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Alaska VIEW STATE →

FEE SCHEDULE NEWS:

  • Alaska Workers’ Compensation Division has adopted a new fee schedule and new conversion factors with an effective date of 01/01/2020. The next expected update is January 2021.

REGULATORY ACTIVITY:

  • Published Bulletin 19-06 regarding payment for fatalities on or after January 1, 2020, but on or before December 31, 2020. To view the bulletin, to go http://labor.alaska.gov/wc/bulletins.htm  
  • Published a notice of a public meeting: The Alaska Workers' Compensation Board will conduct a full board meeting, January 9 -10, 2020. This meeting is open to the public and will begin at 9:00am. The meeting will be held at the following location: Department of Labor Building; 3301 Eagle Street, Hearing Room 208, Anchorage, Alaska. The agenda consists of the regular business of the Workers' Compensation Board and Division, consisting of but not limited to discussion of issues pertaining to the Alaska Workers’ Compensation Act, and approval of potential changes to regulations. The Board will also conduct other business as necessary and useful. To view the notice, go to https://aws.state.ak.us/OnlinePublicNotices/Notices/View.aspx?id=196371

California VIEW STATE →

FEE SCHEDULE NEWS:

  •  The DWC has published a new file for Medi-Cal rates effective December 15, 2019. There were no changes to the database. The next update is expected January 15, 2020. 
  • The Division of Workers’ Compensation (DWC) has posted an order adjusting the Physician Services/Non-Physician Practitioner Services section of the Official Medical Fee Schedule (OMFS) to conform to relevant 2020 changes in the Medicare payment system as required by Labor Code section 5307.1. The Administrative Director update order adopting the OMFS adjustments effective for services rendered on or after January 1, 2020, can be found at https://www.dir.ca.gov/dwc/OMFS9904.htm#7 . The next update is expected April 2020. 
  • The Division of Workers’ Compensation (DWC) has posted an order adjusting the Ambulance Services section of the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1. The update order is effective for services rendered on or after January 1, 2020. The next update is expected January 2021. 
  • The Division of Workers’ Compensation (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 2020 changes in the Medicare payment system as required by Labor Code section 5307.1. The order, which is effective for services on or after January 1, 2020, adopts the Medicare January 2020 annual DMEPOS Fee Schedule update. The order adopting the adjustment can be found https://www.dir.ca.gov/dwc/OMFS9904.htm#3 .

REGULATORY ACTIVITY:

  • Published a notice regarding Fiscal Year 2019/2020 Assessments for Workers' Compensation Administration Revolving Fund, Uninsured Employers Benefits Trust Fund, Subsequent Injuries Benefits Trust Fund, Occupational Safety and Health Fund, Labor Enforcement and Compliance Fund and Workers' Compensation Fraud Account. To view the notice, go to https://www.dir.ca.gov/dwc/dwc_home_page.htm.
  • The Division of Workers’ Compensation (DWC) has issued an order updating the Medical Treatment Utilization Schedule (MTUS) Drug List effective January 15, 2020 pursuant to Labor Code section 5307.29. The Administrative Director’s update order adopts changes to the MTUS Drug List, based on the American College of Occupational and Environmental Medicine (ACOEM) Practice Guidelines, including the following: New drug recommendations addressed in the Hip and Groin Disorder Guideline. The updated MTUS Drug List v.6 and the order can be accessed at https://www.dir.ca.gov/dwc/MTUS/MTUS-Formulary-Orders.html . To view this notice, go to https://www.dir.ca.gov/dwc/dwc_home_page.htm .

Colorado VIEW STATE →

FEE SCHEDULE NEWS:

  •  A new update to the Medical and Hospital Fee Schedule effective 1/1/2020 has been released.

REGULATORY ACTIVITY:

  • Colorado published notice that two adopted rules become effective on January 1, 2020: 7 CCR 1101-3 Workers' Compensation Rules of Procedure with Treatment Guidelines Rule 16 Utilization Standards and Base Rates and Cost to Charge Ratios; and 7 CCR 1101-3 R 18 Rule 18 Exhibit 8 (2019 Clinical Diagnostic Laboratory Fee Schedule.

