VIEW PUBLICATION:
Alabama VIEW STATE →
FEE SCHEDULE NEWS:
- The state has posted new updates to both the Physician and Hospital/ASC Fee Schedules with an effective date of January 1, 2018. A new update for the Hospital/ASC Fee Schedule is expected on April 1, 2018.
Alabama Auto VIEW STATE →
REGULATORY ACTIVITY:
- Published an update to Legal Regulation 161 regarding the state's valuation manual. The regulation becomes effective on January 1, 2018.
Alaska VIEW STATE →
FEE SCHEDULE NEWS:
- The state has released an updated Official Alaska Workers’ Compensation Medical Fee Schedule effective January 1, 2018. Conversion factors have been updated for surgery and radiology services. Inpatient hospital admissions are now paid based on the Medicare Inpatient Prospective Payment System (IPPS). The following materials have been adopted for the new fee schedule:
- Current Procedural Terminology Codes (2018 edition)
- Healthcare Common Procedure Coding System (2018 edition)
- Relative Value Guide (2018 edition)
- Current Dental Terminology (2018 edition)
- Resource-Based Relative Value Scale (effective January 1, 2018)
- Ambulatory Payment Classifications (effective January 1, 2018)
- Medicare Severity Diagnosis Related Groups (effective January 1, 2018).
REGULATORY ACTIVITY:
- The State of Alaska Department of Labor and Workforce Development Workers’ Compensation Board will meet January 11, 2018. The meeting will be held at the following location:
Department of Labor Building, 3301 Eagle Street, Hearing Room 208, Anchorage, Alaska. The agenda consists of the regular business of the Workers' Compensation Board and Division, consisting of but not limited to: discussion of issues pertaining to the Alaska Workers’ Compensation Act, and approval of potential changes to regulations. The Board will also conduct other business as necessary and useful. Public comment will be taken in person or telephonically from 10:15AM to 11:15AM on January 11, 2018, and might be extended to accommodate those present before 10:15AM who did not have an opportunity to comment. To participate telephonically, call 800-315-6338, access code 92019. Individuals or groups of people with disabilities, who require special accommodations, should contact Alexis Newman at (907) 465-6059 by 4:30 PM, December 28, 2017. Please provide advance notice in order for the Department of Labor and Workforce Development to accommodate your needs. For additional information regarding the Board meeting, please contact the Division of Workers' Compensation at 465-2790.
- The Department of Labor and Workforce Development and the Alaska Workers’ Compensation Board give notice that amended versions of material adopted by reference in 8 AAC 45.083, dealing with fees for medical treatment and services, are in effect. To review the list of publications and materials that were adopted by reference, see the Online Public Notice of Amended Material Previously Adopted by Reference, 2018 and Amended Material Previously Adopted by Reference, 2018 ICD, and the following documents:
- Published Bulletins Number 17-04 Minimum/Maximum Compensation Rates for CY 2018; Number 17-05 Death Benefits for CY 2018; Number 17-06 Filing Requirements for 2017 Annual Report, Paying SIF Contributions, and Paying Workers' Safety and Compensation Fees and Number 17-07 Second Injury Fund Contribution Rate for CY 2018.
Arizona Auto VIEW STATE →
REGULATORY ACTIVITY:
- Published regulatory bulletin 2017-03 withdrawing circular letter 2006-08.
Arkansas VIEW STATE →
FEE SCHEDULE NEWS:
- The state adopted new CPT codes and descriptions and the 2018 National Physician Fee Schedule Relative Value file effective January 1, 2018. The next update is expected in January 1, 2019.
REGULATORY ACTIVITY:
- The Arkansas Workers’ Compensation Commission announces the adoption of Rule 099.41, a drug formulary that regulates all outpatient medications prescribed as a result of work-related injuries. The rule adopts a formulary already in use for state government employees who are injured on the job, with additional provisions for opioid prescriptions based on guidelines established by the Centers for Disease Control and Prevention. The rule applies to new injuries occurring on or after July 1, 2018.
California VIEW STATE →
FEE SCHEDULE NEWS:
- The DWC has adopted a MTUS Drug Formulary with an effective date of January 1, 2018.
- The Physician Fee Schedule has been updated with an effective date of January 1, 2018. Statewide geographic adjustment factors and conversion factors have been updated. The next update is expected for April 1, 2018.
- The Practitioner Services Medically Unlikely Edits and the National Correct Coding Initiative Practitioner PTP Edits have been updated with an effective date of January 1, 2018. The next update is expected for April 1, 2018.
- The DMEPOS Fee Schedule has been updated effective January 1, 2018. The next update is expected for April 1, 2018.
- The Clinical Lab Fee Schedule has been updated with an effective date of January 1, 2018. The DWC has adjusted the pathology and clinical laboratory fee schedule to conform with the changes to the Medicare payment system adopted by CMS for calendar year 2018. The next update is expected in January 2019.
- Medi-Cal rates have been released with an effective date of December 15, 2017. The next update is scheduled for January 15, 2018.
- Ambulance fee schedule has been updated with an effective date of January 1, 2018. The state has adopted the 2018 changes to the Medicare Payment System for ambulance. The next update is expected in January 2019.
REGULATORY ACTIVITY:
- The Division of Workers’ Compensation (DWC) is pleased to announce the approval of a labor-management “carve-out” agreement between the City of Los Angeles and the Los Angeles Police Protective League. The agreement covers an estimated 10,000 union members. Carve-out programs allow employers and unionized workforces to create their own alternatives for workers' compensation benefit delivery and dispute resolution under a collective bargaining agreement. Eligibility of parties to participate in a program must be approved by the administrative director of the Division of Workers' Compensation. There are 57 active labor-management carve-out agreements in California, including 27 that cover public safety unions, 21 in the construction industry, and nine in other industries. The requirements to participate and the elements required to be in carve-out programs are contained in Labor Code section 3201.5 for the construction industry and Labor Code section 3201.7 for all other industries, as well as California Code of Regulations, title 8, sections 10200-10204. Reports covering prior years of the program, which has been in force for construction trades since 1993 and for non-construction workforces since 2004, are available on DWC’s website.
- Labor Code §§129 and 129.5 require the Audit and Enforcement Unit of the Division of Workers’ Compensation (DWC) to conduct a profile audit review (PAR) for all adjusting locations of California workers’ compensation claims at least once every five years. Performance of the adjusting locations is measured in five areas of claims administration:
- The payment of accrued and undisputed indemnity;
- The late first payment of temporary disability / first notice of salary continuation;
- The late first payment of permanent disability and death benefits;
- The late subsequent indemnity payments;
- The provision of notices with QME/AME advice.
