Alaska VIEW STATE →

REGULATORY ACTIVITY:

• The State of Alaska Department of Labor and Workforce Development Workers' Compensation Board met October 5-6, 2017.  This meeting was open to the public. The meeting was held at the following location: Department of Labor Building 3301 Eagle Street Hearing Room 208 Anchorage, Alaska.

Arizona VIEW STATE →

FEE SCHEDULE NEWS:

• The state adopted a new medical fee schedule effective October 1, 2017.  Some of the changed regulations are:
  • The Anesthesia conversion factor was updated to $61.00
  • 2016 Assistants at Surgery indicators have been adopted
  • New RBRVS facility rates have been adopted.
• The next update to the Arizona fee schedule is set for October 1, 2018.

Arkansas VIEW STATE →

REGULATORY ACTIVITY:

• The September 1, 2017, implementation of Rule 099.41, Arkansas Workers’ Compensation Drug Formulary, has been extended to January 1, 2018, pending Legislative Review.

Arkansas Auto VIEW STATE →

REGULATORY ACTIVITY:

• Published bulletin 15-2017 affecting the licensure of producers and adjusters.  In part the bulletin states: Effective immediately, all individual applicants for licensure must use their legal name on any documentation submitted to the Department.  Your legal name is the name on any current state, federal or military identification.    If your legal name changes at any time during the period of your licensure, please provide at least thirty (30) days written notice of the change to the Department.

California VIEW STATE →

FEE SCHEDULE NEWS:

• The Physician Fee Schedule and Practitioner Services Medically Unlikely Edits and the National Correct Coding Initiative Practitioner PTP Edits have been updated with an effective date of October 1, 2017.  The update incorporates changes to the Medicare system.  The next update is expected for January 1, 2018.
• The state adopted the DMEPOS Fee Schedule effective October 1, 2017.  The next updates are expected to become effective January 1, 2018.
• The Outpatient and ASC Fee Schedule were updated with an effective date of October 1, 2017. The state has adopted the October 2017 OPPS APC Addenda A and B and ASC Addendum AA and EE to identify the definition of a “surgical procedure”.  All other factors and data 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 September 15, 2017. The next update is scheduled for October 15, 2017.

REGULATORY ACTIVITY:

• The Department of Industrial Relations’ Division of Workers’ Compensation (DWC) has issued modified proposed regulations to adopt the Medical Treatment Utilization Schedule (MTUS) Drug Formulary. The proposed rulemaking implements Assembly Bill 1124 (Statutes 2015, Chapter 525), which mandates adoption of an evidence-based drug formulary.
• DWC has reviewed comments received during the first 15-day comment period and has modified the proposed regulations to provide additional detail and clarity. The second 15-day public comment period ended September 22, 2017.
• Some of the changes proposed in the revised regulations include:
• Added language clarifying that a compounded drug is subject to the compounded drug regulation even if it includes an active ingredient listed as “Exempt” on the MTUS Drug List
• Removed a provision relating to repackaged drugs
• Updated MTUS Drug List header text to match the regulatory language on the Perioperative period definition
• The notice of modification of text of proposed regulation and related rulemaking documents are posted on the DWC rulemaking web page.
• The Division of Workers’ Compensation (DWC) has posted an order adjusting the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1.   The Physician and Non-Physician Practitioner Fee Schedule update Order adopts the following Medicare changes:
• Centers for Medicare and Medicaid Services (CMS) Medicare National Physician Fee Schedule Relative Value File RVU17D October 1, 2017 quarterly update
• National Correct Coding Initiative Physician/Practitioner Services CCI Edits October 1, 2017 quarterly update
• National Correct Coding Initiative Medically Unlikely Edits October 1, 2017 quarterly update

• The order adopting the OMFS adjustments is effective for services rendered on or after October 1, 2017 and can be found at   http://www.dir.ca.gov/dwc/OMFS9904.htm#7.
• The Division of Workers’ Compensation (DWC) has posted an order adjusting the Hospital Outpatient Departments and Ambulatory Surgical Centers section of the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1.
• The Hospital Outpatient Departments and Ambulatory Surgical Centers fee schedule update Order adopts the following Medicare changes:
  • The Centers for Medicare & Medicaid Services (CMS) Medicare Hospital Outpatient Prospective Payment System (HOPPS) October 1, 2017 Addendum A [Zip] quarterly update
  • The Centers for Medicare & Medicaid Services (CMS) Medicare Hospital Outpatient Prospective Payment System (HOPPS) October 1, 2017 Addendum B [Zip] quarterly update
  • The Centers for Medicare & Medicaid Services (CMS) Ambulatory Surgical Center Payment System, October 2017 ASC Approved HCPCS Code and Payment Rates [zip], Column A entitled “HCPCS Code” of  “Oct 2017 ASC AA” and Column A entitled “HCPCS Code” of  “Oct 2017 ASC EE”
  • The order adopting the OMFS adjustments is effective for services rendered on or after October 1, 2017 and is posted on the DWC website.
• The Division of Workers’ Compensation (DWC) has posted an order adjusting the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) section of the Official Medical Fee Schedule to conform to the fourth quarter 2017 changes in the Medicare payment system as required by Labor Code section 5307.1.  The order effective for services rendered on or after October 1, 2017 adopts the Medicare DMEPOS Quarter 4, 2017, DME17-D ZIP file.   The 2017 Parenteral and Enteral Nutrition Fee Schedule File from DME17-A (Updated 01/06/17) ZIP file was not updated for the fourth quarter, and remains in effect for services on or after October 1, 2017.   To obtain the appropriate documentation go to: http://www.dir.ca.gov/dwc/OMFS9904.htm#3
• The WCIS regulations adopted on March 27, 2017 pertaining to medical billing data reporting went into effect on September 27, 2017. The WCIS regulations adopted the IAIABC Workers’ Compensation Medical Bill Data Reporting Implementation Guide, Release 2.0 February 1, 2015 Publication. This version of the IAIABC Guide created the 2410 loop for reporting compound drugs and the K3 segment to report original drugs when reporting repackaged drugs. A detailed list of changes made in the California Medical Implementation Guide Version 2.0 is available on the WCIS website. The Technical Requirement table has also been updated to reflect the changes in the California Implementation Guide.
• The annual WCIS Advisory Meeting will be held in Oakland, California on Monday, October 23, 2017.  Monday, October 23rd, 2017; 9:30 a.m. – 3 p.m.; Elihu Harris State Building, Room 1304; 1515 Clay Street; Oakland, California 94612.

LEGISLATIVE ACTIONS:

• Assembly Bill 1422
  Existing law governing workers’ compensation requires a lien filed by or on behalf of a physician or provider of medical treatment services or medical-legal services, and any accrual of interest related to the lien, to be automatically stayed upon the filing of criminal charges against that physician or provider for an offense involving fraud against the workers’ compensation system, medical billing fraud, insurance fraud, or fraud against the Medicare or Medi-Cal programs. Existing law makes the stay effective from the time of the filing of the charges until the disposition of the criminal proceedings.  This bill, among other things, would revise and recast these provisions to require the liens of a physician, practitioner, or provider and the liens of an entity controlled by a physician, practitioner, or provider who has been charged with specified crimes involving the federal Medicare or Medicaid programs, the Medi-Cal program, or the workers’ compensation system to be automatically stayed, along with any interest accruing, until disposition of the criminal proceedings, except as provided. The bill would also provide that upon conviction of a physician, practitioner, or provider of those specified crimes the automatic stay would be required to remain in effect for any liens not dismissed, as specified, until the commencement of lien consolidation procedures, as provided. The Administrative Director of the Workers’ Compensation System would be authorized to adopt regulations to implement these provisions.  Existing law requires the administrative director to promptly suspend any physician, practitioner, or provider from participating in the workers’ compensation system as a physician, practitioner, or provider if the individual or entity has been convicted of certain crimes, including crimes involving fraud or abuse of the Medi-Cal program, Medicare program, or workers’ compensation system, or fraud or abuse of any patient, or if the individual or entity has been suspended, due to fraud or abuse, from the federal Medicare or Medicaid programs or the individual’s license, certificate, or approval to provide health care has been surrendered or revoked. Existing law establishes procedures for the adjudication of any liens of a physician, practitioner, or provider who is suspended pursuant to this provision. This bill, among other things, would provide that an entity would be subject to suspension as described above if it is controlled, as defined, by an individual who has been convicted of the specified crimes. The bill would specify that the suspension requirements also apply to crimes involving fraud or abuse of the federal Medicaid program and financial crimes that relate to the federal Medicaid program. The bill would authorize the administrative director to adopt regulations specifying any exemptions that would not serve as a basis for exclusion under these provisions. This bill would also make conforming changes.  Effective Date January 1, 2018.
• Senate Bill 430
  Existing law creates the California Insurance Guarantee Association (CIGA) and requires all insurers admitted to transact specified insurance lines in this state to become members. CIGA is required to pay and discharge covered claims, and in connection therewith, pay for or furnish loss adjustment services and defenses of claimants when required by policy provisions. CIGA is authorized to fulfill its duties either directly by itself or through a servicing facility or through a contract for reinsurance and assumption of liabilities by one or more member insurers or through a contract with the liquidator, upon terms satisfactory to CIGA and to the liquidator, under which payments on covered claims would be made by the liquidator using funds provided by CIGA. This bill would also authorize CIGA, with the Insurance Commissioner’s express approval, to reinsure with, or transfer liabilities to, a California admitted and authorized reinsurer or other reinsurer approved by the Insurance Commissioner in order to limit or eliminate adverse development, to stabilize or limit the need for assessments, or to reduce its potential ultimate liability for covered claims, provided certain conditions are met. The bill would require CIGA to undertake the payment and discharge of covered claims directly or through an authorized 3rd-party administrator. The bill would require any reinsurance agreement or transfer of liabilities to be paid using CIGA’s available funds, and would make any recoveries from a reinsurance agreement property of CIGA, to be paid to CIGA’s account from which the payment for reinsurance or transfer of liabilities was made.  Effective Date January 1, 2018.
• Senate Bill 489
  Existing law establishes a workers’ compensation system, administered by the Administrative Director of the Division of Workers’ Compensation, that generally requires employers to secure the payment of workers’ compensation for injuries incurred by their employees that arise out of, or in the course of, employment. Existing law requires an employer to provide all medical services reasonably required to cure or relieve the injured worker from the effects of the injury. Existing law requires every employer to establish a utilization review process and further requires that specified requests for payment for treatment be submitted to the employer or its insurer or claims administrator, within 30 days of the date the service was provided. Existing law also establishes an independent medical review process to resolve disputes over a utilization review decision, as specified. This bill would require that in the case of emergency treatment services, as defined, specified requests for payment for treatment be submitted to the employer, or its insurer or claims administrator, within 180 days of the date the service was provided.  Effective Date January 1, 2017

Colorado VIEW STATE →

FEE SCHEDULE NEWS:

• The medical and facility fee schedule is being updated as of January 1, 2018. The physician fee schedule is to be based on the 2017 Medicare Resource Based Relative Value Scale (RBRVS), except as prescribed by the rule and conversion factors. The inpatient hospital fee schedule has adopted Version 35 of the MS-DRG in addition to new MS-DRG values. Outpatient hospital fee schedule is based on the Medicare’s revised Addendum B from January 1, 2017.
• The next fee schedule update is scheduled for January 1, 2019.

REGULATORY ACTIVITY:

• The state has adopted Rule 16: Utilization Standards and Rule 18: Medical Fee Schedule along with Exhibits to the Medical Fee Schedule.  The two rules become effective January 1, 2018.

Colorado Auto VIEW STATE →

REGULATORY ACTIVITY:

• Posted notice of proposed rule 3 CCR 702-5 regarding 5-2-16 DISCLOSURE REQUIREMENTS FOR PRIVATE PASSENGER AUTOMOBILE POLICIES The purpose of this regulation is to interpret and implement the provisions of §§ 10-4-111(1) and (5) and 10-4-636, of the Colorado Revised Statutes, to provide summary disclosure requirements and the summary disclosure form for private passenger automobile insurance.

Connecticut VIEW STATE →

REGULATORY ACTIVITY:

• Connecticut has posted the Voluntary Loss Costs and Assigned Risk Rates Proposed by NCCI.  

Delaware Auto VIEW STATE →

REGULATORY ACTIVITY:

• Has published the final administrative code regarding the Delaware Motorists Protection Act along with form A.  The form becomes effective December 13, 2017.
• Issued universally applicable bulletin No. 3 dated September 22, 2017.  The bulletin is in regard to the Department's Request that the Department be Notified of a Data Breach or Other Disclosure of Confidential Consumer Information

Florida WC VIEW STATE →

REGULATORY ACTIVITY:

• Florida has posted notice of a rule hearing on 69L-8.071 Materials for use with the Florida Workers’ Compensation Health Care Provider Reimbursement Manual; 69L-8.074 Materials for Use throughout Rule Chapter 69L-7, F.A.C. The hearing will be held on Wednesday, October 4, 2017, at 1:00 p.m. (eastern) Room 102, Hartman Building, 2012 Capital Circle SE, Tallahassee, FL.

Hawaii WC VIEW STATE →

REGULATORY ACTIVITY:

• Has published Form HC-5 Employee Notification to Employer for Calendar Year 2018.
• A public hearing regarding the Workers’ Compensation Medical Fee Schedule will be held on October 26, 2017 at 8:30 am.

Idaho VIEW STATE →

FEE SCHEDULE NEWS:

• The inpatient fee schedule was updated as of October 1, 2017 with the current MS-DRG weights, multiplied by a state-specific base rate. The next update is expected on October 1, 2018.

REGULATORY ACTIVITY:

• The next meeting of the Commission's Advisory Committee is scheduled to be held November 8, 2017 beginning at 9:00 AM in the Industrial Commission's first floor conference room, 700 Clearwater Lane, Boise, Idaho.

Idaho Auto VIEW STATE →

REGULATORY ACTIVITY:

• Has posted notice to amendment rule IDAPA 18 Title 1 Chapter 20 18.01.20 Cancellation, or Refusal to Renew Automobile Insurance Policies.

Illinois VIEW STATE →

REGULATORY ACTIVITY:

• Governor Rauner announced arbitrator reappointments and new arbitrator appointments.  Governor Rauner has reappointed the following Arbitrators for the Illinois Workers’ Compensation Commission: Anthony C. Erbacci, Steven J. Fruth, David A. Kane, Michael K. Nowak, Ketki Shroff Steffen. Joining the Illinois Workers' Compensation Commission as newly appointed Arbitrators are Thomas Ciecko, Robert M. Harris and Robert E. Luedke.
• Adopted a new section to Illinois Administrative Code 2909 regarding Workers' Compensation Large Deductible Business.
• The Peoria office will resume normal operations beginning Tuesday, September 26th. The office hours are from 8:30 am until 5:00 pm. If you have any questions please contact Teena Pitman at (309) 671-3019.

Iowa VIEW STATE →

REGULATORY ACTIVITY:

• Beginning October 2, 2017, all hand-delivered documents for the Division of Workers’ Compensation MUST be delivered directly to the Workforce Development location at 150 Des Moines Street between the hours of 8 am - 4:30 pm.

Kentucky VIEW STATE →

FEE SCHEDULE NEWS:

• The DWC posted revisions to out of state cost to charge ratios retroactive to April 1, 2017 on September 28, 2017.

REGULATORY ACTIVITY:

• Post-award medical disputes can ONLY be filed by selecting the “Motion to Reopen (Medical Dispute)” tab on the “Submit a Filing” page.  LMS will lead the submitting party through preparation of a Motion to Reopen and Form 112 and will provide for the attachment of required supporting documents.

Louisiana Auto VIEW STATE →

REGULATORY ACTIVITY:

• Issued bulletin No. 2017-07 regarding certificates of destruction for water damaged vehicles.
• Published Advisory Letter 2017.02 regarding statutory requirements for granting defensive driver discounts on automobile insurance policy premiums.  Issued on September 27, 2017.

