Alaska VIEW STATE →

FEE SCHEDULE NEWS:

• The state adopted the 2017 ASA basic unit values effective January 1, 2017 and retained the existing anesthesia conversion factor.  The state adopted a new medical and hospital fee schedule effective December 1, 2015 based on the RBRVS values as established by CMS with state published conversion factors. The state has adopted the Medicare Severity Diagnosis Related Groups (MS-DRG) weight published by CMS with the state’s individual conversion factor for inpatient hospital billing.  The data will be updated quarterly along with CMS data.

REGULATORY ACTIVITY:

• As required by AS 44.62.245, the Department of Labor and Workforce Development and the Alaska Workers’ Compensation Board give notice that the following amended versions of material adopted by reference in 8 AAC 45.083, under authority of AS 23.30.098, and dealing with fees for medical treatment and services, are in effect:
  • Posted notice that the adoption of the proposed amendments to the Workers' Compensation Medical Fee Schedule and Exhibit A, Workers' Compensation Supplemental Medical Fee Schedule, dated January 1, 2017 is deferred until further notice.  Continue using the current fee schedule and exhibit A dated January 1, 2014.
  • Posted bulletin 17-02 regarding filing requirements for the 2016 Annual Report; paying SIF Contributions and paying workers' safety and compensation fees.

Arkansas VIEW STATE →

FEE SCHEDULE NEWS:

• A new update was expected for January 1, 2017 however, the state has not yet released any new information on a new schedule.

California VIEW STATE →

FEE SCHEDULE NEWS:

• The Physician and Practitioner Services Medically Unlikely Edits and the National Correct Coding Initiative Practitioner PTP Edits have been updated with an effective date of March 1, 2017.
• The Outpatient and ASC Fee Schedule was updated with an effective date of December 15, 2016. The state has adopted the July 2016 OPPS APC Addendum A, B and M, the July 2016 ASC Addendum AA and EE to identify the definition of a "surgical procedure", removed the "facility only" services payment methodology and revised the "other service" payment method.  All outpatient services will be processed under the APC methodology, with the exception of specific services that continue to be reimbursed based on alternate fee schedules (physical therapy, laboratory, DMEPOS, ambulance).
• Inpatient hospital fee schedule has been updated with an effective date of January 1, 2017. The DWC has adopted the final rule of August 22, 2016 and the correction notice of October 5, 2016, published in the Federal Register, which changes the Medicare payment system.  Updates to the Composite Rate, Hospital Specific Outlier Factor, and Cost to Charge Ratio for the listed hospitals have been adopted.  The next update is scheduled for January 2018.
• The Clinical Lab Fee Schedule has been updated with an effective date of January 1, 2017 and the DMEPOS Schedule has been updated with an effective date of February 1, 2017. The DWC has adjusted the pathology and clinical laboratory fee schedule and also the DMEPOS schedule to conform with the changes to the Medicare payment system adopted by CMS for calendar year 2017. The next update for Clinical Lab Schedule is scheduled for January 2018.
• Medi-Cal rates have been released with an effective date of January 15, 2017. The next update is scheduled for February 15, 2017.

REGULATORY ACTIVITY:

• The Division of Workers Compensation (DWC) and the Workers’ Compensation Appeals Board (WCAB) have made changes to lien and attorney fee disclosure statement requirements which went into effect on January 1, 2017. The changes were made to implement provisions of Senate Bill 1160 and Assembly Bill 1244. The changes are as follows:
  • In compliance with SB 1160, DWC has made available an amended lien form which includes the required declaration affirming eligibility under penalty of perjury per newly enacted Labor Code Section 4903.05(c) effective January 1, 2017. All liens filed after January 1, 2017 must use this new form. The new lien form and the required declaration are now available for all e-filers and JET Filers.  All filers that must pay the filing fee are required to fill out the declaration. Liens filed without the declaration will be dismissed.
  • Also available for e-filers and JET Filers is a declaration for all liens filed prior to January 1, 2017 that require a filing fee under Labor Code Section 4903.05, as mandated by SB 1160. The declaration, which must include information on the type of services provided by the lien claimant, must be filed by July 1, 2017. The Workers’ Compensation Appeals Board (WCAB) has posted new rules on this requirement, and has scheduled a public hearing January 4 on the proposed regulations.
  • SB 1160 also requires that all lien claimants file an original bill with their lien. This is a new requirement that is mandatory for all lien filings as of January 1, 2017.
  • To comply with the new requirements for the attorney fee disclosure statement introduced by AB 1244, DWC has made available a revised attorney fee disclosure statement form in compliance with recently amended Labor Code Section 4906. An amended form with the required information is now posted on DWC’s website.
• The Workers’ Compensation Appeals Board (WCAB) has extended the public comment period for proposed rulemaking changes mandated by Senate Bill 1160.  WCAB conducted a public hearing on January 4 regarding proposed rules in response to SB 1160 (Stats. 2016, Ch. 868), which amended Labor Code section 4903.05 to require that section 4903(b) lien claimants file a declaration that includes information regarding the type of services provided by the lien claimant. This rulemaking will mandate use of an e-filed form declaration to ensure uniform procedures for lien claimants who first file their liens after January 1, 2017 and current lien claimants who are required to file a declaration by July 1, 2017.    The Notice of Rulemaking stated written comments from the public on the proposed rules and amendments would be accepted until 5 p.m. on January 4. The WCAB is now extending the public comment period until 5 p.m. on January 31, 2017.  Comments may be submitted by e-mail to WCABRules@dir.ca.gov or mailed to:  Workers’ Compensation Appeals Board Attention: Annette Gabrielli, Regulations Coordinator P.O. Box 429459 San Francisco CA 94142-9459.
• 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 2017 changes in the Medicare payment system as required by Labor Code section 5307.1.  The Physician and Non-Physician Practitioner Fee Schedule based on the federal Resource Based Relative Value Scale (RBRVS) was adopted pursuant to the requirements of Senate Bill 863 (SB 863) and became effective for services rendered on or after January 1, 2014. As mandated by SB 863, the fee schedule started with separate conversion factors for surgery, radiology, and “all other services” in 2014 and transitions to a single conversion factor (CF) in 2017, for all services except anesthesia, which has its own CF. The 2017 CFs were adjusted for the cumulative change in the Medicare Economic Index and the relative value scale adjustment factors.  The acting administrative director update order adopting the OMFS adjustments effective for services rendered on or after March 1, 2017, can be found athttp://www.dir.ca.gov/dwc/OMFS9904.htm.