The administrative director annually establishes profile audit review and full compliance audit (FCA) standards in accordance with Labor Code §§129(b)(1) and (2) and Title 8, California Code of Regulations §10107.1. The 2018 standards are based on the audit results of calendar years 2014 through 2016. Performance standards for 2018 The PAR performance standard for audits conducted in 2018 is 1.47573. Audit subjects with PAR performance ratings of 1.47573 or lower will be required to pay any unpaid compensation, but no penalties will be assessed. If an audit subject’s PAR performance rating is 1.47574 or higher, the audit will expand to a FCA, and an additional sample of indemnity claims will be audited. The FCA performance standard for audits conducted in 2018 is 1.67487. Audit subjects with an FCA performance rating of 1.67487 or less will be required to pay any unpaid compensation and penalties will be assessed for all violations involving unpaid and late paid compensation. If an audit subject’s full compliance audit performance rating is 1.67488 or higher, an additional sample of denied claims as well as the expanded sample of indemnity claims will be audited. Penalties will be assessed for all violations as appropriate pursuant to 8CCR §§10111 through 10111.2. More information on the performance standards that will be in use for the profile audit reviews and full compliance audits during calendar year 2018 will be posted on the DWC Audit and Enforcement Unit web page.
- The Division of Workers’ Compensation (DWC) has posted an order adjusting the Ambulance services section of the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1. The update order is effective for services rendered on or after January 1, 2018, and can be found at the DWC website’s http://www.dir.ca.gov/dwc/OMFS9904.htm.
- The Division of Workers’ Compensation (DWC) is announcing the increase of the mileage rate for medical and medical-legal travel expenses by one cent to 54.5 cents per mile effective January 1, 2018. This rate must be paid for travel on or after January 1, 2018 regardless of the date of injury. Labor Code section 4600, in conjunction with Government Code section 19820 and the Department of Personnel Administration regulations, establishes the rate payable for mileage reimbursement for medical and medical-legal expenses and ties it to the Internal Revenue Service (IRS). IRS Bulletin Number IR-2017-204 dated December 14, 2017 announced the rate increase. The updated mileage reimbursement form is posted on the DWC website.
- The Division of Workers' Compensation (DWC) has posted an adjustment to the pathology and clinical laboratory section of the Official Medical Fee Schedule to conform to the 2018 changes in the Medicare payment system, as required by Labor Code section 5307.1. The public should take note that the Medicare Clinical Laboratory Fee Schedule methodology has changed for the 2018 update. Due to changes in federal law, the Medicare Clinical Laboratory Fee Schedule for 2018 is based upon data establishing weighted median private payor rates, and “cross walking” or gap-filling where private payor rates are not available. The new methodology does not use geographic adjustments. The order adopting the updated 2018 Pathology and Clinical Laboratory Fee Schedule is effective for services rendered on or after January 1, 2018 and can be found at http://www.dir.ca.gov/dwc/OMFS9904.htm#2.
- 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 2018 changes in the Medicare payment system as required by Labor Code section 5307.1. The order, which is effective for services on or after January 1, 2018, adopts the Medicare DMEPOS fee schedule first release for calendar year 2018. The order adopting the adjustment can be found on the DWC website.
- The Division of Workers’ Compensation (DWC) has posted an order adjusting the Physician Services/Non-Physician Practitioner Services section of the Official Medical Fee Schedule (OMFS) to conform to relevant 2018 changes in the Medicare payment system as required by Labor Code section 5307.1. The order is the second Administrative Director order for the 2018 update to the Physician and Non-Physician Practitioner Fee Schedule. It adopts a revised Relative Value Unit (RVU) file for 2018, which was issued by the Centers for Medicare and Medicaid Services on December 20, 2017. The Administrative Director Order dated December 27, 2017 adopts the updated 2018 RVU file and makes a minor technical correction to the text of regulation. The Administrative Director update order adopting the OMFS adjustment is effective for services rendered on or after January 1, 2018, and can be found at http://www.dir.ca.gov/dwc/OMFS9904.htm.
California-Auto VIEW STATE →
REGULATORY ACTIVITY:
- Published bulletin 2017-02 regarding export lists.
Colorado VIEW STATE →
FEE SCHEDULE NEWS:
- The state has released an update to Rule 18 with an effective date of January 1, 2018. Rule 18 encompasses the Medical, Inpatient DRG and CCR, Outpatient, Dental, and Pathology/Laboratory fee schedules. The fee schedules are based on the 2017 CPT codes and descriptions. The next expected update is January 1, 2019.
Connecticut VIEW STATE →
REGULATORY ACTIVITY:
- Pursuant to Section 31-280b, Chairman John A. Mastropietro has appointed Commissioners Scott A. Barton and Jodi M. Gregg to sit as panel members on appeals before the Compensation Review Board for the calendar year beginning January 1, 2018.
Connecticut Auto VIEW STATE →
REGULATORY ACTIVITY:
- Published bulletin No FS-32 regarding the effective date of changes made to the principle-based reserving valuation manual.
Delaware Auto VIEW STATE →
REGULATORY ACTIVITY:
- Posted notice of revised regulation regarding Title 18 DE Admin Code 603. The order:
- 03 Delaware Motorists Protection Act Regulation 603 implements the Delaware Motorists Protection Act. Recently, the Legislature passed HB 114, "An Act to Amend Title 21 of the Delaware Code Relating to Bodily Injury and Property Damage Coverage on Motor Vehicles," signed into law by the Governor on June 13, 2017 and effective on December 13, 2017 (six months after the date of enactment). The Act amends 21 Del.C. §2902 to raise the minimum bodily injury and property damage limits in all automobile insurance policies newly written or renewed after the effective date of the Act.
- On July 15, 2017 the Department filed a general notice of amendments to Regulation 603 that updated coverage limits codified in the regulation to reflect the increased limits in HB 114. That notice was published in the August 1, 2017 Register of Regulations.
- Attached to Regulation 603 is Form A, the Coverage Election form that must be presented by the insurer, broker or agent to the policyholder and acknowledged by the policyholder's signature that describes various types and levels of coverage. In its July 15, 2017 General Notice, the Department should have also updated the coverage limits set forth on Form A, Line 6. Accordingly, by way of this notice, the Department is updating Form A, Line 6 to reflect the revised coverage minimums promulgated by HB 114.
- This amendment is exempt from the requirement of public notice and comment because it is an amendment to existing regulations to make them consistent with changes in basic law, but which do not otherwise alter the substance of the regulations, pursuant to 29 Del.C. §10113(b)(5).
- Delaware has issued a final regulatory implementation order:
- 901 Arbitration of Automobile and Homeowners' Insurance Claims.
- SUMMARY OF THE EVIDENCE AND INFORMATION SUBMITTED
- The Department of Insurance (the Department) gave notice in the Delaware Register of Regulations at 21 DE Reg. 398 (11/01/17) of proposed amendments to Regulation 901, Arbitration of Automobile and Homeowners' Insurance Claims.
