE →

REGULATORY ACTIVITY:

• After careful consideration, the Industrial Commission will close its Greenville Regional Office, effective June 28, 2019. The Commission will continue to serve the citizens of Eastern North Carolina by holding hearings in the Greenville area, and litigant travel time to hearings will not be affected. Deputy Commissioners Thomas H. Perlungher and Kevin V. Howell will transfer from the Greenville Office to the Commission's main office in Raleigh, which will allow them to report to an office closer to home and/or satisfy a preference for office location. In addition, the office closure will result in cost savings for the Commission.
• On April 18, 2019, the General Assembly confirmed Governor Cooper's appointment of Ken Goodman to the Industrial Commission, effective May 1, 2019. Representative Goodman, a member of the North Carolina House of Representatives in his fifth term, is a former business owner from Rockingham, North Carolina. He is actively involved in a number of civic organizations and served as a Board Member of the Richmond Community College Foundation. From 1969 until 1975, Goodman served in the Army National Guard. Commissioner Goodman's term will expire April 30, 2025.

North Dakota VIEW STATE →

REGULATORY ACTIVITY:

• Effective April 1, 2019, WSI will no longer require all total knee arthroplasty procedures be performed in the inpatient hospital setting. The Utilization Review (UR) department will now allow for the approval of a total knee arthroplasty described by CPT codes 27446 or 27447 in the outpatient hospital and ambulatory surgical center settings. WSI’s UR department utilizes Official Disability Guidelines (ODG) as the standard of care in the review of services requiring prior authorization. ODG includes guidelines for Knee Joint Replacement and Outpatient Joint Replacement Treatment Guidelines, which outline the clinical indications of medical necessity for this procedure.  To view this notice, go to http://www.workforcesafety.com/news/news-item/change-to-utilization-review-process-for-total-knee-arthroplasty.

LEGISLATIVE ACTIONS:

• House Bill 1064

The enacted legislation creates a new section in the workers’ compensation statute.  The legislation relates to the office of administrative hearings in regard to case processing, tracking and reporting.  It also establishes a required report. In part, the legislation establishes that the office shall track the time elapsed between the date the office receives a file from workforce safety and insurance and the date of the administrative law judge's decision, and monthly calculate a rolling six-month average of time elapsed; adopt case processing standards and policies, including provisions intended to meet a goal of an average of two hundred fifteen days or less per case. Administrative law judges have an average of two hundred fifteen days to issue a decision for any injured worker case from the date the office of administrative hearings receives a file from workforce safety and insurance. The date of the last assigned file is the date of assignment for all consolidated files. The office of administrative hearings and workforce safety and insurance shall report statistical information regarding results under the case processing standards and policies to the legislative management and the state advisory council each quarter.  Effective Date August 1, 2019.

• Senate Bill 2184

An act to amend and reenact subsection 7 of section 23-07.5-02, sections 65-01-02, 65-01-11, 65-01-15, 65-02-20, 65-02-21.1, 65-05-07, 65-05-08.1, and 65-05-08.3, subsections 5 and 12 of section 65-05-12.2, section 65-05-28, subsection 2 of section 65-05-29, section 65-05-30, subsection 3 of section 65-05-32, subsection 5 of section 65-05.1-01, subsection 6 of section 65-05.1-02, and subsection 1 of section 65-07-03 of the North Dakota Century Code, relating to the definition of allied health care professional and health care provider with respect to workers' compensation claims and benefits.  Effective Date August 1, 2019.

Ohio VIEW STATE →

REGULATORY ACTIVITY:

• Published notice of proposed rules to the BWC Board of Directors.  The rules under consideration are 4123-6-01.2 Provisional treatment reimbursement approval pilot program.  Public comments will be received through May 14, 2019.  To view the notice and proposed rule, go to https://www.bwc.ohio.gov/basics/guidedtour/generalinfo/OACInReview.asp.
• Published notice of proposed rules to the BWC Board of Directors.  The rules under consideration are Chapter 3 - BWC claims procedure rules- 5-year review.  Public comments will be received through May 14, 2019.  To view the notice an proposed rule, go to https://www.bwc.ohio.gov/basics/guidedtour/generalinfo/OACInReview.asp.
• Published notice of proposed rules to the BWC Board of Directors.  The rules under consideration are Chapter 19- Self-insuring employer rules.  No cutoff date for public comments has been announced.  To view the notice and proposed rule, go to https://www.bwc.ohio.gov/basics/guidedtour/generalinfo/OACInReview.asp.
• Published notice that comments due to rules 4123-6-08 Bureau fee schedule; 4123-6-37.2 Payment of hospital outpatient services; and 4123-6-37.3 Payment of ambulatory surgical center services have been extended to May 1, 2019.  To view the notice, go to  https://www.bwc.ohio.gov/basics/guidedtour/generalinfo/OACInReview.asp
• Published notice that comments due to rules Chapter 6 - Lumbar fusion surgery, HBAI and medical treatment reimbursement requests and 4123-6-21.3 Outpatient medication formulary have been extended to June 1, 2019.  To view the notice, go to https://www.bwc.ohio.gov/basics/guidedtour/generalinfo/OACInReview.asp