Maine VIEW STATE →

FEE SCHEDULE NEWS:

• Post-award medical disputes can ONLY be filed by selecting the “Motion to Reopen (Medical Dispute)” tab on the “Submit a Filing” page.  LMS will lead the submitting party through preparation of a Motion to Reopen and Form 112 and will provide for the attachment of required supporting documents.

REGULATORY ACTIVITY:

• The Board has updated its inpatient facility fee schedule (Appendix III) for dates of discharge on or after October 1, 2017. The fees are based on version 35 of the US Federal Government’s DRG Grouper for FY 18. Questions or concerns regarding the annual update may be addressed to Barriere@maine.gov.

Maryland VIEW STATE →

REGULATORY ACTIVITY:

• HB1484 – Medical Benefits – Payment of Medical Services & Treatment was passed during the 2017 Legislative session and becomes law October 1, 2017. Changes to L&E § 9-660 now require a healthcare provider who provides medical services to a covered employee to submit the bill for services rendered to the Employer or Insurer within 12 months from the later of the date the treatment was provided; the claim for compensation was accepted by the Employer or Insurer; or the claim for compensation was determined by the Commission to be compensable.  In addition, the Employer or Insurer may not be required to pay a bill submitted after the time period unless the healthcare provider files an application for payment with the Commission (the C-51) within 3 years from the later of the date the treatment was provided to the covered employer; the date the claim for compensation was accepted by the Employer or Insurer; or the claim for compensation was determined by the Commission to be compensable. Under this provision, the healthcare provider should use the Commission’s C51 form to file an application for payment with the Commission after submitting the bill to the Employer or Insurer. Any questions, please contact the Commission’s Medical Office at 410-864-5320.
• Vocational Rehabilitation disputes: Parties with a dispute regarding vocational rehabilitation services only can file a Vocational Rehabilitation Dispute form (VR04) for expedited resolution. The parties must file the form electronically via the Commission’s Online Services; there is no paper version. To access the Vocational Rehabilitation Dispute form VR04, log into Online Services and choose File Forms, selecting it from the list. The VR04 cannot be used to file other issues. If an emergency hearing is needed for other issues you must file a Request for Emergency Hearing form H26R. Upon receipt of the Vocational Rehabilitation Dispute form, the Duty Commissioner shall contact the parties by telephone the next business day following submission of the form. Parties are required to provide current telephone numbers on the form and shall be available the next business day following submission of the form. If the Duty Commissioner is unable to resolve the dispute, a hearing will be scheduled within 5 business days.
• Maryland has proposed a rule regarding notice of cancellation of a workers' compensation insurance policy.

Massachusetts VIEW STATE →

REGULATORY ACTIVITY:

• A Health Care Services Board meeting was held Saturday September 16, 2017 9:30 AM at the Department of Industrial Accidents Conference room 10-140 1 Congress Street, Suite 100 Boston, Massachusetts 02114. The Board voted on the minutes of previous meeting and reviewed the Neck and Back treatment guideline draft.  There was a presentation on High Frequency Stimulation Treatment.
• BOSTON — The Department of Industrial Accident (DIA) launched a 2-year pilot program called the Opioid Alternative Treatment Pathway (OATP) which aims to be another tool to address the state’s opioid epidemic by giving attorneys, judges, and injured workers within the DIA system quicker access to medical professionals to make treatment decisions.  To assist in this process, specially qualified Care Coordinators with knowledge and experience in dealing with issues relating to the long-term use of opioids are needed to assist and direct the care for the injured worker.  In order to be considered as a Care Coordinator, please submit a resume and complete the following questionnaire. The questions are designed to help us gain insight as to your experience and professional approach as to how you best achieved pain control with the least opioids as well as your ability to foster a therapeutic alliance with the injured worker and restore the individual to the maximum functional level.   To find out more information go to: https://www.mass.gov/news/opioid-care-coordinator-information-and-questionnaire.

Medicare VIEW STATE →

FEE SCHEDULE NEWS:

• DMEPOS – CMS has released a new update effective October 1, 2017. The next update is expected on January 1, 2018.
• ASC – CMS has released a new quarterly update to the ASC fee schedule with an effective date of October 1, 2017. The next expected update is January 1, 2018.
• OPPS – CMS has released a new quarterly update to the hospital outpatient fee schedule with an effective date of October 1, 2017. The next expected update is January 1, 2018.

Minnesota VIEW STATE →

FEE SCHEDULE NEWS:

• The state has updated their Inpatient Fee Schedule with an effective date of January 1, 2018.
• New Medical Fee Schedule conversion factors have been adopted effective October 1, 2017. The next update is scheduled for October 1, 2018.

REGULATORY ACTIVITY:

• The Minnesota Department of Labor and Industry (DLI) has updated the draft of proposed rule amendments to Minnesota Rules 5220.1900. A link to the updated draft has been posted on the rulemaking docket, which can be accessed at dli.mn.gov/PDF/docket/5220docket.PDF. DLI plans to publish and send out an official Notice of Intent to Adopt Rules and/or Notice of Hearing on the proposed rules by the end of 2017.
• DLI is currently finalizing the Statement of Need and Reasonableness (SONAR) for the proposed rules. The SONAR must include information about the probable costs of the rules and other issues to the extent ascertainable. If you would like to provide information about any of the issues described below, contact Matt Jobe at rules@state.mn.us or (651) 284-5006 by Oct. 6, 2017.
• Posted notice in the state register regarding threshold of payment for catastrophic, high-cost injuries; annual adjustment to workers' compensation vocational rehabilitation hourly rates and notice of availability of PC-pricer program for payment of in-patient hospital services for workers' compensation patients discharged on or after October 1, 2017.
• Published that action was being taken on an exempt rule.  The rule in question is in regards updating Workers' Compensation Independent Medical Examination Fees and Workers' Compensation Conversion Factors.

Mississippi VIEW STATE →

FEE SCHEDULE NEWS:

• The inpatient fee schedule was updated as of October 1, 2017 with current MS-DRG weights, a new annual Base Rate and Outlier Threshold and Cost-to-Charge Ratios.  The next update is expected for October 1, 2018.

Montana VIEW STATE →

REGULATORY ACTIVITY:

• Posted an amended notice of public hearing regarding Treatment Guidelines.  The amended meeting is on October 2, 2017 in Sanders Auditorium - 111 North Sanders St, Helena.  In the matter,  of the amended notice of public hearing on proposed amendment of ARM 24.29.1591 related to utilization and treatment guidelines for workers' compensation injuries http://erd.dli.mt.gov/work-comp-claims/medical-regulations/utilization-and-treatment-guidelines24-29-323 pro-arm.docx.

Nebraska VIEW STATE →

REGULATORY ACTIVITY:

• Erin N. Fox has rejoined the court to serve as its General Counsel, effective September 13, 2017.

Nevada VIEW STATE →

REGULATORY ACTIVITY:

• The Board for the Administration of the Subsequent Injury Account for Self-Insured Employers will hold a public meeting on October 18, 2017 at 10:00 a.m., at 1301 North Green Valley Parkway, Conference Room B, Henderson, Nevada.  The public is advised that some of the members of the Board may participate in the meeting via telephone.

New Jersey No-Fault VIEW STATE →

REGULATORY ACTIVITY:

• Issued Bulletin No 17-06 regarding pre- and post- disaster regulatory guidance. 