- The amendments as proposed raise the filing fees for Automobile Insurance and Homeowners' Insurance claims from $30.00 to $50.00. These fees have not been adjusted since the regulation was codified on March 1, 2002. The Department also proposed non-substantive amendments to correct style and subsection references. The Department's internal docket number for this regulatory project is 3647-2017.
- The Department did not hold a public hearing on the proposed regulation. The Department accepted written comments, suggestions, briefs, and compilations of data or other materials concerning the proposed amendment until the 4:30 p.m. EST, the 4th day, December 2017, which was thirty days from the date of publication. No comments, suggestions, briefs, or compilations of data or other materials concerning the proposed amendments were submitted.
- FINDINGS OF FACTS
- The Commissioner finds that it is appropriate to adopt proposed amendments to 18 DE Admin. Code 901 as proposed. The Department received no comments on the proposed filing fee increases, and these fees have not been raised since 2002.
- DECISION TO AMEND THE REGULATION
- For the foregoing reasons, the Commissioner concludes that it is appropriate to amend 18 DE Admin. Code 901 as proposed.
- EFFECTIVE DATE OF ORDER
- The actions hereinabove referred to were taken by the Commissioner pursuant to 18 Del.C. §311 and Chapter 23, and 21 Delaware Code, Sections 2118 and 2118B on December 15, 2017. The effective date of this Order shall be ten (10) days from the date this Order is published in the Delaware Register of Regulations.
- SUMMARY OF THE EVIDENCE AND INFORMATION SUBMITTED
District of Columbia VIEW STATE →
FEE SCHEDULE NEWS:
- The state adopts the quarterly Medicare updates. Please refer to the Medicare modules section for more information.
Florida WC VIEW STATE →
REGULATORY ACTIVITY:
- Posted notice of withdrawal of rule 69L-7.100 Florida Workers' Compensation Manual for Ambulatory Surgical Centers (ASCs) and for 69L-7.501 Florida Workers' Compensation Reimbursement Manual for Hospitals.
Hawaii No-Fault VIEW STATE →
FEE SCHEDULE NEWS:
- The state has adopted the Medicare 2018 version effective January 1, 2018. The next update is expected January 1, 2019.
Hawaii WC VIEW STATE →
FEE SCHEDULE NEWS:
- The state has adopted changes to the physician, drug and biological (ASP), clinical lab and DME fee schedules with an effective date of January 1, 2018. The next update is expected January 2019.
REGULATORY ACTIVITY:
- Hawaii has published the 2018 maximum weekly wage base and maximum weekly benefit amount.
Idaho VIEW STATE →
FEE SCHEDULE NEWS:
- The medical fee schedule has been updated as of January 1, 2018 with the new 2018 National Physician Fee Schedule Relative Value File.
- The outpatient and ASC fee schedules have been updated to use the 2018 Medicare OPPS APC relative weights effective January 1, 2018. The outpatient and ASC base rates remain unchanged. The next update is expected in January 2019.
REGULATORY ACTIVITY:
- The Industrial Commission Claims and Benefits department conducts compliance audits of insurers and their designated in-state adjusters. Periodic audits are performed to ensure insurer and self-insured employers are in compliance with claims adjusting requirements as required by Statute and Rule.
Illinois VIEW STATE →
FEE SCHEDULE NEWS:
- The medical and facility fee schedules have been updated with an effective date of January 1, 2018. The following resources were adopted by the Illinois Workers’ Compensation Commission for their fee schedule: 2018 CPT, 2018 HCPCS published by CMS, 2018 National Correct Coding Policy Manual, 2018 Relative Value Guide and the November 2017 Federal Register. The next update is expected on January 2019.
REGULATORY ACTIVITY:
- Posted in the State Register notice of proposed rules regarding the registration of Workers' Compensation Utilization Review Organizations.
Iowa VIEW STATE →
REGULATORY ACTIVITY:
- Posted notice of the adoption of amended rules. The amended rules become effective on January 24, 2018. Pursuant to the authority of Iowa Code section 86.8, the Workers’ Compensation Commissioner hereby amends Chapter 1, “Purpose and Function,” Chapter 2, “General Provisions,” Chapter 3, “Forms,” Chapter 4, “Contested Cases,” Chapter 5, “Declaratory Orders,” Chapter 6, “Settlements and Commutations,” Chapter 8, “Substantive and Interpretative Rules,” and Chapter 12, “Formal Review and Waiver of Rules,” Iowa Administrative Code. These amendments relate to recent changes enacted in 2017 involving Iowa Code chapter 85, concerning the evaluation of permanent impairments under Iowa Code section 85.34, vocational training and education under Iowa Code section 85.70(2), suitable work under Iowa Code section 85.33, and commutations under Iowa Code section 85.45. These amendments also update agency addresses, agency telephone numbers, and statutory references. Cross references in these rules to provisions of Iowa Code chapter 85 should be understood to include the amendments enacted in 2017 Iowa Acts, House File 518.
- Pursuant to the authority of Iowa Code section 86.8, the Workers’ Compensation Commissioner hereby amends Chapter 1, “Purpose and Function,” Chapter 2, “General Provisions,” Chapter 3, “Forms,” Chapter 4, “Contested Cases,” Chapter 5, “Declaratory Orders,” Chapter 6, “Settlements and Commutations,” Chapter 8, “Substantive and Interpretative Rules,” and Chapter 12, “Formal Review and Waiver of Rules,” Iowa Administrative Code. These amendments relate to recent changes enacted in 2017 involving Iowa Code chapter 85, concerning the evaluation of permanent impairments under Iowa Code section 85.34, vocational training and education under Iowa Code section 85.70(2), suitable work under Iowa Code section 85.33, and commutations under Iowa Code section 85.45. These amendments also update agency addresses, agency telephone numbers, and statutory references. Cross references in these rules to provisions of Iowa Code chapter 85 should be understood to include the amendments enacted in 2017 Iowa Acts, House File 518. These amendments will become effective January 24, 2018.
Maine VIEW STATE →
FEE SCHEDULE NEWS:
- The state has updated adopted changes to the physician, outpatient and ASC facility fee schedules with an effective date of January 1, 2018. The Medical Fee Schedule update incorporates portions of the 2018 CPT and Medicare RBRVS. The next medical fee schedule update is expected in January 2019.
REGULATORY ACTIVITY:
- Reminder In accordance with 39-A M.R.S.A. §209-A, the annual update of the Medical Fee Schedule has been completed for dates of service on or after 1-1-18. Questions or concerns regarding the annual update may be addressed to Kimberlee.Barriere@maine.gov.