Colorado Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Published a revised draft of bulletin B-5.26 for comment regarding requirements related to disputed claims subject to appraisal. The purpose of this bulletin is to clarify the position of the Colorado Division of Insurance (“Division”) regarding the consumer’s rights when there is a dispute over the amount of loss during the claim handling process. Specifically, the bulletin provides guidance to insurers, insureds and licensed public adjusters, when a person or entity invokes their rights under the appraisal clause found in most, if not all, property insurance policy contracts. Bulletins are the Division’s interpretations of existing insurance law or general statements of Division policy. Bulletins themselves establish neither binding norms nor finally determine issues or rights. To view the bulletin, go to https://www.colorado.gov/pacific/dora/draft-bulletins-informal-public-comment . 
  • Adopted Bulletin B-1.33 regarding process for a claimant or a claimant’s attorney to request commercial or personal automobile policy information from an insurer. 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., on or after January 1, 2020. The bulletin can be found at https://www.colorado.gov/pacific/dora/node/94966?utm_medium=email&utm_source=govdelivery. 
  • Adopted Bulletin 1.34 regarding guidance for insurers providing automobile liability information pursuant to § 10-3-1117, c.r.s. The purpose of this Bulletin is to provide guidance to Insurers concerning the Division’s process for handling requests for automobile policy information made on or after January 1, 2020, when the Division of Insurance is the registered agent of the automobile insurer. The bulletin can be found at https://www.colorado.gov/pacific/dora/node/94966?utm_medium=email&utm_source=govdelivery

Connecticut VIEW STATE →

FEE SCHEDULE NEWS:

  • New Ambulance rates effective 1/1/2020 have been released. The next update to Ambulance rates is expected in January 2021.

REGULATORY ACTIVITY:

  • Published bulletin 2019-14 on December 20, 2019 regarding an update to Professional Guide for Attorneys, Physicians and Other Health Care Practitioners Guidelines for Cooperation. To view the bulletin, go to https://wcc.state.ct.us/memos/2019/2019-14.htm . This update deals specifically with the definitions to the roles of Physician Assistants and Advanced Practice Registered Nurses, to bring them in line with Memorandum No. 2018-04 and the Official Connecticut Practitioner Fee Schedule Guidelines.

Delaware VIEW STATE →

REGULATORY ACTIVITY:

Florida WC VIEW STATE →

REGULATORY ACTIVITY:

  •  The Florida Department of Economic Opportunity has determined the statewide average weekly wage paid by employers subject to the Florida Reemployment Assistance Program Law to be $970.58 for the four calendar quarters ending June 30, 2019. Section 440.12(2), Florida Statutes (2019), expressly provides that, for injuries occurring on or after August 1, 1979, the weekly compensation rate shall be equal to 100 percent of the statewide average weekly wage, adjusted to the nearest dollar, and that the average weekly wage determined by the Department of Economic Opportunity for the four calendar quarters ending each June 30 shall be used in determining the maximum weekly compensation rate with respect to injuries occurring in the calendar year immediately following. Accordingly, the maximum weekly compensation rate for work-related injuries and illnesses occurring on or after January 1, 2020, shall be $971.00. To view this notice, go to https://www.myfloridacfo.com/Division/WC/noticesRules.htm. To view the bulletin, go to https://www.myfloridacfo.com/Division/WC/bulletins.htm .

Hawaii No-Fault VIEW STATE →

FEE SCHEDULE NEWS:

  • The state has adopted a new fee schedule effective January 1, 2020. The next update is expected January 2021.
  •  The state has adopted a new Ambulance fee schedule effective January 1, 2020. The next update is expected January 2021.

Hawaii WC VIEW STATE →

FEE SCHEDULE NEWS:

  •  The state has adopted a new fee schedule effective January 1, 2020. The next update is expected January 2021.

REGULATORY ACTIVITY:

Illinois VIEW STATE →

FEE SCHEDULE NEWS:

  •  The medical and facility fee schedules have been updated with an effective date of January 1, 2020. The next update is expected in January 2021.

REGULATORY ACTIVITY:

  •  The Chairman has ordered that stamped copies of documents will be limited to 8 copies each. This order is effective December 9, 2019. To view this order, go to https://www2.illinois.gov/sites/iwcc/news/Pages/news.aspx#iwcc-111 
  • The Governor has appointed eight new arbitrators. The new arbitrators are: Joseph D. Amarilio, Buffalo Grove, IL; Deborah J. Baker, Chicago, IL; Linda Jean Cantrell, Marion, IL; Christopher A. Harris, Chicago, IL; Adam Hinrichs, Geneseo, IL; Elaine Llerena, Chicago, IL; William J. McLaughlin, Tinley Park, IL; and Dennis S. O’Brien, Springfield, IL.
  • Proposed an amendment to Administrative Code 9110 by adding a new section 9110.100 regarding explanation of benefits.
  • Notice of Arbitrator Assignments Effective January 1, 2020 The following Arbitrators will be assigned and/or reassigned to the following Chicago Calls, effective January 1, 2020:
  • Arbitrator Joseph Amarilio will take the Call previously designated as TBA.
  • Arbitrator Elaine Llerena will take the Call previously designated as Cellini.
  • Arbitrator Christopher Harris will take the Call previously designated as TBA4.
  • Arbitrator William McLaughlin will take the Call previously designated as Robert Harris.
  • All other Chicago Assignments will remain as reported previously.

