THE LINK

VIEW PUBLICATION:



Clear

Alaska VIEW STATE →

REGULATORY ACTIVITY:

  • The Medical Services Review Committee will be holding a series of public meetings on the following dates and times: Friday, June 21, 2019, from 10:00am to 5:00pm, Friday, July 26, 2019, from 10:00am to 5:00pm and Friday, August 9, 2019, from 10:00am to 5:00pm. All the meetings will be held at the following location: Department of Labor Building; 3301 Eagle Street; Hearing Room 208; Anchorage, Alaska.  The purpose of these meetings is to discuss and make recommendations to the department and the Workers’ Compensation Board involving the appropriateness, necessity, and cost of medical and related services provided under the Workers’ Compensation Act. The primary deliverable shall be recommendations relating to Alaska medical fee schedule to be adopted under 8 AAC 45.083 for calendar year 2020. The public may attend these meetings in person or telephonically by calling 800-315-6338 and entering access code 92019 when prompted for the participant pin code. Individuals or groups of people with disabilities, who require special accommodations, should contact Alexis Newman at (907) 465-6059 or newman@alaska.gov at least five working days in advance of each meeting. Please provide as much advance notice as possible in order for the Department of Labor and Workforce Development to take the necessary steps to accommodate your needs. For additional information regarding this meeting, please contact the Division of Workers' Compensation at 465-2790. To view this notice, go to https://aws.state.ak.us/OnlinePublicNotices/Notices/View.aspx?id=194315.
  • The SIME selection panel, established under 8 AAC 45.092 to select physicians for the Alaska Workers' Compensation Board's list of second independent medical examiners, will meet on the following dates and times: June 7, 2019 – 12:00 pm to 1:00 pm; June 12, 2019 – 12:00 pm to 1:00 pm; June 25, 2019 – 12:00 pm to 1:00 pm; July 8, 2019 – 12:00 pm to 1:00 pm; July 10, 2019 – 12:00 pm to 1:00 pm.  All interested persons are invited to attend. All meetings will be held telephonically.  To attend, call 800-315-6338, access code 92019. Individuals or groups of people with disabilities, who require special accommodations, should contact Alexis Newman at (907) 465-6059 or newman@alaska.gov at least 3 working days in advance of each meeting. Please provide advance notice in order for the Department of Labor and Workforce Development to accommodate your needs. For additional information regarding this meeting, please contact Sue Reishus at (907) 465-6058 or sue.reishus@alaska.gov.  To view this notice, go to https://aws.state.ak.us/OnlinePublicNotices/Notices/View.aspx?id=194206.

 

Arizona VIEW STATE →

REGULATORY ACTIVITY:

  • The Industrial Commission of Arizona is pleased to announce the launch of the new ICA Community! ICA Community user accounts are available to any authorized individual, including claimants, attorneys, employer representatives/adjusters, carrier representatives/adjusters, and third-party administrator representatives/adjusters. Users may create ICA Community accounts by visiting the "ICA Community" webpage (https://azicawc.force.com/claims/) and following the steps to create a new account by requesting access to a workers' compensation claim and ALJ file.  Individuals who previously had user accounts established in the ICA Claims Portal will be receiving an e-mail (at the e-mail address associated with the ICA Claims Portal) from Salesforce with username, instructions on accessing the ICA Community, and a link to create a new password. The sender of the e-mail will be "noreply@salesforce.com on behalf of ICA Claims Community." If you had a user account in the ICA Claims Portal and do not receive an e-mail today, please check your "spam" folder or, alternatively, visit the ICA Community and create a new account. Please note that the reset password link in the e-mail is only valid for 24 hours. If the reset password link expires or, during the new account setup process, you receive a message stating, "You are an existing Contact and your vetting request might already be in progress," please select the "Log In" button in the upper right corner of the ICA Community and follow the "Forgot your password?" link. User accounts migrated from the ICA Claims Portal will include access to Claim records that were previously approved in the ICA Claims Portal. Please note that document migration will be continuing over the next 48 hours. If you are unable to view a document in ICA Community, please check back later. For more information about the new system, please visit azica.gov/newsystem. Training resources regarding usage of the ICA Community have been posted to the web page. If you have any problems logging into or creating an account in ICA Community, please call Customer Service at (602) 542-6734 or e-mail claims@azica.gov .
  • Notice of 2019-2020 Physicians’ and Pharmaceutical Fee Schedule Public Hearing:  On July 1, 2019, the Industrial Commission of Arizona will hold its Annual Fee Schedule Public Hearing pertaining to the annual review of the Physicians’ and Pharmaceutical Fee Schedule.  See A.R.S. § 23-908(B).  The hearing will be held at 1:00 p.m. in the first-floor auditorium of the Commission, which is located at 800 West Washington Street, Phoenix, Arizona, as part of the Commission’s scheduled meeting for that day.  In addition to public comments, the Commission will also consider a proposal prepared by Commission staff, which is currently posted on the Commission’s MRO webpage (https://www.azica.gov/divisions/medical-resource-office-mro).  The Staff Proposal is a preliminary document that is intended to serve as a foundational document for discussions that may arise during the public hearing process.  The record is considered open, and written and oral comments will be accepted until close of business on July 8, 2019.  Written comments may be submitted c/o Jacqueline Kurth, Manager, Medical Resource Office, via fax (602) 542- 4797; email to mro@azica.gov; or mail to P.O. Box 19070, Phoenix, Arizona 85005-9070.  To view the staff proposal and pharmaceutical guidelines and the proposed fee schedule tables, go to https://www.azica.gov/divisions/medical-resource-office-mro.

