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Alaska VIEW STATE →

REGULATORY ACTIVITY:

  • The Alaska Department of Labor and Workforce Development and the Alaska Workers’ Compensation Board propose to adopt regulation changes in Title 8 of the Alaska Administrative Code, dealing with material adopted by reference and the definition of rehabilitation specialist, including the following:
    • (1) 8 AAC 45.083 is proposed to be amended as follows: Update fee schedule material adopted by reference
    • (2) 8 AAC 45.415 is proposed to be changed as follows: Clarify definition of rehabilitation specialist.

A copy of the proposed regulation changes and the material proposed for adoption by reference is available on the Alaska Online Public Notice System and by contacting Alexis Newman at (907) 465-6059 or alexis.newman@alaska.gov. After the public comment period ends, the Department of Labor and Workforce Development and the Workers’ Compensation Board will either adopt the proposed regulation changes or other provisions dealing with the same subject, without further notice, or decide to take no action. The language of the final regulation may be different from that of the proposed regulation.

  • Posted a proposed fee schedule that will become effective January 1, 2020.  To view the fee schedule, go to http://labor.alaska.gov/wc/.

California VIEW STATE →

FEE SCHEDULE NEWS:

  • The DWC has published a new file for Medi-Cal rates effective September 15, 2019. No drug information was changed in this file. The next update is expected October 15, 2019.
  • The DWC has posted an adjustment to the inpatient hospital section of the Official Medical Fee Schedule (OMFS) to conform to changes in the 2020 Medicare payment system as required by Labor Code section 5307.1. The effective date of the changes is November 1, 2019.
  • The (DWC) has posted an order adjusting the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) section of the Official Medical Fee Schedule to conform to the fourth quarter 2019 changes in the Medicare payment system as required by Labor Code section 5307.1.  The order, which is effective for services on or after October 1, 2019, adopts the Medicare October 2019 Quarter 4 DMEPOS Fee Schedule update.  The next update is expected January 1, 2020.
  • The DWC has adopted the Official Medical Fee Schedule to conform to changes in the Medicare payment system with an effective date of October 1, 2019. The next update is expected for January 2020.
  • The DWC has adopted a new Pathology and Clinical Laboratory Schedule to conform to changes in the Medicare payment system with an effective date of 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 October 1, 2019.  The next update is expected for January 2020.

REGULATORY ACTIVITY:

  • The Division of Workers’ Compensation (DWC) has posted an order adopting regulations to update the evidence-based treatment guidelines of the Medical Treatment Utilization Schedule (MTUS).   The updates, effective for medical treatment services rendered on or after October 7, 2019, incorporate by reference the American College of Occupational and Environmental Medicine’s (ACOEM’s) most recent Hip and Groin Disorders Guideline (April 24, 2019) to the Clinical Topics section of the MTUS. To view the notice, go to https://www.dir.ca.gov/dwc/dwc_home_page.htm.
  • The Division of Workers’ Compensation (DWC) launched an updated free online education course for physicians treating patients in the California workers’ compensation system.  “Caring for California’s Injured Workers: Using California’s Medical Treatment Utilization Schedule (MTUS) 2019” is one of a series of education modules developed for medical doctors, chiropractors and nurses. The course is also available to anyone else wishing to learn about the MTUS, and a completion certificate is available. The MTUS is the primary source of guidance for treating physicians and physician reviewers for the evaluation and treatment of injured workers. The MTUS incorporates evidence-based treatment guidelines of the American College of Occupational and Environmental Medicine (ACOEM), which are published by the Reed Group.  “All medical providers who treat injured California workers should understand and follow the MTUS. The online course is a convenient tool for providers to learn how to use the treatment guidelines and formulary that are designed to improve medical outcomes for injured workers,” said DWC Executive Medical Director Dr. Raymond Meister.  Medical doctors, chiropractors and nurses who take the course will receive up to one and a half hours of free CME credit. Qualified medical evaluators (QMEs) may report up to one- and one-half hours of credit for QME reappointment. The course is also available to anyone else wishing to learn about the MTUS, and a completion certificate is available.  The education module covers:
    • What the MTUS is, how to use it, and how you may be able to obtain free online access to the MTUS-ACOEM treatment guidelines;
    • How to navigate the MTUS-ACOEM treatment guidelines and apply recommendations for patient care;
    • The MTUS Drug Formulary;
    • When to consider recommendations outside of the MTUS guidelines for the care;
    • When to consider recommendations outside of the MTUS guidelines for the care of your patient; and
    • The role of utilization review (UR) and independent medical review (IMR) physicians.

