Alabama VIEW STATE →

FEE SCHEDULE NEWS:

• The state has posted new changes to the hospital and ASC fee schedules effective April 1, 2017.  New updates will become available July 2017.
• The state has posted a new physician fee schedule effective January 1, 2017.

Alaska VIEW STATE →

REGULATORY ACTIVITY:

• The state has posted a notice of proposed changes relating to second independent medical evaluation procedures and the definition of previously rehabilitated in the regulations of the Alaska Department of Labor and Workforce Development and the Alaska Workers’ Compensation Board.

Arizona VIEW STATE →

REGULATORY ACTIVITY:

• Published updated Lump Sum Discount tables on March 30, 2017.  The tables are effective January 1, 2017.
• Under A.R.S. 23-1065(F), after notice and a hearing, the Commission was authorized to levy an additional one-half percent assessment under A.R.S. § 23-1065(A) if the total annual reserved liabilities of the Special Fund for apportionment under §§ 23-1065(B) and (C) exceed six million dollars.  The Commission will hold a public hearing to gather information concerning this assessment on May 11, 2017, at 1:00 p.m.  in the Commission’s first floor auditorium located at 800 West Washington Street, Phoenix, Arizona.  This hearing will be held as part of the Commission’s scheduled meeting for that day.  The record is considered open, and written and oral comments will be accepted until the close of the hearing on May 11, 2017.  Later, the Commissioners will discuss and may act on this assessment.  Written comments may be submitted prior to the hearing c/o Kara Dimas, Executive Secretary, Office of the Commission Director, P.O.  Box 19070, Phoenix, Arizona 85005-9070.

LEGISLATIVE ACTIONS:

• Senate Bill 1478
  The enacted legislation Exempts model system programs from inspections or investigations by the Division of Occupational Safety and Health (ADOSH) and repeals membership requirements for the Occupational Safety and Health Review Board (Review Board). Privatizes boiler inspections.  Effective Date: July 15, 2017.

Arkansas VIEW STATE →

LEGISLATIVE ACTIONS:

• Senate Bill 760
  The enacted legislation clarifies the statute regarding final settlements of workers’ compensation claims involving joint petitions under the workers’ compensation law that resulted from initiated measure 1948, No. 4 and for other settlement purposes.  Effective Date: July 3, 2017.

California VIEW STATE →

FEE SCHEDULE NEWS:

• The Outpatient and ASC Fee Schedule were updated with an effective date of June 1, 2017. The state has adopted the April 2017 OPPS APC Addenda A and B and the April 2017 ASC Addendum AA and EE are adopted to identify the definition of a “surgical procedure”.  The state also incorporates the January 2017 OPPS Addenda J and M and revised wage indexes and conversion factors.  The "WC Multipliers" remain unchanged since the 12/15/2016 revision.  All outpatient services are 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).
• Medi-Cal rates have been released with an effective date of April 15, 2017. The next update is scheduled for May 15, 2017.

REGULATORY ACTIVITY:

• The Office of Administrative Law (OAL) has approved the Division of Workers’ Compensation’s (DWC) final version of the Workers’ Compensation Information System (WCIS) regulations regarding medical billing reporting.  The regulations include release of the California EDI Implementation Guide for First and Subsequent Reports of Injury (FROI/SROI), Version 3.1, for reporting beginning 12 months following the effective date of the regulations (March 27, 2018).  The regulations also include updates to the California Electronic Data Interchange (EDI) Implementation Guide for Medical Bill Payment Records, Version 2.0, which brings California reporting requirements into compliance with IAIABC standards for medical bill payment reporting, for reporting beginning six months following the effective date of the regulations (September 27, 2017).  DWC believes that these updates will allow WCIS to collect more robust and useful data that will assist with research regarding workers’ compensation issues.

Colorado VIEW STATE →

REGULATORY ACTIVITY:

• The Division of Workers’ Compensation posted notice of a public hearing for rule 2-5 amendments to the premium surcharge rate paid by carriers and self-insureds employers.  The hearing was to be held on May 1, 2017 at 10:00 AM at 633 17th Street Denver CO.

Florida WC VIEW STATE →

REGULATORY ACTIVITY:

• The Florida Department of Financial Services, Division of Workers' Compensation held a public meeting of the Three-Member Panel on Wednesday, April 19, 2017, beginning at 10:00 a.m., in room 116 of the J. Edwin Larson Building located at 200 East Gaines Street, Tallahassee, Florida. The purpose of the meeting was to review and adopt the 2017 editions of the Health Care Provider Reimbursement Manual, Hospital Reimbursement Manual, and the Ambulatory Surgical Center Reimbursement Manual. Public comment was also received. The meeting agenda and the drafts of the respective reimbursement manuals are available on the Florida Division of Workers’ Compensation website.
• Florida has proposed Rule Workshop 69L-8, Selected Materials Incorporated by Reference Wednesday, May 31, 2017, 1:00 p.m. (eastern) Room 102, Hartman Building, 2012 Capital Circle SE, Tallahassee, FL.  The proposed rules incorporate updated versions of currently adopted resource materials utilized in the determination and reimbursement of the costs of medical care provided to Florida’s injured employees. The proposed rules promote the efficient delivery of medical care to Florida’s injured employees by reducing the potential for errors and delays resulting from the use of dated materials.

Iowa VIEW STATE →

LEGISLATIVE ACTIONS:

• House File 518
  The enacted legislation makes various changes to Iowa Code chapter 85 related to workers’ compensation by reducing benefits, limiting benefits, changing the qualifications for benefits, and reducing the interest rate calculation.  The Bill provides for training, at an Iowa community college that at a minimum, will result in the awarding of an associate degree or completion of a certificate program that will enable a worker who has sustained a shoulder injury, as specified in Iowa Code section 85.34(2), to return to the workforce.  The Iowa Workforce Development (IWD) Department is required to evaluate those workers for career and training opportunities.  The Iowa community colleges are required to have a new Career Vocational Training and Education Program to address the needs of those workers.  Each of those injured workers will be entitled to up to $15,000 for the payment of tuition, fees, and required equipment, to be paid for by the injured worker’s employer or employer’s insurer.  The community college may be required to report each semester on the status of the employee’s training.  An annual report on the Program is due to the General Assembly beginning December 1, 2018.  The report is to be provided by the IWD, in cooperation with the Department of Education, the Insurance Division of the Department of Commerce, and all community colleges.  Effective Date: July 1, 2017.