New Jersey WC VIEW STATE →

REGULATORY ACTIVITY:

• Postednotice of amendment to rule 12:235-1.6 regarding maximum workers' compensation benefits.  The proposed maximum benefit for be in effect for injuries occurring in calendar year 2018.  The proposed maximum benefit will be $903.00 per week.
• Published comments received on proposed rule regarding the conduct of judges.  The state is proposing to repeal N.J.A.C. 12:235-10.1-10.12.  Amend rules N.J.A.C. 12:235-10.13,10.16, and 10.20. It is also proposing a new rule N.J.Z.C. 12:235-10 Appendix.  The Department is proposing repeals, amendments, and a new rule, which would result in the adoption of a new Code of Conduct for Judges of Compensation (Code). The proposed adoption of a new Code is prompted by the Supreme Court of New Jersey (Supreme Court) having recently adopted a revised New Jersey Code of Judicial Conduct, effective September 1, 2016, which applies to judges who serve within the judicial branch of State government, as opposed to those, like Judges of Compensation, who serve within the executive branch of State government. The existing Code of Conduct for Judges of Compensation is reflected within the rules at N.J.A.C. 12:235-10.1 through 10.12 and was modeled on the New Jersey Code of Judicial Conduct. Consequently, it only follows that with the recent revision of the New Jersey Code of Judicial Conduct, the Division of Workers' Compensation would want to update its Code of Conduct for Judges of Compensation so as to ensure that Judges of Compensation are held to the same exacting standards as are their counterparts in the Judiciary.  Thus, the Department is proposing the repeal of N.J.A.C. 12:235-10.1 through 10.12 and its replacement with N.J.A.C. 12:235-10 Appendix, which would contain a Code of Conduct for Judges of Compensation virtually identical to the recently revised New Jersey Code of Judicial Conduct. As to the nature of the revisions to the New Jersey Code of Judicial Conduct recently made by the Supreme Court, which are reflected in the proposed new Code of Conduct for Judges of Compensation, the December 12, 2014 letter from Deborah T. Poritz, Chief Justice (Ret.), Chair of the Ad Hoc Committee on the Code of Judicial Conduct to Chief Justice Stuart Rabner (available online: http://www.judiciary.state.nj.us/reports2016/judicialconduct.pdf) is instructive. In that document, the Committee Chair explained, for example, that in general, the Committee had sought more precisely to describe the conduct prohibited (or permitted) by the Rules, adding that language in the Code had been modified, not necessarily to conform to the language found in the American Bar Association (ABA) Model but, rather, to achieve the goals of clarity and specificity, for example, the phrase "in All Activities" at the end of Canon 2 was deleted as too vague. Also, the Chair explained that consistent with its goal of "certainty," it had unanimously recommended that the word "should" be changed to "shall" in every Canon and Rule where it previously existed, except in Canon 1 as is evident within the revised Code itself. According to the Chair, this recommendation had followed the approach implemented in the revision of the 1990 ABA Model Code and found in the current Model Code. Specifically, regarding format, the Chair stated the following: The Committee members found that the disciplinary process had become more formal and public over the past several years and concluded, in that context, that the format of our Code could be confusing and that it is sometimes difficult to differentiate between general principles, rules (the violation of which can result in discipline), and interpretive comments. The Committee therefore determined that there is a need for greater specificity in respect of those actions requiring discipline but that aspirational goals found in our current Code should be retained. That approach continues to build on both the bedrock principles under which our current system has operated and the over 30 years of New Jersey precedent interpreting the Canons. Thus, as does the ABA Model Code, the Committee's proposal contains Canons that express general principles of conduct followed by rules that prescribe specific standards of conduct. As to the amendments proposed within this rulemaking, most of those are technical in nature, either eliminating cross-references to the sections of N.J.A.C. 12:235-10 that are proposed for repeal and replacing them with references to the Code of Conduct for Judges of Compensation, which would be appended to N.J.A.C. 12:235-10; or changing other cross-references throughout the subchapter to reflect recodifications resulting from the repeal of N.J.A.C. 12:235-10.1 through 10.12. In addition, the Department is proposing new N.J.A.C. 12:235-10.13(a)4 (recodified as N.J.A.C. 12:235-10.1(a)4), which would include, as a cause for discipline or removal, failure to notify the Director when the judge has reason to believe that a medical report, medical bill for services, or medical finding has been altered, falsified, or withheld by a licensed physician, dentist, chiropractor, osteopath, optometrist, physical therapist, medical technician, attorney, or a representative of an insurance carrier or self-insured. This workers' compensation-specific provision appears within the current rules at N.J.A.C. 12:235-10.12; however, there is no corresponding provision within the revised New Jersey Code of Judicial Conduct. Consequently, in order to preserve this important prescription for Judges of Compensation, the Department is proposing that it be added to the list of causes for discipline or removal at recodified N.J.A.C. 12:235-10.1. Finally, due to the proposed repeal of N.J.A.C. 12:235-10.1 through 10.12, the Department is proposing that N.J.A.C. 12:235-10.13 through 10.23 be recodified as N.J.A.C. 12:235-10.1 through 10.11. As the Department has provided a 60-day comment period for this notice of proposal, this notice is excerpted from the rulemaking calendar requirements, pursuant toJ.A.C. 1:30-3.3(a)5.
• Has posted notice for a public hearing regarding the 2018 maximum benefit rates and conduct of judges.
• As per the N.J. Department of Treasury, Division of Purchase and Property, the N.J. Department of Labor and Workforce Development – Division of Workers’ Compensation shall utilize certified court reporter services set forth under the current Statewide Contract (T-2767) for Certified Court Reporters/Certified Real Time Court Reporters. In accordance with that contact and its method of operation, J.H. Buehrer & Associates, Jersey Shore Reporting, L.L.C., and William C. O’Brien & Associates, Inc., shall provide the certified court reporters for all the courts in the N.J. Division of Workers’ Compensation for the period of September 11, 2017 through September 29, 2017.
• As per the N.J. Department of Treasury, Division of Purchase and Property, the N.J. Department of Labor and Workforce Development - Division of Workers' Compensation shall utilize certified court reporter services set forth under the current Statewide Contract (T-2767) for Certified Court Reporters/Certified Real Time Court Reporters. In accordance with that contact and its method of operation, J.H.  Buehrer & Associates, Jersey Shore Reporting, L.L.C., and William C. O’Brien & Associates, Inc., shall provide the certified court reporters for all the courts in the N.J. Division of Workers' Compensation for the period of September 11, 2017 through September 29, 2017.  J.H. Buehrer & Associates shall provide certified court reporters for the Central region of the State.  This consists of the workers’ compensation courts in New Brunswick, Lebanon, Freehold, Trenton and Toms River. Jersey Shore Reporting, L.L.C., shall provide certified court reporters for the workers' compensation courts in portions of the Northern region and all the Southern region as follows:  Paterson, Hackensack, Jersey City, Plainfield, Mt. Holly, Camden, Atlantic City and Bridgeton.  William C. O'Brien & Associates, Inc. shall provide certified court reporters for the courts in the remainder of the Northern region as follows: Mt. Arlington and Newark.  As per the contract, the fees for stenographic services shall be:
  • Dismissal for Lack of Prosecution $30.00
  • Section 20 Dismissals $90.00
  • Order Approving Settlement $90.00
  • Trials on Reports $125.00
  • Total Award w/ Decision of 2nd Injury Fund (SIF) Eligibility $125.00
  • Testimony on litigated Matters (per Yi day) Transcripts $150.00

New Mexico VIEW STATE →

REGULATORY ACTIVITY:

• The New Mexico Workers' Compensation Administration will conduct a public hearing on the adoption of new WCA Rules at: 1:30 p.m., Friday, October 27, 2017 Workers’ Compensation Administration 2410 Centre Avenue SE, Albuquerque, NM 87106.   The proposed rule will be available on the WCA website at: http://www.workerscomp.nm.gov/ on September 14, 2017.  To receive a copy of the proposed rule by e-mail, contact the WCA General Counsel Office at (505) 841-6869. To receive a copy by mail, submit a self-addressed, stamped envelope with your request to WCA General Counsel Office, 2410 Centre Ave. SE, Albuquerque, NM  87106.   Comments may be made at the public hearing and written comments will be accepted until the close of business on October 27, 2017.  The Director will take all comments into consideration.  The WCA proposes to repeal and replace Part 4 (Claims Resolution) of Title 11 to implement rules for filing pleadings within the new WCA e-filing system. The proposed rule also makes minor changes to the Health Care Provider (HCP) section to clarify the HCP selection process. There were minor changes to the Mediation section, decreasing the time to reschedule a mediation conference from 90 to 75 days. The fee schedule is also being updated to coincide with the AMA codes. Both proposed rules will take effect January 1, 2018.  The Director of the WCA has authority to adopt reasonable rules pursuant to NMSA 1978, §52- 5-4 (2003).
• Has proposed a Medical Fee Schedule to become effective on January 1, 2018.