Maryland VIEW STATE →
FEE SCHEDULE NEWS:
- The state has released new conversion factors and reimbursement rates for Medical, Anesthesia, Orthopedic and Neurological Surgical Services, and Ambulatory Surgical Centers with an effective date of January 1, 2018. The next fee schedule update is expected in January 2019.
REGULATORY ACTIVITY:
- Published its Fiscal Year 2017 Annual Report. To view the report, go to http://www.wcc.state.md.us/Gen_Info/Publications.html#Annual_Reports.
- Posted notice that new requirements for the state's 2018 fee schedule have been posted on their web site.
- WCC is now using the latest, improved version of "I'm not a robot" (called reCAPTCHA) that you see at the bottom of the Public Claim Data Inquiry and Vocational Rehabilitation Online Services before the submit button. This new version uses pictures to make it easier to use. Check the box next to the "I'm not a robot" phrase. If you get a green checkmark right away, you pass and can continue. If it takes you instead to the challenge, just follow the on-screen instructions to solve the puzzle.
- Reminder: Maryland has posted notice of amendments to Regulations .01, .03, and .04 under COMAR 14.09.01 General Administrative. Regulations .01, .03, and .04 under COMAR 14.09.01 General Administrative. Comments will be received on the proposed rules through January 22, 2018. Final action on the proposal will be considered by the Workers' Compensation Commission during a public meeting to be held on February 8, 2018, at 10 E. Baltimore Street, Baltimore, MD 21202.
Massachusetts VIEW STATE →
REGULATORY ACTIVITY:
- Pursuant to the authority of M.G.L. c. 11 BE and in accordance with M.G.L. c. 30A, a public hearing was held on Wednesday, December 13, at 9:00 a.m. in the First Floor Conference Room, 100 Hancock Street, Quincy, MA relative to the adoption of 101 CMR 353.00: Payment for Primary Care Clinician Plan Services and repeal of 114.3 CMR 53.00: Payment for Primary Care Clinician Plan Services.
- Pursuant to the provisions of M.G.L.c. 118E and in accordance with M.G.L. c. 30A, the Executive Office of Health and Human Services (EOHHS) held a public hearing on Wednesday, December 13, 2017, at 1:00 p.m. in the First Floor Conference Room, 100 Hancock Street, Quincy, MA relative to the adoption of: 101 CMR 322.00: Durable Medical Equipment, Oxygen, and Respiratory Therapy Equipment and repeal of 114.3 CMR 22.00 Durable Medical Equipment, Oxygen, and Respiratory Therapy Equipment.
- Pursuant to the authority of M.G.L. c. 11 BE and in accordance with M.G.L. c. 30A, a public hearing was held on Wednesday, December 20, 2017, at 11:00 a.m. First Floor Conference Room, 100 Hancock Street, Quincy, MA relative to the adoption of 101 CMR 350.00 Home Health Services.
- Issued Administrative Bulletin 17-19 Effective October 1, 2017 regarding 101 CMR 343.00 Hospice Services Updates to the Hospice Rates. While effective October 1, 2017 the bulletin was not published until December 5, 2017.
- Amended Bulletin 17-19 on December 12, 2017 regarding 101 CMR 343.00: Hospice Services: Updates to the Hospice Rates.
- Posted notice of a public hearing regarding rule 101 CMR 345.00 Temporary Nursing Services.
Massachusetts-Auto VIEW STATE →
REGULATORY ACTIVITY:
- The Board of Pharmacy adopted Permanent Administrative Rules including rules regarding prepackaging or repackaging of drugs.
Medicare VIEW STATE →
FEE SCHEDULE NEWS:
- Physician – CMS has posted new updates to the National Physician Fee Schedule Relative Value File effective January 1, 2018. The next expected update is April 1, 2018.
- HCPCS – New HCPCS codes have been published by CMS with an effective date of January 1, 2018. The next expected update is in April 1, 2018.
- Clinical Laboratory – CMS has released the new 2018 clinical laboratory fee schedule with an effective date of January 1, 2018. The next expected update is January 1, 2019.
- DMEPOS – CMS has released a new update effective January 1, 2018. The next update is expected on April 1, 2018.
- ASC – CMS has released a new update to the ASC fee schedule with an effective date of January 1, 2018. The next expected update is April 1, 2018.
- Ambulance – CMS released the 2018 ambulance fee schedule with an effective date of January 1, 2018. The next expected update is scheduled for January 1, 2019.
- OPPS – CMS has released a new update to the hospital outpatient fee schedule with an effective date of January 1, 2018. The next expected update is April 1, 2018.
- CCI and MUE Edits – CMS has released the January 1, 2018 changes for the MUE and CCI edits. The next expected update is for April 1, 2018.
Michigan VIEW STATE →
REGULATORY ACTIVITY:
- Published the 2018 Weekly Benefit Tables.
- Published two emergency rules: Bureau of professional licensing for a standing order for dispensing opioid antagonists’ emergency rules and Bureau of medical marijuana regulation medical marijuana facilities licensing act emergency rules in the state register on December 15, 2017.
Michigan Auto VIEW STATE →
REGULATORY ACTIVITY:
- Issued a memorandum which supersedes a previous memorandum regarding the rescission of Bulletin 2006-17 (issued June 7, 2017).
Mississippi VIEW STATE →
REGULATORY ACTIVITY:
- Rule 20 Mississippi Administrative Code Chapter 1 and Chapter 2 become effective on January 17, 2018.
Mississippi Auto VIEW STATE →
REGULATORY ACTIVITY:
- Mississippi Posted notice of proposed amendments to Title 19 Part 4 Chapter 3 Mississippi Automobile Insurance Assigned Risk Plan. This Regulation amends existing Title 19, Part 4, Chapter 3, "Mississippi Automobile Insurance Assigned Risk Plan" to provide for changes to the Board selection and Board Meeting. Written comments accepted until January 8, 2018.
Montana VIEW STATE →
REGULATORY ACTIVITY:
- On January 12, 2018 at 10:00 a.m., the Department of Labor and Industry will hold a public hearing in the basement auditorium of the Sanders Building (DPHHS), 111 North Sanders, Helena, Montana, to consider the adoption of the new rule. The proposed rule and Montana Workers Compensation Housing, Rent, or Lodging Monthly Rates by selecting the link are attached. Persons may present their data, views, or arguments, either orally or in writing, at the hearing. Data, views, or arguments may also be submitted to: The Department of Labor and Industry, Attn: Jason Swant, Employment Relations Division, P.O. Box 8011, Helena, MT 59604-8011; or email JSwant@mt.gov, and must be received no later than 5:00 p.m., January 19, 2018.
Nebraska VIEW STATE →
FEE SCHEDULE NEWS:
- A new medical fee schedule has been adopted with an effective date of January 1, 2018. The fee schedule is based on 2018 CPT codes, descriptions, modifiers and the National Correct Coding Initiative as established by Centers for Medicare and Medicaid Services. New conversion factors have been adopted. The next update is scheduled for January 2019.