Kentucky VIEW STATE →

REGULATORY ACTIVITY:

• “The Workers' Compensation Nominating Committee is now accepting applications to fill a vacant position of Administrative Law Judge in the Kentucky Department of Workers' Claims.  Pursuant to KRS 342.230(3), the term for the vacant Administrative Law Judge position expires December 31, 2017.  This is a full-time position, subject to appointment by the Governor of and confirmation by the Kentucky State Senate.  Appointees shall not hold any other public office or maintain any private practice.”

LEGISLATIVE ACTIONS:

• House Bill 377
  The enacted legislation amends KRS 337.1223 to provide discretion to the Workers' Compensation Funding Commission to consult with the Office of Financial Management and grant the commission the authority to also contract with outside investment firms within the parameters of KRS Chapter 45A, and require that the Office of Financial Management be consulted and participate in the selection of outside investment firms; however, the Funding Commission has the final approval. Fees for the outside contracts shall be paid from the investment earnings.  The legislation  create a new section of KRS Chapter 342 for the General Assembly to declare the issues surrounding the Kentucky coal workers' pneumoconiosis fund; create a new section of KRS Chapter 342 to close the coal workers' pneumoconiosis fund on July 1, 2017 to all new claims, transfer liabilities and assets to the Kentucky Employers' Mutual Insurance Authority, and set forth assessment requirements for 2017 and 2018; amend KRS 342.1242, 342.316, 342.320, 342.732, 342.792, 342.794, and 342.120 to bring the statutes into conformity with closing the coal workers' pneumoconiosis fund and transfer to the Kentucky Employers' Mutual Insurance Authority. KRS 342.1241 is repealed; EMERGENCY. Effective Date: April 10, 2017.

Maine VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted new Inpatient DRG values effective April 1, 2017. based on Version 34 of the US Federal Government’s DRG Grouper for FY 17.  The next update is expected October 2017.
• The state has updated adopted changes to the physician, outpatient and ASC facility fee schedules with an effective date of January 1, 2017. The next medical fee schedule update is expected in January 2018.
• The state has updated the Outpatient and ASC Facility Fee Schedules with an effective date of April 1, 2017.  The next outpatient facility fee schedule update is expected October 2017.

LEGISLATIVE ACTIONS:

• Legislative Document 313
  The enacted legislation changes the time frame that a former employee of the Workers’ Compensation Board may practice before the Board from 2 years to 1 year. Effective Date: September 21, 2017.

Maryland VIEW STATE →

LEGISLATIVE ACTIONS:

• House Bill 1294
  The enacted legislation increases the cap – from $45,000 to $65,000 – on unpaid benefits that may survive to a covered employee’s dependents or spouse when the employee was receiving permanent total disability benefits and died from causes unrelated to the claim. The bill must be construed to apply only prospectively and may not be applied or interpreted to have any effect on, or application to, any claims arising before the bill’s October 1, 2017 effective date. Effective Date October 1, 2017.

• House Bill 1315; Senate Bill 72
  This bill expressly authorizes a workers’ compensation insurer to develop a tiered rating plan containing risk tiers that are applied to the uniform classification system that must be used for rate making.  A tiered rating plan must (1) establish discrete tiers based on defined risk attributes that are reasonably related to the insurer’s business and economic purposes and are not arbitrary, capricious, or unfairly discriminatory; (2) require each insured to be placed in the highest quality tier for which it qualifies; and (3) be filed with the Insurance Commissioner at least 30 days before it may be used.  The Commissioner must disapprove a tiered rating plan if the data produced under the plan cannot be reported in a manner consistent with the uniform classification system and statistical plan.  The bill also expressly authorizes an insurer to file a merit rating plan with the Commissioner for insureds who do not qualify for a uniform experience rating plan.  Effective Date October 1, 2017.

Massachusetts VIEW STATE →

REGULATORY ACTIVITY:

• The Department of Industrial Accidents has made a revision to the Form 105 – Agreement to Extend 180 Day Pay Without Prejudice Period.  The revision appears in the notice just below the employee’s signature and is intended to clarify the purpose and scope of the agreement to extend benefits under the pay without prejudice clause in M.G.L. c. 152, Sec. 8.  The new form 105 took effect on March 31, 2017.
• The state published two new bulletins: Bulletin 17-06 and 17-07.  Bulletin 17-06 addresses 114.3 CMR 22: Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment providing Updates and Corrections to HCPCS codes effective January 1, 2017/  Bulletin 17-07 addresses 101 CMR 334.00: Prostheses, Prosthetic Devices and Orthotic Devises providing HCPCS updates and corrections effective January  1, 2017.

Michigan VIEW STATE →

REGULATORY ACTIVITY:

• Published its 2016 Annual Report.
• “The Resolution, Rehabilitation and Rules Division will be presenting training seminars on the 2016 Health Care Rule changes effective January 13, 2017.  The seminars will be held on the following dates from 9:30 a.m. to 11:30 a.m.:
  • Lansing: Tuesday, May 9, 2017 at the MDOT Horatio S Earle Learning Center Conference Room, 7575 Crowner Drive, Lansing, MI
  • Detroit:   Wednesday, May 10, 2017 at the Cadillac Place Building, Room L150, 3026 W Grand Blvd., Detroit, MI
  • Grand Rapids:  Tuesday. May 23, 2017 at the GRCC M-Tec Building, Room 206, 622 Godfrey Avenue SW, Grand Rapids.
  • This seminar covers new rules, rule changes, and definitions which became effective January 13, 2017.
  • These seminars are free of charge and are for anyone who is involved in the billing process and the hearing process of medical bills for the treatment of work related injuries.  Your questions are welcomed and encouraged.
  • Please complete the registration form and return, via fax or email, by the date indicated.  Entry into any state office building will require picture identification.”