California VIEW STATE →

FEE SCHEDULE NEWS:

  • The DWC has published a new file for Medi-Cal rates effective June 15, 2019. The next update is expected July 15, 2019.
  • The DWC has adopted the Official Medical Fee Schedule to conform to changes in the Medicare payment system with an effective date of July 1, 2019. The next update is expected October 1, 2019.
  • A new DMEPOS Fee Schedule has been adopted with an effective date of July 1, 2019. The next update is expected October 1, 2019.
  • The DWC has adopted a new Outpatient and ASC fee schedule to conform to changes in the Medicare payment system with an effective date of July 1, 2019.  The next update is expected October 1, 2019

REGULATORY ACTIVITY:

  • The Division of Workers’ Compensation (DWC) has posted an order adjusting the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1.  The Physician and Non-Physician Practitioner Fee Schedule update order adopts the following Medicare changes: • CMS Medicare National Physician Fee Schedule Relative Value File RVU19C July 1, 2019 quarterly update • National Correct Coding Initiative Practitioner Procedure to Procedure (PTP) Edits July 1, 2019 quarterly update • National Correct Coding Initiative Medically Unlikely Edits July 1, 2019 quarterly update (excluding MUE “0” value codes) • CMS ZIP Code to Carrier Locality files July 1, 2019 quarterly update, for Geographic Practice Cost Index (GPCI) locality mapping    The order adopting the OMFS adjustments is effective for services rendered on or after July 1, 2019 and can be found at https://www.dir.ca.gov/dwc/OMFS9904.htm#7.  The notice can be viewed at https://www.dir.ca.gov/dwc/dwc_home_page.htm.
  • The Workers’ Compensation Appeals Board (WCAB) has posted a proposed reorganization and renumbering of its Rules of Practice and Procedure (Rules) for public comment.  WCAB’s Rules are found in the California Code of Regulations, Title 8, commencing with sections 10300 - 10999. WCAB is reworking the organizational structure of the Rules which were initially adopted in 1966, as they no longer accommodate the number and complexity of Rules adopted in the modern era. The reorganization is intended to do the following:
    • Organize articles to reflect the order of events in a case
    • Eliminate duplicative rules
    • Break up complex rules
    • Simplify and modernize language of rules for clarity
    • Create additional space between rules, so that additional rules can be added without the need for decimals.

WCAB invites the public to comment on the notice, draft regulations text and initial statement of reasons on its rulemaking page prior to engaging in formal rulemaking under Labor Code sections 5307 and 5307.4. Comments may be submitted by email to WCABRules@dir.ca.gov or by mail to:  Workers' Compensation Appeals Board Attn: WCAB forums P.O. Box 429459 San Francisco, CA 94142- 9459. The forum will close on July 5. The comments received will be reviewed and considered for adoption. WCAB will then submit the complete package of reorganized and revised Rules, along with the required forms and other documentation, to the Office of Administrative Law on July 30 to begin formal rulemaking. WCAB anticipates holding a public hearing on the reorganized and revised Rules on September 24, 2019. To view this notice, go to https://www.dir.ca.gov/dwc/dwc_home_page.htm.  To view a copy of the proposed rule, go to https://www.dir.ca.gov/WCAB/ForumDocs/WCAB_Forum-Section10300.htm.

  • DWC Posts Adjustments to Official Medical Fee Schedule (Hospital Outpatient Departments/Ambulatory Surgical Centers):  The Division of Workers’ Compensation (DWC) has posted an order adjusting the Hospital Outpatient Departments and Ambulatory Surgical Centers section of the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1. The Hospital Outpatient Departments and Ambulatory Surgical Centers fee schedule update order adopts the following Centers for Medicare & Medicaid Services (CMS) Medicare changes: • The CMS Medicare Hospital Outpatient Prospective Payment System (OPPS) July 2019 Addendum A quarterly update • The CMS Medicare OPPS July 2019 Addendum B quarterly update • The CMS Ambulatory Surgical Center Payment System, July 2019 ASC Approved HCPCS Code and Payment Rates, Column A entitled “HCPCS Code” of “Jul 2019 ASC AA” and Column A entitled “HCPCS Code” of “Jul 2019 ASC EE” • Certain sections of the CMS Medicare OPPS July 2019 Integrated Outpatient Code Editor (I/OCE), IOCE Quarterly Data Files V20.2 quarterly update • CMS July 2019 Update of the Hospital Outpatient Prospective Payment System (OPPS), Change Request (CR) 11318 (May 24, 2019), Transmittal R4313CP. The order adopting the OMFS adjustments is effective for services rendered on or after July 1, 2019 and is posted on DWC at https://www.dir.ca.gov/dwc/OMFS9904.htm#6.

Colorado VIEW STATE →

FEE SCHEDULE NEWS:

REGULATORY ACTIVITY:

Connecticut VIEW STATE →

REGULATORY ACTIVITY:

  • Issued memorandum number 2019-02 regarding Limited Liability Companies - Revised Forms 6B and 75.  In light of the recent Supreme Court decision in Gould vs. Stamford, 331 Conn. 289 (2019), holding that single-member limited liability companies (LLCs) are not required to elect to accept the provisions of the Workers’ Compensation Act, Chairman’s Memorandum 2003-02 is hereby withdrawn. The Commission has amended Forms 6B and 75 accordingly.  To view a copy of the memorandum, go to https://wcc.state.ct.us/memos/2019/2019-02.htm.   To view the revised forms, go to https://wcc.state.ct.us/download/forms.htm.
  • The Workers’ Compensation Commission has just received shipment of its new Bulletin No. 53, amended to January 1, 2019, which is available to the public free of charge. Bulletin No. 53 contains the entire Workers’ Compensation Act, additional related statutes, workers’ compensation administrative regulations, and illustrations of the most up-to-date Connecticut’s workers’ compensation forms.  Please contact your nearest Workers’ Compensation Commission District Office for your free copy of the new Bulletin No. 53. You may also call the Commission’s Education Services at (860) 493-1500. To view this notice, go to https://wcc.state.ct.us/memos/2019/2019-03.htm.
  • In light of Public Act 19-17 which allows for police officers, parole officers, and firefighters to receive certain workers’ compensation benefits for post-traumatic stress disorder (PTSD) caused by their participation in specific events, the Commission’s Form 30C “Notice of Claim for Compensation” has been revised, with a revision date of July 1, 2019. Please use this newest revision of the Form 30C, which can be obtained below or from our Online Forms page. To view this notice, go to https://wcc.state.ct.us/memos/2019/2019-04.htm.