To view additional information regarding the education module, go to https://www.dir.ca.gov/dwc/CaliforniaDWCCME.htm.

Colorado VIEW STATE →

REGULATORY ACTIVITY:

  • Posted notice of a proposed amendment to Rule 5 Claims Adjusting Requirements.  To view the proposed rule, go to https://www.colorado.gov/pacific/cdle/workers-compensation-proposed-and-adopted-rules.  A date for public hearing has not been announced.
  • A notice of a public hearing to afford all interested persons an opportunity to be heard prior to the adoption of proposed amendments to the Workers’ Compensation Rules of Procedure, 7 C.C.R. 1101-3 was given for November 4, 2019 at 10:00 am at 633 17th Street, Denver, Colorado.  The Director of the Division of Workers’ Compensation has the authority to promulgate rules pursuant to the Workers’ Compensation Act as set forth in section §8-47-107. The public hearing will be held in accordance with the provisions of the Colorado Administrative Procedures Act, section 24-4-103, CRS.  Any interested party is invited to appear at the hearing and testify or to submit written data, arguments or position papers to Paul Tauriello, Director, Division of Workers’ Compensation, 633 17th Street, Suite 400, Denver, CO 80202.  Any written submissions should be submitted to the Director prior to the hearing.   The topics to be considered are:  Rule 16-7(A) and 16-11(B) (2).   The proposed rule changes will be available at the Department’s website on or before September 3, 2019, 2019.  Copies of the proposed rules will also be available by request at the Division’s Customer Service Office, 633 17th Street, 4th Floor, Denver, Colorado.  To view information on the proposed rule, go to https://www.colorado.gov/pacific/cdle/workers-compensation-proposed-and-adopted-rules.

Colorado Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Issued draft bulletin 3-1.33. The purpose of this Bulletin is to provide guidance on how to send a request to the Division of Insurance for automobile policy information when the Division of Insurance is the registered agent of the automobile insurer, and to provide claimants and attorneys representing claimants with the process and forms to be used when requesting automobile policy information pursuant to § 10-3-1117, C.R.S. To view this bulletin, go to https://www.colorado.gov/pacific/dora/draft-bulletins-informal-public-comment.

Connecticut VIEW STATE →

REGULATORY ACTIVITY:

  • The Workers’ Compensation Commission issued an update to the Professional Guide for Attorneys, Physicians, and Other Health Care Practitioners Guidelines for Cooperation. This update deals specifically with the definitions and reimbursement rates for One-Time Medical Evaluations and Second Opinions. The changes were effective for dates of service beginning September 1, 2019. The updated Professional Guide for Attorneys, Physicians, and Other Health Care Practitioners Guidelines for Cooperation can be found at https://wcc.state.ct.us/download/acrobat/proguide.pdf. To view this notice, go to https://wcc.state.ct.us/.
  • Published memorandum no. 2019-08 regarding fee increase for Commissioner's Examinations and memorandum no. 2019-09 regarding commissioner's examination procedure.  Memorandum no. 2019-09 became effective on September 15, 2019.  To view the memorandums, go to https://wcc.state.ct.us/.

Delaware Auto VIEW STATE →

REGULATORY ACTIVITY:

Idaho VIEW STATE →

REGULATORY ACTIVITY:

Illinois VIEW STATE →

REGULATORY ACTIVITY:

  • Posted adoption of amended rules regarding electronic and paper billing by health care providers treating injured workers. The amended rule appeared in the August 30, 2019 State Register but became effective August 19, 2019.  Title 50: Insurance Chapter I Department of Insurance Subchapter hh Workers' Compensation Part 2908 Workers' Compensation Electronic and Standardized Paper Billing is the title of the amended rule.  To view the register, go to https://www.cyberdriveillinois.com/departments/index/register/home.html.
  • On September 23, 2019, Governor Pritzker appointed Kathryn Doerries as a Commissioner of the Illinois Workers’ Compensation Commission.  Chairman Michael J. Brennan and the IWCC welcome and congratulate Ms. Doerries.  Commissioner Doerries will preside on Panel A as the Business Member.