Colorado VIEW STATE →

REGULATORY ACTIVITY:

• Colorado posted corrections to the Medical Fee Schedule Excel spreadsheet. This correction was limited to the a few procedures covered under the “Medicine Section Conversion Factor $67.00” that should have been calculated using "PM&R Section Conversion Factor $41.14".  The code range for this correction is: 97610-97814. The corrected spreadsheet has been posted to the website under the spreadsheet name:  2017_CO_MFS_01_19_2017.

Connecticut VIEW STATE →

FEE SCHEDULE NEWS:

• Ambulance rates schedule has been updated as of January 1, 2017. The next update is scheduled for January 1, 2018.

REGULATORY ACTIVITY:

• On January 1, 2017 Connecticut published ambulance rates for 2017. To receive a copy of the ambulance rates for 2017 contact Renee Holota at e-mail Renee.Holota@ct.gov.

Delaware VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted their new medical and facility fee schedule with an effective date of January 31, 2017. The next update is scheduled for January 31, 2018.

Florida WC VIEW STATE →

REGULATORY ACTIVITY:

• DWC posted notice of a public hearing regarding rule 69L-30, Expert Medical Advisors to be held on Tuesday, February 7, 2017 at 10:00 a.m. in Room 102 of the Hartman Building at 2012 Capital Circle SE, Tallahassee.  The proposed changes reflect statutory changes allowing Judges of Compensation Claims to appoint Expert Medical Advisors, update a website address, and update the list of final orders that disqualify a physician from Expert Medical Advisor certification.
• The Division held a hearing on January 5th regarding Rule 69L-31 Utilization and Reimbursement Dispute.
• The state has finalized the effective date for Revision F Medical Bill Reporting. Revision F must be fully implemented by March 15, 2017.  On and after that date Revision E will no longer be accepted for reporting medical bills.  On January 11, 2017, Michelle Carter at the FL DWC formally announced the transition to Revision F filing format of Medical EDI Data must be completed by March 15, 2017.

Hawaii No-Fault VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted the Medicare 2017 version effective January 1, 2017. The next update is expected January 1, 2018.

Hawaii WC VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted changes to the physician, drug and biological (ASP), clinical lab and DME fee schedules with an effective date of January 1, 2017. The next expected update is for January 1, 2018.

REGULATORY ACTIVITY:

• The director of the Department of Labor and Industrial Relations posted notice that the adoption of the proposed amendments to the workers' compensation medical fee schedule and exhibit A, Workers' Compensation Supplemental Medical Fee Schedule dated January 1, 2017, is deferred until further notice.  The director directed participants to continue to use the current rules and exhibit a dated January 1, 2014 fee schedule.

Idaho VIEW STATE →

FEE SCHEDULE NEWS:

• The medical fee schedule has been updated as of January 1, 2017 with the new 2017 National Physician Fee Schedule Relative Value File.
• The inpatient fee schedule was updated as of October 1, 2016 with the current MS-DRG weights, multiplied by a state-specific base rate. The next update is expected on October 1, 2017.
• The outpatient and ASC fee schedules have been updated to use the 2017 Medicare OPPS APC relative weights effective January 1, 2017.  The outpatient and ASC base rates remain unchanged.  The next update is expected in January 2018.

REGULATORY ACTIVITY:

• On January 6, 2017 Idaho published Hospital Outpatient Surgery Center (ASC) Effective January 1, 2017.  The Documents published were Addendum B – Weights by CPT Code) CMS-1656-CN) and Addendum D1 – Status Indicators.
• A meeting is scheduled on February 8, 2017 by the Idaho Advisory Committee on Workers’ Compensation to discuss EDI updates and medical fee schedule proposals.

Illinois VIEW STATE →

REGULATORY ACTIVITY:

• Until further notice, Arbitrator Frank Soto will be overseeing the Chicago docket currently assigned to Arbitrator Andros.  All future correspondence (including settlement contracts) for cases currently assigned to Arbitrator Andros should be directed to Arbitrator Soto at the following address:

Illinois Workers’ Compensation Commission
Attn: Arbitrator Soto
100 W. Randolph, Suite 8-200
Chicago, IL 60601

• Any correspondence received that is addressed to Arbitrator Andros will be forwarded to Arbitrator Soto.