New York VIEW STATE →

REGULATORY ACTIVITY:

• Posted an emergency rule and proposed amendments to an existing rule in the latest Register.  The emergency rule is WCB-36-17-00003-E Workers' Compensation Board-Option to Self-Insure for Jockey Fund. The purpose of the emergency rule is to allow the option for the Jockey Fund to self-insure for Workers' Compensation Coverage.  The rule proposed amendments to an existing rule (Permanent Impairment Guidelines for Schedule Loss of Use Determinations) is to incorporate Workers' Compensation Impairment Guidelines for determination of permanent impairment.
• Chair Proposes New Permanent Impairment Guidelines: Date: September 6, 2017.  In April 2017, Governor Andrew M. Cuomo signed into law the 2017-2018 Executive Budget, which contained several significant pieces of workers’ compensation reform designed to protect workers while also achieving savings for businesses. Included in the reforms was Workers’ Compensation Law (WCL) § 15(3) (x), which requires new Permanency Impairment Guidelines (“Guidelines”) to be adopted by January 1, 2018. The new Guidelines cover determinations of permanency under WCL § 15(3) (a) through (v), which are also known as scheduled loss of use. As required by law, the Board “published proposed” guidelines on September 1, 2017. Publication in the State Register commences a 45-day comment period (which expires on Monday, October 23, 2017). The Guidelines, along with regulations necessary to implement the Guidelines, are available on the Board’s website (www.wcb.ny.gov).  The publication of these proposed Guidelines on September 1, 2017 allows for a full and robust public comment period, and ensures that the regulatory process (including, if needed, a re-publication and second public comment period) can conclude prior to the mandatory implementation of new Guidelines by January 1, 2018. The Board strongly encourages the public, injured workers, employers, self-insured employers, insurance carriers, third-party administrators, attorneys, medical providers, and labor and business organizations to provide comment. Please submit your comments on or before October 23, 2017 via: Proposed Impairment Guidelines Comments. The Board will evaluate all comments received, and will consider necessary revisions as the process advances. The Board is committed to the timely and successful implementation of guidelines that are, as the legislation states, “reflective of advances in modern medicine that enhance healing and result in better outcomes” [WCL § 15(3) (x)]. It should be noted that these are proposed Guidelines, which are not in effect.  A copy of the announcement is attached.
• Published bulletin number 046-965 regarding changes to the disability benefits claim filing process. The New York State Workers' Compensation Board is making changes to the disability benefits claim filing process to simplify filing and capture more information earlier in the life of a disability benefits claim.  To reduce the number of forms used to file disability benefits claims, the Notice and Proof of Claim for Disability Benefits (Form DB-450) and the Notice of Proof of Claim for Disability Benefits of Unemployed Claimant (Form DB-300) have been combined into a new Form DB-450, entitled Notice and Proof of Claim for Disability Benefits. Claimants will now use the revised Form DB-450 to file all disability benefit claims with the Board or insurance carriers, regardless of their employment status.  To make Form DB-450 easier to complete, the filing instructions have been clarified and information on how to locate the mailing address for submitting the form to the appropriate insurance carrier (or the Board) is included.
• Questions have also been added to the new Form DB-450 to collect the following information earlier in the claim: Whether the claimant's disability was the result of a motor vehicle accident. And if so, did the accident involve a commercial vehicle and is third-party action being taken? The new Form DB-450 is available on the Board's website. Please see: Notice and Proof of Claim for Disability Benefits (Form DB-450). Use of the new Form DB-450 is effective immediately. The old form will continue to be accepted until December 22, 2017.

North Carolina VIEW STATE →

REGULATORY ACTIVITY:

• Raleigh, N.C. – Recent reports suggest enactment of Senate Bill 407 creates a new section of the Industrial Commission to target employee misclassification. It does not. Instead, the legislation largely codifies preexisting initiatives of the Commission.  The Employee Classification Section of the Industrial Commission was established in December 2015 through Executive Order 83, issued by former Governor Pat McCrory. The Executive Order directed various state agencies, under the management of the Director of the Section, to collaborate independent investigations to determine whether a violation has occurred with the respective agency’s operating statutes. The North Carolina General Assembly codified the Executive Order in recent legislation, which was signed into law on August 11, 2017 by Governor Roy Cooper. Complaints of misclassification for the first and second quarters of calendar year 2017 were up over 644% from the first and second quarters of calendar year 2016.   According to Bradley Hicks, Section Director, “Senate Bill 407 will allow the Employee Classification Section to strengthen the statewide collaborations with agencies in accessing information combat worker misclassification.”   The Section began receiving complaints from various partner agencies beginning in January 2016. Since the Section’s creation, it has entered into information sharing agreements with the NC Department of Commerce: Division of Employment Security and US Department of Labor: Wage and Hour Division. In addition, the Employee Classification Section has been collaborating with the NC Board of Examiners for Plumbing Heating and Fire Sprinkler Contractors, the NC Department of Labor and the NC Department of Justice since the fall of 2016 as well.  If you know of any misclassification, please contact the Employee Classification Section.  The Section is open for business today and ready to help solve this problem.

North Dakota VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted changes to the Physician Drug, Ambulatory Surgical Centers, Outpatient and Medical Provider Fee Schedule effective October 1, 2017. The next expected update is set for January 1, 2018.

REGULATORY ACTIVITY:

• WSI recently revised the Advanced Beneficiary Notice of Non-Coverage (ABN) form, which a provider should use effective immediately. Revisions include general formatting changes and the addition of an “other” section, which allows a provider to identify other non-reimbursable services or items not previously listed on the ABN.
• A provider may use the ABN form to inform an injured worker about the costs associated with services WSI may not cover. The ABN allows an injured worker to decide whether to obtain the service or item in question and to accept financial responsibility if WSI denies coverage. WSI recommends obtaining a signed ABN form prior to providing the following to an injured worker:
  • Services and items not allowed, or which exceed statutory limitations, per North Dakota Administrative Code (link is external) (e.g. Game Ready, acupuncture, trigger point injections)
  • Medical equipment and supplies, which are no longer medically necessary but an injured worker wishes to keep or continue receiving
  • Services denied in advance by WSI's Utilization Review department or the claim adjuster
  • Upgrades to medically necessary services or items, which are not medically necessary (e.g. luxury eye glass frames or lenses options)
• Use of the ABN form does not waive WSI’s requirement that a provider submits all charges related to a worker’s compensation injury to WSI for medical bill auditing. To bill charges for which a signed ABN is present, append modifier GA to each applicable bill line and submit to WSI with medical documentation and the ABN form. WSI will review all charges and documentation to make the most appropriate payment determination for each charge. A provider may only bill a patient or other insurance when specified by WSI’s remittance advice reason codes.
• If you have questions please send an email to wsipr@nd.gov (link sends e-mail).

Oklahoma VIEW STATE →

FEE SCHEDULE NEWS:

• The DMEPOS and ambulance rates, which are based on the CMS DMEPOS and Ambulance fee schedules, have been updated effective as of October 1, 2017.  Next update is expected in January 1, 2018.

REGULATORY ACTIVITY:

• Posted notice of final adoption of rules Title 810 Chapter 1 General Information; Chapter 10 Practice and Procedure; Chapter 15 Medical Services and Chapter 25 Workers' Compensation Insurance and Self Insurance.