Oregon VIEW STATE →

REGULATORY ACTIVITY:

• Published the March edition of news and case notes.  To view the publication, go to https://www.oregon.gov/wcb/Pages/news-notes.aspx.
• The Oregon Division of Financial Regulation recently adopted the following rule: ID 05-2019: Revisions to Workers’ Compensation Insurance Test Audit Program. Rules affected: OAR 836-043-0125, 836-043-0130, 836-043-0135, 836-043-0145, 836-043-0150, 836-043-0155, 836-043-0165.  Rule Summary: Revises wording of description of alternative audit level. Filed: April 19, 2019. Effective: July 1, 2019.  To view the adopted rules, go to https://dfr.oregon.gov/laws-rules/Pages/adopted-rules.aspx.

LEGISLATIVE ACTIONS:

• House Bill 2087

The enacted legislation establishes caps relating to civil penalties that the Director of Consumer and Business Services may impose for violations of certain workers’ compensation statutes or required practices. For an employer or insurer that intentionally or repeatedly induces claimants for compensation to fail to report accidents the maximum penalty for each violation is two thousand dollars or more than forty thousand dollars in the aggregate during a calendar year.  For employers, self-insured employers, insurers, managed care organization or service companies that fail to comply with statutes, rules or orders of the director regarding reports or other requirements necessary to carry out the purposed of the chapter the maximum penalty per violation is four thousand dollars and no more than one hundred eighty thousand dollars in the aggregate for violations during a calendar year.   Effective Date January 1, 2020.

Pennsylvania WC VIEW STATE →

REGULATORY ACTIVITY:

• Published the April Fee Schedule Update Memo. To view the memo, go to https://www.dli.pa.gov/Businesses/Compensation/WC/HCSR/MedFeeReview/Fee%20Schedule/Pages/default.aspx.

Rhode Island VIEW STATE →

REGULATORY ACTIVITY:

• Published information letter number 19-01 regarding 2019 cost of living increase.  To view the notice, go to http://www.dlt.ri.gov/wc/infoletters.htm.  The cost of living increase for 2019 will be 1.3%.  Effective May 10, 2019 weekly benefits paid to these employees should be increased by 1.3%.  To view the cola rate table, go to;  http://www.dlt.ri.gov/wc/COLArates.htm.

LEGISLATIVE ACTIONS:

• Senate Bill 242

The enacted legislation relates to labor and labor relations regarding Rhode Island’s uninsured protection fund. The legislation provides that the provisions of § 28-53-7 which addresses payments from the uninsured protection fund to employees of uninsured employers, would apply to injuries that occur on or after September 1, 2019. Effective Date September 1, 2019.

Tennessee VIEW STATE →

REGULATORY ACTIVITY:

• Abbie Hudgens, Administrator for the Tennessee Bureau of Workers’ Compensation, announced that the Rules of the Tennessee Department of Labor and Workforce Development, Bureau of Workers' Compensation will no longer be construed to limit the amounts that air ambulance service providers can recover.  This change is due to adverse court rulings in other states that involve similar provisions as well as the current state of federal law.  As a result of the Bureau’s revised interpretation, air ambulance service providers will no longer be limited by the rules’ fee schedules.  Effective Date April 1, 2019.
• The Tennessee Workers' Compensation Educational Conference is now open.  The 22nd conference will be held in Murfreesboro, TN on June 12-14.  For additional information, go to https://www.tn.gov/workforce/injuries-at-work/bwc-newsroom/2019/4/4/educational-conference-registration-is-now-open.html.  To register, go to https://www.tn.gov/workers-comp-conference.