Mississippi VIEW STATE →

REGULATORY ACTIVITY:

• “The MWCC was merged into the State General Fund on July 1, 2016, as mandated by SB 2362. This has created numerous problems for the Commission especially in the area of budgeting. Since this change was implemented, the Governor has cut spending authority for General Fund Agencies four times during FY 17. These cuts reduced the Commission's spending authority by $301,597 for FY 17.The Commission's FY 18 appropriation bill, SB 2975, cut the Commission's spending request by $779,007. As a result of these budget cuts, the Commission is forced to take action and reduce Commission expenses. Effective immediately, pursuant to Rule 18(h) of the Procedural Rules of the Mississippi Workers' Compensation Commission, the Commission is suspending payment and/or reimbursement of expert medical witness fees. This suspension covers the fees addressed in Rules9(6) and 18(h) of the Procedural Rules of the Mississippi Workers' Compensation Commission.”

Missouri VIEW STATE →

REGULATORY ACTIVITY:

• Missouri has posted two new forms involving employers electing to become self-insured. The new forms are WC 304-G and WC 304-I.

Montana VIEW STATE →

REGULATORY ACTIVITY:

• Montana has posted their fee schedule effective on July 1, 2017.
• On May 5, 2017, at 10:00 a.m., the Department of Labor and Industry (department) will hold a public hearing in conference rooms A and B of the Beck Building, 1805 Prospect Avenue, Helena, Montana, to consider the proposed amendment of ARM 29.1433, 24.29.1534, and 24.29.1538 pertaining to workers' compensation facility service rules and rates and conversion factors.

LEGISLATIVE ACTIONS:

• Senate Bill 275
  The enacted legislation defines the construction industry in the workers’ compensation construction premium credit program.  The legislation amends section 39-71-2211, MCA.  Effective Date: April 13, 2017.

Nebraska VIEW STATE →

REGULATORY ACTIVITY:

• Kids' Chance of Nebraska is seeking new applicants for upcoming school year. For the children of Nebraska workers who have been severely or fatally injured in a workplace accident, this opportunity could provide critical financial assistance for higher education and open up new possibilities for the future.

Nevada VIEW STATE →

REGULATORY ACTIVITY:

• The Board for the Administration of the Subsequent Injury Account for Self-Insured Employers held a public meeting on April 19, 2017 at 10:00 a.m., at 1301 North Green Valley Parkway, Conference Room B, Henderson, Nevada.
• The Board for the Administration of the Subsequent Injury Account for Associations of Self-Insured Public or Private Employers held a public meeting on April 13, 2017, 10:00 AM, at 1301 North Green Valley Parkway, Conference Room B, Henderson Nevada.

New Hampshire VIEW STATE →

REGULATORY ACTIVITY:

• On April 25, 2017 the Department of Insurance has posted notice of amendments to its rules regarding third party administrators.

New Jersey WC VIEW STATE →

REGULATORY ACTIVITY:

• The N.J. Division of Workers’ Compensation has just been informed that Castlepoint National Insurance Company is insolvent and has been placed into liquidation by the Insurance Commissioner of the State of California.  The administration of all claims against this carrier will be handled the office of the New Jersey Property-Liability Insurance Guaranty Association (NJ PLIGA) in accordance with N.J.S.A. 34:15–103 et seq.
• New Jersey has issued an order effective Monday April 17, 2017 regarding the requirement of physicians to use specific forms when filing for an internal appeal form with the state for PIP Pre-Service Appeal Form and PIP Post-Service Appeal Form.

New Mexico VIEW STATE →

REGULATORY ACTIVITY:

• New Mexico Workers’ Compensation Administration Director Darin A. Childers has appointed Rachel A. Bayless to serve as a workers’ compensation judge. She assumed her new position on April 8, 2017, replacing retiring Judge Terry Kramer. Bayless joined the WCA in February 2014 and has served as the agency’s General Counsel since that time. As the agency’s chief legal advisor, she advised the director on a vast array of legal issues affecting the WCA and the workers’ compensation system, in addition to often serving as an expert advisor on workers’ compensation law during legislative sessions.  Effective April 10, all pending and administratively closed cases before the New Mexico Workers’ Compensation Administration previously assigned to Judge Terry Kramer will be reassigned to Bayless. Parties who have not yet exercised their right to challenge or excuse will have 10 days from April 10, to challenge or excuse Judge Bayless pursuant to N.M.A.C. Rule 11.4.4.13. Questions about case assignments should be directed to WCA Clerk of the Court Heather Jordan at 505-841-6028.
• The IME Provider Selection Committee is revising its list of qualified IME Providers. Applications from providers will be accepted from March 1, 2017 through April 30, 2017. Written public comments on any health care provider being considered for inclusion or continuation in the list of certified IME providers will be accepted from May 1, through the close of business May 31, 2017. A list of all applications received from new and continuing IME providers is available from the Medical Cost Containment Unit, PO Box 27198, Albuquerque, NM 87125-7198, (505) 841-6811.
• New Mexico Governor Susana Martinez has signed Senate Bill 155, sponsored by Sen. Jacob Candelaria (D-Albuquerque). The new law attempts to clarify a worker’s entitlement to disability benefits when an injured worker unreasonably refuses a post-injury return to work offer, or is terminated for misconduct after returning to work post-injury. The new law would also allow for fines of up to $10,000 against employers who terminate workers for pretextual reasons in order to avoid payment of benefits to the worker, or as retaliation against the worker for simply seeking benefits.

LEGISLATIVE ACTIONS:

• Senate Bill 155
  The enacted legislation amends sections of the workers’ compensation act to reestablish return to work and clarify benefit entitlement.  Effective Date: June 18, 2017.

• Senate Bill 367
  The enacted legislation amends sections of the New Mexico Insurance code; amending requirements related to examination Reports and investigatory hearings.  The enacted legislation changes annual financial Statement filing penalties. It removes stop-loss insurance from the list of accident and health insurance products; allowing Accident and health insurers to write stop-loss insurance.  The legislation allows casualty insurers to continue to write accident and Health insurance. The legislation revises various requirements related to Surplus lines insurance. It allows insurers to pay claims by Electronic fund transfer. The legislation amends the insurance fraud act to establish a fee payment deadline and late payment penalty; including student health policies within provisions relating to individual health insurance. It removes student health plans from the list of blanket health insurance products and from the list of products that are not managed health care plans. The legislation extends the superintendent of insurance's review period for marketing materials and for credit life and credit health product filings; It repeals the surplus lines insurance Multistate compliance compact.  Effective Date June 18, 2017.