Oregon VIEW STATE →

REGULATORY ACTIVITY:

• Has updated Bulletin 112 for reimbursement of injured workers' travel, food, and lodging costs.  Lodging and meals rates are effective October 1, 2017 through September 30, 2018.  Private vehicle mileage rate is effective January 1, 2017.
• Posted notice regarding the effects House Bills 2337 and 2338 will have on PTD and fatal benefits.
• The Workers’ Compensation Division (WCD) recently updated the Training Guide to Performing Independent Medical Exams. Update includes:
  • IME provider expectations
  • Self-evaluation
  • Provider awareness
  • Examples of worker’s complaints and tips to avoid IME complaints.
• Posted proposed amendments to Rule Chapter 436 Division 050 regarding Employer/Insurer Coverage Responsibilities.
• The Department of Consumer and Business Services has updated its web-based PTD calculator posted to: https://www4.cbs.state.or.us/exs/wcd/ptd/
• The PTD calculator has two versions available:
  • The "web" version is used with an active internet connection and updates automatically. The web calculator is the preferred version if you have an internet connection.
  • The "stand-alone" version of the web calculator is for offline use (no active internet connection). The standalone version will automatically update when an internet connection is established. To update, you must have an active internet link, then start the stand-alone calculator and allow it to update. You can obtain this version using the link on the PTD calculator webpage, https://www4.cbs.state.or.us/exs/wcd/ptd/.
• This calculator is kept up to date and has been tested with the major web browsers. It should work   on any operating system.  If you have questions about or difficulties with the web-based PTD calculator, please contact Barbara Belcher at the phone number or email address:  Workers' Compensation Division (503) 947-7751/FAX (503) 947-7725 email barbra.hall@oregon.gov.
• Oregon has posted an addendum to bulletin number 124 regarding cost of living matrix and corrected vocational assistance fee schedule effective July 1, 2017.
• Revised Bulletin 102, "Reimbursement from the Retroactive Program," and Form 3285, "Request for Reimbursement from the Retroactive Program," are available online at:
• http://wcd.oregon.gov/Bulletins/bul_102.pdf (Bulletin 102) http://wcd.oregon.gov/WCDForms/3285.xlsx (Form 3285) http://wcd.oregon.gov/BulletinExtra/3285exmp.xlsx (Example of completed Form 3285)
• The Workers’ Compensation Division has posted final (permanent) rules, effective Oct. 8, 2017, affecting:
  • OAR 436-010, Medical Services,
  • OAR 436-030, Claim Closure and Reconsideration, and
  • OAR 436-035, Disability Rating Standards.
• Link: http://wcd.oregon.gov/laws/Documents/New_rules/10-30-35-17055-7lc.pdf.
• These rules will replace temporary rules issued by the division after the Supreme Court’s decision in Brown v. SAIF Corporation, 361 Or 241 (2017).  You may review public testimony and the agency’s responses at:  http://wcd.oregon.gov/laws/Documents/Proposed_rules_and_testimony/Div-010-030-035p-2017-07-25/TNR-final-2017-09-07.pdf

Pennsylvania WC VIEW STATE →

REGULATORY ACTIVITY:

• Posted the following notice in the state register: Under 34 Pa. Code § 131(b) (relating to payments for prescription drugs and pharmaceuticals—generally), the Department of Labor and Industry, Bureau of Workers' Compensation, gives notice that it utilizes the Red Book, published by Truven Health Analytics, to determine the average wholesale price of prescription drugs.
• Posted the following notice in the state register:  Under 34 Pa. Code § 667(b) (relating to compensation policy), the Department of Labor and Industry (Department), Bureau of Workers' Compensation, gives notice of the range of fees charged by Utilization Review Organizations (URO) and Peer Review Organizations (PRO) for services performed under the Workers' Compensation Act (77 P.S. §§ 1—1041.4 and 2501—2625) during 2016. The Department further provides notice of the average fee charged by each URO and PRO during 2016.Posted notice to receive comments on a proposal to amend regulations regarding the appeals board.  The proposal proposed two amendments:   Require both parties’ briefs to be submitted before making a decision to schedule oral argument and use the briefs, not oral argument, to start the internal appellate review process and Make oral arguments discretionary with the WCAB where necessary to address novel or complex legal issues, as is the practice in other Commonwealth appellate courts.
• 2016 Utilization Review Organizations Minimum and Maximum Fees

• URO/PRO	Minimum Fee	Maximum Fee
  Alico Services LTD	$238.97	$2,923.19
  American Review Systems, Inc.	$160.00	$3,930.00
  CAB Medical Consultants	$350.00	$5,334.75
  Caduceus Lex Medical Auditing	$195.85	$4,024.88
  CEC, Inc.	$410.00	$4,760.65
  Chiro Med Review Co.	$235.45	$5,633.15
  Denovo Management	$144.00	$3,350.00
  DLB Services	$84.96	$3,918.78
  Hajduk & Assoc. URO/PRO Ser.	$1.00	$3,463.82
  Industrial Rehabilitation Assoc.	$375.00	$5,875.00
  KVS Consulting Services	$314.18	$4,455.69
  Laurel Reviews	$394.67	$3,681.22
  Margroff Review Services	$233.61	$3,903.53
  McBride & McBride Associates	$535.90	$4,100.21
  Quality Assurance Reviews, Inc.	$595.00	$6,792.84
  Rachels Reviews	$173.54	$4,992.24
  T & G Reviews	$400.00	$3,875.00
  Uniontown MRPC	$204.72	$6,713.50
  Watson Review Services	$168.56	$4,525.82
  West Penn IME, Inc.	$496.00	$6,432.24
  Total Averages (2016)	$285.57	$4,634.33oral arguments discretionary with the WCAB where necessary to address novel or complex legal issues, as is the practice in other Commonwealth appellate courts.

Rhode Island VIEW STATE →

REGULATORY ACTIVITY:

• Next meeting of the RI Workers' Compensation Court Medical Advisory Board will be held on 10/24/2017 in the Workers' Compensation Court Room 4M, One Dorrance Plaza, Providence, RI from 6:00 PM to 8:00 PM.

South Carolina VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted a new Medical Services Provider Manual based on current CPT codes and the 2017 CMS Relative Value Units (RVU) with an effective date of September 1, 2017.  A new physician fee schedule is set to become effective September 1, 2018.

Texas VIEW STATE →

FEE SCHEDULE NEWS:

• The quarterly home health and dental fee schedules published by Medicaid have been updated as of October 1, 2017. The next update is expected in January 2018.

REGULATORY ACTIVITY:

• The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) has finalized revisions to plain language notices PLN-1, PLN-2, and PLN-4 through PLN-12, as well as new PLN-3a, PLN-3b, and PLN-3c.  TDI-DWC’s goal is to improve the notices insurance carriers use to communicate with injured employees. Generally, the purpose of the finalized plain language notices 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 PLN-3, 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 PLN-3a, PLN-3b and PLN-3c are also finalized.  Informal drafts of the plain language notices were posted on the TDI-DWC website on April 12, 2017, with an informal comment period ending on May 12, 2017. Based upon comments, TDI-DWC made a number of changes to the notices as posted, including clarifying whether a copy of the notice must be sent to TDI-DWC; removing the “date carrier received notice of injury”/”notice of injury date” field on most of the notices; changing the numbering of the PLN-3, PLN-13, and PLN-14 to the PLN-3a, PLN-3b, and PLN-3c in order to group the PLNs relating to impairment income benefits together into one series, as well as changing the title of each of the notices to differentiate between their purposes; and, generally reviewing and amending the carrier instructions for consistency and clarity.  The finalized notices are available on the TDI-DWC website at tdi.texas.gov/forms/form20plain.html, and are effective March 1, 2018. Insurance carriers may choose to continue using the existing plain language notices or to begin using the revised notices until the effective date. On or after March 1, 2018, insurance carriers must use the revised plain language notices.
• The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) seeks input on the development of a Designated Doctor Plan-Based Audit (Plan-Based Audit) to review the quality of designated doctor reports and the necessity of additional testing and/or referrals ordered by the designated doctors to resolve the issue in question. The Plan-Based Audit sets the scope, methodology, selection criteria, and program area responsibilities as laid out in the Medical Quality Review Process. A copy of the proposed Designated Doctor Plan-Based Audit is available on the TDI website at www.tdi.texas.gov/wc/hcprovider/medadvisor.html.  The Medical Advisor approved a Designated Doctor Plan-Based Audit plan as part of the CY 2017 Medical Quality Review Annual Audit Plan, which is available on the TDI website at tdi.texas.gov/wc/hcprovider/documents/auditplan17.pdf.  Workers’ compensation system participants can submit suggestions for this Plan-Based Audit by email to OMA@tdi.texas.gov by 5:00 p.m. Central time on Wednesday, October 4, 2017. If you have any questions regarding this memo, contact Mary Landrum at 512-804-4814 or Mary.Landrum@tdi.texas.gov.
• The Texas Department of Insurance, Division of Workers’ Compensation Austin office opens at its new location October 23.  All proceedings, including benefit review conferences, contested case hearings, and appointments with the Office of Injured Employee Counsel will be at the new location starting October 23.  The new address is TDI – Division of Workers’ Compensation, Austin field office, 7551 Metro Center Drive, Suite 100, MS – 301, Austin, Texas 78744-1645. The telephone number will remain 1-800-252-7031.  The old location, 4616 W. Howard Lane, will continue to serve system participants through October 20. If you are an injured employee or workers’ compensation system participant needing help, call 1-800-252-7031.This office serves injured employees and other workers’ compensation system participants in 14 counties: Bastrop, Blanco, Burleson, Burnet, Caldwell, Fayette, Gonzales, Hays, Lavaca, Lee, Llano, Milam, Travis, and Williamson.
• The Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) is accepting comments on an informal working draft of new 28 Texas Administrative Code (TAC) §133.30, available at http://www.tdi.texas.gov/wc/rules/drafts.html. The informal working draft was posted on the TDI-DWC website on September 22, 2017 and the comment period closes on October 23, 2017 at 5 p.m. Central time. The informal working draft is not a formal rule proposal and comments received will not be treated as formal public comments for the purposes of the Administrative Procedure Act. There will be an opportunity to formally comment once the rule is proposed and published in the Texas Register. Informal comments may be submitted by email to InformalRuleComments@tdi.texas.gov or by mail or delivery 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 New §133.30 would expand the accessibility of telemedicine services in the Texas workers’ compensation system by allowing health care providers to bill and be reimbursed for telemedicine services regardless of where the injured employee is located at the time the services are delivered. Health care providers must follow applicable Medicare payment policies and billing provisions found throughout Chapter 133 and 134 of TDI-DWC rules when billing for telemedicine services. Under the new rule, an exception would remove any limitation on the geographic area or location of the injured employee outlined by Medicare. Instead, a health care provider would be able to bill and be reimbursed for telemedicine services with no restriction on where the injured employee is at the time the services are delivered.  TDI-DWC also requests stakeholders to consider and comment on the necessity of the Medicare originating site facility fees in light of the informal rule text. The current fees allow originating site facilities to bill and be reimbursed a set amount for telemedicine services provided at their facility.
• Workers’ Compensation Weekly Benefit Rates Set for October 1, 2017, Through September 30, 2018: The workers’ compensation state average weekly wage for dates of injury from October 1, 2017, through September 30, 2018, is set at $913.37. The maximum weekly benefit rates for workers’ compensation income benefits is set at $913 and the minimum weekly benefit rate is set at $137 for that period. The maximum and minimum weekly benefit rates for dates of injury from October 1, 2016, through September 30, 2017, were $913 and $137 respectively. In accordance with Texas Labor Code (TLC) §408.047, the workers’ compensation state average weekly wage is equal to 88 percent of the average weekly wage in covered employment as computed each year by the Texas Workforce Commission under TLC §207.002(c).  A table showing maximum and minimum weekly benefit amounts for injuries that occurred on or after January 1, 1991, is available on the Texas Department of Insurance website at tdi.texas.gov/wc/employee/maxminbens.html.
• 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 4.80 percent.  This rate is computed by using the treasury constant maturity rate for one-year treasury bills (1.30 percent) issued by the United States Government, as published by the Federal Reserve Board on September 16, 2011 (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 October 1, 2011 through December 31, 2011.  For more information regarding calculation of the Discount Rate and Interest Rate, contact Comp Connection at 800- 252-1031, option 3. Issued in Austin, Texas, on the 25 day of September 2011.
• Released a study by the Texas Department of Insurance Workers' Compensation Research and Evaluation Group entitled Outcome Comparisons of Return to Work Rehabilitation Programs by Accreditation Status.

Texas Auto VIEW STATE →

REGULATORY ACTIVITY:

• Issued Commissioner's Bulletin B-0022-17 regarding the processing of claims from counties affected by the hurricane.
• Issued bulletin B-0024-17 regarding suspension of certain licensing requirements and fees for certain persons and entities living in the areas affected by the Harvey disaster.
• Issued bulletin B-0025-17 regarding Hurricane Harvey - Restricting New Business for Personal Auto and Residential Property Insurance.  Governor Greg Abbott issued a proclamation declaring a disaster due to the effects of Hurricane Harvey. The proclamation directs that all necessary measures, both public and private, as authorized under §418.017 of the Texas Government Code, be implemented to meet that threat. President Donald Trump issued a major disaster declaration and ordered federal aid to supplement state and local recovery efforts in the area affected by Hurricane Harvey. TDI reminds insurers that before they may restrict writing new business in response to a catastrophic natural event, they must file a restriction plan with TDI and obtain prior approval under Insurance Code §827.008. Insurers file restriction plans with the Company Licensing and Registration Office by email at CLRFilings@tdi.texas.gov. Insurers that do not comply with statutory requirements are subject to enforcement action.  Questions regarding this bulletin should be directed to the Company Licensing and Registration Office by calling 512-676-6375, or by email at CompanyLicense@tdi.texas.gov.
• Issued bulletin B-0026-17 regarding Hurricane Harvey Policy Renewal:  Governor Greg Abbott issued a proclamation declaring a disaster due to the effects of Hurricane Harvey. The proclamation directs that all necessary measures, both public and private, as authorized under §418.017 of the Texas Government Code, be implemented to meet that threat. President Donald Trump issued a major disaster declaration and ordered federal aid to supplement state and local recovery efforts in the area affected by Hurricane Harvey.  TDI reminds insurers of their obligations under Insurance Code Chapter 551:
• Under Insurance Code 551.107 when nonrenewing a standard fire, homeowners, or farm or ranch owner’s policy due to a policyholder filing three or more claims under a policy in any three-year period, insurers may not consider:
• • losses caused by natural causes;
  • claims filed but not paid or payable; or
  • claims history for water damage under Insurance Code §544.353.

• Insurers may not consider a customer inquiry as a basis for non-renewal under Insurance Code §551.113.
• All insurers should remember to comply with the requirements of Insurance Code Chapter 551 as applicable to the lines of coverage they write.
• In addition, insurers should remember that practices related to non-renewal are subject to restrictions against unfair discrimination under Insurance Code Chapter 544, Subchapters A and B.
• Insurers that do not comply with statutory requirements are subject to enforcement action.
• Questions regarding this bulletin should be directed to the Property and Casualty Lines Office by calling (512) 676-6710, or by email at CommercialPC@tdi.texas.gov.
• For more information contact: CommercialPC@tdi.texas.gov.
• The Commissioner has issued bulletin B-0027-17 regarding flood damaged vehicles.
• The Commissioner has issued bulletin B-0031-17 regarding hurricane Harvey - withdrawal of business for personal auto and residential property insurance.

Vermont Auto VIEW STATE →

REGULATORY ACTIVITY:

• Posted notices of intent to revise Regulation 1-79-2 regarding Fair Claims Practices.  The proposed rule revises the existing insurance trade practices regulation to update the methodology used to determine the cash settlement value insurers pay in motor vehicle total losses. The rule clarifies how the value of a replacement vehicle is determined in the event that the claimant's vehicle is determined to be a total loss. The proposed rule also codifies requirements for matching of replacement items and parts for partial losses.  Public hearing:  11/6/2017 at 10 am., DFR offices, 89 Main Street, 3rd Floor Conference Room, Montpelier, Vermont. Deadline for comment:  11/14/17.