Iowa VIEW STATE →

REGULATORY ACTIVITY:

Kentucky VIEW STATE →

REGULATORY ACTIVITY:

Louisiana VIEW STATE →

REGULATORY ACTIVITY:

  • The  Louisiana  Workforce  Commission  intends to amend certain portions of the Medical Guidelines contained in the Louisiana Administrative Code, Title  40,  Labor  and  Employment,  Part  I,  Workers’ Compensation  Administration,  Subpart  2,  Medical Guidelines,  Chapter  21,  regarding  chronic  pain  guidelines. This  Rule  is  promulgated  by  the  authority  vested  in  the director  of  the  Office  of  Workers’  Compensation  found  in R.S. 23:1291 and R.S. 23:1310.1(C). To view the notice and proposed rules, go to https://www.doa.la.gov/Pages/osr/reg/regs2019.aspx, view the September Edition.

Maryland VIEW STATE →

REGULATORY ACTIVITY:

  • The Commission is pleased to announce that on September 10, 2019 Governor Larry Hogan appointed Morrisann Martinto the Maryland Workers’ Compensation Commission. Morrisann Martin is a graduate of Goucher College and earned her Juris Doctor from the University Of Baltimore School Of Law. After having spent 10 years in the insurance industry as an adjuster, claims supervisor, and home office examiner, her legal career has been in private practice as a partner at the firm of Downs, Ward, Bender, Hauptmann, and Herzog, P.A. (formerly Morgan Carlo Downs, P.A.) where she represented employers, insurers, uninsured employers, and self-insured employers before the Maryland Workers’ Compensation Commission and Circuit Courts. She is a member of the Maryland State Bar Association’s Negligence, Insurance, and Workers’ Compensation Section, as well as the Workers’ Compensation Section of Maryland Defense Counsel, Inc. She served numerous years on the board of MSIECA (Maryland Self-Insurers’ and Employers’ Compensation Association, Inc.), and has been a lecturer and presenter at the MWCEA annual conference.

Medicare VIEW STATE →

FEE SCHEDULE NEWS:

  • Physician – CMS has released the new Physician data tables effective October 1, 2019. The next expected update is January 1, 2020.
  • Clinical Lab – CMS has released new updates to the Clinical Lab data effective October 1, 2019. The next expected update is January 1, 2020.
  • HCPCS – CMS has released a new update to the HCPCS data effective October 1, 2019. The next expected update is January 1, 2020.
  • DMEPOS - CMS has released a new update to the DMEPOS data effective October 1, 2019. The next expected update is January 1, 2020.
  • ASC - CMS has released a new update to the ASC module effective October 1, 2019. The next expected update is January 1, 2020.
  • CMS has released a new update to the OPPS data effective October 1, 2019. The next expected update is January 1, 2020.
  • ASP Drugs - CMS has released a new update to the ASP Drugs data effective October 1, 2019. The next expected update is January 1, 2020.

Michigan VIEW STATE →

REGULATORY ACTIVITY:

  • The Workers’ Disability Compensation Agency is in the process of updating all of its forms to August 2019 editions to reflect the revised department and agency name as outlined in Executive Order 2019-13. These revisions do not affect any required data elements.

Michigan Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Published bulletin 2019-14-INS regarding annual adjustment of the maximum work loss benefit and survivors' loss benefit payable under policies of personal protection insurance.  This bulletin supersedes bulletin 2018-19-INS.
  • Posted a notice of new rules to be added regarding Utilization Review Rules (Insurance and Financial Services, Insurance). These rules are mandatory under Section 3157a of the Insurance Code, MCL 500.3157a, which was added by Public Act 21 of 2019. Section 3157a was intended to help lower overall costs of automobile insurance by ensuring that persons injured in motor vehicle accidents receive an appropriate level of care. Under that section, DIFS is required to promulgate rules that will establish criteria or standards for utilization review that identify utilization of treatment, products, services, or accommodations under the no-fault automobile insurance statute that are above the usual range of utilization based on medically accepted standards. “Utilization review” is the initial evaluation by an insurer or the Michigan Catastrophic Claims Association of the appropriateness, based on medically accepted standards, of the level and the quality of treatment, products, services, or accommodations provided under personal protection insurance benefits. The rules must include a process by which medical providers submit records to, and comply with, any decision of, DIFS regarding utilization review. To view the posting, go to https://dtmb.state.mi.us/DTMBORR/AdminCode.aspx?AdminCode=Department&Dpt=IF&Level_1=Insurance.