- The state has also adopted changes to Inpatient DRG/Trauma hospital rates with an effective date of January 1, 2018. The next update is expected in January 2019.
REGULATORY ACTIVITY:
- Nebraska held a public hearing on December 13, 2017 regarding adopting Rule 15 and amending rule 26 and 47.
Nevada VIEW STATE →
REGULATORY ACTIVITY:
- Published notice of adoption of actuarial annuity table. The table became effective December 4, 2017.
New Jersey No-Fault VIEW STATE →
REGULATORY ACTIVITY:
- Issued Bulletin Number 17-12 regarding auto cycle insurance - personal injury protection coverage requirements - implementation of P.L. 2016, c.35.
New Jersey WC VIEW STATE →
REGULATORY ACTIVITY:
- Posted notice in the December 4, 2017 issue of the register notice of proposed re adoption with amendments of NJAC 13:73 Workers' Compensation Insurance Coverage for Horse Racing Industry Employees.
- Posted notice of adoption of maximum worker' compensation benefit rates by adopting Subchapter 1, General Provisions Section 12:235-1.6 effective December 18, 2017 for injuries occurring in calendar year 2018. The rule as adopted is: SUB-CHAPTER 1. GENERAL PROVISIONS: 12:235-1.6 Maximum workers' compensation benefit rates
- (a) In accordance with the provisions of N.J.S.A. 34:15-12. a, the maximum workers' compensation benefit rate for temporary disability, [page=4013] permanent total disability, permanent partial disability, and dependency is hereby promulgated as being $ 903.00 per week.
- (b) The maximum compensation shall be effective as to injuries occurring in the calendar year 2018.
New Mexico VIEW STATE →
FEE SCHEDULE NEWS:
- The state has adopted new hospital and healthcare provider fee schedules effective January 1, 2018. The next expected update is in January 2019.
- The Gross Tax Receipts schedule has been updated for the period of January 1 through June 30th. The next expected update is in July 2018.
REGULATORY ACTIVITY:
- The WCA's e-filing system begins January 1, 2018 and its use will be mandatory for all represented parties. All represented parties are required to use the Electronic Adjudication Management System (EAMS) to file court documents online in all workers' compensation cases. Workers and employers who are unrepresented are not required to e-file, but are encouraged to do so.
- Before you begin e-filing, review of the newly updated relevant rules of the court is highly recommended. The rules for e-filing a WCA complaint can be found on the WCA website under WCA Rules and Statutes (11.4.4.9 Claims Resolution (effective 1/1/2018)).
- Reminder Amended Title 11 Chapter 4-part 4 Claims resolution rules become effective on January 1, 2018.
New York VIEW STATE →
REGULATORY ACTIVITY:
- Published notice in the state register of amendments to rules regarding the Jockey Fund and its option to self-insure.
- Posted two notices in the state register on December 27, 2017, an adoption notice and a proposed rule notice. The adoption was for Impairment Guidelines for Schedule Loss of Use Evaluations. These rules become effective January 1, 2018. The proposed was for the establishment of a prescription drug formulary.
New York No-Fault VIEW STATE →
REGULATORY ACTIVITY:
- Posted notice of final adoption of Insurance Regulation 150 regarding private passenger motor vehicle insurance multi-tier programs. The rule becomes effective on March 13, 2018
North Carolina VIEW STATE →
REGULATORY ACTIVITY:
- On December 19, 2017, the Industrial Commission filed proposed rules for the utilization of opioids, related medications, and pain management treatment in workers’ compensation claims. The rules proposed for adoption are promulgated to ensure that injured workers are provided the services and care intended by the Workers’ Compensation Act and that medical costs are adequately contained. “It is the Commission’s responsibility to ensure that injured workers receive reasonable and necessary care for their injuries. As part of that responsibility, it is critical that the Commission take steps to identify best practices and adopt meaningful solutions to help address this crisis where possible,” stated Chairman Allen. The proposed rules are intended to facilitate the timely and effective delivery of appropriate medical treatment for pain management in workers’ compensation claims. Notice of these rules will be published in the January 16, 2018 issue of the North Carolina Register. A public hearing is scheduled for March 2, 2018, and the Commission will accept written comments until March 19, 2018. The earliest effective date of the proposed rules, if adopted by the Industrial Commission and approved by the Rules Review Commission, is May 1, 2018. The proposed rules can be found on the Industrial Commission website at www.ic.nc.gov/121917proposedopioidrules.pdf. Any questions should be directed to Kendall Bourdon at kendall.bourdon@ic.nc.gov.
North Dakota VIEW STATE →
FEE SCHEDULE NEWS:
- The state has adopted changes to the Ambulance, Anesthesia, Clinical Laboratory, Dental, DME, Home Health, Inpatient Hospital, Physician Drug, Ambulatory Surgical Centers, Outpatient and Medical Provider Fee Schedule effective January 1, 2018. The next expected update is set for April 1, 2018.
REGULATORY ACTIVITY:
- North Dakota has amended the rules of procedure. The amended rules become effective January 1, 2018.
- Effective January 1, 2018, WSI will implement a change to the chiropractic pilot program. The pilot program currently requires a chiropractor to obtain authorization for all chiropractic treatment extending beyond the initial office visit. Based on preliminary data and provider feedback, WSI will alter the program to include a window period.
- WSI defines the window period as a period of initial chiropractic treatment on a claim not requiring prior authorization. For initial treatment with a date of service on or after January 1, 2018, each claim will have one window period, which will include:
- 6 visits or 60 days of care, whichever comes first, including initial evaluation
- Treatment of all body parts accepted on a claim
- Up to two modalities per visit
- WSI offers several options for submitting a request for medications, which require prior authorization. A provider should refer to the WSI Formulary/Medication Restrictions list (link is external) to identify which medications require prior authorization.
- To request prior authorization of a medication, a provider may select one of the following options:
- Contact WSI Customer Service at 701-328-3800 or 800-777-5033 to speak with a pharmacy technician
- Obtain the Provider’s Request for Medication Prior Authorization (M11) form from the WSI website and fax to 888-786-8695
- WSI requires supporting medical documentation for authorization of certain medications, e.g. brand name medications. Once WSI receives and reviews all of the necessary information, the requesting party will receive notification of the authorization status.
Ohio VIEW STATE →
FEE SCHEDULE NEWS:
- The medical fee schedule has been updated with an effective date of January 1, 2018.
Oklahoma VIEW STATE →
FEE SCHEDULE NEWS:
- The DMEPOS and ambulance rates, based on the CMS DMEPOS and Ambulance fee schedules, have been updated effective as of January 1, 2018. Next update is expected in April 2018.