 

Delaware VIEW STATE →

REGULATORY ACTIVITY:

  • Published a final order regarding compensation for Chiropractic Services. Regulation 1318 Compensation for Chiropractic Services prohibits insurance carriers and third-party administrators who are regulated by the Department from including in any health insurance policy terms and conditions that unreasonably discriminate against access to chiropractic care or services. It also prohibits compensation of Doctor of Chiropractic that is unreasonable or discriminatory. In the context of comments received on the Department’s proposed new Regulation 1321, the Commissioner acknowledged that the term “certificate,” as used in subsections 5.1 and 5.2 of that regulation, could imply extraterritoriality for that regulation, and that the underlying 24 Del.C. §2621 does not give the Commissioner extraterritorial jurisdiction (see adoption order published elsewhere in this edition of the Register of Regulations). Similarly, subsection 5.1 of Regulation 1318 would benefit from a similar clarification in that underlying 24 Del.C. §716 does not give the Commissioner extraterritorial jurisdiction. Accordingly, the Commissioner is clarifying that 18 DE Admin. Code 1318 § 5.1 applies only to certificates issued under Delaware policies or contracts. This amendment is exempt from the requirement of public notice and comment because it is a non-substantive change in existing regulations to correct technical errors, pursuant to 29 Del.C. §10113(b) (4). This order shall be effective 10 days after publication in the Register of Regulations.

 

Delaware Auto VIEW STATE →

REGULATORY ACTIVITY:

  • The Department of Insurance's Dover office will be moving to 1351 West North Street, Suite 101, Dover, Delaware effective July 15, 2019.

Idaho VIEW STATE →

REGULATORY ACTIVITY:

  • Posted notice of a public hearing regarding taking comments on three temporary and proposed rules. Rules under consideration are 0000.1900 - Omnibus; 17.11.01 - Administrative Rules of Peace Officer and Detention Officer temporary Disability Act; and 17.0000.1900F - Omnibus.  The public hearing will be held on August 6, 2019 at 2:00 p.m. at 11321 W. Chinden Blvd., Boise, Idaho. Video-conferences will also be held at the same time at the following locations: 1111 W. Ironwood Drive, Suite A, Coeur D'Alene, Idaho; 1820 E. 17th Street, Suite 300 Idaho Falls, Idaho; 1118 F Street, Lewiston, Idaho; and 1411 Fa;;s Avenue East, Suite 915, Twin Falls Idaho.  To view the notice and rules, go to https://iic.idaho.gov/2020-administrative-rulemaking/.

 

Idaho Auto VIEW STATE →

REGULATORY ACTIVITY:

 

Illinois VIEW STATE →

REGULATORY ACTIVITY:

 

Indiana VIEW STATE →

REGULATORY ACTIVITY:

  • The 2019 Self-Insurance application and guidelines are now available.  For more information and to download the necessary forms go to https://www.in.gov/wcb/2367.htm.

Lump sum payment information must be memorialized through EDI within 30 days of Board approval of a settlement.  This will be done via "PY" followed by an "FN" filing. Please see the updated Settlement Procedures for more information. No compliance measures regarding EDI 3.1 are being taken at this time.  We anticipate beginning to track performance for transactions that were filed on or after October 1, 2019 and no penalties will be issued before November 1, 2019 for EDI 3.1 monitored violations. The Board will be reviewing claims that were filed between September 1, 2018 and March 20, 2019 for compliance matters as previously announced in July 2017. To view this notice, go to https://www.in.gov/wcb/

Iowa VIEW STATE →

REGULATORY ACTIVITY:

  • Posted notice of intended action in regards to amending Chapter 2, “General Provisions,” Chapter 3, “Forms,” Chapter 4, “Contested Cases,” Chapter 5, “Declaratory Orders,” Chapter 10, “Informal Dispute Resolution Procedures,” and Chapter 11, “Electronic Data Interchange (EDI),”Any interested person may submit written or oral comments concerning this proposed rulemaking. Written or oral comments in response to this rule making must be received by the Division no later than 4:30 p.m. on June 25, 2019. Comments should be directed to: James Elliott, Division of Workers’ Compensation 1000 East Grand Avenue, Des Moines, Iowa 50319Phone: 515.725.3829Fax: 515.281.6501Email: elliott@iwd.iowa.gov.  A public hearing will be held on June 25, 2019 at 9:30 a.m. in Room 106 150 Des Moines Street, Des Moines Iowa.  To view the notice and proposed rules, go to https://www.legis.iowa.gov/law/administrativeRules.

Kansas VIEW STATE →

REGULATORY ACTIVITY:

  • The Department of Labor, Labor Market Information Services, has reported that the state's average weekly wage for calendar year 2018, in accordance with Section 44-704 of the Kansas Employment Security Law, was $888.29.  Pursuant to K.S.A. 44-510c, the maximum workers compensation weekly benefit for the period of July 1, 2019 to June 30, 2020 will be $666.00.  This maximum will apply to those accidents occurring between July 1, 2019 and June 30, 2020.  The minimum weekly benefit rate for fatalities for the same period, pursuant to K.S.A. 44-510b, will be $444.00.  To view this notice, go to https://www.dol.ks.gov/WC/home.

 

Kentucky VIEW STATE →

REGULATORY ACTIVITY:

  • 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. 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, compounded drugs, and prescription drugs not listed in the formulary require preauthorization. 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.
  • Posted notice of amendment of the Workers' Compensation Pharmaceutical Formulary Regulation.  The Department of Workers’ Claims has amended the pharmaceutical formulary regulation, 803 KAR 25:270, as follows: (1) The last sentence of Section 3, subsection (3) has   been amended to read, “Within two (2) business days of presentation of a prescription drug with an “N” status without articulated sound medical reasoning, the insurance carrier shall notify the medical provider and injured employee that preauthorization is required for the prescribed drug.”  (2) The Section 3, subsection (4) has been amended to delete the language “Except as provided in subsection (1) of this Section, prescription drugs dispensed for outpatient use by any person other than a pharmacist require preauthorization.” Subsequent subsections have been renumbered accordingly. An emergency regulation will remain in place until the ordinary regulation takes effect. Formulary effective dates and all other provisions of the regulation remain unchanged.