New York VIEW STATE →

FEE SCHEDULE NEWS:

• New changes to the DMEPOS fee schedule have been adopted with an effective date of May 1, 2017.
• The state has released new reimbursement rates for Acute Per-Case Inpatient Hospital Rates, Exempt Hospitals, Exempt Units and Detoxification Inpatient Rates retroactive to January 1, 2017.

REGULATORY ACTIVITY:

• As announced in Subject Number 046-878 Board Adopts New Administrative Review, Full Board Review, and Applications for Board Reconsideration Regulations, the Board adopted new regulations for Administrative Review, Full Board Review, and Applications for Reconsideration effective October 3, 2016. The new regulations repealed §300.13, §300.15 and §300.16 of Title 12 of NYCRR, and adopted a new §300.13.
• New 12 NYCRR 300.13 sets forth the prescribed formatting, completion, service and submission requirements for applications for review and rebuttals filed on and after October 3, 2016. Applications for review and rebuttals that do not meet the prescribed formatting, completion, service and submission requirements may be denied, and rebuttals may not be considered. These requirements do not apply to applications and rebuttals filed by an unrepresented claimant.
• Pursuant to §300.13(b) (1), applications for review must be in the format prescribed by the Chair; this requirement also applies to rebuttals (see 12 NYCRR 300.13[c]). In Subject Number 046-878, the Chair designated Application for Board Review (Form RB-89), and Rebuttal of Application for Board Review (Form RB-89.1), version 09-16, as the prescribed format. The Subject Number advised parties that after December 1, 2016, only the revised forms, Form RB-89 (09-16) and Form RB-89.1 (09-16) would be accepted. Applications submitted after December 1, 2016, using a version other than Form RB-89 (09-16), are not in the prescribed format and will be denied. Rebuttals submitted using a version other than Form RB-89.1 (09-16), after December 1, 2016, will not be considered.
• Revised forms for Application for Reconsideration/Full Board Review (RB-89.2, version 1-17), and Rebuttal of Application for Reconsideration/Full Board Review (Form RB-89.3, version 1-17) are also now available on the Board’s website. For Applications for Reconsideration/Full Board Review filed after May 26, 2017, the Board will only accept version 1-17 forms. This includes the proper form identifier. Applications submitted using the old form or with an incorrect identifier are not in the prescribed format and will be denied. Rebuttals submitted using the old form will not be considered.
• New § 300.13(b)(1) mandates that all applications for review “must be filled out completely,” which means that each section or item of Form RB-89, Form RB-89.1, Form RB-89.2, and Form RB-89.3 is completed in its entirety pursuant to the instructions for each form. A Form RB-89 (09-16), Form RB-89.2 (1-17), Form RB-89.1 (09-16), or RB-89.3 (1-17) is not “filled out completely” when a party responds to sections or items on the form merely by referring to the attached legal brief or other documentation without further explanation. For example, responding to section/item 11 on Form RB-89 (09-16) or section/item 13 on Form RB-89.2 (1-17) by simply stating, “See attached” is not sufficient and the form is not filled out completely. AS OF MAY 26, 2017 ANY APPLICATION FOR REVIEW BY A PARTY OTHER THAN AN UNREPRESENTED CLAIMANT THAT IS NOT FILLED OUT COMPLETELY WILL BE DENIED, AND ANY REBUTTAL FILED BY A PARTY OTHER THAN AN UNREPRESENTED CLAIMANT THAT IS INCOMPLETE WILL NOT BE CONSIDERED (see 12 NYCRR 300.13[b][4][i]).
• As a reminder, appellants and respondents are encouraged to review new 12 NYCRR 300.13 to ensure they comply with all requirements, including the following examples:
  • The Board may deny consideration of applications where the legal brief is longer than eight pages “… unless the appellant specifies, in writing, why the legal argument could not have been made within eight pages. In no event shall a brief longer than 15 pages be considered” (12 NYCRR 300.13[b][1][i]).
  • The Board may deny applications when documents are included (with or attached to the application) that are already in the Board’s electronic case folder at the time the administrative review is submitted (12 NYCRR 300.13[b][1][ii]).
  • The Board may consider additional evidence submitted with the application only if a sworn affidavit, setting forth the evidence, and explaining why it could not have been presented before the Workers’ Compensation Law Judge, is submitted with the evidence. Newly filed evidence submitted without the sworn affidavit will not be considered by the Board (12 NYCRR 300.13[b][1][iii]).
  • Parties must file an application or rebuttal using one of the methods prescribed in 12 NYCRR 300.13(b)(3)(ii), Subject No. 046-878 and this Subject No 046-940; otherwise, the application will be denied and/or the rebuttal will not be considered.
  • Parties that submit duplicate filings may be deemed to be raising or continuing an issue without reasonable grounds, and may be subject to assessments under Workers’ Compensation Law § 114-a(3) (12 NYCRR 300.13[b][3][i]).
• The full text of the new §300.13 is available both on the New York State Register and the Board’s website under Laws, Regulations and Decisions. Forms RB-89 (09-16), RB-89.2 (1-17), RB-89.1 (09-16), and RB-89.3 (1-17) are also available on the Board’s website.

North Carolina VIEW STATE →

REGULATORY ACTIVITY:

• The Industrial Commission is pleased to announce the first meeting of the task force to study and recommend solutions for the problems arising from the intersection of the opioid epidemic and related issues in workers’ compensation claims. The first meeting was scheduled for 2:00 p.m. on Thursday, April 6, 2017, in the Dobbs building at 430 N. Salisbury Street, Raleigh, NC 27603. NOTE ROOM CHANGE: Please note that the meeting has been moved to the Jim Long Hearing Room, Room 3099, on the third floor.