Minnesota VIEW STATE →

FEE SCHEDULE NEWS:

  • The Department of Labor and Industry has adopted new Medical, Outpatient and ASC and Inpatient Fee Schedules with an effective date of October 1, 2019. The next updates are expected October 2020.

Mississippi VIEW STATE →

REGULATORY ACTIVITY:

  • Previous amendments to Rule 2.12 have been in effect for almost two years. A review of all other states’ practices indicated many states have perimeters to protect future medical benefits in settlement. After the implementation of previous Rule changes, feedback from the parties practicing before the Commission, and research concerning other jurisdictions, Rule 2.12 required adjustments concerning fees on the basis of fairness to both attorney and client pursuant to Miss. Code Ann. 71-3-63.  The following link contains the proposed changes: https://www.sos.ms.gov/adminsearch/ACProposed/00024417b.pdf.  To view the notice, go to https://mwcc.ms.gov/#/LawsMore.

Montana VIEW STATE →

REGULATORY ACTIVITY:

  • The Department is proposing to update the existing rule to incorporate by reference the current ODG Drug Formulary available at the website: http://erd.dli.mt.gov/work-comp-claims/medical-regulations/formulary. Concerned persons may comment orally or in writing at the public hearing. Public comment can also be submitted to Jason Swant, Department of Labor & Industry, 1805 Prospect Avenue, Helena, MT 59624-1728, Tel: (406) 444-6451 TDD/Montana Relay Service/etc.*711.
  • On October 16, 2019, at 11:00 a.m., the Classification Review Committee will hold a public hearing in the basement conference room of the Montana Commissioner of Securities and Insurance, at Helena, Montana, to consider the amendment of ARM 6.6.8301 pertaining to establishment, deletion, or revision of classifications for various industries for supplementing the NCCI Basic Manual for Workers' Compensation and Employers Liability.

Nevada VIEW STATE →

REGULATORY ACTIVITY:

New Hampshire VIEW STATE →

REGULATORY ACTIVITY:

New Jersey WC VIEW STATE →

REGULATORY ACTIVITY:

  • Posted notice of 2020 maximum workers' compensation benefits rates for temporary disability, permanent total disability, permanent partial disability, and dependency under the Workers' Compensation Law.  Because a 60-day comment period has been provided in this notice of proposal, this notice is excerpted from the rulemaking calendar requirement pursuant to N.J.A.C. 1:30-3.3(a) 5. The proposed amendment will ensure that payments to workers' compensation recipients entitled to maximum benefits will increase in line with the upward trend of wages in the State's economy, thus, preserving the real purchasing power of their benefits. The proposed amendments will increase from $921.00 to $945.00, the weekly benefit rate received by individuals eligible for the maximum weekly benefit rate for temporary disability, permanent total disability, permanent partial disability, and dependency under the Workers' Compensation Law. The 2020 maximum benefit rate represents a 2.6 percent increase in the current maximum benefit rate.

New Mexico VIEW STATE →

REGULATORY ACTIVITY:

New York VIEW STATE →

REGULATORY ACTIVITY:

  • The New York State Workers’ Compensation Board is developing a web-based Medical Portal to submit medical information and access other Board information electronically. The Portal will be available in the upcoming weeks. To help medical providers learn more, the Board has created five-minute training video that explains how to access the Portal. For an overview of the Medical Portal, go to http://www.wcb.ny.gov/medicalportaloverview/.
  • In preparation for the NYS Workers’ Compensation Board Drug Formulary Prior Authorization System, the Board has created a Drug Formulary Administration webpage providing detailed instructions and requirements for entering payer contact information for the system. On September 5, 2019, payers were able to start using the Formulary Administration application to enter their Level 1, Level 2, and Order of the Chair contacts for their organization. To enter Formulary contacts, each payer’s eClaims administrator must log into the online Formulary Administration application using their NY.gov ID and password. To view the Drug Formulary Administration website, go to http://www.wcb.ny.gov/content/ebiz/drugformulary/.
  • The Chair has proposed amendments to 12 NYCRR §300.14 that clarify the process governing applications to reopen a claim. This proposal was published in the September 11, 2019, State Register. The proposal also includes minor clarifications to 12 NYCRR §300.13. The Board will be accepting comments from the public until November 12, 2019. The proposed changes are available on the Board’s website. See: Proposed Amendment of 12 NYCRR 300.13 and 300.14.  To view the rules, go to http://www.wcb.ny.gov/content/main/wclaws/Part-300_13_300_14/.
  • The Workers’ Compensation Board is offering new resources to assist in the transition to Form CMS-1500, which will streamline medical billing and reduce the paperwork requirements currently in the workers’ compensation system. The Board has developed a training video to show health care providers, and all others who will be using Form CMS-1500, how to use the form and the required narrative reports to bill for their services to workers’ compensation patients.  To view the training video, follow this link: CMS-1500 Training Video or go to https://www.youtube.com/watch?v=CHJwAvSJ_eM.