REGULATORY ACTIVITY:
- Effective January 1, 2018, the Internal Revenue Service has announced an increase in the mileage reimbursement rate from $.535 to $.545 per mile. (See IR-2017-204, Issued 12/14/2017). The new rate applies to mileage incurred on or after January 1, 2018.
Oregon VIEW STATE →
FEE SCHEDULE NEWS:
- The state has updated their fee schedule effective January 1, 2018.
REGULATORY ACTIVITY:
- Published revised bulletin 316 regarding claims processing administrative cost factor to become effective January 1, 2018. This revised bulletin notifies insurers and self-insured employers of the 2018 claim processing administrative cost factor. The Workers’ Compensation Division (division) applies this factor to approved reimbursements for supplemental disability benefits and certain claim costs. The factor is calculated under Oregon Administrative Rule (OAR) 436- 050-0180. This bulletin replaces Bulletin 316 issued Dec. 15, 2016. The claim processing administrative cost factor for calendar year 2018 is 20.35 percent.
- The Workers’ Compensation Division published an industry notice, House Bill 2338 relating to changes to death benefits.
- The Workers’ Compensation Division has posted final rules that are effective Jan. 1, 2018:
- OAR 436-010, Medical Services http://wcd.oregon.gov/laws/Documents/New_rules/10-17060ub-short.pdf
- OAR 436-050, Employer/Insurer Coverage Responsibility http://wcd.oregon.gov/laws/Documents/New_rules/50-17061ub-short.pdf
- OAR 436-060, Claims Administration http://wcd.oregon.gov/laws/Documents/New_rules/60-17062ub-short.pdf
- OAR 436-075, Retroactive Program http://wcd.oregon.gov/laws/Documents/New_rules/75-17063ub.pdf
- OAR 436-010, Medical Services Revised rule 0210 implements Enrolled House Bill 3363 (2017). 436-010-0210, Appendix A, “Matrix for health care provider types” now refers to a “doctor of osteopathic medicine” rather than to a “doctor of osteopathy.”
- OAR 436-050, Employer/Insurer Coverage Responsibility Revised rule 0150 has amended criteria for financial strength rating of public sector self-insured employers, to include more relevant financial ratios and assigned points, and provide that a municipal bond rating of Aa3, AA-, or higher will be considered to be a strong financial strength rating. The revised rule clarifies that the director may take one or more actions (not just a single action) if a self-insured employer’s financial strength rating is found to be weak. Revised rule 0170 now states that a self-insured employer’s excess insurance policy may not contain provisions or endorsements that do not comply with Oregon law. Revised rule 0175 requires that a self-insured employer’s report of losses include the medical reimbursement amounts applied to each claim, if applicable. Revised rule 0180 includes correction of a typographical error – the word “annual” has been deleted from section (1), subsection (e): “Under this section, ‘Incurred but not reported’ (IBNR) will be calculated by applying a loss development factor determined by the director against the employer’s annual incurred losses.” Also, section (4), subsection (c) has been revised so it applies to both self-insured employers and self-insured employer groups. Revised rule 0190 implements House Bill 2336 (2017) by explaining that the director may refer a self-insured employer’s or self-insured employer group’s claims for processing to an assigned claims agent. Revised rule 0195 has a corrected reference to Form 1869, replacing the incorrect reference to Form 1865. Revised rule 0260 implements House Bill 2186 by explaining that a self-insurance program under ORS 30.282(3) meets the organizational requirements to be certified as a self-insured employer group. Revised rule 0280 implements House Bill 2186 by explaining that a self-insurance program under ORS 30.282(3) meets the organizational requirements to be certified as a self-insured employer group. Revised rule 0290 has clearer procedures for cancellation and termination of members of a self-insured employer group and for reporting related information to the director.
- OAR 436-060, Claims Administration Revised rule 0005 includes a general definition of “dependent,” plus a reference to ORS 656.005(10). Revised rule 0035 includes an amended reference to the definition of insurer in rule 0005. Adopted rule 0075 implements Enrolled House Bill 2338 (2017) and consolidates several current provisions relevant to death benefits. This rule describes appropriate payment of death benefits under ORS 656.204 and 656.208, to include provisions that address: Final disposition of the body and funeral expenses; • Payments to surviving beneficiaries; • Benefit to surviving spouse; • Benefit to surviving child; • Benefit to surviving dependent; • Benefit to child or dependent attending higher education; and • Death during permanent total disability. • Revised rule 0095 includes the requirement, currently in OAR 436-010-0265(10)(b), for an insurer to forward a copy of the signed IME report to the attending physician. • Revised rule 0140 explains that an “Updated Notice of Acceptance at Closure” is not necessary to begin payment of death benefits following a worker’s death during a period of permanent total disability under ORS 656.208. Rule 0140 also has clearer requirements for notices of denial, particularly for any denial based in whole or in part on an independent medical examination. • Revised rule 0147 includes amended criteria for eligibility for a worker-requested medical examination (WRME). The revised rule also specifies that the worker or worker’s attorney must schedule a date for the WRME and inform the director and insurer of that scheduling within 14 days of the director’s notice, but the WRME itself may take place outside of that 14-day window. • Revised rule 0150 has amended requirements for timely payment of death benefits.
- OAR 436-075, Retroactive Program Repealed rule 0001 described the director’s authority. The director’s authority is established by Oregon statutes, and the rule is unnecessary. • Repealed rule 0002 described the purpose of division 075. The purpose statement did not include information that is not available in the division and rule titles, and the rule is unnecessary. • Amended rule 0003 now excludes the effective date of rules in division 075. Rule 0003 cannot determine the effective date of other rules. The effective date of each rule is set when it is filed with the Secretary of State, and the date is listed below the rule in the “Hist” (history) line. • Amended rule 0005 incorporates the definitions in ORS chapter 656 by reference, unless a term is specifically defined in these rules or the context otherwise requires. Terms that are defined in chapter 656 or that are not used in division 075 have been deleted. • Repealed rule 0006 stated that orders of the Performance Section are deemed orders of the director. The director’s authority is established by Oregon statutes, and the director may delegate that authority within the Department of Consumer and Business Services without establishing administrative rules in each instance. The rule is unnecessary. • Amended rule 0008 clarifies the processes for requesting hearings regarding certain orders or actions of the director. • Amended rule 0010 clarifies the criteria for Retroactive Program eligibility. • Amended rule 0020 clarifies the payment of death benefits under the Retroactive Program, including that statutory benefits will only be offset by a surviving spouse’s Social Security benefits for claims with dates of injury between July 1, 1973, and April 1, 1974. Certain instructions about the calculation and payment of death benefits have been deleted because they are described elsewhere in division 075 or in OAR 436-060. • Amended rule 0030 includes instructions for calculating benefits payable for a partial month. • Amended rule 0040 clarifies payment procedures if a worker dies during a period of permanent total disability, including that statutory benefits will only be offset by a surviving spouse’s Social Security benefits for claims with dates of injury between July 1, 1973, and April 1, 1974. Certain instructions about the calculation and payment of death benefits have been deleted because they are described elsewhere in division 075 or in OAR 436-060. • Amended rule 0065 clarifies the effect of dispositions and settlements on Retroactive Program eligibility, to include that a disposition or claims settlement must be approved by the director before submission to the Workers’ Compensation Board to be eligible for reimbursement from the Retroactive Program. • Amended rule 0070 clarifies reimbursement procedures under the Retroactive Program, to include a reference to Form 3285, “Requests for Reimbursement from the Retroactive Program,” and explanation that an equivalent form may be used to request reimbursement if it includes all of the data elements on Form 3285. • Amended rule 0090 clarifies, through use of plainer wording, the effects of third party recoveries on Retroactive Program benefits.