North Dakota VIEW STATE →

REGULATORY ACTIVITY:

• The North Dakota WSI has adopted changes that a provider may submit professional charges (CMS-1500/837p) and documentation electronically to WSI through iHCFA. WSI is also working to implement submission of institutional charges (UB-04/837i) through iHCFA.
• iHCFA is a specialized clearinghouse that offers the electronic submission of bills, medical reports, and supporting documents to workers' compensation payers. This new billing option will result in quicker bill payment, confirmation reports of bill receipt, and elimination of paper and associated expenses for a provider.
• iHCFA provides the following options for submitting professional medical bills, which were not previously available:
  • Direct connection with WSI for medical bill and documentation submission
  • Online claim form interface, including documentation attachment
  • Indirect connection with a provider’s existing clearinghouse, dependent on the clearinghouse’s ability to meet certain technical requirements.
• A provider interested in submitting professional (CMS-1500/837p) bills via EDI must register with both WSI and iHCFA.
• To register with WSI, complete the Payee Registration and Substitute W-9 form. WSI requires a new or an existing provider complete this form prior to submitting through iHCFA. A provider must submit a Payee Registration and Substitute W-9 form for each business NPI they bill to WSI.
• To register with iHCFA, or for additional information, contact iHCFA at 973-795-1641 (option 2).
• WSI has adopted the AMA’s CPT® Guidelines for telemedicine services. Telemedicine seeks to improve a patient's health by permitting two-way, real time interactive communication between the patient and a physician or practitioner at a distant site. The CPT Guidelines indicate telemedicine services involve the use of interactive telecommunications equipment that, at a minimum, includes both audio and video. CPT codes approved for telemedicine are identifiable by the presence of a ★ symbol preceding the code. The AMA also collectively lists these services in Appendix P of the CPT Guidelines.  A provider should submit a claim for a telemedicine service using Place of Service (POS) code 02. Appropriate billing includes the CPT or HCPCS code for the professional service appended with modifier GT or 95. WSI issues reimbursement for the CPT code billed per WSI fee schedule, when deemed medically necessary and related to the work injury.  WSI also allows reimbursement for an originating site fee per WSI Fee Schedule. A provider should submit a claim for this service with HCPCS code Q3014 on a CMS-1500 using POS 02 or a UB-04 using type of bill 131.

Ohio VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted changes to the ASC and outpatient fee schedule rates effective May 1, 2017. The next update is scheduled for May 2018.

REGULATORY ACTIVITY:

• Ohio has published final rule for rule 4123-6-02.5 Provider Access to the HPP- provider not certified.  The final rule was published on April 25, 2017.  The rule becomes effective on June 1, 2017.
• Ohio has published the final rule for Rule 4123-5-18 Medical proof for required for payment of compensation.  The final rule was published on April 25, 2017.  The rule becomes effective on June 1, 2017.
• Ohio has posted amendments to two rules.  The amended rules are 4123-15-09 Prohibition against unnecessary claim file possession and 4123-15-03 Standard of conduct.

Oklahoma VIEW STATE →

REGULATORY ACTIVITY:

• Oklahoma has published a new e-mail address for inquiries regarding fee schedules.  The new address is feeschedule@wcc.ok.gov

Oregon VIEW STATE →

REGULATORY ACTIVITY:

• An industry notice was released by the state of Oregon: “Accurate and timely claim reporting is essential to ensure the Workers’ Compensation Division has accurate and complete claim data. The division uses claim data to monitor industry performance, respond to inquiries, perform dispute resolution, and assist with return to work. ORS 656.264 and OAR chapter 436 require insurers and self-insured employers to report certain claims information to the division. Any delay in providing this information impedes the division’s regulatory processes.  Since 2012, the division has sent Insurer Delinquency Reports each quarter (January, April, July, and October) by certified mail to claim processors. The delinquency report identifies missing claims data, forms, and related documents that have not been reported to the division. Claim processors are required to respond to each item included on the delinquency report within 30 days from the date on the cover letter included with the report. The division is aware that several claim processors are not responding timely, leaving many report items unresolved over several quarters or years.   Under ORS 656.745(2), OAR 436-060-0011(10), and OAR 436-060-0200, the director may issue a civil penalty against any insurer or self-insured employer that fails to comply with statutes, rules, or the director’s orders regarding reports or failure to file required notices or forms within time frames required by rule.   Starting with the July 2017 delinquency report, the division will assess civil penalties against insurers or self-insured employers for items not resolved by the deadline. Each unresolved item on the delinquency report that is more than 30 days from the report cover letter date will be penalized.  If there are items on the delinquency report that are not the responsibility of the claims processor listed, the processor must respond with that information within the 30 day time frame. A nonresponse will be considered unresolved and subject to penalty.  The division expects claim processors to review and respond to the delinquency report in a timely and complete manner.   For questions about the delinquency report, contact Quality Control Specialist Kim Muller at kim.a.muller@oregon.gov or 503-947-7596. For questions about civil penalties, contact Medical Resolution and Sanctions Manager Steve Passantino at steve.s.passantino@oregon.gov or 503-947-7584. “
• The Oregon Supreme Court issued its decision in Brown v. SAIF Corporation (361 Or 241) on March 30, 2017, reversing the Court of Appeals decision. The Supreme Court’s opinion is available on the Judicial Department’s website at: http://www.publications.ojd.state.or.us/docs/S062420.pdf.  The court’s decision interprets terminology used in ORS chapter 656, including “injury,” “compensable injury,” and “accepted condition.” The court’s interpretation impacts the Workers’ Compensation Division’s administrative rules, particularly the rules in OAR chapter 436, divisions 030 (Claim Closure and Reconsideration) and 035 (Disability Rating Standards).   The division is reviewing its rules to determine what changes need to be made. We want to act quickly, but thoughtfully. In the coming days we will develop and share a plan for the rulemaking process. The process will include an opportunity for stakeholders to participate and provide input.  In the meantime, there will be a transition period before the division is able to fully implement the changes. Requests for reconsideration that are currently pending before the Appellate Review Unit will be reviewed with the Supreme Court’s decision in mind. We do not plan to abate Orders on Reconsideration that have already been issued; orders that have not yet become final may be appealed to the Hearings Division.  If you have question about this notice, please contact Appellate Review Unit Manager Danae Hammitt at 503- 947-7753 or danae.c.hammitt@oregon.gov.  Questions about the division’s rulemaking process can be directed to Fred Bruyns, rules coordinator, at 503-947-7717 or fred.h.bruyns@oregon.gov.
• This industry notice supersedes the previous Dec. 28, 2016, notice “Application of an incurred but not reported (IBNR) factor” and provides information about upcoming changes to the method the Workers’ Compensation Division uses to calculate security deposits for self-insured employers and employer groups.   Due to ambiguity in Oregon Administrative Rule (OAR) 436-050-0180(1)(e) regarding the incurred but not reported (IBNR) calculation, the division will apply an IBNR factor to all security deposit calculations for self- insured employers and employer groups beginning in 2018.  Following rulemaking, it is anticipated that IBNR will be calculated by applying a loss development factor against the employer’s incurred losses, which includes both future claim liability and annual incurred losses. This is consistent with the information shared throughout the Division 50 rulemaking process carried out in 2015 and 2016, but inconsistent with the final wording of the rule.   Application of an IBNR factor helps ensure that security deposits for self-insured employers and employer groups are sufficient to cover their respective claim liabilities and other amounts due to the director under ORS chapter 656 in the event of default or insolvency. In previous years, the division has applied an IBNR factor of 0 percent to security deposits. However, the Department of Consumer and Business Services actuaries have advised a factor of 20 percent to safely include all costs of injuries that will be filed as claims at a later date.   To provide self-insured employers and employer groups time to plan for and finance the resulting increases in their security deposits, the division will raise the IBNR factor incrementally over a period of three years, starting in 2018, reaching 20 percent in 2020. After reaching 20 percent, the factor will be periodically reviewed for sufficiency. The planned implementation is as follows:    2018 IBNR Factor 7%  2019 IBNR Factor 14%  2020 IBNR 20 %  The division understands that this is a significant shift in the security deposit calculation process that will require more financial contribution from self-insured employers and employer groups. However, this change is necessary to ensure the long-term health of the self-insurance coverage option in Oregon while placing the financial burden of insolvent self-insured employers and employer groups on the responsible entities.
• The Workers’ Compensation Division has published temporary rules to its website:

OAR 436-010, Medical Services http://wcd.oregon.gov/Rules/div_010/10-17052t_ub.pdf
OAR 436-030, Claim Closure and Reconsideration http://wcd.oregon.gov/Rules/div_030/30_17053t_ub.pdf
OAR 436-035, Disability Rating Standards http://wcd.oregon.gov/Rules/div_035/35_17054t_ub.pdf

• These rules are effective  April 11, and align the Workers' Compensation Division's rules with the Supreme Court’s decision in Brown v. SAIF Corporation (361 Or 241).
• The amended rules have been incorporated into their respective divisions, which are now a combination of permanent and temporary rules.
• Oregon has published a revised Bulletin No 248 regarding MCO geographic service areas (GSAs) on April 27, 2017.  This bulletin notifies all interested parties of current MCO GSAs.  The division is revision this bulletin to add an additional ZIP code (GSA 11:97703 to Exhibit A.  This bulletin replaces Bulletin No 248 issued March 19, 2015.
• The Workers' Compensation Division published the following Industry Notice dated April 26, 2017:
  • "Employer and insurer responsibilities under workers’ compensation large deductible policies."  If you have questions about this notice, contact the division at 503-947-7176 or wcd.ldpinquiries@oregon.gov.
• The division revised Bulletin 239, "Claim closing and other impairment-focused examinations and forms for reporting impairments," to reflect changes to the Oregon Administrative Rules effective April 11,2017, as a result of the Oregon Supreme Court's opinion in Brown v. SAIF Corporation, 361 Or 241 (2017). Bulletin 239 is available online: http://wcd.oregon.gov/Bulletins/bul_239.pdf.

Rhode Island VIEW STATE →

REGULATORY ACTIVITY:

• Rhode Island has published the COLA for 2017.

South Carolina VIEW STATE →

REGULATORY ACTIVITY:

• At a Special Business Meeting on Tuesday, April 25, 2017 the South Carolina Workers’ Compensation Commission approved a motion to voluntarily withdraw the proposed changes to Chapter 67 Regulations in Document No. 4735 and resubmit Document 4735 with the non-substantive changes recommended by the Senate Judiciary Subcommittee. On Wednesday, April 26, 2017 the Commission submitted a formal request to Legislative Council to resubmit Document 4735 including the non-substantive changes recommended by the Senate Judiciary Subcommittee for legislative review.   Below is a summary of the changes:   67-214.  Subpoenas, G.:  Add the following phrase for clarity: “or to a party’s right to compensation from a third party.”   67-215.  Motions, B. (2).:    Grammatical changes from the word “will” to “may” and from “has already filed” to “already has filed.”  67-215. Motions, H.:  Grammatical changes deleting the word “has” in two places, and changing “(i)” to “(1)” and “(ii)” to “(2).”  67-611.  Pre-hearing Brief.  In (B)(1) specified 15 days as the number of days the moving party must provide the Form 58 and proof of service to the opposing party before the scheduled hearing and specified 10 days as the number of days a nonmoving party must provide a response before a scheduled hearing.  Added subsection (5) -  The parties may extend the Form 58 filing deadlines required in (B)(1) and (2) by consent agreement in writing.    67-613. Postponement or Adjournment of the Scheduled Hearing.: Add subsection (4) – “A new hearing date shall be scheduled by the Commissioner assigned the case at the discretion of the Commissioner.”  67-1802. Mediation Required with Certain Claims, A. (1):  Delete the phrase “but only after the employee has reached maximum medical improvement per the opinion of a physician or psychologist:”
• As noticed on December 13, 2016, effective March 1, 2017, the Commission began requiring the use of the newly revised Form 14B dated 12/2016. Any other version of the Form 14B submitted will result in the associated pleading being returned to the filing party. The only exception is if the previous Form 14B (dated 9/13) was completed by the physician before January 1, 2017.   Please use the most recent forms available on the Commission’s website.    For additional information, please contact:  Amy Bracy Judicial Director Judicial@wcc.sc.gov 803.737.567.