Indiana VIEW STATE →

FEE SCHEDULE NEWS:

• The outpatient and inpatient fee schedules follow Medicare reimbursement guidelines and are updated when these Medicare modules become effective. The last update for the inpatient fee schedule was October 1, 2016 and January 1, 2017 for the outpatient fee schedule.

Iowa VIEW STATE →

REGULATORY ACTIVITY:

• Beginning in 2017, DWC will no longer hold hearings in Iowa Falls.  Instead the hearings will be held in Fort Dodge, on the Iowa Central Community College campus, at the following location:

Iowa WORKS
3 Triton Circle
Fort Dodge, IA 50501

Maryland VIEW STATE →

REGULATORY ACTIVITY:

• The state has posted the 2017 Mileage Reimbursement Rate, Cola and Maximum Rate of Benefits for 2017.  Mileage Reimbursement rate is $0.53.  The COLA is $0.33.
• The Maximum Rates of Benefits are:
  • Temporary Total Disability $1,052.00 per week
  • Permanent Total Disability $1,052.00
  • Permanent Partial Disability $114.00
  • Temporary Partial Disability $526.00
  • Serious Disability Benefits $789.00
  • Death Benefits $1052.00 with a benefit limit of $70,861.00.
• Pursuant to the Open Meetings Act, Annotated Code of Maryland, General Provisions Article (“GP”), § 3-302.1, the MD Workers’ Compensation Commission (the “Commission) is making available to the public an agenda containing known items of business to be discussed and information regarding any portion of the meeting expected to be closed. Agendas for the January through June 2017 meeting dates may be found on the state’s Schedules: Hearings & Meetings page. Questions may be directed to the Secretary of the Commission, Ms. Stacey L. Roig at sroig@wcc.state.md.us.
• Maryland updated their MRA values on 12/27/2017.

Massachusetts VIEW STATE →

REGULATORY ACTIVITY:

• Massachusetts has released two administrative bulletins:
  • Administrative Bulletin 16-20: 101 CMR 343.00: Hospice Rates: Update to the Hospice Rates
  • Administrative Bulletin 16-19: 114.3 CMR 14.00: Dental Services: Updated CDT Dental Codes.
• The hospice rates were released January 6 but have an effective date of October 2016.  The Dental Codes have an effective date of January 1, 2017.

Michigan VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted changes to the physician fee schedule effective January 13, 2017.  The updated rules, manual, and fee schedule worksheets are based on 2016 October release CMS Physicians Fee Schedule, as well as 2016 CPT® and HCPCS Level II procedure codes.  Some of the rules revised with the new schedule are:
  • Rules on billing and reimbursement of drug testing, drug screening, and drug confirmation testing
  • Rules on reimbursement for commercially manufactured topical medications, which are over-the-counter or contain over-the-counter ingredients
  • Rules on anesthesia billing and reimbursement with the addition of modifier–AD
  • Rules clarifying reimbursement for ASC facility charges pertaining to multiple procedures.

REGULATORY ACTIVITY:

• The Bureau of Labor Market Information & Strategic Initiatives has reported the state average weekly wage as of June 30, 2016, to be $965.62. In accordance with Section 418.355(2) of the Workers' Disability Compensation Act, the 2017 maximum weekly benefit based on 90% of the state average weekly wage is $870.00.
• Michigan has released the 2017 Calculation Program Version 18.  2017.  Please note the following changes contained in PA 266 of 2011 are not included in this version:
  • Old-age SS coordination:
  • Calculation does not reflect the cap specified in section 418.354(1).
  • Interest on judgments:
  • The accrued benefits and interest calculation does not reflect the changes to interest calculation as specified in section 418.801(6) as amended.

• Please note the following hints when installing:
  • This is a single user system. Please do not attempt to install in a network environment and make accessible by more than one user, as both calculation and program errors will occur. This application is also not supported in a Windows NT or Citrix environment.
  • Calculation Program, Version 18.0, is not fully compatible with some of the latest operating systems.
  • Click Calculation Program Help Manualto view the help manual which includes instructions on installing this program. It may be helpful to print these instructions before continuing. If you have a previous version of this program on your PC, it must be uninstalled first.
  • Once you have printed and read the install instructions, click exeto download the new version to your computer. You MUST save this file to your hard drive and install it from there. The file size is 13MB, so it may take a few minutes depending upon the speed of your connection. If you wish to install this program on more than one computer, you can save the setup.exe file to any external media (e.g., flash drive, CD, etc.).
  • The user must have administrator rights in order to be able to uninstall and install the program.
  • Once installed, locate the PARTIAL_DATA folder and grant full read/write permission.  This folder stores partial data files and calculations from existing cases.
  • Running the program in compatibility mode may also be necessary depending on the Windows operating system version.  To do so, right click on the Calculation Program shortcut icon on the desktop, choose "Properties," choose "Compatibility" tab and check "Run this program in compatibility mode for" and then select your operating system.  Also check "Run this program as an administrator."

To gain more information regarding the program go to:  http://www.michigan.gov/wca/0,4682,7-191--401443--,00.html.

Minnesota VIEW STATE →

FEE SCHEDULE NEWS:

• The state has updated their Inpatient Fee Schedule with an effective date of January 1, 2017.