A training webinar is available on the DWC’s website under the “Drug Formulary” tab and at http://info.mcg.com/odg-on-demand-webinar-kentucky-formulary.html. Support and training is also available through the ODG Helpdesk at 800-488-5548 or online at odghelp@mcg.com. Questions about the formulary regulation may be directed to John Mann at 502-782-4532 or JohnW.Mann@ky.gov. Additional information is available at https://labor.ky.gov/comp. Department of Workers' Claims is located at 657 Chamberlin Ave, Frankfort, KY 40601. Other questions concerning Department of Workers' Claims can be addressed by calling (502) 564-5550.  To view the notice, go to https://labor.ky.gov/comp/Pages/default.aspx.

 

Maine VIEW STATE →

REGULATORY ACTIVITY:

  • On May 21, 2019, the Board of Directors voted to adopt an assessment rate for insurers of 2.76% for Fiscal Year 2020 beginning on July 1, 2019.  Assessment letters for insurers and self-insured employers will be mailed shortly and payments are due by June 7, 2019. For questions contact Jan Adams (207) 287-7084 or see https://www.maine.gov/wcb/Departments/businessservices/annualassessment.html.
  • The June 11th Board of Directors Business meeting has been cancelled. The July meeting has been changed from July 9th to July 23rd. The July meeting will be held at the Bangor Regional Office. If you have any questions, please contact Debi at 287-7086.
  • Published the spring edition of their MRS newsletter.  To view the published newsletter, go to https://www.maine.gov/wcb/Departments/omrs/mrsnewsletters.html.

 

Maryland VIEW STATE →

FEE SCHEDULE NEWS:

  • The state has reposted changes to the Medical Fee Schedule retroactive to January 1, 2019.

REGULATORY ACTIVITY:

  • Posted Notice of final action regarding petition for judicial review procedures. 
  • On May 9, 2019, the Workers’ Compensation Commission adopted amendments to Regulation .01 under COMAR 14.09.11 Judicial Review Procedures.

 

Medicare VIEW STATE →

FEE SCHEDULE NEWS:

  • Physician – CMS has posted new updates to the National Physician Fee Schedule Relative Value File effective July 1, 2019. The next expected update is October 1, 2019.
  • ASP Drugs – CMS has released new updates to the ASP Drugs file with an effective date of July 1, 2019. The next expected update is October 1, 2019.
  • HCPCS - CMS has released new updates to the HCPCS module with an effective date of July 1, 2019. The next expected update is October 1, 2019.
  • DMEPOS - CMS has released new updates to the DMEPOS file with an effective date of July 1, 2019. The next expected update is October 1, 2019.
  • ASC – CMS has released a new update to the ASC fee schedule with an effective date of July 1, 2019. The next expected update is October 1, 2019.
  • OPPS - CMS has released a new update to the OPPS fee schedule with an effective date of July 1, 2019. The next expected update is October 1, 2019.
  • CCI and MUE Edits – CMS has posted the new July 1, 2019 update to the CCI and MUE edits modules. The next expected update is October 1, 2019.

Michigan VIEW STATE →

REGULATORY ACTIVITY:

  • Emily McDonough has been named the new Administrator of the Funds Administration and Self-Insured Program Division effective June 17.  Emily previously served as an Assistant Attorney General in the Labor Division of the Department of Attorney General and provided representation to various state agencies within LARA, including the Workers’ Compensation Agency.  She is a graduate from Thomas M. Cooley Law School.  Emily will be an excellent addition to the Workers’ Compensation Agency.

Michigan Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Published bulletin 2019-11-INS regarding disputes between no-fault automobile insurers and health care providers. This bulletin exceeds bulletin 2018-13-INS issued in June 6, 2018. Public Acts 21 and 22, enacted on June 11, 2019, amended numerous provisions of the Insurance Code of 1956, MCL 500.100 et seq. (Code), including Section 3112, MCL 500.3112. Section 3112, after amendment, now provides: "A health care provider listed in section 3157 may make a claim and assert a direct cause of action against an insurer, or under the assigned claims plan under sections 3171 to 3175, to recover overdue benefits payable for charges for products, services, or accommodations provided to an injured person." As amended, Section 3112 overturns Covenant Medical Center, Inc v State Farm Mutual Auto Ins Co, 500 Mich  191; 895 NW2d 490 (2017), which held that health care providers did not have  a statutory cause of action against no-fault insurers for recovery of personal protection insurance benefits. The amended statute provides the "statutory cause of action" found lacking by the Supreme Court in Covenant.   In addition, the amended statute renders Bulletin 2018-13-INS obsolete because the bulletin was issued to explain the impact of the Covenant decision on disputes between no-fault automobile insurers and health care providers. Bulletin  2018-13-INS  also  addressed  the "reasonableness"  of health  care  providers'  charges,  and  auto insurers'  obligation  to  pay  "reasonable  charges"  for  "reasonably  necessary"  products,  services,  and accommodations for an injured person's care. Public Acts 21 and 22 did not alter this fundamental principle. Public Act 21 also requires the implementation of reimbursement rate caps beginning July 1, 2021. Until that date, auto insurers and health care providers are reminded that "an insurance carrier need pay no more than a reasonable charge and that a health care provider can charge no more than that." McGill v Automobile Association of Michigan, 207 Mich App 402, 502; 526 NW2d 12 (1994). "Consequently, insurers must determine in each instance whether a charge is reasonable in light of the service or product provided." Advocacy Org for Patients & Providers v Auto  Club Ins Association, 257 Mich App 365, 379; 670 NW2d  569 (2003).(1)  In light of the immediate effect of the amendment to Section 3112, health care providers may assert a direct cause of action  against  an  insurer  or  the  Michigan  Assigned  Claims  Plan  when  there  is  a  dispute  over  the , reasonableness of charges.