South Dakota VIEW STATE →

REGULATORY ACTIVITY:

• The South Dakota Department of Labor and Regulation’s Workers' Compensation Proposed Rules Web page (http://dlr.sd.gov/workers_compensation/proposed_admin_rules.aspx) has been updated to include the following notice of a public hearing.
  • Department of Labor & Regulation
  • Division of Labor and Management
  • Notice of Public Hearing to Adopt Rules
• A public hearing will be held in the Sharpe Conference Room, Missouri River Plaza, 123 W. Missouri Avenue, Pierre, South Dakota, on May 15, 2017 at 10 a.m., to consider the adoption and amendment of proposed rules to 47:02:02 and 47:03:05. The rules text can be viewed at http://dlr.sd.gov/workers_compensation/documents/proposed_rules_2017_fee_schedule_042417.pdf.

Tennessee VIEW STATE →

REGULATORY ACTIVITY:

• Tennessee has posted notice to amend two rules:  Rule 0800-02-07 Case Management and 0800-02-13 Procedures for Penalty Assessments and Hearing Contested Cases.  The rules were posted on March 29, 2017 and will become effective June 27, 2017.
• Reminder the State has posted amendments to rules 0800-02-17 Rules for Medical Payment, 0800-02-18 Medical Fee Schedule, and 0800-02-19 Inpatient Hospital Fee Schedule. The state will hold a public hearing for these rules on June 8, 2017.

Texas VIEW STATE →

FEE SCHEDULE NEWS:

• The quarterly home health and dental fee schedules published by Medicaid have been updated as of April 1, 2017. Next update is scheduled for July 1, 2017.

REGULATORY ACTIVITY:

• The Texas Department of Insurance Division of Workers' Compensation has determined, pursuant to the authority and direction given under the Texas Workers' Compensation Act (Texas Labor Code, §401.023), that any interest or discount provided for in the Act shall be at the rate of 4.50 percent. This rate is computed by using the treasury constant maturity rate for one-year treasury bills (1.00 percent) issued by the United States Government, as published by the Federal Reserve Board on March 17, 2017 (the 15th day preceding the first day of the calendar quarter for which the rate is to be effective), plus 3.5 percent as required by Texas Labor Code, §401.023. The rate shall be effective April 1, 2017, through June 30, 2017. The rate in effect for the previous period of January 1, 2017, through March 31, 2017, was 4.41 percent.   For more information regarding calculation of the discount rate and interest rate, contact Dylan McCoy, Texas Department of Insurance, financial services at 512-676-6195.
• The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) is accepting public comments on revisions to plain language notices PLN01 through PLN12, as well as new PLN13 and PLN14. To help establish a possible effective date for the new and revised notices, TDI-DWC specifically requests that stakeholders consider and comment on how much time may be necessary for implementation.  TDI-DWC’s goal is to improve the notices insurance carriers use to communicate with injured employees. Generally, the purpose of the revisions is to provide consistency in language and formatting and to provide an emphasis on plain language. The revisions apply to both the English and Spanish versions of the forms. In addition, the PLN03, which has historically been used to report up to five different benefit scenarios, has been divided into three different notices. After review, TDI-DWC determined that the separation of different benefit scenarios helps ensure only necessary information is being relayed to the injured employee in a simple and easy to understand manner. Therefore, new PLN13 and PLN14 are also available for comment.  If you want to comment on the proposed revisions to the forms, submit your written comments by 5:00 p.m. Central time on May 12, 2017. Send written comments by email to Rulecomments@tdi.texas.gov or by mail to: Texas Department of Insurance, Division of Workers' Compensation  Maria Jimenez  Workers' Compensation Counsel MS – 4D  7551 Metro Center Drive, Suite 100  Austin, Texas 78744-1645 The draft plain language notices are available on the TDI-DWC website at tdi.texas.gov/wc/rules/drafts.html. A current version of each plain language notice is also available on the TDI-DWC website at www.tdi.texas.gov/forms/form20numeric.html.

Utah WC VIEW STATE →

REGULATORY ACTIVITY:

• Reminder Utah has published bulletin 1-2017 regarding restorative Service Billing.

LEGISLATIVE ACTIONS:

• House Bill 90
  This enacted legislation authorizes commercial insurers, the state Medicaid program, workers’ compensation insurers, and public employee insurers to implement policies to minimize the risk of prescribing certain controlled substances. The enacted legislation defines terms; authorizes a health insurance policy, a health plan offered to state employees, the Medicaid program, and workers' compensation insurance to establish policies to minimize the risk of opioid addiction and overdose; applies to insurance plans entered into or renewed on or after July 1, 2017; requires a report to the Health and Human Services Interim Committee; and sunsets the requirement for prescribing policies on July 1, 2022.  Effective Date July 1, 2017.

Virginia VIEW STATE →

REGULATORY ACTIVITY:

• Virginia has proposed a Medical Fee Schedule for Adoption.  Comments may be provided until May 10th. From April 10-May 10, 2017 the public has the opportunity to review the medical fee schedule and to provide comments to the Medical Fee Schedule Regulatory Advisory Panel via the Commission. A Public Hearing will be held on May 23 at 8:30 a.m. at the Virginia Workers’ Compensation Commission, 1000 DMV Drive, Richmond, Virginia 23220, in Courtroom A, as well. The public hearing provides another opportunity for the public to provide comments on the Medical Fee Schedule.
• New Mailing Address for Roanoke Office: Effective May 1, 2017, the mailing address for the Roanoke office will be 3959 Electric Rd., Ste. 425, Tanglewood West, Roanoke, VA 24018.