Virginia VIEW STATE →

REGULATORY ACTIVITY:

• Published emergency regulation 18VAC85-21. Regulations Governing Prescribing of Opioids and Buprenorphine (amending 18VAC85-21-30, 18VAC85-21-40, 18VAC85-21-60, 18VAC85-21-70, 18VAC85-21-80, 18VAC85-21-130, 18VAC85-21-140, 18VAC85-21-150, 18VAC85-21-160). The emergency regulation is effective August 24, 2017 through September 14, 2017.
• In late June of this year, a notification was sent to all stakeholder groups advising that the Commission would re-implement the Variance Notification process. File audits will be conducted with an analysis of compensation due against EDI-SROI payment information received. Should a file audit reveal an underpayment of $50 or greater, a Variance Notification letter will be sent to the injured worker and claims administrator.  The Variance Notification letters will officially begin to generate on Thursday, September 21, 2017.

Virginia Auto VIEW STATE →

REGULATORY ACTIVITY:

• Has issued administrative order 12045 regarding Commercial Automobile Standard Forms – approves revised policy forms CA 02 68 Virginia Changes in Policy – Cancellation and Nonrenewal and CA 22 46 Virginia Medical Expense and Income Loss Benefits Endorsement and new policy forms CA 04 50 - Primary and Noncontributory – Other Insurance Condition, CA 05 18 - Virginia Public or Livery Passenger Conveyance Exclusion and CA 05 19 Virginia Public or Livery Passenger Conveyance and On-demand Delivery Services Exclusion. The order is effective October 1, 2017.
• Has issued administrative order 120041 regarding AIPSO Filing VA 17-09 makes revisions to Sections 35, 36, and 44 applicable for Commercial Auto to add administrative procedures for converting voluntary premium for miscellaneous nonfleet personal vehicles and named non-owner applicants to car years.   The order is effective October 1, 2017.

Washington VIEW STATE →

REGULATORY ACTIVITY:

• Posted rules regarding the Acupuncture Pilot Program affecting Chapter296-20 WAC; Chapter 296-23 WAC Radiology, Radiation Therapy, Nuclear Medicine, Pathology, Hospital, Chiropractic, Physical Therapy, Drugless Therapeutics and Nursing – Drugless Therapeutics.  The purpose of this rulemaking is to initiate a pilot that would help determine how acupuncture treatment could best be incorporated into the workers’ compensation setting. The department has reviewed the best available scientific and clinical evidence related to the efficacy of acupuncture for treating low back pain. Current rules state that the department or self-insurer will not allow nor pay for acupuncture (WAC 296-20-03002). Additionally, the department or self-insurer will not pay for services performed by Acupuncturists (WAC 296-20-01505). Under this pilot, these current provisions related to acupuncture treatment and acupuncturists will be waived only for pilot participants. The pilot will begin October 1, 2017 and will continue throughout a two-year period or as otherwise specified. Pilot program results will be considered in developing proposed rule language, medical coverage decisions and/or payment policy. L&I has determined that such a waiver is in the public interest and necessary to conduct this pilot project.
• Subject of Possible Rule Making: Amendment of sections of chapter 263-12 WAC, Practice and procedure. Procedural rules for hearings conducted by the agency. Allow for disposition of appeal when the department of labor and industries or the self-insured employer must initially [initially] present its case in chief and the appellant does not appear at the hearing. Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 52.020. Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: In appeals filed from orders that determined a worker had obtained benefits through willful misrepresentation or in appeals from citations issued by the division of occupational safety and health, the department or self-insured employer has the burden of initially introducing all of its case[s] in chief. When the appealing party or their representative does not appear at the initial hearing, the department of labor and industries or the self-insured employer is required to present its proof in support of defending the appealed order. The rule would allow for disposition of the appeal due to the appellant's nonappearance without the need to take evidence from the department or self-insured employer.  Process for Developing New Rule: Interested parties can participate in the adoption process for the new rule and formulation of the rule before publication by contacting the individual listed below. The public can also participate by providing written comments and/or testimony during the public hearing and comment process.  Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting David Threedy, P.O. Box 42401, Olympia, WA 98504-2401, phone 360-753-6823, fax 885-586-5611 [855-586-5611], TTY 800-833-6388, email dave.threedy@biia.wa.gov, web site www.biia.wa.gov.
• Subject of Possible Rule Making: • Chapter 296-20 WAC, Medical aid rules. • Chapter 296-23 WAC, Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing—Drugless therapeutics, etc. • Acupuncture. Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 51.04.020, 51.04.030, and 34.05.313. Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: The department of labor and industries (L&I) has reviewed the best available scientific and clinical evidence related to the efficacy of acupuncture for treating low back pain. Based on this review, L&I has decided to initiate a pilot that would help determine how acupuncture treatment could best be incorporated into the workers' compensation setting. Current rules state that the department or self-insurer will not allow nor pay for acupuncture (WAC 296-20-03002). Additionally, the department or self-insurer will not pay for services performed by acupuncturists (WAC 296-20-01505). Under this pilot, these current provisions related to acupuncture treatment and acupuncturists will be waived only for pilot participants. The pilot will begin October 1, 2017, and will continue throughout a two-year period or as otherwise specified. Pilot program results will be considered in developing proposed rule language, medical coverage decisions and/or payment policy. L&I has determined that such a waiver is in the public interest and necessary to conduct this pilot project. Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: L&I is governed by Title 51 RCW, Washington's Industrial Insurance Act. No other state or federal agencies are responsible for interpreting and enforcing the provisions of this act. Process for Developing New Rule: Pilot rule making. Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Jami Lifka, Medical Program Specialist, L&I, Office of the Medical Director, P.O. Box 44321, Olympia, WA 98504-4321, phone 360-902-4941, fax 360-902-6315, TTY 711 or 360-902-4941, email Jami.Lifka@Lni.wa.gov, web site Lni.wa.gov. Additional comments: For information related to the pilot program requirements and how to participate in the pilot, please contact Zachary Gray at 360-902-5025 or achary.Gray@Lni.wa.gov. You can also subscribe to the acupuncture pilot listserv at http://lni.wa.gov/Main/Listservs/LNI-Acupuncture.asp. Additional information can be found on the acupuncture pilot web site at www.Lni.wa.gov/Acupuncturepilot.
• o Adopted changes to Vocational Rehabilitation (Option 2) (Chapter 296-19A WAC).  The adopted rule will become effective on October 20, 2017.
• o Subject of Possible Rule Making: Update to pharmacy benefit manager rules.  Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 02.060, 48.02.220. Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: In this rule-making process, the office of the insurance commissioner (OIC) will revise existing sections or add new sections to the rules regarding pharmacy benefit managers (PBM) in chapter 284-180 WAC to incorporate minor technical additions that the agency has identified as being necessary to fully implement 2016 c 210 §§ 1 and 2 through 7. As an example of one of these changes, OIC will require each PBM to provide the name of the person who will serve as the single point of contact between PBM and OIC. Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: Not applicable. Process for Developing New Rule: Submit written comments by October 6, 2017.Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Bianca Stoner, P.O. Box 40258, Olympia, WA 98504, phone 360-725-7041, fax 360-586-3109, TTY 360-586-0241 or 360-725-7087, email rulescoordinator@oic.wa.gov, web site https://www.insurance.wa.gov/.

West Virginia VIEW STATE →

REGULATORY ACTIVITY:

• Posted the Assigned Risk Plan Rates Effective November 1, 2017 and the Workers' Compensation Lost Costs Effective November 1, 2017.

Wisconsin VIEW STATE →

FEE SCHEDULE NEWS:

• The certified radiology database has been updated with an effective date of July 1, 2017.  The next update is scheduled for January 1, 2018.

Wyoming VIEW STATE →

REGULATORY ACTIVITY:

• Posted notice in the state register amendments to the state’s Medical Fee Schedule.  The public may make comments by COB on October 20, 2017.   Has posted proposed rules regarding the state's workers compensation fee schedule.  Comments will be received through October 20, 2017.