The following Arbitrators will be assigned and/or reassigned to the following Zones, effective January 1, 2020:

  • Zone 1: Arbitrator Linda Cantrell will replace Arbitrator Edward Lee. Arbitrators Gallagher and Nowak will continue to serve in Zone 1.
  • Zone 2: Arbitrator Dennis O’Brien will take the call previously designated as TBA5. Arbitrator Lee will take the call that was designated as Cantrell. Arbitrator Pulia will remain in Zone 2.
  • Zone 3: Arbitrator Adam Hinrichs will take the call previously designated as Paul Seal. Arbitrators Rowe-Sullivan and Granada will continue to serve in Zone 3.
  • Zone 4: Arbitrator Cellini will take the call previously designated as Dollison. Arbitrator Doherty will take the call previously designated as TBA 2 and Arbitrator Hegarty will take the call previously designated as Erbacci.
  • Zone 5: Arbitrator Erbacci will take the call previously designated as Hegarty. Arbitrator Seal will take the call previously designated as Doherty and Arbitrator Glaub will remain in Zone 5.
  • Zone 6: Arbitrator Robert Harris will take the call previously designated as Ory. Arbitrators Soto and Friedman will remain in Zone 6.

Iowa VIEW STATE →

REGULATORY ACTIVITY:

  • The Iowa Division of Workers' Compensation (DWC) has used charge accounts to bill for records requests. DWC uses its 1970s legacy mainframe system to administer charge accounts for records requests. Because of DWC's transition off of its 1970s legacy mainframe system, it will no longer use charge accounts to bill for records requests beginning on March 2, 2020. Beginning March 2, 2020, DWC will do the following to bill for records requests: Send a separate invoice for each records request to the requestor. After receipt of payment for the records from the requestor, release the records to the requestor. To view this notice, go to https://www.iowaworkcomp.gov/effective-march-2-2020-change-billing-practices-records-requests
  • Published notice of a new tool online. The Iowa Division of Workers' Compensation (DWC) requires the use of agency forms for certain filings. To view and use the new forms tool, go to https://www.iowaworkcomp.gov/forms 

Maine VIEW STATE →

FEE SCHEDULE NEWS:

  •  The state has adopted changes to the physician, outpatient and ASC facility fee schedule with an effective date of January 1, 2020. The next medical fee schedule update is expected in January 2021.

REGULATORY ACTIVITY:

Maryland VIEW STATE →

FEE SCHEDULE NEWS:

  • The state has adopted a new Medical Fee Schedule effective January 1, 2020. The next update is expected in January 2021.

REGULATORY ACTIVITY:

  •  Posted calendar year 2020 Medical Fee Guide including Maryland Specific Conversion Factors; Medical Services and Treatment Reimbursement rates; Ambulatory Surgery Centers Reimbursement Rates; Anesthesiology Base unit and calculation; Orthopedic/Neurological Surgical CPT Codes; CPT codes not valued by CMS and miscellaneous information. To view the documentation, go to http://www.wcc.state.md.us/MFG/Medical_Fee_Schedule.html 
  • Enhancements to NCCI’s Workers Compensation Coverage Verification (WCCV) now include the “Track Policy” service that allows users to be notified via email when a cancellation and subsequent reinstatement transaction is received for a chosen policy. The email notice sent will note a cancellation or reinstatement and include the employer name the user searched on, the policy number, the coverage search date, and the cancellation or reinstatement effective date. The option is available from the search results page.

Massachusetts VIEW STATE →

REGULATORY ACTIVITY:

Medicare VIEW STATE →

FEE SCHEDULE NEWS:

  •  OPPS – CMS has released new updates to the hospital outpatient fee schedule with an effective date of January 1, 2020. The next expected update is April 2020. 
  • ASC – CMS has released a new update to the ASC fee schedule with an effective date of January 1, 2020. The next expected update is April 2020.
  • Clinical Laboratory – CMS has released the new 2020 clinical laboratory fee schedule with an effective date of January 1, 2020. The next expected update is January 2021. 
  • Ambulance - CMS has released the new 2020 Ambulance fee schedule with an effective date of January 1, 2020. The next expected update is January 2021.

Michigan Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Issued bulletin 2019-26-INS regarding choice of bodily injury liability coverage limits form and personal injury protection (PIP) choice forms. This bulletin supersedes bulletin 2019-24-INS in order to re-publish choice of bodily injury liability coverage limits form and Michigan selection of personal injury protection medical coverage forms. To view the bulletin, go to https://www.michigan.gov/difs/0,5269,7-303-12900_12906---,00.html
  • Issued bulletin 2019-29-INS regarding Choice of Bodily Injury Liability Coverage Limits Form and Personal Injury Protection (PIP) Choice Forms. To view the bulletin, go to https://www.michigan.gov/difs/0,5269,7-303-12900_12906---,00.html 

Montana VIEW STATE →

REGULATORY ACTIVITY:

  •  The Commissioner of Securities and Insurance issued an Advisory Memorandum regarding asserting comparative negligence without adequate factual investigation. To view the memorandum, go to https://csimt.gov/laws-rules/advisory-memos/

Nebraska VIEW STATE →

FEE SCHEDULE NEWS:

  •  The state has adopted a new medical fee schedule and new Inpatient DRG/Trauma hospital rates with an effective date of January 1, 2020. The next update is expected in January 2021.