- The Workers’ Compensation Division has posted temporary OAR 436-009, “Oregon Medical Fee and Payment Rules,” to its website:http://wcd.oregon.gov/laws/Documents/New_rules/9-17064t-ub-short.pdf.
- These rules allow health care providers and workers’ compensation insurers to use 2018 medical billing codes on and after Jan. 1, 2018. The division expects to replace these temporary rules with permanent rules effective April 1, 2018.
- Posted the final permanent rule OAR 436-060-0025 Rate of Temporary Disability Compensation. The rule becomes effective January 1, 2018. The attached rule replaces the temporary rule that has been in place since October 1 of this year. A summary of the changes are below:
- Restores the method for determining the weekly wage for workers employed through a union hiring hall to the one in place before Jan. 1, 2017; for these workers, insurers must calculate the rate of compensation on the basis of a five-day work week at 40 hours a week, regardless of the number of days actually worked per week;
- Corrects a typographical error to explain that the insurer may not include any gap in “earnings” (not “employment”) of more than 14 days that was not anticipated in the wage earning agreement, when calculating the average earnings; and
- Clarifies that when a wage earning agreement has been changed due to reasons other than a pay raise, it is a new wage earning agreement.
Oregon-Auto VIEW STATE →
FEE SCHEDULE NEWS:
- The state has updated their fee schedule effective January 1, 2018.
Pennsylvania No-Fault VIEW STATE →
FEE SCHEDULE NEWS:
- The state adopts quarterly Medicare updates. Please refer to the Medicare modules section for more information.
Pennsylvania WC VIEW STATE →
FEE SCHEDULE NEWS:
- The state has adopted changes to the PAWC Part A and Part B Fee Schedule services with an effective date of January 1, 2018. The next expected update is for April 2018.
Rhode Island VIEW STATE →
REGULATORY ACTIVITY:
- Amended Workers' Compensation Administrative Account Rules and Procedures (260-RICR-50-05-12) go into effective on December 27, 2017.
South Carolina VIEW STATE →
REGULATORY ACTIVITY:
- On November 27th, 2017 the Circuit Court of the Second Judicial Circuit, in and for Leon County, State of Florida, entered the attached Order of Liquidation, Injunction, and Notice of Automatic Stay, Case No.: 2017 CA 2421, finding sufficient grounds for an order to liquidate Guarantee Insurance Company. This Order is sufficient to determine Guarantee Insurance Company is an “insolvent insurer” within the meaning of S.C. Code § 38-31-20(7) (1976).
The South Carolina Property and Casualty Insurance Guaranty Association Act provides that All proceedings involving covered claims in which the insolvent insurer is a party or is obligated to defend a party in any court in this State must be stayed ninety days from the date insolvency is determined to permit proper defense by the association. S.C. Code Ann. § 38-31-160 (1976). - Posted the 2018 Maximum Weekly Compensation Rate. At the Business Meeting on December 11, 2017, the Commission approved the maximum weekly compensation rate at $838.21 for injuries arising on and after January 1, 2018. The South Carolina Department of Employment and Workforce certified the average weekly wage July 1, 2016 through June 30, 2017.
- Regulation 67-1601 A (1) provides the expenses incurred for travel to receive medical attention which shall be reimbursed to the claimant are mileage to and from a place of medical attention which is more than five miles away from home in accordance with the amount allowed state employees for mileage. The state employee mileage rate is based upon the standard business mileage rate established by the Internal Revenue Service. Effective January 1, 2018 the reimbursement rate for state employee mileage is 54.5 cents per mile. This represents a one cent per mile increase from the 2017 rate of 53.5 cents per mile. Therefore, effective January 1, 2018, the new mileage reimbursement rate to and from a place of medical attention is 54.5 cents per mile.
Tennessee VIEW STATE →
REGULATORY ACTIVITY:
- The Tennessee Bureau of Workers’ Compensation’s Rules regarding Electronic Medical Billing for Workers Compensation Claims have been filed with the Secretary of State and will become effective July 1, 2018. These rules provide a legal framework for electronic billing, processing, and payment of medical services and products provided to an injured employee and data reporting required by Tennessee Code Annotated § 50-6-202 and can be found here. The Companion Guide to these Rules can be found here. In preparation of the full implementation of the rules, payers should be able to exchange data electronically by January 1, 2018 and healthcare providers or their agents should be able to exchange this data by June 1, 2018. However, in response to public comment regarding questions about these dates, the mandatory implementation date for all parties was changed as is reflected in the final section of the rules, which reads as follows: 0800-02-26-.10 Effective Date (1) These Rules are required for all medical services and products provided on or after July 1, 2018. For medical services and products provided prior to July 1, 2018, medical billing and processing shall be in accordance with the rules in effect at the time the health care was provided unless both payer and provider elect to comply with these Rules.
Tennessee-Auto VIEW STATE →
REGULATORY ACTIVITY:
- Published two new bulletins 17-3 Electronic Reporting of Dividends and 17-02 Forced Bundling of Umbrella and Personal Lines.
Texas VIEW STATE →
FEE SCHEDULE NEWS:
- New conversion factors have been adopted as of January 1, 2018. The next update is scheduled for January 1, 2019.
- The state of Texas adopts the quarterly Medicare modules update. Please refer to the Medicare modules section for more information.
REGULATORY ACTIVITY:
- Posted notice of amendments to various divisions forms to implement HB 2111.