North Carolina VIEW STATE →

REGULATORY ACTIVITY:

  • North Carolina Industrial Commission is pleased to announce the appointment of Erin F. Taylor as a Deputy Commissioner. Ms. Taylor has an extensive background in workers’ compensation law, having practiced for over 20 years as a workers’ compensation attorney at the law firm of Cranfield, Sumner & Hertzog, LLP. Her areas of workers’ compensation expertise include asbestos-related claims and other occupational diseases. Ms. Taylor has been a frequent speaker at Continuing Legal Education seminars, where she has presented on a variety of workers’ compensation topics, including return to work issues, communications with medical providers, case law updates, and Medicare issues. She earned her J.D. from Campbell University School of Law, where she was an academic scholarship recipient. Ms. Taylor will be hearing cases assigned to the Charlotte Regional Office.
  • The North Carolina Industrial Commission has established the maximum weekly benefit for 2020 pursuant to N.C. Gen. Stat. § 97-29. Effective January 1, 2020, the maximum weekly benefit applicable to all injuries and claims arising on and after January 1, 2020, shall be one thousand sixty-six dollars ($1,066.00).

Oklahoma VIEW STATE →

REGULATORY ACTIVITY:

  • In a move toward greater efficiency, cost reduction, and improved customer service in state government, the Oklahoma Workers’ Compensation Commission (WCC) and the Court of Existing Claims (CEC) are consolidating their Tulsa courtroom and office space. The two agencies have inked an agreement which will provide for combined operations in the Houston Avenue state office building in downtown Tulsa. “This agreement is an opportunity to take advantage of economies of scale and introduce some common sense into a governmental operation.” said Commissioner Mark Liotta, Chairman of the WCC. “The WCC is the follow-on agency to the CEC as it winds down, we manage very similar operations, just with different jurisdictional dates. There is no continuing reason for us to maintain separate spaces in Tulsa.” The Presiding Judge of the CEC,  L. Brad Taylor, commented, “While the CEC and the WCC are separate branches of government, both strive through a continuing relationship of cooperation to serve the great State of Oklahoma and further support Governor Stitt’s vision of Oklahoma being a top 10 state.” The savings will be seen in an overall reduction of office space being leased by the Commission. The WCC is giving up the majority of its office space and moving into available offices within the CEC. Injured workers and employers who have cases before either agency will share waiting areas, attorney conference areas, and other common areas. The newly abandoned office space, about half of the WCC’s current lease, will become available for the state Office of Management Enterprise Services to lease to other agencies needing room as of September 1, 2019. Further, the WCC and CEC will share reception staff, which will reduce labor costs. “I applaud the CEC and WCC for prioritizing efficiency and cost savings for the taxpayer as they consolidate their Tulsa operations,” said Governor Stitt. With legislation passed in Oklahoma’s most recent session, the CEC will continue to wind down operations, reducing from four full-time judges on July 1, 2020, to one appointed by the Governor. The CEC will use retired active judges to staff their three-judge panel for appeals and continue to operate a courtroom in Tulsa as well. Oklahoma’s workers’ compensation system was reformed in 2013, establishing the WCC, which became fully operational February 1, 2014.  The WCC provides a forum for workers’ compensation hearings and appeals, ensures workers' compensation insurance compliance by all employers, and regulates organizations who wish to self-fund their workers’ compensation obligations. Although an executive branch, administrative and regulatory agency, the WCC exercises the State’s judicial authority, making it a hybrid, quasi-judicial agency.