In this regard, the Director notes that Michigan courts have expressly approved an insurer's determination of reasonableness when the insurer reimbursed 100% of a health care provider's charge where it did not exceed the highest charge for the same procedure charged by 80% of other providers rendering the same service. See Advocacy Org, reasonableness of charges.

Any questions regarding this bulletin should be directed to:

Department of Insurance and Financial Services

Office of General Counsel

530 W. Allegan Street - 8th Floor

P.O. Box 30220

Lansing, Michigan 48909-7720

Toll Free: (877) 999-6442 supra, 257

To view this bulletin, go to https://www.michigan.gov/difs/0,5269,7-303-12900_12906---,00.html.

 

Minnesota VIEW STATE →

REGULATORY ACTIVITY:

  • The Department of Labor and Industry (DLI) investigates complaints from registered rehabilitation providers (vendors and qualified rehabilitation consultants) about an employer's or insurer's failure to pay or deny a rehabilitation service invoice. Substantiation of complaints may result in penalties up to $2,000.  A payer has 30 days from the receipt of a rehabilitation provider's bill to pay or deny all charges, according to Minnesota Statutes § 176.102, Minn. Stat. § 176.221 and Minnesota Rules 5220.1900. For any portion that is denied, the employer or insurer must provide written notification stating the specific service charge and the reason for denial (see Minn. R. 5220.1900). A new, fillable Penalty Request for Failure to Pay or Deny Rehabilitation Invoice form is located under "Optional forms" on the DLI Work Comp:  Forms webpage. Rehabilitation providers are reminded that all billing shall be on a Vocational Rehabilitation Invoice form prescribed by the commissioner (see Minn. Stat. § 176.102). Failure to submit an invoice to an employer or insurer covering all the points listed in the example invoice will result in the penalty request being dismissed. More information: For more information, contact Mike Hill at 651-284-5153 or hill@state.mn.us.

Mississippi VIEW STATE →

FEE SCHEDULE NEWS:

  • The Commission has adopted a new Medical Fee Schedule with an effective date of June 15, 2019.

REGULATORY ACTIVITY:

  • In an effort to expedite settlements, this Settlement Summary will be required to be attached to all settlements insuring that the Commission has the proper information when evaluating settlements. This is effective July 1, 2019.  To view this notice, go to https://mwcc.ms.gov/#/home.

 

Missouri VIEW STATE →

REGULATORY ACTIVITY:

  • The Division of Workers’ Compensation accepts the Claim for Compensation and Answer to Claim for Compensation (with cover letter, if submitted) electronically from Law Firms where the attorneys are admitted practicing law in the State of Missouri. There is no cost to the Law Firm associated with setting up these email accounts.  To sign up please take the following steps:
    • 1) Send an email to ElectronicFiling@labor.mo.gov. Please include all authorized email addresses for the Law Firm to be allowed access to upload the filing electronically to the Division.
    • 2) You will receive an invitation to create your Box account for each email submitted. The invite will come from the Division inviting you to collaborate on Box. Accept the invite that appears below the name of your Law Firm.
    • 3) Once the Box account is created, you will be granted authority to upload the filing you are submitting into your Law Firm folder. The Division plans to sweep the filings daily. There will be no change to the Division’s current procedure for processing the Claim for Compensation or Answer to Claim for Compensation. You will continue to receive acknowledgments of filing by mail.  If you have any questions, please call 573-526-0359.  To view this notice, go to https://labor.mo.gov/DWC.
  • Missouri has new State Average Weekly Wage and Maximums effective July 1, 2019. The State Average Weekly Wage (SAWW) used to determine maximum workers' compensation benefits for the fiscal year beginning July 1, 2019 and ending June 30, 2020 is $934.90. This SAWW produces the maximum weekly benefit rates for injury and illness occurring on or after July 1, 2019, as follows: Temporary Total Disability $981.65 Permanent Total Disability $981.65 Permanent Partial Disability $514.20 Death $981.65.  Also, as of July 1, 2019 the mileage allowance for travel is $.55 per mile. To view this notice, go to https://labor.mo.gov/DWC/notices.

Montana VIEW STATE →

FEE SCHEDULE NEWS:

The proposed Medical and Facility fee schedules were posted as adopted with no changes and became effective July1, 2019.  The next update is expected July 1, 2020

REGULATORY ACTIVITY:

  • Has posted their proposed fee schedules to become effective July 1, 2019.  To view the fee schedules, go to http://erd.dli.mt.gov/.
  • Posted notice of adoption of Montana Utilization and Treatment Guidelines. The adopted rules add a new section to the rule. The added section is section (6) which adds the recently adopted formulary to the Utilization and Treatment Guidelines rule.  The formulary rule became effective April 1, 2019.  To view the adopted rule, go to http://www.mtrules.org/gateway/RuleNo.asp?RN=24%2E29%2E1611.
  • Posted notice of adoption as proposed rule 24.29.1433 Facility Service Rules and Rates for Services provided on or after July 1, 2013; 24.29.1534 Professional Fee Schedule for Services provided on or After July 1, 2013; and 24.29.1538 Conversion Factors for Services provided on or After January 1, 2008.  To view this notice, go to http://www.mtrules.org/gateway/ShowNoticeFile.asp?TID=9170.

 

Nebraska VIEW STATE →

REGULATORY ACTIVITY:

  • The Nebraska Workers’ Compensation Court congratulates Allen Kassebaum upon his induction into the Central States Association Hall of Fame at its 2019 Spring Seminar in Madison, Wis. on June 20 (https://twitter.com/IAIABC/status/1141786581445074947). The Central States Association is an association of jurisdictional workers’ compensation agencies from the central region of the U.S., including Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin. Allen has been an active participant in Central States Association activities since 2005 and has twice served as that organization’s president and vice president. Allen currently manages the Nebraska Workers’ Compensation Court’s Regulatory Programs section, which is responsible for the medical services, compliance (including electronic data interchange), and self-insurance programs of the court.
  • Announced the publication of an updated statistical report.  The report Statistical Report, 2009-2019 summarizes information reported to the Nebraska Workers’ Compensation Court by employers and insurers for work-related injuries and illnesses that occurred during calendar years 2009 through 2018, regardless of the year in which the reports were filed. To view the report, go to https://www.wcc.ne.gov/information-for-the-public/court-forms-and-publications/statistical-reports/cy-2009-2018-statistical-report.