- The division amends the following forms to replace “hearing officer” with “administrative law judge” and “official de la audencia” with “juez de derecho administrativo:”
- DWC Form-024, Benefit Dispute Agreement
- DWC Form-024s, Acuerdo para disputa de beneficios
- DWC Form-025, Benefit Dispute Settlement
- DWC Form-025s, Acuerdo por disputa de beneficios
- DWC Form-049, Request to Schedule a Medical Contested Case Hearing (MCCH)
- DWC Form-049s, Solicitud para Programar una Audiencia para Disputar Beneficios Médicos (Medical Contested Case Hearing – MCCH, por su nombre y siglas en inglés)
- DWC Form-150a, Notice of Withdrawal of Representation
- DWC Form-150as, Aviso de Anulación de Repesentación Legal
- DWC Form-152, Application for Attorney Fees
In addition, the fax number has been updated on Forms DWC024, DWC024s, DWC025, and DWC025s to (512) 804-4011. Finally, the updated revision and barcode date for each of these forms is 11/17.
The division emphasizes that no substantive or procedural changes have been made to any of these forms. The division will continue to accept the prior revision form while system participants transition to the updated forms.
The purpose for these clerical changes is to implement HB 2111 (85th Regular Session) which amended the Texas Workers’ Compensation Act to replace the phrase “hearing officer” with “administrative law judge.”
- Published bulletin B-0041-17 regarding the annual change to the medical fee guideline conversion factors as established in Title 28 TAC Section 134.203.
- The Texas Department of Insurance, Division of Workers' Compensation (DWC) has released the 2017 Health Care Provider Performance Based Oversight (PBO) assessment results. Heath care providers were assessed on their performance in one of three categories:
- timely filing the DWC Form-069, Report of Medical Evaluation;
- completeness of the DWC Form-073, Work Status Report; or
- documentation supporting why the injured employee was prevented from returning to work as reported on the DWC Form-073, Work Status Report.
Of the 152 health care providers reviewed for the timeliness of filing the DWC Form-069, Report of Medical Evaluation: 113 had scores placing them in the high performer tier, 30 were in the average performer tier, and 9 had scores placing them in the poor performer tier. Of the 87 health care providers reviewed for the completeness of the DWC Form-073, Work Status Report: 50 had scores placing them in the high performer tier, 26 were in the average performer tier, and 11 had scores placing them in the poor performer tier. Of the 87 health care providers reviewed for documentation supporting why the injured employee was prevented from returning to work, as reported on the DWC Form-073, Work Status Report: 41 had scores placing them in the high performer tier, 29 were in the average performer tier, and 17 had scores placing them in the poor performer tier. The results and a list of the health care providers included in the 2017 PBO assessment are posted on the Texas Department of Insurance website at www.tdi.texas.gov/wc/pbo/pboresults.html. If a health care provider is not listed, he or she was not assessed in 2017; however, no health care provider in the Texas workers' compensation system is exempt from compliance with the Workers' Compensation Act and DWC rules. More information on PBO and the 2017 assessment is available on the TDI website at www.tdi.texas.gov/wc/pbo/hcppbo.html. DWC will assess insurance carriers separately in 2018.
Utah No-Fault VIEW STATE →
FEE SCHEDULE NEWS:
- The state has adopted a new fee schedule with an effective date of January 1, 2018. The next expected update is expected in January 2020.
Utah WC VIEW STATE →
FEE SCHEDULE NEWS:
- The state adopted changes to their physician fee schedule rates with an effective date of December 1, 2017. The next update is expected in December 2018.
REGULATORY ACTIVITY:
- Published their 2018 Medical Fee Schedule Standards effective December 1, 2018.
Vermont VIEW STATE →
FEE SCHEDULE NEWS:
- The state has adopted changes to physician fee schedule rates effective on January 1, 2018. Next expected update is in January 2019.
Virginia VIEW STATE →
FEE SCHEDULE NEWS:
- The state has adopted the Virginia Workers' Compensation Medical Fee Schedules with an effective date of January 1, 2018. The fee schedule includes rates for physician and facility services.
Virginia Auto VIEW STATE →
REGULATORY ACTIVITY:
- Issued administrative order AO 12051 and AO 12052:
- 12051: Effective February 1, 2018 - AIPSO Filing VA 17-12 revises Section 38 to amend administrative procedures to remove the subscriber ballots for Commercial Auto.
- 12052: Effective February 1, 2018 - AIPSO Filing VA 17-11 revises Section 38 to amend administrative procedures to remove the subscriber ballots for Personal Auto.
Washington VIEW STATE →
FEE SCHEDULE NEWS:
- The Department of Labor & Industries has adopted new 2018 codes for medical and ASC fee schedules effective January 1, 2018. A new fee schedule update is expected in July 2018.
REGULATORY ACTIVITY:
- The Washington Board of Industrial Insurance Appeals has filed notice of adoption of permanent rules to become effective January 6, 2018. The purpose of the adopted rules are to revise the board's rules of practice and procedure by amending WAC 263-12-01501, 263-12-01701, 263-12-059, 263-12-085, 263-12-090, 2663-12-115, 263-12-116, 263-12-117, and 263-12-195. Rules are being modified to meet current business needs including changes necessary for the board of industrial insurance appeals (BIIA) to transition to electronic filing and a paperless file, to reduce duplicate filings, codify the board's policy on weapons, to implement charges for copy fees, and to clarify current practice and procedure for conferences, hearings, perpetuation deposition, exhibits, and indexing of significant decisions.
- Posted notice of rulemaking regarding medical aid rules. The purpose of this rulemaking is to update the Medical Aid Rules rates. The affected rules describe elements used in the process of updating the maximum allowable payments for most professional health care services. These elements are set in rule in order to follow the established methodologies of the Department and maintain consistency with the Health Care Authority and Medicaid Purchasing Administration. Specifically, the proposed rule changes will do the following:
- WAC 296-20-135: Update the conversion factors used by the Department for calculating reimbursement rates for most professional health care and anesthesia services. The conversion factors will be updated to correspond to changes in the medical procedure codes, the relative value units, and anesthesia base units. These changes will enable the Department to continue a reimbursement methodology consistent with other state agencies. Cost-of-living increases may be incorporated into the changes in the conversion factors.
- WAC 296-23-220 and 230: Update the maximum daily reimbursement level for physical and occupational therapy services so the Department may, if necessary, give cost-of-living increases to affected providers.
- Posted notice of proposed rulemaking regarding pension discount rate 2018. The purpose of this proposed rulemaking is to reduce the current pension discount rate to 6.1 percent in 2018. The pension discount rate is the interest rate used to account for the time value of money when evaluating the present value of future pension payments. Currently, WAC 296-14-8810 sets the pension discount rate at 6.2 percent. The Department has worked with the Workers’ Compensation Advisory Committee (WCAC) to develop a plan for reducing the pension discount rate annually, through 2022, until it reaches 4.5 percent. A public hearing will be held on January 23, 2018 with comments being due no later than January 24, 2018,
West Virginia VIEW STATE →
FEE SCHEDULE NEWS:
- The state follows Medicare methodology and codes become valid for payment once CMS adopts them. Please refer to the Medicare modules section for more information.
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