REGULATORY ACTIVITY:

• Minnesota has posted possible amendments to Rule 5220.1900 concerning vocational rehabilitation.
• Minnesota has posted a draft of proposed rule 5220.1990 Rehabilitation Service Fees and Costs.  A copy of the draft proposed rule is attached. The proposed draft rule was discussed at the Rehabilitation Review Panel Meeting on January 5th, 2017.
• Minnesota has posted notice of submission of adopted rule without a public hearing.  The notice is in regards to rules 5219 Independent Medical Examination Fees and rule 5221 Workers’ Compensation Medical Service and Fees.  The agency is proposing to file with the Office of Administrative Hearings on January 30, 2017.  Comments can be submitted through 4:30PM February 6, 2017 to the Office of Administrative Hearings either by e-comments at https://minnesotaoah.granicusideas.com//discussions or by mail at PO Box 64620, St. Paul Minnesota.  55164-0620. No effective date has been established.

Montana VIEW STATE →

REGULATORY ACTIVITY:

• Montana has updated the shoulder injury treatment guideline and adopted new guidelines for cumulative trauma and thoracic outlet syndrome.  The guidelines became effective on December 31, 2016.

Nebraska VIEW STATE →

REGULATORY ACTIVITY:

• Amendments to the court's non-adjudicatory Rules 26, 63, and 73 were adopted, with varying effective dates, at a December 14, 2016 public meeting.
• Schedules of Fees for Medical Services, Inpatient Hospital Diagnostic Related Group (DRG), and Inpatient Hospital Trauma Services (effective January 1, 2017) may be downloaded from the Fee Schedules section of the court's web site.
• Judge Dirk V. Block was sworn in on January 13, 2017 to serve on the bench of the Nebraska Workers' Compensation Court.

Nevada VIEW STATE →

FEE SCHEDULE NEWS:

• The Division of Industrial Relations of the Department of Business and Industry in Nevada has revised their fee schedule to use the most recent editions of the Relative Value for Physicians, Relative Value Guide of Anesthesiologists, Medicare’s current reimbursement for HCPCS codes K and L, ASC Hospital Outpatient Group List 2016 and the Nevada Specific Codes with an effective date of February 1, 2017. The next expected update is scheduled for February 1, 2018.

New Jersey No-Fault VIEW STATE →

REGULATORY ACTIVITY:

• New Jersey has adopted Medical Protocols for their PIP program.  The effective date is October 17, 2016; the operative date is April 17, 2017.

New Jersey WC VIEW STATE →

REGULATORY ACTIVITY:

• New Jersey has published their schedule for indemnity benefits exclusive of amputation and enucleation effective January 1, 2017.

New York VIEW STATE →

FEE SCHEDULE NEWS:

• An updated for the EAPG rates effective January 1, 2017 has been posted by NYDOH.

REGULATORY ACTIVITY:

• Issued bulletin subject number046-909 entitled Form Submission Guidelines.

North Carolina VIEW STATE →

FEE SCHEDULE NEWS:

• The North Carolina Industrial Commission has adopted changes to their Professional, DME and Laboratory Fee Schedule Tables with an effective date of January 1, 2017.
• The North Carolina Industrial Commission has approved the temporary rule presented at a public meeting on November 18, 2016 amending their medical fee schedule rule 04 NCAC 10J.0101 regarding reimbursement for services provided by Ambulatory Surgical Centers.  A maximum reimbursement rate of 200% shall apply to institutional services that are eligible for payment by CMS when performed at an ASC and a maximum reimbursement rate of 135% shall apply to institutional services performed at an ASC that are eligible for payment by CMS if performed at an outpatient hospital facility, but would not be eligible for payment by CMS if performed at an ASC.  The rule was adopted December 6, 2016 and took effect on January 1, 2017.

REGULATORY ACTIVITY:

• On December 30, 2016, Governor Pat McCrory designated Charlton L. Allen to continue serving as Chairman of the North Carolina Industrial Commission. Pursuant to Session Law 2016-125, he will serve as Chairman of the Commission for a term of four years. Charlton Allen joined the Industrial Commission on July 1, 2014 as a Commissioner. He was then designated Chairman effective February 1, 2016.
• Governor Pat McCrory has designated Yolanda K. Stith to serve as Vice-Chair of the North Carolina Industrial Commission for a term of four years pursuant to Session Law 2016-125. Yolanda Stith joined the Industrial Commission on December 21, 2016 as a Commissioner.
• Chairman Allen has appointed Charles K. Duckett as Administrator/Chief Operating Officer of the Industrial Commission, effective January 1, 2017. The Administrator is a senior-level position tasked with overseeing the Commission’s budget, personnel, and other managerial operations.
• On Wednesday, January 4, 2017, the Industrial Commission upgraded the Electronic Document Filing Portal to EDFP 2.3.0. The new release allows almost all documents to be filed via EDFP as long as they are filed in claims that have existing IC file numbers. The Industrial Commission encourages all current EDFP users as well as those not yet required to use it to become familiar with the new version of EDFP. Therefore, as of Thursday, January 5, 2017, the Commission started to accept via EDFP all document types included in the EDFP 2.3.0 upgrade even if the document types are not listed in Table 1 of the current Rule 04 NCAC 10A .0108. “If you choose to submit such document types, you should copy the correct IC filing email address according to Rule 04 NCAC 10A .0108 when you serve the documents on the opposing party and let the Commission know in the e-mail that the documents were also filed via EDFP.”
• Chairman Allen has selected Asia J. Prince to be the Director of Claims Administration for the Industrial Commission, effective January 1, 2017. Most recently, Mr. Prince has served as a Special Deputy Commissioner in the Executive Secretary’s Office, and prior to that, a Special Deputy Commissioner with the Deputy Commissioner’s Section. Mr. Prince is a cum laude graduate of the University of North Carolina at Greensboro, where he was a member of the Beta Gamma Sigma business honor society. He received his Juris Doctor from the University of North Carolina at Chapel Hill. He is currently a Fellow with the E.A. Morris Fellowship for Emerging Leaders.
• Brian Ratledge has joined the North Carolina Industrial Commission to serve as General Counsel. Mr. Ratledge was most recently the General Counsel at the North Carolina Department of Administration. Prior to joining the Department of Administration, he was in private practice in Raleigh. He has also previously served as the Chairman of the Wake County Board of Elections. Finally, Mr. Ratledge is a graduate of the University of Tennessee at Knoxville where he received his B.A. in Political Science (Honors Program) and a graduate of the Campbell University School of Law.
• The approved temporary rule amendment to Rule 04 NCAC 10J .0103 went into effect on January 1, 2017. A legal challenge to this temporary rule has been filed in Wake County Superior Court. Additional updates will be provided when appropriate.
• On January 19, 2017, the Rules Review Commission approved the rule amendment with technical corrections to Rule 04 NCAC 10A .0108.  Therefore, this amendment will go into effect on February 1, 2017.