REGULATORY ACTIVITY:

New Hampshire VIEW STATE →

REGULATORY ACTIVITY:

New Jersey WC VIEW STATE →

REGULATORY ACTIVITY:

  •  Governor Murphy signed into law Senate Bill S1967 (N.J.S.A. 34:15-95.6) providing supplemental benefits to the dependents of public safety workers payable by the Second Injury Fund. Under this law, in order to process these benefits, all insurance carriers and self-insured employers responsible for the payment of workers’ compensation death benefits to dependents of public safety workers shall provide the N.J. Division of Workers’ Compensation - Office of Special Compensation Funds with the identities, including current mailing addresses, of said dependents, together with a copy of the formal award of dependency benefits and the calculation of the supplemental benefits, no later than the 60th day after the date on which it is determined that the payment of supplemental benefits to these dependent is required pursuant to this legislation. Failure to timely provide said information, including the correct calculation of benefits, to the Office of Special Compensation Funds resulting in the payment of an incorrect amount of benefits, shall result in the individual insurance carrier or self-insured employer’s liability for payment of said supplemental benefits. This law only provides for payment of supplemental benefits to those dependents who were formally awarded dependency benefits by a Judge of Compensation in the N.J. Division of Workers’ Compensation. If dependents of a public safety worker have not received a formal dependency award from a N.J. Judge of Compensation, but rather are receiving voluntary tendered dependency benefits, and wish to qualify for the new supplemental benefits, a Dependency Claim Petition to Convert Voluntary Tender to Formal Judgment Pursuant to N.J.S.A. 34:15-95.6 must be filed with the N.J. Division of Workers’ Compensation. Then, a claim for supplemental benefits will be processed as set forth above. To view this announcement, go to https://www.nj.gov/labor/wc/content/notices.html#Supp_Ben .

New Mexico VIEW STATE →

FEE SCHEDULE NEWS:

  • The state has adopted new hospital and healthcare provider fee schedules effective January 1, 2020. The next expected update is in January 2021.
  • The Gross Tax Receipts schedule has been updated for the period of January 1 through June 30th 2020. The next expected update is in July 2020.

New York VIEW STATE →

FEE SCHEDULE NEWS:

  •  The Chair has adopted the amendment of 12 NYCRR 329-1.3, Part 333, 348.2, and 301.3, as well as the addition of Part 329-4 incorporating updates to the medical fee schedules by reference to conform to the statute expanding provider types who can be authorized under the Workers’ Compensation Law. The Notice of Proposed Rule Making was published in the July 3, 2019, edition of the State Register. A Notice of Adoption was published in the December 11, 2019, edition of the State Register. The amendments became effective January 1, 2020. To view a copy of this notice, go to http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1239.jsp

REGULATORY ACTIVITY:

  •  Issued bulletin subject number 046-1232 regarding change in reimbursement rates for inpatient psychiatric exempt units of service. Pursuant to New York Public Health Law § 2807-c(6-1), the workers' compensation fee schedule for inpatient hospital care tracks New York Medicaid rates, with limited statutory modifications. The New York State Department of Health is required by statute to announce the workers' compensation inpatient rates. These rates, which also apply to treatment provided under the Comprehensive Motor Vehicle Reparations Act, Volunteer Firefighters' Benefit Law, and Volunteer Ambulance Workers' Benefit Law, are posted on the Board's website. Please see 2018 Medical Care Fee Schedules. The Centers for Medicare and Medicaid Services recently approved State Plan Amendment 18-0059, which increased the payment adjustment factor for psychiatric inpatient services provided to individuals that are 17 years of age or under from 1.0872 to 1.3597, effective July 1, 2018. This age adjustment payment factor is applied to the psychiatric operating per diem rate component. Please note that the rate schedule remains unchanged from the psychiatric rates previously certified effective July 1, 2018. Only the calculation file has been updated since the payment adjustment factor used to calculate the payment of a claim for individuals 17 years of age and under has changed. To view this bulletin, go to http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1232.jsp
  • Issued bulletin subject number 046-1233 regarding new 2019 reimbursement rates for acute per case inpatient hospital rates, exempt hospitals, exempt units and detoxification inpatient rates. The New York State Department of Health (DOH) recently provided the Workers' Compensation Board with updated reimbursement rates for acute per case inpatient rates for the period of January 1, 2019, through December 31, 2019. Rates of payments for these services are based upon rates determined for state governmental agencies (Medicaid) in accordance with Article 2807-c (6) (1). These rates also apply to treatment provided under the Comprehensive Motor Vehicle Reparations Act, Volunteer Firefighters' Benefit Law, and Volunteer Ambulance Workers' Benefit Law. Please see 2019 Medical Care Fee Schedules. For discharges beginning on and after July 1, 2019, the APR-DRG Service Intensity Weights (SIWs) cost thresholds and average length of stay (ALOS) effective July 1, 2018, should continue to be used for payment purposes, in conjunction with the APR-DRG 3M grouper version 34. Please note, that the rates on the schedules are based upon the same methodology used in the rates effective January 1, 2018, through December 31, 2018, but also take into consideration the following: o The inclusion of 2019 budgeted capital as reported by hospitals and calculated in accordance with Section 8 of Article 2807-c of the Public Health Law; o The removal of prospective rate adjustments, associated with the capital component of each of the inpatient rates, which had previously been included to reflect the reconciliation of budgeted to actual costs and utilization for the period of January 1, 2014 – December 31, 2015; o The inclusion of a 2019 trend factor of 2.2% based upon the initial Consumer Price Index (CPI) as published by the Congressional Budget Office and as required by Section 10 of Article 2807-c of the Public Health Law; o Adjustments to the acute, specialty hospital and critical access hospital rates, where applicable, as a result of Article 19 of the NYS Labor Law that established new minimum wage increases beginning January 1, 2019; o Rate appeal for Cobleskill Regional Hospital due to conversion from acute per discharge to Critical Access Hospital per diem reimbursement effective January 1, 2019; and o Rate appeal for Eastern Niagara Hospital due to change in teaching status and eligibility for Graduate Medical Education adjustments in their acute rates. To view this bulletin, go to http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1233.jsp
  • The New York Workers' Compensation Formulary (NY WC Formulary) became effective on Thursday, December 5, 2019, for all new prescriptions. Starting that day, all new prescriptions for injured workers in New York State had to be listed within the NY WC Formulary unless an alternative medication has been approved through the NYS Workers' Compensation Board's new prior authorization process. Effective December 5, 2019, the electronic prior authorization process was able be available to registered providers and carriers/self-insured employers through the Board's Medical Portal. Please visit http://www.wcb.ny.gov/content/main/hcpp/DrugFormulary/overview.jsp for: 
  • An overview of the NY WC Formulary and the prior authorization process 
  • The latest version of the NY WC Formulary (effective December 5, 2019) 
  • A video overview for medical providers 
  • A Quick Guide to the NY WC Formulary 
  • An NY WC Formulary Dashboard Guide for Medical Providers Information and resources related to the Board's Medical Portal are available on the Board's Medical Portal Overview webpage. For more information:
  •  General Formulary questions: email WCBFormularyQuestions@wcb.ny.gov
  • Technical Support questions: email WCBCustomerSupport@wcb.ny.gov
  • Subscribe to receive email notifications at: http://www.wcb.ny.gov/ notify To view this bulletin, go to http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1236.jsp
  • In 2013, the Board adopted a national standard (International Association of Industrial Accident Boards and Commissions' [IAIABC] Claims Electronic Data Interchange [EDI] Release 3.0) for Claim Administrators to electronically submit employer claims data. The electronic filing of claims data was instituted by the Board to provide timely, accurate, and credible electronic reporting. 12 NYCRR 300.22 was amended in 2014 to mandate First Report of Injury (FROI) and Subsequent Report of Injury (SROI) filings for all Claim Administrators. As part of this regulatory amendment, certain Board forms (C-2, C-669, C-7, C-8/8.6, VAW-2, and VF-2) were replaced by their EDI-equivalent FROI/SROI transactions. It has recently come to the Board’s attention that compliance with this EDI mandate may not be 100%, especially in instances where there are ongoing payments in closed cases. The Board is sending this reminder to Claim Administrators to ensure that the appropriate FROI/SROI transaction is filed in every case in which there is a current, ongoing payment. This reminder extends to all cases regardless of their age or status (open or closed) with the Board. It is vital that all data in the Board’s claims information system (CIS) concerning ongoing payments in individual workers’ compensation cases is up-to-date and accurate, especially as it takes the first steps towards creating a new Business Information System (BIS).The Board has partnered with CapTech Ventures (CapTech) to work on its BIS project. BIS is a part of the Board’s multi-year business process re-engineering project, which will modernize and convert the Board’s multiple paper-based legacy systems (including, but not limited to, CIS) to a single web-based platform. BIS will allow the Board to automate and design efficient workflows, provide self-service capabilities to stakeholders, and measure the effectiveness of the workers’ compensation system. The Office of the State Comptroller recently approved the Board’s contract with CapTech, and CapTech representatives began project work on-site at the Board’s Executive Office in Schenectady at the end of August. Your anticipated cooperation with this directive is greatly appreciated. Failure to abide will (1) minimize the goals of the Board’s electronic reporting mandate, (2) negatively impact the effectiveness of the planned migration of data from CIS to BIS, and (3) interfere with the ability to measure the effectiveness of the workers’ compensation system once BIS is implemented. Failure to abide by this directive may also result in the assessment of penalties against Claim Administrators consistent with Workers’ Compensation Law and its regulations. Should you have any questions, please direct them to eClaims@wcb.ny.gov . Additional information is also located on the eClaims frequently asked questions webpage. 
  • Posted the Workers' Compensation Board schedule for board meeting in 2020. To view the schedule of meetings, go to http://www.wcb.ny.gov/content/main/TheBoard/BoardMeetings.jsp