Oregon VIEW STATE →

REGULATORY ACTIVITY:

  • Each year, the Department of Consumer and Business Services adopts by rule the workers’ compensation premium assessment rate that is paid by employers to fund workers’ compensation and workplace safety and health programs. The rule also adopts the rate for an additional amount that is collected from all self-insured employers and self-insured employer groups to fund the Self-Insured Employers Adjustment Reserve and the Self-Insured Employer Group Adjustment Reserve. These funds ensure worker benefits are available in the event of a financial failure of a self-insured employer or self-insured employer group. Before recommending the 2020 rate, the department must analyze financial data and review and authorize a proposed workers' compensation pure premium rate filing by the National Council on Compensation Insurance. The proposed premium assessment rate for 2020 is expected to be announced by mid-September. Additional assessments to fund the Self-Insured Employer Adjustment Reserve and Self-Insured Employer Group Adjustment Reserve are also expected to remain unchanged. These are preliminary rates and are subject to change during the rulemaking process. This rulemaking will adopt the assessment rates that will be in effect from Jan. 1, 2020, to Dec. 31, 2020.
  • The Oregon Workers’ Compensation Division has posted proposed OAR 436-070, Workers’ Benefit Fund (WBF) Assessment, to: https://wcd.oregon.gov/laws/Pages/proposed-rules.aspx. Rule 0003 includes the effective date for OAR 436-070, and this date will be revised from Jan. 1, 2019 to Jan. 1, 2020. Rule 0010 will set the 2020 Workers’ Benefit Fund assessment rate. Analysis to determine the rate is ongoing.
  • The Oregon Workers’ Compensation Division has published temporary rules, OAR 436-035, effective Sept. 3, 2019. The revised rules reflect the decision of the Oregon Supreme Court in Caren v. Providence Health System Oregon, 365 Or 466 (2019). The court concluded that, before impairment can be apportioned based on a preexisting condition, there must be an accepted and denied combined condition. Some provisions in the rules were not consistent with this requirement. Summary of changes:
    • Amended rule 0007 explains when pre-existing conditions can and cannot be apportioned in determining awards for permanent impairment and that the loss must be caused in material part by the injury.
    • Amended rule 0012 explains how preexisting conditions affect the determination of work capacity (residual functional capacity).
    • Amended rule 0014 explains when a combined condition can and cannot be considered in determining permanent impairment.

Temporary rules are effective for a maximum of 180 days. Standard (permanent) rulemaking will be almost immediately to develop replacement rules.

  • Issued Bulletin Number 382 regarding retroactive program benefits effective October 1, 2019. This bulletin notifies insurers of: The annual increase in Retroactive Program benefits; and the methods used to calculate these benefits and determine the amount of Retroactive Program reimbursement. The Retroactive Program benefit, established by ORS 656.506(7) and administered under OAR chapter 436 division 075, is an additional amount paid to eligible workers or their beneficiaries when benefit levels are lower than what is currently being paid for like injuries. Program recipients are primarily workers previously determined to have a permanent total disability and beneficiaries of workers who suffered fatal injuries.   To view the bulletin, go to https://wcd.oregon.gov/forms/Pages/bulletins.aspx.
  • Issued a revised Bulletin Number 112 regarding reimbursement of injured workers' travel, food, and lodging costs.  The state has also issued a revised form 3921.  To view additional information, go to https://wcd.oregon.gov/forms/Pages/bulletins.aspx.
  • The Oregon Workers' Compensation Board published the August edition of Board News and Case Notes.  To view the August edition, go to https://www.oregon.gov/wcb/Pages/index.aspx.
  • Each year, the Department of Consumer and Business Services adopts by rule the workers' compensation premium assessment rate that is paid by all employers to fund workers' compensation and workplace safety and health programs. In the “Notice of Proposed Rulemaking Hearing,” filed with the Secretary of State on Aug. 29, 2019, the department explained that a proposed premium assessment rate would be announced by the middle of September. Based on economic forecasts, department analysts recommend a premium assessment rate of 8.4 percent. The proposed increase from 7.8 percent to 8.4 percent will allow the department to maintain current service levels throughout 2020.  Additional assessments to fund the Self-Insured Employer Adjustment Reserve and Self-Insured Employer Group Adjustment Reserve are expected to decline by 50 percent from 2019 levels. However, these too are proposed rates and are subject to change during the rulemaking process. To view the documents regarding these rules, go to https://www.oregon.gov/dcbs/cost/Pages/rulemaking.aspx.  The notice of the rule and additional information regarding the rule is attached.