Nevada VIEW STATE →

REGULATORY ACTIVITY:

  • Published a notice regarding DIR Workers' Compensation Section Treating and/or Rating Panels. Dear Health Care Providers: Thank you for your interest in the State of Nevada, Division of Industrial Relations (DIR) Workers’ Compensation Section (WCS) Treating Panel of Physicians and Chiropractors and/or the Rating Panel of Physicians and Chiropractors. We regret to inform you that, due to recent legislation passed by the Nevada State Legislature, there is a temporary moratorium on reviewing and adding providers to either of the DIRIWCS physician/chiropractor panels, effective immediately. The new legislation includes substantial changes to the requirements and information that must be provided regarding each physician/chiropractor listed. This process necessitates significant IT development and other related tasks. Revised applications for providers will be posted on the DIR/WCS website when available. At this time, we anticipate this moratorium continuing until January 2020. This date is tentative and subject to change. We apologize for the inconvenience this may cause providers; however, these changes are necessary to allow the DIR/WCS to comply with the new statutory requirements. We appreciate your interest in providing services to Nevada’s injured employees and those with occupational diseases. Please monitor our website for updates and for the new applications.  To view this notice, go to  http://dir.nv.gov/WCS/Important/.
  • Nevada has published the Summer Edition of the Workers’ Compensation Chronicle Newsletter.  To view the current newsletter, go to http://dir.nv.gov/WCS/Home/.

New York VIEW STATE →

FEE SCHEDULE NEWS:

  • A new update to reimbursement rates for DMEPOS was released with an effective date of August 1, 2019.

REGULATORY ACTIVITY:

  • Published Subject Number 046-1173 regarding updates to disability benefits claim forms.  The New York State Workers' Compensation Board (WCB) has made updates to forms that are used for disability benefits claims. Two disability benefits claim forms have been updated to streamline the process of reviewing a total or partial payer rejection of a disability benefits claim, while two other disability benefits forms have been made obsolete. In addition, the mailing address of the Board’s Disability Benefits Bureau has changed.  The forms that changed are Notice and Proof of Claim for Disability Benefits (Form DB-450 and Notice of Total or Partial Rejection of Claim for Disability Benefits (Form DB-451). The bulletin also noted two forms that are obsolete and no longer in use. The obsolete forms are Notice of Disability Benefits Payment (Form DB-455 and Tables of Permanent Contributions (Form DB-791.  To view this notice, go to http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1173.jsp.
  • Posted a notice of a proposed rule with no hearing scheduled.  The affected parties of the proposed rule are Group self-insured trusts that are inactive but not insolvent. The purpose of the rule is to provide assistance with inactive but not insolvent group self- insured trusts to purchase ALPs to wind down liabilities.  To view the rule as published, go to https://www.dos.ny.gov/info/register/2019.html and click on the May 29th edition of the state register. 
  • The New York State Workers' Compensation Board Summer 2019 Conference; Coming to three locations across the State:
    • Albany - July 1, 2019
    • Rochester - July 31, 2019
    • New York City - August 5, 2019

All sessions will be from 1:00 pm to 4:30 pm. These half-day, afternoon programs are targeted to all who have a professional interest in the New York State workers' compensation system. Multiple CLEs and CMEs will be available!  For more information about the Board's regional conferences, write to Outreach@wcb.ny.gov.

New York No-Fault VIEW STATE →

REGULATORY ACTIVITY:

  • New York has published two Circular Letters regarding reimbursement of auto claims under specific circumstances.  The circular letters are number 3 (2019) and 4 (2019) respectively.  Circular number 3 deals with medical reimbursement under no fault.  Circular number 4 deals with claims involving transportation network vehicles.  To view both Circular Letters, go to https://www.dfs.ny.gov/industry_guidance/circular_letters.

Oklahoma VIEW STATE →

REGULATORY ACTIVITY:

  • Commission Rule 810:10-1-11 requires each insurance carrier to designate a single agent for service of notice by filing a Designation of Service Agent (CC-Form-7) with the Commission.  In some instances, the most current designated service agent information with the Commission has become outdated, resulting in default orders being issued against respondents.  This notice serves as a reminder to all carriers, designated service agents, and respondent attorneys of the obligation under the cited rule to keep this information current so that carriers may promptly notify their counsel to appear before the Commission and avoid unnecessary delay and/or default.  A CC-Form-7 is attached for reference to the notice email you received. To view this notice, go to https://www.ok.gov/wcc/Legal/Alerts/index.html.   To view the form, go to https://www.ok.gov/wcc/Forms/index.html.

Oregon VIEW STATE →

REGULATORY ACTIVITY:

  • Published bulletin 381 regarding Self-Insured Base Rates.  This bulletin notifies self-insured employers of the base rates to be used for calculating the premium assessment for quarters occurring during the period from July 1, 2019, through June 30, 2020. In addition, this bulletin provides reporting instructions and rating plan options. All forms and rates referenced in this bulletin are not effective until July 1, 2019.  Refer to Bulletin 378 in order to complete the second quarter (April, May, June) 2019 Workers’ Compensation Payroll and Assessment Reports.  To view the bulletin, go to https://wcd.oregon.gov/forms/Pages/bulletins.aspx.
  • Published Bulletin 1 (Revised) Attorney fees: ORS 656.262(11) (a); ORS 656.308(2) (d) (effective 7/1/19).  To view the bulletin, go to https://www.oregon.gov/wcb/legal/Pages/bulletins.aspx.
  • The Workers' Compensation Board has published the May Issue of Case News & Notes Current Issue for Oregon Department of Consumer and Business Services.  To view the publication, go to https://www.oregon.gov/wcb/Pages/news-notes.aspx.
  • Posted notice announcing that the TTD/PPD calculator has been updated to reflect the 7/1/2019 State Average Weekly Wage calculation. This version of the TTD/TPD calculator replaces all previous versions that may have been installed on computers. This web version will be kept up to date and should be used as the primary calculation tool. It has been tested with the major web browsers and should work on any operating system. Older versions of the desktop calculator no longer work. The web calculator has two versions available:
    • The "web" version is used with an active internet connection and updates automatically. The web calculator is the preferred version if you have an internet connection.
    • The "stand-alone" version of the web calculator is for offline use (no active internet connection). The stand-alone version will automatically update when an internet connection is established. To update, you must have an active internet link, then start the stand-alone calculator and allow it to update. You can obtain this version at Windows TTD / TPD Stand-alone Calculator. If you need access to the PTD or PPD calculation tools, you can find them on the Disability Calculators page.  To view this notice, go to https://www4.cbs.state.or.us/exs/wcd/ttd/.
  • The Oregon Workers’ Compensation Division has scheduled time for review of possible amendments to OAR chapter 436. Please RSVP if you would like to join us for one or both of the following meetings:
    • 11, 2019, 8:30 a.m., Room F (basement), Labor & Industries Building, 350 Winter Street NE, Salem Oregon Regarding OAR 436-105, Employer-at-Injury Program (EAIP), including a possible requirement to submit documentation in support of EAIP reimbursement requests, restoring a provision removed in 2017 describing the method for calculation of partial days of reimbursement for salaried workers, and clarifying that the restriction for using both EAIP and Preferred Worker program benefits only applies to the same claim during the same claim opening.
    • 11, 2019, 1:30 p.m., Room 260 (2nd floor), Labor & Industries Building, 350 Winter Street NE, Salem Oregon Regarding OAR 436-050, Employer/Insurer Coverage Responsibility, and 436-085, Premium Assessment, including implementation of House Bill 3003 (insurance policy in lieu of surety), and premium assessments for self-insurance employers.

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 July 1, 2019. The next expected update is in October 1, 2019.

 

South Carolina VIEW STATE →

REGULATORY ACTIVITY:

Tennessee VIEW STATE →

REGULATORY ACTIVITY:

  • Published a general overview of workers' compensation legislation passed by the 2019 session of the 111th General Assembly.  To view the overview, go to https://www.tn.gov/workforce/injuries-at-work/bureau-announcements.html.
  • Posted notice of proposed amendment to rule chapter 0800-02-19 Inpatient Hospital Fee Schedule.  The proposed amendment was posted on June 12, 2019.  The proposed rule has a projected effective date of September 10, 2019.  No public meeting has been set at this time.  To view the posted notice, go to https://tnsos.org/rules/PendingRules.php.
  • Posted notice of proposed amendment to rule 0800-02-19 Rules for Medical Payment.  The proposed amendment was posted on June 12, 2019.  The proposed rule has a projected effective date of September 9, 2019.  No public meeting has been set at this time.  To view the posted notice, go to https://tnsos.org/rules/PendingRules.php.

Texas VIEW STATE →

REGULATORY ACTIVITY:

  • On May 8, 2019, the Texas Department of Insurance, Division of Workers’ Compensation (DWC) solicited and received constructive input from workers’ compensation system participants on the proposed Physical Medicine and Rehabilitation Services Plan-Based Audit (Plan-Based Audit). DWC appreciates the input provided by system participants. All comments were carefully considered and discussed. The commissioner of workers’ compensation approved the Plan-Based Audit on May 29, 2019.  All medical quality reviews initiated on or after January 1, 2019, will follow the approved Medical Quality Review Process (Process) in effect. The Process and Plan-Based Audit are posted on the TDI website at:  tdi.texas.gov/wc/hcprovider/medadvisor.html.  If you have any questions regarding this memo, contact Mary Landrum at 512-804-4814 or Mary.Landrum@tdi.texas.gov.  A copy of this announcement can be viewed at https://www.tdi.texas.gov/alert/whatsnew/index.html.
  • The Texas Department of Insurance, Division of Workers’ Compensation (DWC) is accepting comments on an informal working draft of rules for 28 Texas Administrative Code §134.150 and §134.155 to implement Senate Bill (SB) 935, 86th Legislature (2019). Rule 134.150 describes the process for reimbursement of services provided by a federal military treatment facility (FMTF), and Rule 134.155 describes procedures for resolving disputes over charges by an FMTF.  SB 935 requires DWC to adopt rules necessary to implement Labor Code §413.0112 no later than December 1, 2019. The rules will establish requirements for processing medical bills for services provided to an injured employee by an FMTF, as well as a separate medical dispute resolution process to resolve charges billed directly to an injured employee by an FMTF. The change in law made by SB 935 applies to health care services provided to an injured employee on or after January 1, 2020, regardless of the date of injury.  To view this notice, go to https://tdi.texas.gov/wc/rules/drafts.html.

Vermont VIEW STATE →

REGULATORY ACTIVITY:

  • The new Form 28(FY20) and the Form 28A (FY20), which you should use to update claimant’s rates as of July 1, 2019, are now available.  You can download both forms from our web site at:  http://labor.vermont.gov/forms/#comp.
  • The new maximum for those injuries arising after June 30, 1986 is $1,353.00.  The new maximum for injuries prior to that date is $902.00.  The minimum in all cases is $451.00.
  • Please be aware of the requirement to forward a copy of the Form 28 to the injured worker or dependent.

Virginia VIEW STATE →

REGULATORY ACTIVITY:

  • The Virginia Workers’ Compensation Commission proposes to amend subsection B of Commission Rule 2.3, Expedited Hearings, as recommended by the Workers’ Compensation Inns of Court Advisory Conference. The Commission also proposes to repeal Commission Rule 14, Medical Communities, in light of amendments to Va. Code Sec. 65.2-605 enacted in 2016 that define “medical community,” superseding the definition set forth in Rule 14. To view this notice, go to http://www.vwc.state.va.us/news/Proposed-Amendment-and-Repeal.
  • Posted notice regarding update to the Medical Fee Schedule Transition Review Timeline.  To view this notice, go to http://www.vwc.state.va.us/news/Medical-Fee-Schedules-Special-Notices.