North Dakota VIEW STATE →

REGULATORY ACTIVITY:

  •  Effective January 1, 2020, WSI implemented a new Fee Schedule for Long-Term Care Hospital (LTCH) charges. The LTCH Fee Schedule will require a provider to bill LTCH charges upon discharge only and will not allow for reimbursement of bills submitted as an interim stay. WSI will reimburse inpatient LTCH services based on Diagnosis Related Groups (DRGs) using the following Standard Calculation Formula: Base Rate X Medicare's MS-DRG Weights = Reimbursement Rate. For 2020, the Base Rate is $237,000.00. WSI will post the LTCH Fee Schedule Guideline under Fee Schedule Guidelines on January 1, 2020. Additional information provided in the LTCH Fee Schedule Guideline will include:
  • Reimbursement Methodologies for High Cost Outlier, Short Stay Outlier, and Interrupted Stay
  • Payment Parameters
  • Billing Requirements
  • Reimbursement Procedures

If you have questions about this article, or to request an advance copy of the LTCH Fee Schedule Guideline, please send an email to wsipr@nd.gov . To receive provider news, subscribe to our Email Updates list. To view this notice, go to https://www.workforcesafety.com/news/new-fee-schedule-long-term-care-hospitals .

Ohio VIEW STATE →

FEE SCHEDULE NEWS:

  •  A new medical fee schedule has been adopted with an effective date of January 1, 2020. The next expected update for the medical fee schedule is in January 2021.

REGULATORY ACTIVITY:

Oklahoma VIEW STATE →

REGULATORY ACTIVITY:

  •  In June 2019, pursuant to statutory direction at 85A O.S. § 50(H) (14) (b), the Workers’ Compensation Commission (“WCC”) sought an impartial, external consultant to analyze Oklahoma’s Fee Schedule, and to propose an amendment for WCC approval. After following the statutory RFP process, the Commission selected Fair Health to assist in this endeavor on August 8, 2019. Soon after initial planning discussions, representatives from Fair Health immediately began analyzing existing fee schedule maximum allowable rates in comparison to data from workers’ compensation fee schedules and medical fee schedules of public and private payors across the country, analyzing the market for workers’ compensation medical services based upon the frequency of current charges and the availability of care, and receiving comment on the various challenges of the current fee schedule and proposed solutions from stakeholders within the workers’ compensation system. As demonstrated in a detailed timeline, the WCC facilitated and announced numerous opportunities, in public meetings, online, via mail, and email for all potential stakeholders, including the members of our two advisory boards, to share comments and provide input regarding potential revisions to the Fee Schedule. Fair Health has since received input from such stakeholders through these meetings and the online information portal. Additionally, Fair Health made multiple visits to Oklahoma to hear first-hand from Oklahoma stakeholders. To view this notice and the timeline, go to https://www.ok.gov/wcc/Legal/Alerts/index.html .

Oregon VIEW STATE →

FEE SCHEDULE NEWS:

  • The state has adopted the new 2020 CPT and HCPCS codes for their medical fee schedule with an effective date of January 1, 2020. The next expected update to the medical fee schedule is in April 2020.

REGULATORY ACTIVITY:

  • The Workers' Compensation Division (WCD) published the following industry notice to clarify WCD's interpretation of when a worker is "significantly limited in the repetitive use" of a body part under OAR 436-035-0019(1), following Broeke v. SAIF, 300 Or App 91 (2019). This industry notice clarifies the Workers’ Compensation Division’s (WCD) interpretation of when a worker is “significantly limited in the repetitive use” of a body part under OAR 436-035-0019(1), following Broeke v. SAIF, 300 Or App 91 (2019).
  • Issued revised Bulletin 316 regarding claims processing administrative cost factor. This revised bulletin notifies insurers and self-insured employers of the 2020 claim processing administrative cost factor. The Workers’ Compensation Division (division) applies this factor to approved reimbursements for supplemental disability benefits and certain claim costs. The factor is calculated under Oregon Administrative Rule (OAR) 436- 050-0180. This bulletin replaces Bulletin 316 issued Dec. 10, 2018. The claim processing administrative cost factor for calendar year 2020 is 24.31 percent. To view the revised bulletin, go to https://wcd.oregon.gov/forms/Pages/bulletins.aspx . The revised bulletin is effective January 1, 2020. 
  • Posted notice of final rules, revised bulletin and form all taking effect on January 1, 2020. The rules adopted are:
  • The Workers’ Compensation Division issues civil penalties for violations of statutes, rules, and orders of the director, such as claims processing and coverage reporting violations. Currently, depending on the seriousness and frequency of a violation, a civil penalty may range from $100 or less to $2,000 per violation. Effective Jan. 1, 2020, House Bill 2087 (2019) amends the civil penalty law, ORS 656.7451, to: o Establish separate penalty caps for employers and insurers that induce workers not to report their injuries – $2,000 per violation and $40,000 in aggregate per calendar year. o Increase the per-violation penalty cap for insurers, self-insured employers, and service companies that fail to pay assessments or comply with the law from $2,000 to $4,000 and increase the total (aggregated) penalty cap from $10,000 per three-month period to $180,000 per calendar year. o Revise the total (aggregated) penalty cap for employers (except self-insured employers) and managed care organizations that fail to pay assessments or comply with the law from $10,000 per three-month period to $40,000 per calendar year. The per violation cap remains $2,000. 
  • Issued revised Bulletin 232 regarding notice of claim acceptance according to ORS 656.262(6). Form 3058 Notice to Worker has also been revised. The revise form should be used no later than February 1, 2020. To view the bulletin and form, go to https://wcd.oregon.gov/forms/Pages/bulletins.aspx
  • Posted proposed rules for rule OAR 436-030 Claim Closure and Reconsideration and rule OAR 436-035 Disability Rating Standards. A hearing regarding the proposed rules will be held on January 16, 2020 at 10:00 a.m. in the OSHA large training room, 1st Floor 16760 SW Upper Boones Ferry Road, Portland Oregon. To view the proposed rule, go to https://wcd.oregon.gov/laws/Pages/proposed-rules.aspx 

Pennsylvania WC VIEW STATE →

FEE SCHEDULE NEWS:

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

REGULATORY ACTIVITY:

  •  For all WCAIS Registered Users: In January, you will see a new Quick Link on your dashboard titled “Records Request Online”. We encourage users to use this new link to submit any non-subpoena request for records rather than having to submit these requests by mail or fax. When you click on the link you simply need to enter the claimant name (last and first) and upload an authorization form, with proper documentation, in PDF format. As with requests mailed or faxed to the bureau, be sure to include the claimant’s name, Social Security Number (at least the last 4 digits), injury date(s) and party representation in your documentation. For a preview of step by step instructions of how to submit requests online, go to https://www.dli.pa.gov/Businesses/Compensation/WC/Pages/default.aspx
  • Department of Labor & Industry for the fiscal year ending June 30, 2019, the maximum compensation payable under the Workers' Compensation Act, under Article 1, subsections 105.1 and 105.2, shall be $1,081.00 per week for injuries occurring on and after Jan. 1, 2020. For purposes of calculating the update to payments for medical treatment rendered on and after Jan. 1, 2020, the percentage increase in the Statewide Average Weekly Wage is 3.1 percent. To view this notice, go to https://www.dli.pa.gov/Businesses/Compensation/WC/claims/Pages/Statewide-Average-Weekly-Wage-(SAWW).aspx

Tennessee VIEW STATE →

REGULATORY ACTIVITY:

  •  Issued an advisory for case managers concerning face-to-face meetings. For workers' compensation claims that involve case managers, the face-to-face meeting in all catastrophic cases should occur within 14 days of the injury. For non-catastrophic injuries, the face-to-face meeting should occur within 14 days of the Case Manager’s assignment to the case. To view the advisory, go to https://www.tn.gov/workforce/injuries-at-work/bureau-announcements.html .

Texas VIEW STATE →

REGULATORY ACTIVITY:

  •  The Texas Department of Insurance, Division of Workers' Compensation (DWC) is readopting all sections within Chapters 102-116. This re-adoption complies with Texas Government Code §2001.039, requiring a state agency to review each of its rules every four years and to readopt, readopt with amendment, or repeal the rule. A notice of rule review was published in the July 19, 2019, issue of the Texas Register. DWC determined that the reasons for adopting the chapters continue to exist. The notice of re-adoption will be published in the December 13, 2019, issue of the Texas Register. Any repeals or suggested amendments identified during the review of these rules may be considered in future rulemaking. To view this notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html
  • Published the 2020 Performance Based Oversight Assessment Insurance Carriers Methodology. To view the published document, go to https://www.tdi.texas.gov/alert/whatsnew/index.html
  • The Texas Department of Insurance, Division of Workers' Compensation (DWC) has released the 2019 Health Care Provider Performance Based Oversight (PBO) assessment. For 2019, health care providers were assessed on their performance in one of three categories: o timely filing of the DWC Form-069, Report of Medical Evaluation; o completeness of the DWC Form-073, Work Status Report; or o documentation supporting why the injured employee was prevented from returning to work as reported on the DWC Form-073, Work Status Report. DWC reviewed 97 health care providers for the timeliness of filing the DWC Form-069, Report of Medical Evaluation with the following results: 73 had scores placing them in the high performer tier, 18 were in the average performer tier, and six had scores placing them in the poor performer tier. DWC reviewed 113 health care providers for the completeness of the DWC Form-073, Work Status Report with the following results: 49 had scores placing them in the high performer tier, 28 were in the average performer tier, and 36 had scores placing them in the poor performer tier. DWC reviewed 113 health care providers for documentation supporting why the injured employee was prevented from returning to work, as reported on the DWC Form-073, Work Status Report with the following results: 55 had scores placing them in the high performer tier, 39 were in the average performer tier, and 19 had scores placing them in the poor performer tier. 
  • The 2019 PBO assessment results and a list of the health care providers that were reviewed are posted on the TDI website. If a health care provider is not listed, they were not assessed in 2019; however, no health care provider in the Texas workers' compensation system is exempt from compliance with the Texas Labor Code and DWC rules. More information on PBO and the 2019 assessment are available on the TDI website. DWC will assess insurance carriers separately in 2020. To view the results, go to https://www.tdi.texas.gov/wc/pbo/pboresults.html .

Utah No-Fault VIEW STATE →

FEE SCHEDULE NEWS:

  • The state has adopted a new fee schedule with an effective date of January 1, 2020. The next expected update is in January 2022.

REGULATORY ACTIVITY:

Utah WC VIEW STATE →

FEE SCHEDULE NEWS:

  • The state adopted changes to their physician fee schedule and guidelines with an effective date of January 1, 2020. The next update is expected in January 2021.

Vermont VIEW STATE →

FEE SCHEDULE NEWS:

  • The state adopted changes to their physician fee schedule with an effective date of January 1, 2020. The next update is expected in January 2021.

Vermont Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Published insurance bulletin number 206. The Vermont Insurance Division has recently seen an increase in the use of "virtual claims adjustment systems" that require the insured or the insured's body shop to submit photographs or videos to the insurer in lieu of having a claims adjuster assess the damage to an automobile in person. At the same time, the Division has seen a rise in consumer complaints alleging that the virtual adjustment process has unreasonably delayed the settlement of vehicle damage claims or resulted in inadequate settlement offers. The purpose of this Bulletin is to clarify the Division's position regarding the use of virtual adjusting in the settlement of motor vehicle partial and total loss claims. To view this bulletin, go to https://dfr.vermont.gov/view/regbul?tid=73&field_rb_type_value=All

Virginia VIEW STATE →

REGULATORY ACTIVITY:

  • The 2020 Medical Fee Schedules begin January 1, 2020. The Commission has developed a new drop-down option in the Medical Fee Schedule Reference Tool to select which year of the Schedule you need to reference. This feature will simplify the fee lookup process. The tool fetches reimbursement amounts directly from the medical fee schedule based on the fee year, determines region information and more. To view the updated look up tool, go to http://medicalfeeschedule.workcomp.virginia.gov/ .

Washington VIEW STATE →

FEE SCHEDULE NEWS:

  •  The Department of Labor & Industries has adopted new 2020 codes for the medical and ASC fee schedules effective January 1, 2020. The next fee schedule update is expected in July 2020.

REGULATORY ACTIVITY:

  •  The physical medicine project is developing best practices for occupational therapists and physical therapists to encourage early use of active care with a focus on function. L&I’s staff — which included a physical therapist, occupational therapist and chiropractor — was put to this task. Very early on, a therapy stakeholder group made up of clinics both large and small, as well as representatives of the state therapy professional organizations was created. Together, they produced a preliminary set of best practices for therapy providers and a standardized progress report form. The new progress report form is in its final testing and scheduled to become available by January 2020 and Development of a work rehabilitation guideline by our Advisory committees in partnership with state therapy associations. If you’d like to learn more, visit our Physical Medicine project web page at https://lni.wa.gov/patient-care/health-care-incentive-programs/physical-medicine-best-practices-project?utm_medium=email&utm_source=govdelivery .  

West Virginia VIEW STATE →

REGULATORY ACTIVITY:

  • Issued information letter 206 regarding mandatory reporting of known or suspected insurance fraud and related criminal activity and potential consequences for failure to report. The West Virginia Insurance Fraud Prevention Act mandates the reporting of insurance fraud or criminal offenses otherwise related to the business of insurance. The Act is located at Chapter 33, Article 41 of the West Virginia Code, as amended, and provides that “[any] person engaged in the business of insurance having knowledge or a reasonable belief that fraud or another crime related to the business of insurance is being, will be or has been committed shall provide to the commissioner the information required by...the commissioner.” Code § 33-41-5(a) (Emphasis supplied). To view the informational letter, go to https://www.wvinsurance.gov/Resources/Informational-Letters .



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