Washington VIEW STATE →

REGULATORY ACTIVITY:

• The state has posted notice of amendments to rule 296-20 Prescription Drug Program and Interchangeable Biologics. The purpose of this rulemaking is to update Chapter 296-20 WAC, Medical Aid Rules. This rulemaking will amend rules that are now inconsistent with Engrossed Senate Bill 5935 (Chapter 242, Laws of 2015), a new law related to interchangeable biologics, and new rule language from the Washington State Health Care Authority (HCA) related to the Washington State Prescription Drug Program (PDP). The proposed language will also incorporate by reference the provisions of the therapeutic interchange in HCA’s WAC 182-50-200. The proposed rule language will accomplish the following: - WAC 296-20-03011 will be amended to include new content regarding “interchangeable biologics” that is explicitly and specifically dictated by ESB 5935, now codified in statute in RCW 69.41.110. - Definitions in WAC 296-20-01002 will be amended to be consistent with recently amended definitions by the HCA regarding Washington State’s PDP. HCA definitions will be adopted without material change. - Language in WAC 296-20-03011 also will incorporate by reference the HCA’s rules for therapeutic alternatives and the therapeutic interchange. This will allow the department’s rules on this program to be consistent with HCA language now and for future HCA amendments.
• Washington Division: Insurance Services (Retrospective Rating)
  Topic: Proposal (CR-102) - Retro Rules Update
  Brief Description: The purpose of this rulemaking is to implement changes to the rules governing the Retrospective Rating Program as a result of updated studies, specifically those regarding hazard groups assignments and Retro plan tables. When changes to the rules governing the Retrospective Rating program were implemented in 2011, the Department committed to repeating the studies that created these rules. Updating the hazard groups and Retro plan tables continues to improve fairness in the distribution of refunds among the participants in the Retro program. It is anticipated that these changes will take effect with July 1, 2017 enrollment.
• Washington Coverage Determination Artificial Disc Replacement (ADR)* - Re-review
  • * Artificial Disc Replacement is the same as Total Disc Arthroplasty (TDA)
  • Artificial disc replacement is a potential alternative procedure to cervical fusion in patients with radiculopathy and/or myelopathy secondary to degenerative disc disease. The most recent evidence, however, does not favor ADR as a treatment for lumbar degenerative disc disease.
  • Coverage decisions: Lumbar ADR and Cervical ADR (Effective date: June 1, 2017)
  • Washington Coverage Determination Pharmacogenomic Testing
  • Pharmacogenomic testing is also known as drug-gene testing or pharmacogenetic testing.  It looks for changes or variants in a person’s genes that may determine whether a medication could be an effective treatment for them or whether they could have side effects to a specific medication.
  • Coverage Decision: Not Covered (Effective date: July 1, 2017)
  • Psychiatric conditions: The Health Technology Clinical Committee (HTCC) has determined that pharmacogenomic testing for depression, mood disorders, psychosis, anxiety, attention deficit/hyperactive disorder (ADHD) and substance use disorder is not a covered benefit.
• The HTCC reviewed the evidence on pharmacogenomic testing for the selected conditions in January 2017, and found the technology unproven for safety, efficacy and cost-effectiveness based on the quality of available evidence. The decision was finalized in March 2017. Complete information on this HTCC determination is available here: http://www.hca.wa.gov/about-hca/health-technology-assessment/health-technology-reviews.
• In adopting this HTCC coverage determination, the Department has concluded that the determination does not conflict with any state statute. Any coverage for investigational treatment would be considered per WAC 296-20-02850.  Any coverage for health technologies that have a FDA Humanitarian Device Exemption status would be considered per RCW 14.120 (1) (b)
• Other conditions: L&I does not cover pharmacogenomic testing for any other conditions.

LEGISLATIVE ACTIONS:

• House Bill 1755
  The enacted legislation requires the department of labor and industries to, for a state fund claim, provide reasonable ongoing notice to the employer of the status of compromise or settlement negotiations between the injured worker or beneficiary and the department.  Effective Date July 23, 2017 .

West Virginia VIEW STATE →

LEGISLATIVE ACTIONS:

• Senate Bill 198
  The enacted legislation amends and reenacts Section 18C -3-3 of the code of West Virginia, 1931 as amended, relating to expansion of the Health Sciences Service Program to allow persons who practice emergency medicine in underserved areas of the state. Effective Date July 3, 2017.

Wyoming VIEW STATE →

REGULATORY ACTIVITY:

• Director John Cox has named John Ysebaert to the position of Deputy Director of the Wyoming Department of Workforce Services (DWS). As Administrator for the DWS Standards and Compliance Division, Ysebaert played a key role in the DWS reorganization in 2011. He served as Administrator of the Division for six years where he oversaw the compliance arm of the agency, including the Workers' Compensation, Occupational Safety and Health Administration (OSHA), Labor Standards and Employment Tax programs. Notably, during his time as Administrator, Ysebaert led key initiatives within the OSHA and Workers' Compensation programs to expand safety expertise and resources to employers in Wyoming.
• “Wyoming Workers’ Compensation has received concerns regarding the recent, unexpected change in reimbursement for pharmacy services. We are currently working with both the Wyoming Pharmacy Association and our vendor Corvel/CVS Caremark to resolve this issue. The goal is to re- establish a price model that is fair and balanced to all parties; Wyoming pharmacies and the employers in the state of Wyoming, who ultimately pay the premiums.  To that end, we have set a series of three meetings across the state where we will meet with pharmacy representatives in a collegial, problem solving approach. Please feel free to join us at one of these meetings and help us identify a solution. The meetings are: •  March 28th at the Riverton Workforce Center,  422 E. Fremont Avenue at 11:00 am •  March 31st at the Sheridan Workforce Center, 247 Grinnell Plaza, Suite 200 at 9:00 am •  March 31st at the Casper Labor Standards Conference Room, 851 Werner Court,  at 12:30 p. m.   In the interim, we will reimburse transactions as per the Wyoming Workers’ Compensation Rules & Regulations, CHAPTER 9 – FEE SCHEDULES, Section 6. Fees for Pharmacy Items. (a)  Pharmaceuticals shall be reimbursed at the lower of: (i)  Average Wholesale Price (AWP) minus 10% plus a $5.00 dispensing fee; or (ii) The provider’s usual and customary charge. In no case shall any provider bill for charges greater than those charged to the general public for like services. The Division reserves the right to review such charges and reimburse at the usual and customary rate if a discrepancy is found.  Please forward any questions or concerns to Rae Anne White RN, Nurse District Manager at 307-777-8219 or Fax 307-777-8724.”