Texas VIEW STATE →

REGULATORY ACTIVITY:

• The Texas Department of Insurance, Division of Workers' Compensation (DWC) will review all sections within the “Old Law” chapters, Chapters 41-69, of Title 28, Part 2 of the Texas Administrative Code (TAC), in accordance with Texas Government Code § 2001.039. Accordingly, DWC is accepting public comments on whether the rules within the “Old Law” chapters, 28 TAC Chapters 41 – 69, still have reason to exist and whether these rules should be repealed, readopted, or readopted with amendments as required for rule review under Texas Government Code § 2001.039. DWC is specifically requesting comments as to whether 28 TAC § 42.105 (DWC, Medical Fee Guideline) should be updated to reference the current requirements of 28 TAC § 134.201 (DWC, Medical Fee Guideline for Medical Treatments and Services Provided under the Texas Workers' Compensation Act).  To comment on this rule review project, you must submit written comments by 5 p.m., Central time, on May 6, 2019. Comments received after that date will not be considered. Send written comments or hearing requests by email to rulecomments@tdi.texas.gov or by mail to: Texas Department of Insurance, Division of Workers' Compensation Cynthia Guillen Office of Workers' Compensation Counsel MS – 4D 7551 Metro Center Drive, Suite 100 Austin, Texas 78744-1645 Any repeals or necessary amendments identified during the review of these rules will be proposed and published in the Texas Register in accordance with the Administrative Procedures Act, Texas Government Code Chapter 2001.  To view this notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.

Virginia VIEW STATE →

REGULATORY ACTIVITY:

Published new compensation and cola rates effective in 2019.

• Effective October 1, 2019 the cost of living (COLA) rate will be 1.85%
• Effective July 1, 2019 the maximum compensation rate will be $1,102
• Effective July 1, 2019 the minimum compensation rate will be $275.50

To view this notice, go to http://www.vwc.state.va.us/news/New-Compensation-and-COLA-Rates.

Virginia Auto VIEW STATE →

LEGISLATIVE ACTIONS:

• Senate Bill 1293

Provides that any release executed as a result of a liability insurer settling a personal injury claim with an underinsured claimant for the available limits of the liability insurer's coverage shall not operate to release any parties other than the liability insurer and the underinsured motorist. The bill clarifies that neither a duty to defend nor an attorney-client relationship is created between the underinsured motorist and counsel for the underinsured motorist benefits insurer without the express intent and agreement of the underinsured motorist. The measure modifies the language in the written notice that is required to be provided to the underinsured motorist upon settlement to further clarify that no attorney-client relationship or duty to defend is created between the underinsured motorist and the underinsured motorist benefits insurer as a result of the settlement and release. The bill clarifies that by sending the notice and release to the underinsured motorist's last known address by certified mail, the liability insurer satisfies the requirement of having the underinsured motorist sign the release and initial the notice. Effective Date  July 1, 2019.

Washington VIEW STATE →

REGULATORY ACTIVITY:

• Legislation in 2018 (SSB 6245) required Labor & Industries to review its procurement process for interpreter services for injured workers and crime victims. After reviewing our options and gathering feedback from interpreters, providers, and workers, L&I has decided to contract with one or more scheduling organizations. This means we will be purchasing in-person spoken language interpreter services through a new scheduling system by September 2020. There are still more decisions to make, including the functions of the scheduling system.  To help us answer these questions, we will be reaching out to interpreters, providers, and workers.
• Effective 4/25/2019, physical and occupational therapy students may assist on L&I claims. L&I has adopted a modified version of Medicare Part B’s policy on physical and occupational therapy students.  L&I considers supervised students an extension of their supervising therapist. To view additional information, go to http://www.lni.wa.gov/ClaimsIns/Providers/Billing/FeeSched/2018/Updates2018.asp?utm_medium=email&utm_source=govdelivery.
• Washington is updating the state’s hearing aid replacement policy. This rulemaking amends WAC 296-20-1101, Hearing aids and masking devices, allowing the replacement of hearing aids upon request five years after the issue date of the current hearing aids. The rule language was developed through the recommendations and consensus of a department initiated and led workgroup of expert and interested parties. The changes were adopted 4/2/2019 and will be effective on 5/15/2019.  To view the updated policy, go to http://www.lni.wa.gov/ClaimsIns/Rules/New/Proposed/default.asp?RuleID=268&utm_medium=email&utm_source=govdelivery.
• Published in the state register that May 15, 2019 is the effective date of a rule regarding the replacement of hearing aids request five years after the issue date of the current hearing aids.  Rules affected are WAC 296-20-1101.  To view this notice, go to http://lawfilesext.leg.wa.gov/law/wsr/2019/08/19-08-076.htm.

West Virginia VIEW STATE →

REGULATORY ACTIVITY:

• Published Information Letter Number 203 providing a summary of the 2019 legislation affecting insurance.  To view the letter, go to https://www.wvinsurance.gov/Resources/Informational-Letters.