OWCP VIEW STATE →

FEE SCHEDULE NEWS:

  • The U.S. Department of Labor’s Office of Workers’ Compensation Programs has adopted new schedules for anesthesia services, ambulatory surgical centers, RRC Codes, Procedure Codes, RVU and Conversion Factors and Geographic Practice Costs with an effective date of August 30, 2019.

REGULATORY ACTIVITY:

  • Injured workers that are newly prescribed opioids will be limited to an initial 7-day supply. An injured worker may receive a maximum of four sequential 7-day supply prescriptions (an initial and three subsequent prescriptions), a total of 28 days, before prior authorization is required. For additional opioid prescriptions exceeding the initial 28-day period, the prescribing physician will need to submit a form certifying the medical necessity of continued opioid use for approval from OWCP.  To view additional information, go to https://www.dol.gov/owcp/dfec/opioidactionplan.htm.

Pennsylvania WC VIEW STATE →

FEE SCHEDULE NEWS:

  • The state has adopted changes to the PAWC Part A and Part B Fee Schedule services with an effective date of October 1, 2019. The next update is expected in January 2020.

South Carolina VIEW STATE →

REGULATORY ACTIVITY:

  • Issued a report for FY 2019 regarding the fines and fees collected during the fiscal year.  To view the report, go to https://wcc.sc.gov/news/2019-09/2019-fines-and-fees-report-proviso-11773.
  • South Carolina Workers’ Compensation Commission is pleased to announce the new portal, KERMIT (Key Element Reporting Management & Incident Tracking), to provide easier access and better service for Claimants, Carriers, Attorneys, Self-Insureds and Trading Partners. KERMIT allows all parties involved in workers’ compensation claims to submit claims, complete required reports and forms and pay any applicable fees and fines electronically. KERMIT will go live on October 28, 2019! The previous portal, eCase, will no longer be used, and ALL users will have to re-register for an account with KERMIT.  In addition, to KERMIT, South Carolina Workers’ Compensation will also be going live with the release of the IAIABC EDI Claims 3.1 XML format for data reporting on December 4, 2019. To view this notice, go to https://wcc.sc.gov/it-kermit-system-updates.

Texas VIEW STATE →

FEE SCHEDULE NEWS:

  • A new Home Health and Dental Fee Schedule have been adopted with an effective date of September 5, 2019.

REGULATORY ACTIVITY:

  • The Texas Department of Insurance has issued bulletin B-0008-19 reminding health plans, pharmacy benefit managers, and utilization review agents of the utilization review and adverse determination requirements and the changes starting September 1, 2019. To view the bulletin, go to https://www.tdi.texas.gov/bulletins/2019/B-0008-19.html.
  • Published notice of proposed new rules to implement Senate Bill 935 enacted this past calendar year. 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 a federal military treatment facility (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 the notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html. To view the rules, go to https://www.tdi.texas.gov/wc/rules/2019rules.html.
  • The Texas Department of Insurance issued a bulletin on August 28 reminding health plans, pharmacy benefit managers, and utilization review agents that a pharmacist cannot deny a physician’s order for a drug or treatment over questions of medical necessity or appropriateness. That bulletin has been amended to clarify specialty physician reviews. The Texas Department of Insurance reminds health plans, pharmacy benefit managers, and utilization review agents (URAs) that only appropriate physicians, doctors, or health care providers may issue adverse determinations. Under Texas law and rules, a pharmacist cannot deny a physician’s order for a drug or treatment over questions of medical necessity or appropriateness. Title 28, Section 19.1705(d) of the Texas Administrative Code requires that “adverse determinations must be referred to and may only be determined by an appropriate physician, doctor, or other health care provider … to determine medical necessity or appropriateness, or the experimental or investigational nature, of health care services.” In addition, the treating physician must be given the opportunity for a peer-to-peer discussion about the treatment plan before the URA issues an adverse determination. Title 28, Section 19.1710 of the Texas Administrative Code requires that the discussion “include, at a minimum, the clinical basis for the URA's decision and a description of documentation or evidence, if any that can be submitted by the provider of record that, on appeal, might lead to a different utilization review decision.”  Beginning September 1, 2019, Senate Bill 1742 from the 86th Texas Legislature requires that all utilization reviews for services ordered by a physician must be reviewed by a licensed physician. Specialty physicians have the option of requesting that a denial or a denial of an appeal be reviewed by a physician of the same or similar specialty. TDI will continue to review compliance with utilization review rules as part of regular audits and exams. Any health plan out of compliance faces potential disciplinary action, including administrative penalties. To view the amended bulletin, go to https://www.tdi.texas.gov/bulletins/index.html.
  • The Texas Department of Insurance, Division of Workers' Compensation (DWC) has revised DWC Form-073, Work Status Report. The revised form is available at tdi.texas.gov/forms/form20numeric.html.  The revised DWC Form-073 reflects that advanced practice registered nurses (APRNs) may complete and file the form as authorized by House Bill (HB) 387 (86th Legislature, Regular Session, 2019). Other changes were made to the form to make it appear less cluttered and to update unnecessary, outdated information.   On August 7, 2019, DWC posted a proposed draft of DWC Form-073 and requested informal comments. Because the draft was not a formal rule proposal under the Administrative Procedures Act, comments were not treated as formal public comments. However, based on the comments received, DWC made further revisions to the form.  To view the notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html. 
  • Issued bulletin B-009-19 regarding legislation enacted in the 86th Legislature, Regular Session 2019.This bulletin provides summaries of selected bills enacted by the 86th Legislature that affect workers’ compensation and may be relevant to individuals and entities regulated by the Texas Department of Insurance, Division of Workers’ Compensation (DWC). DWC is only providing summary information in this bulletin regarding particular provisions of the bills that may apply to the regulation of workers’ compensation. Please refer to the actual bills for the complete content of the legislation. Bills listed in this bulletin will link directly to the bill text. You may also access the bills, as well as other legislative information, at the Texas Legislature Online website at https://capitol.texas.gov/.  While DWC encourages use of this bulletin to aid in your compliance efforts, individuals and entities regulated by DWC are responsible for ensuring compliance with all enacted legislation affecting the business they conduct.
  • Texas has published the statewide average weekly wage/maximum and minimum weekly benefits effective October 1, 2019 - September 30, 2020. The statewide average weekly wage is $971.71.  To view the complete listing of benefits effective October 1, 2019 go to, https://www.tdi.texas.gov/wc/employee/maxminbens.html.

Washington VIEW STATE →

REGULATORY ACTIVITY:

  • The Washington State Department of Labor & Industries has issued an update to its coverage decision on Proton Beam Therapy (Re-review). Based on a Health Technology Clinical Committee coverage determination finalized on July 12, 2019, the department's new decision covers proton beam therapy for additional types of primary cancer and is effective on October 1, 2019. Proton beams have less scatter radiation than other sources of energy (e.g., gamma rays and x-rays). Because of this feature, proton beam can deliver high doses of radiation to the tumor while limiting the “scatter” dose received by surrounding tissues. Proton beam therapy is used to treat tumors located deep within the body and close to critical organs and body structures. Coverage decision: Covered with conditions (Effective date: October 1, 2019).  To view the coverage decision, go to http://www.lni.wa.gov/ClaimsIns/Providers/TreatingPatients/ByCondition/ProtonBeamTherapy.asp?utm_medium=email&utm_source=govdelivery
  • The Washington State Department of Labor & Industries announces changes to the Outpatient Drug Formulary and Selected Preferred Drug List effective October 1, 2019.  The changes are available for review in the online Outpatient Drug Formulary and Selected Preferred Drug List PDF documents. Summary of changes: new drug classes added: A6W, C4X, C4Y, H1D, H8V, J8E, V10, Z0K.  To view additional information on the Outpatient Drug Formulary and Selected Preferred Drug List, go to https://www.lni.wa.gov/ClaimsIns/Providers/TreatingPatients/Presc/default.asp.

West Virginia VIEW STATE →

REGULATORY ACTIVITY:

  • Posted a notice regarding Workers' Compensation Independent Medical Examiners (IME) on September 3, 2019.  The notice is a reminder of duties of a provider to provide credentials to whoever they provide services to.  To view the notice, go to https://www.wvinsurance.gov/.

Wisconsin VIEW STATE →

FEE SCHEDULE NEWS:

  • A new Hospital Radiology Database has been released retroactive to July 1, 2019. The next update is expected in January 2020.

Wyoming VIEW STATE →

REGULATORY ACTIVITY:



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