 

 

Washington VIEW STATE →

REGULATORY ACTIVITY:

  • Posted notice of an expedited rulemaking. The purpose of this expedited rulemaking is to amend WAC 296-14-400, Re-openings for benefits, to remove the requirement that applications to re-open a workers’ compensation claim must be submitted by a provider in the department’s Medical Provider Network (MPN) as a result of the State of Washington Court of Appeals decision (Ronald V. Ma'ae v. State of WA Dept of Labor And Industries, 2019 WL 1492822) that found the department cannot prohibit non-MPN providers from submitting re-opening applications. This rule amendment allows the department to be in compliance with the Court of Appeals decision. The department proposes removing the following language from WAC 296-14-400: For services or provider types where the department has established a provider network, beginning January 1, 2013, medical treatment and documentation for reopening applications must be completed by network providers. To view this notice, go to http://www.lni.wa.gov/LawRule/WhatsNew/Proposed/default.asp?RuleID=371.  Comments are due by July 22, 2019.
  • The Department of Labor & Industries payment policies and fee schedules for 2019 are now available online, and they are effective July 1st. For additional information, go to https://www.lni.wa.gov/ClaimsIns/Providers/Billing/FeeSched/2019/default.asp?utm_medium=email&utm_source=govdelivery.
  • Posted notice of effective date of self-insurance rules and regulation Chapter 296-15 which was adopted December 18, 2018 and became effective July 1, 2019.  A copy of the order adopting the rule and the rule language can be viewed at http://www.lni.wa.gov/LawRule/WhatsNew/Proposed/default.asp?RuleID=263.
  • Posted notice of proposed rulemaking regarding vocational rehabilitation (Chapter 296-19A WAC).  The purpose of this rulemaking is to support the department’s vocational recovery effort by:
    • Ensuring expectations of vocational providers are better aligned with the return-to-work language in RCW 51.32.095;
    • Addressing minimum requirements for vocational providers/firms; and
    • Outlining when and to what degree vocational providers may be subject to corrective action or sanctions.

To view the notice of proposed rulemaking, go to http://www.lni.wa.gov/LawRule/WhatsNew/Proposed/default.asp?RuleID=267.

  • Posted notice of proposed rule amendment: WAC 296-14-400 Re-openings for benefits, this rule explains the requirements for reopening a workers' compensation claim that has been previously closed. The purpose of the proposal is to amend WAC 296-14-400 Re-openings for benefits, to remove the requirement that applications to reopen a workers' compensation claim must be submitted by a provider in the department's medical provider network (MPN) as a result of the state of Washington court of appeals decision (Ronald V. Ma'ae v. State of WA Dept of Labor And Industries, 2019 WL 1492822) that found the department cannot prohibit non-MPN providers from submitting reopening applications. This rule amendment allows the department to be in compliance with the court of appeals decision. The department proposes removing the following language from WAC 296-14-400: For services or provider types where the department has established a provider network, beginning January 1, 2013, medical treatment and documentation for reopening applications must be completed by network providers. Reasons Supporting Proposal: In 2012, the department amended its rules related to what services for injured workers may be provided by a nonnetwork provider in order to align with the statewide MPN established under RCW 51.36.010, as amended by SSB 5801, chapter 6, Laws of 2011. Recently, the Washington state court of appeals ruled that the requirement in WAC 296-14-400 that a worker submit medical documentation from only a network doctor to reopen a claim for aggravation was outside the statutory authority. Ronald V. Ma'ae v. State of WA Dept of Labor and Industries, 2019 WL 1492822. The court held the amendment to WAC 296-14-400 to be invalid, and the language of the rule must now be amended to be in compliance with the court's decision. To view the proposed rule, go to http://lawfilesext.leg.wa.gov/law/wsr/2019/11/19-11-110.htm

West Virginia VIEW STATE →

REGULATORY ACTIVITY:

  • Published notice of the workers' compensation daily benefit rate computation sheet effective July 1, 2019 through June 30, 2020.  The new effective state average weekly wage effective July 1, 2019 is $865.11 for maximum and $193.33 for minimum.  To view the notice regarding benefits effective July 1, 2019, go to https://www.wvinsurance.gov/Workers-Compensation.

Wyoming VIEW STATE →

REGULATORY ACTIVITY:

  • Director Robin Sessions Cooley recently named Holly McKamey Simoni the new Administrator of Workforce Programs for the Wyoming Department of Workforce Services (DWS). Simoni has served the agency for the past 12 years, where she demonstrated exemplary leadership in the Vocational Rehabilitation (VR) section of the agency. In her role as VR Regional Manager, she lead the state in piloting new VR programming and projects. Her most recent project consisted of implementing two new VR Coordinator positions, which is a first for Wyoming and have already decreased client wait times.  "Holly Simoni has proven herself as an innovative, capable leader during her time as a Regional Manager for VR," Director Cooley said. "Placing Holly as the new Administrator for Workforce Programs will allow us to serve the entire spectrum of our clientele, including the most vulnerable. Her expertise in VR and track record in implementing innovative solutions is perfectly suited to this position. Workforce Programs help people get family-sustaining jobs, and positively impact the lives of so many citizens in Wyoming."  Simoni has been with DWS since 2006 when she began as a VR Counselor in Rawlins before moving up to the position of Regional Manager in 2013. She holds a Bachelor of Science in Health and Human Development from Montana State University and a master’s degree in Rehabilitation Counseling from Assumption College.

 



DISCLAIMER: The material contained herein is for informational purposes only. It is subject to change without notice. The statements provided herein are not a comprehensive presentation of the subject matter as there are other laws, regulations, and cases that may affect the material presented. It should not be relied upon as legal advice. Rather, you should consult with appropriate legal counsel before making any decisions, including any system and/or policy changes. Medata does not assume any liability associated with your use or reliance on this information. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, for any purpose, without the express written permission of Medata.