North Dakota VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted changes to the medical and hospital fee schedules effective January 1, 2017. The next expected update is set for January 1, 2018.

Ohio VIEW STATE →

REGULATORY ACTIVITY:

• A rule package in the category Workers’ Compensation - Bureau of Workers’ Compensation is being considered for review: Fee schedule and payments for medical services. -Rule Numbers: 4123-6-08 Bureau fee schedule; 4123-6-37.2 Payment for hospital outpatient services; 4123-6-37.3 Payment of ambulatory surgical center services.
• There are several proposed rules for comment. Two of the proposed rules address medical issues and the other rule addresses coverage.  The medical rules that have been proposed are 4123-5-18-Medical proof required for payment of compensation and 4123-6-02.5 Provider accesses to the HPP - Provider not certified.  The coverage rule that has been proposed is 4123-17-24 Other states coverage.  The state will receive public comment on these rules through COB February 16, 2017.

Oklahoma VIEW STATE →

REGULATORY ACTIVITY:

• The Oklahoma Workers’ Compensation Commission (OK WCC) will be implementing electronic reporting of workers’ compensation first reports of injury (FROI) and subsequent reports of injury (SROI).  The state will be implementing the IAIABC Standard Release 3. Electronic reporting will be required for all trading partners:  insurers, self-insured employers, and claim administrators.  Mandatory implementation is planned for January 1, 2018.  Electronic reporting will be via Electronic Data Interchange (EDI) transactions using the Claims 3.0 reporting standards adopted by the International Association of Industrial Accident Boards and Commissions (IAIABC).  Additional information on the IAIABC EDI transactions for FROI and SROI can be found online at the IAIABC website, http://www.iaiabc.org.
• Oklahoma posted notice of proposed amendments to rules Chapter 1 General Information; Chapter 10 Practice and Procedure; Chapter 15 Medical Services and Chapter 25 Insurance and Self Insurance.  Hearings for the proposed rules are as follows:
  • Chapter 1 Tuesday February 21, 2017 at 1:30 PM in Commission Chambers on the 2nd Floor of the Denver N Davison Building 1915 N. Stiles Avenue, Oklahoma City
  • Chapter 10 Tuesday February 21, 2017 at 1:30 PM in Commission Chambers on the 2nd Floor of the Denver N Davison Building 1915 N. Stiles Avenue, Oklahoma City
  • Chapter 15 Tuesday February 21, 2017 at 1:30 PM in Commission Chambers on the 2nd Floor of the Denver N Davison Building 1915 N. Stiles Avenue, Oklahoma City
  • Chapter 25 Tuesday February 21, 2017 at 1:30 PM in Commission Chambers on the 2nd Floor of the Denver N Davison Building 1915 N. Stiles Avenue, Oklahoma City.

Oregon VIEW STATE →

REGULATORY ACTIVITY:

• Bulletin 189, "Preferred Worker Program, Oregon Administrative Rules (OAR) 436-110," and related forms have been revised.  The bulletin describes the types of assistance available through the Preferred Worker Program and how to use the attached forms to request assistance.  The division is revising this bulletin and related forms, and introducing a new form, Form 5135 "Preferred Worker Program Placement Payment Request", as a result of rule changes effective January 1, 2017. This bulletin effective January 1, 2017 replaces Bulletin 189 effective May 8, 2015.  The forms being revised are: 2190, 2350, 3293, 4122, 4875, 3014, and 4903.  Form 2968 is not being revised.  Form 5135 is a new form.
• Oregon has released revised bulletin Number 112 regarding reimbursement of injured workers travel, food and lodging costs. The bulletin was issued on January 3, 2017. This bulletin provides Form 3921, “Request for Reimbursement of Expenses,” and the rates injured workers are reimbursed for travel, food, and lodging costs as directed by Oregon Administrative Rule (OAR) 436-009-0025. The Workers’ Compensation Division is updating this bulletin and Form 3921 to adopt the private vehicle mileage rate, effective January 1, 2017.  The lodging and meal rates remain the same as previously published. This bulletin replaces Bulletin No. 112 dated Sept. 6, 2016.  Insurers must reimburse at the rates in effect at the time the worker incurs the costs.
• The US Department of the Treasury has published guidance for stand-alone Cyber Security insurance and TRIA. The document is dated December 20, 2016 and can be viewed at https://federalregister.gov/d/2016-31244. Oregon expects all commercial insurers to comply with this federal guidance.  Oregon product standards checklist 440-3610 contains the appropriate TOI and sub-TOI coding for filing a Cyber Security product.  Please contact Jan Vitus at 503-947-7278 or vitus@oregon.gov if you have questions or need assistance.
• Oregon has issued bulletin 101 Revised and 310 Revised.
• Bulletin 101:
  • This bulletin provides or describes forms that meet the requirements of Oregon Revised Statute (ORS) 656.265, and Oregon Administrative Rules (OAR) 436-060-0010 and 436-060-0015:
    • Form 801, “Report of Job Injury or Illness”
    • Form 3283, “A Guide for Workers Recently Hurt on the Job”
    • Form 1138, “What happens if I’m hurt on the job?”
  • The Workers’ Compensation Division revised Form 801 to add acknowledgements to the worker and employer sections of the form explaining that the worker has the right to choose a health care provider, subject to certain restrictions. The employer is reminded that restriction of the worker’s choice of or access to a health care provider may result in civil penalties. Insurers are encouraged to start using the new form immediately. However, to allow time for insurers to update their systems, insurers have until April 1, 2017 to distribute the new forms to their insureds. Form 801 claim filing requirements are described in OAR 436-060-0010 and OAR 436-060-0011.  Requirements related to Forms 3283 and 1138 are in OAR 436-060-0015.  This bulletin replaces Bulletin No. 101 dated Dec. 2, 2015.

• Bulletin 301:
  • This bulletin provides a revised Form 801. The division revised Form 801 to add acknowledgements to the worker and employer sections of the form explaining that the worker has the right to choose a health care provider, subject to certain restrictions. The employer is reminded that restriction of the worker’s choice of or access to a health care provider may result in civil penalties. Form 3283 has not been revised. This bulletin replaces Bulletin 310 dated December 9, 2015.
• Revised form 3058 has been published in Spanish.  Form 3058 goes with Bulletin 232 issued December 22, 2016.
• Oregon has posted notice regarding proposed changes to Oregon Rules:
  • OAR 436-009 Oregon Medical Fee Schedule and Payment Rules OAR 436-010 Medical Services.

• In connection with these proposed changes Oregon will be holding a public hearing on February 16, 2017 at 10:00 a.m. at the Labor and Industries Building on 350 Winter Street NE, Salem, Oregon in Room F.  Stakeholders can either attend the meeting and make oral comments or submit written comments regarding the proposed rule changes.  Written comments can be submitted to Fred Bruyns, Rules Coordinator Workers' Compensation Division 350 Winter Street NE, P.O. Box 14480 Salem, Oregon 97309-0405; e-mail fred.h.bruyns@oregon.gov.   The closing date for written comments is February 22, 2017.  Any question regarding the hearing or the submission of written comments should be directed to Fred Bruyns 503-947-7717 or e-mail h.bruyns@oregon.cov.

South Carolina VIEW STATE →

REGULATORY ACTIVITY:

• Regulation 67-1601 A (1) provides the expenses incurred for travel to receive medical attention which shall be reimbursed to the claimant are mileage to and from a place of medical attention which is more than five miles away from home in accordance with the amount allowed state employees for mileage. The  state  employee  mileage  rate is  based  upon the  standard  business  mileage  rate established  by  the  Internal  Revenue    Effective  January  1,  2017  the reimbursement  rate  for  state  employee  mileage  is  53.5  cents  per  mile.  This represents a half a cent per mile decrease from the 2016 rate of 54 cents per mile. Therefore,  effective  January  1,  2017,  the  new  mileage  reimbursement  rate  to  and from a place of medical attention is 53.5 cents per mile.
• Pursuant to R67-1605 the Net Present Value (NPV) tables are calculated at the yield-to-maturity rate of the 5-year U.S. Treasury Note reported by the Federal Reserve on the first business day following January. The tables can be located at: http://www.wcc.sc.gov/welcomeandoverview/NPVT/Pages/default.aspx.
• The Commission  has  conducted  a  public  hearing  on  January  5,  2017,  at  10:30  m.  in  Hearing  room  A  at  the  Commission  to  receive  comments  on  the  proposed  changes  to  Chapter  67.  The full text of the proposed regulations is available on the South Carolina General Assembly Home Page:  http://www.scstatehouse.gov/regnsrch.php (enter 4735 as the document number).

Tennessee VIEW STATE →

REGULATORY ACTIVITY:

• Form C-30 | Attending Physician's Report" has been removed and is no longer necessary. The revised forms C-30A | Final Medical Report, C-32 | Standard Form Medical Report for Industrial Injuries, and C-35A | Notice of Appeal Rights for a Utilization Review Denial should be used.

Texas VIEW STATE →

REGULATORY ACTIVITY:

• The Texas Department of Insurance’s Division of Workers’ Compensation (DWC) re-certified 10 employers to self-insure workers’ compensation claims. Together, the companies employ about 15,000 people in Texas.  DWC renewed: Associated Wholesale Grocers, Inc.; E.I. du Pont de Nemours and Company; The Sherwin-Williams Company; Space Exploration Technologies Corp.; FedEx Freight, Inc.; Guardian Industries Corp.; International Paper Company; James Construction Group, LLC; Louisiana-Pacific Corporation; The Procter & Gamble Company. To be certified to self-insure, a company must meet state requirements and have a minimum workers’ compensation insurance unmodified manual premium of $500,000. For more information on applying to the Self-Insurance Regulation program, visit the TDI website at tdi.texas.gov/wc/si/index.html.
• On December 9, 2016, Commissioner of Workers' Compensation Ryan Brannan adopted the repeal of existing 28 Texas Administrative Code (TAC) §152.3 and §152.4. Commissioner Brannan also adopted new §152.3, §152.4, and §152.6. The adoption was filed with the Office of the Secretary of State on December 16, 2016. The adoption will be published in the December 30, 2016 issue of the Texas Register and may be viewed on the Secretary of State website at http://www.sos.state.tx.us/texreg/index.shtml.  A  courtesy  copy  of  the  adoption  is  available  on  the  Texas Department of Insurance (TDI) website at http://www.tdi.texas.gov/wc/rules/2016rules.html.  The repeal and re-enactment of §152.3, Approval or Denial of a Fee by the Division, and §152.4, Guidelines for Legal Services Provided to Claimants and Carriers, is necessary to update the attorney fee rules for the first time since 1991.  The  new  rules  reflect  changes  in  the  industry  since  152.3  and  §152.4  were  originally  adopted,  and are designed to ensure there is quality representation available within the workers’ compensation system. Additionally, they allow more time at the beginning of a dispute for preparation and case management in order to encourage early resolution of claim disputes. New §152.6, Attorney Withdrawal, requires attorneys to comply with the Texas Disciplinary  Rules  of  Professional  Conduct  when  withdrawing  from  a  claim  and  to  obtain  an  order  granting  the attorney’s withdrawal prior to withdrawing after notice of a benefit review conference or contested case hearing is received. These requirements will help prevent an attorney’s withdrawal from having a material adverse effect on the client and will assist the division in tracking representation within the workers’ compensation system.  New §152.3, §152.4, and §152.6 have a delayed effective date of January 30, 2017. Attorney and legal assistant services rendered prior to January 30, 2017 must be billed in accordance with the rules in effect on the date the services were provided. Due to system processing requirements, an application for attorney fees may not contain dates of legal services that span across the effective date.  Therefore,  one  application  must  be  submitted  for services  rendered  on  or  after  January  30,  2017,  and  a  separate  application  must  be  submitted  for  services provided prior to and including January 29, 2017.  The  Texas  Department  of  Insurance,  Division  of  Workers  Compensation  (TDI-DWC)  is  posting  the  finalized  DWC Form-150,  Notice  of  Representation;  DWC  Form-150a,  Notice  of  Withdrawal  of  Representation;  DWC  Form-151, Attorney Application for Web Access; and DWC Form-152, Application for Attorney Fees, simultaneously with these rules.  Additional  information  and  the  forms  are  available  on  the  TDI  website  at http://tdi.texas.gov/wc/forms/documents/afeeforms1216.pdf.
• The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) has finalized revisions to amended DWC Form-150, Notice of Representation; DWC Form-151, Attorney Application For Web Access; and DWC Form-152, Application for Attorney Fees; as well as new DWC Form-150a, Notice of Withdrawal of Representation. The revisions to DWC Form-150 split the notice of representation and notice of withdrawal of representation into two separate forms, creating the DWC Form-150a. The new DWC Form-150a is provided as a means of compliance with the requirements of new 28 Texas Administrative Code (TAC) §152.6, regarding attorney withdrawal. The revisions to the DWC Form-151 are non-substantive in nature and primarily amend the form for clarity and to conform to current agency style. The DWC Form- 152 is amended to mirror the requirements of new 28 TAC §152.3, regarding approval or denial of fee by the division, and ensure TDI-DWC is receiving the necessary information to fulfill its statutory duty to approve attorney fees in the workers’ compensation system.    Informal drafts of the forms were posted on the TDI-DWC website on August 17, 2016, with an informal comment period ending September 19, 2016.   The finalized forms are available on the TDI-DWC website at http://www.tdi.texas.gov//forms/form20numeric.html, and are effective January 30, 2017. Attorneys should use the updated forms beginning January 30, 2017, to ensure compliance with the new rules. Additionally, attorneys should note that applications for attorney fees submitted on previous versions of the DWC Form-152 may not be accepted by the division.   TDI-DWC is posting the finalized forms simultaneously with the adopted repeal and re-enactment of 28 TAC §152.3 and §152.4, as well as new §152.6. Additional information about the adopted rules is available on the TDI website at: http://www.tdi.texas.gov/wc/rules/2016rules.html.
• The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) recently adopted the repeal and re-enactment of §152.3 and §152.4, as well as new §152.6.  New §152.4 increases the maximum hourly rates that may be charged by attorneys and legal assistants in the workers’ compensation system. Effective January 30, 2017, the maximum hourly rates increased from $150 an hour to $200 for attorneys and from $50 an hour to $65 for legal assistants.  New §152.4 also includes the following increases in the guidelines for legal services: the service maximum for communications per month increased from two hours to three hours, the service maximum for direct dispute resolution negotiation with the other party increased from three hours to three and a half hours, and the service maximum for preparation and submission of an agreement or settlement increased from one hour to two hours, effective January 30, 2017.  Here is what you need to know about these changes:
  • Attorneys may continue to submit the DWC Form-152, Application for Attorney Fees, through the Web- Enabled Attorney Fee Processing System (WAFPS), fax, or mail.
  • The new rules have a delayed effective date of January 30, 2017. Attorney and legal assistant services must be billed per the rules in effect on the date the services were provided. Thus, applications requesting fees for services provided prior to January 30, 2017, may not exceed a maximum hourly rate of $150 an hour for attorneys and $50 an hour for legal assistants, and the hours must comply with the guidelines for legal services in effect at that time.
  • Due to system processing requirements, an application may not contain dates of legal services that span across the effective date. If services include dates in both time periods, separate applications must be submitted requesting the appropriate maximum hourly rates: $150/$50 for services provided prior to January 30, 2017, and $200/$65 for applications requesting fees for services provided on or after January 30, 2017.
  • Under the new rules, attorneys must use their own bar card number when requesting attorney fees and must notify the division when withdrawing representation at any point during the claim. In some instances, the attorney must first provide good cause and receive a division order granting the withdrawal before withdrawing from a claim.
  • Along with the rules, the division amended DWC Form-150, Notice of Representation; DWC Form-151, Attorney Application for Web Access; and DWC Form-152, Application for Attorney Fees; as well as created new DWC Form-150a, Notice of Withdrawal of Representation. The finalized forms will be effective January 30, 2017, and are available on the TDI website at tdi.texas.gov/forms/form20numeric.html.  Attorneys should use the updated forms beginning January 30, 2017, to ensure compliance with the new rules. Additionally, attorneys should note that applications for attorney fees submitted on a previous version of the DWC Form-152 may not be accepted by the division.  Please also note that WAFPS will be unavailable January 28–29, 2017, so that the system can be updated to reflect the new requirements of adopted §152.3 and §152.4. Attorneys using WAFPS will need to submit applications for attorney fees before January 28, 2017, or after January 29, 2017, at the appropriate maximum rates for the time period that the services were provided. If you have any questions about the new rules, please contact Emily McCoy at Emily.McCoy@tdi.texas.gov. For more information, visit the TDI website at www.tdi.texas.gov/alert/whatsnew/2016/index.html.
• Texas has disciplined two physicians treating injured workers.
• The Division ordered the following for DR. Prtichett:
  • Gary L Pritchett, D.C. is ordered to not apply for certification of the division's designated doctor list for a period of three years from the date this order is signed by the Commissioner of Workers' Compensation.  If Gary L.  Pritchett, D.C. applies for certification of the division's designated doctor list during the three-year period the division will deny the application.  The order was effective September 23, 2016
• The division ordered the following for Dr. Carter:
  • It is  ORDERED that  from  the  date  of this  order, Jerome Oliver Carter,  M.D.,  shall  be removed from the  Texas  workers’  compensation system and  will  no longer participate  in the Texas workers’  compensation  system,  network  or  non-network,  as a  health care provider.  Dr.  Carter will not participate in treating, examining, and/or consulting with other physicians regarding injured employees who are covered under the Texas workers’ compensation system.  Additionally, Dr.  Carter will not receive direct or indirect remuneration from the Texas workers’ compensation system.  This order does not apply to emergency cases, as defined by 28 TEX.  ADMIN.  CODE § 133.2.  This order was effective September 20, 2016.
• The order for Dr. Pritchett primarily pertains to actions by the Division.  The division has barred Dr. Pritchett from serving as a designated doctor for a 3-year period.
• The order for Dr. Carter applies across the board.  The Division has barred Dr. Carter from treating injured workers or receiving remuneration for treating injured workers except in the case of an emergency.  This is a total ban barring Dr. Carter for life from participating in the workers' compensation system in Texas.

Utah WC VIEW STATE →

REGULATORY ACTIVITY:

• Utah has updated their Medical Care Rule by specifying actions an advanced practice registered nurse must take when prescribing Schedule II controlled substances for injured workers.

Vermont VIEW STATE →

REGULATORY ACTIVITY:

• The Commissioner has finally adopted and published Rule 45 on January 6, 2017.  These rules update the Workers' Compensation program administrative citation and penalty provisions to address the debarment penalties added to the statutes, and Supreme Court decisions on penalty assessment and calculation. The Rules also address recent changes to the Workers' Compensation's fraud provisions.

Virginia VIEW STATE →

REGULATORY ACTIVITY:

• Virginia has published two new FQA for two new online forms 61A and 16A.
• Virginia has published an updated Medical Fee Schedule Time line.
• Virginia has released a copy of the proposed MFS for comment and feedback.

Wisconsin VIEW STATE →

FEE SCHEDULE NEWS:

• The certified physician database has been updated with an effective date of January 1, 2017. The next update is scheduled for July 2017.

REGULATORY ACTIVITY:

• Issued a Governor's Executive Order #228 relating to the implementation of the recommendations of the Co-Chairs of the Governor's Task Force on Opioid Abuse.