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Arizona VIEW STATE →

REGULATORY ACTIVITY:

  • The Industrial Commission of Arizona is pleased to announce that Ruby Tate joined the Claims Division as Claims Manager Monday, February 12th. Ms. Tate has over 16 years of Arizona workers' compensation claims experience, including extensive experience with program implementation. In the past year, she has been instrumental in the development of the new Claims Division computer system.
  • Bonnie Holly will continue the great work of the Special Fund Division by serving as the Interim Special Fund Manager. Ms. Holly joined the Special Fund Division in June 2017 with 20 years of Arizona workers' compensation claims experience.

California VIEW STATE →

FEE SCHEDULE NEWS:

  • Medi-Cal rates have been released with an effective date of February 15, 2018. The next update is scheduled for March 15, 2018.
  • The Outpatient and ASC fee schedule was updated with an effective date of March 15, 2018. The state has adopted the Medicare 2018 OPPS APC Addenda, ASC Addendum AA and updated wage-adjusted conversion factors.

Colorado Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Has posted notice regarding receiving comments on two draft rules.  The two rules are 3 CCR 702.5 Regulation 5-1-14 Penalties for Failure to Promptly address property or Casualty Claims and 3CCR 702.5 Regulation 5-2-15 Concerning Consumer Protection for Vehicle Valuation and Rental Reimbursement. The Division requests comments on this revised draft regulation.

Connecticut VIEW STATE →

FEE SCHEDULE NEWS:

  • Ambulance rates have been updated as of January 1, 2018. The next expected update to these rates is scheduled for January 2019.

Florida No-Fault VIEW STATE →

FEE SCHEDULE NEWS:

  • The state adopts the Medicare modules that are in effect on January 1st of each year with an effective date of March 1. The most recent update is March 1, 2018 and the next update is scheduled for March 2019.

Florida WC VIEW STATE →

REGULATORY ACTIVITY:

  • Notice of Development of Rulemaking
    Department: Department of Financial Services
    Division: Division of Worker's Compensation
    Rule No.: 69L-31.003, 69L-31.004, 69L-31.005, 69L-31.006, 69L-31.007, 69L-31.008, 69L-31.009, 69L-31.010, 69L-31.011, 69L-31.012, 69L-31.013, 69L-31.014, 69L-31.016
    Purpose: The proposed rulemaking amends existing rules governing the process for the resolution of reimbursement disputes between workers’ compensation carriers and health care providers, creates a new rule, and repeals an existing rule. Changes proposed include:
    • amending Rule 69L-31.005, F.A.C., to provide greater detail regarding the materials that must accompany a petition for dispute resolution (Petition Form);
    • amending Rule 69L-31.008, F.A.C., to clarify the computation of the time period within which a Petition Form must be submitted to the Division, to increase the time period for the submission of a Petition Form from 30 days to 45 days, to add the website address for the Division’s Web Portal, and to provide additional guidance regarding the electronic submission of a Petition Form;
    • amending Rule 69L-31.009, F.A.C., to increase the time period for a carrier to respond to a petition from 10 days to 30 days;
    • repealing Rule 69L-31.012, F.A.C.;
    • creating Rule 69L-31.016, F.A.C., to address penalties for improper reimbursement and billing practices.

Revisions to certain rule titles are proposed to more accurately reflect the subject matter or issues addressed by the rule. Other changes proposed include minor edits and the adoption of revised forms.
https://www.flrules.org/gateway/View_Notice.asp?id=20029062

  • Notice of Development of Rulemaking
    Department: Department of Financial Services
    Division: Division of Worker's Compensation
    Rule No.: 69L-6.025
    Purpose: The proposed amendment to paragraph 69L-6.025(4)(b), F.A.C., will allow employers an additional opportunity to remain compliant with their payment agreement schedules by increasing the number of times the Department will rescind an Order Reinstating Stop-Work Order from two to three in any one case. The proposed amendment to paragraph 69L-6.025(7)(c), F.A.C., will allow employers whose Reinstatement of Stop-Work Orders have been rescinded, the opportunity to enter into new payment agreements after making three monthly payments of the original agreed amount. Currently, the employer is required to make six monthly payments of the original agreed amount after the rescission of the Reinstatement of the Stop-Work Order prior to entering into a new payment agreement. Reducing the number of payments required from six to three will shorten the timeframe for entering into a new payment agreement.
    https://www.flrules.org/gateway/View_Notice.asp?id=20029159
  • Posted notice of a petition received.  NOTICE IS HEREBY GIVEN that the Department of Financial Services, Division of Workers’ Compensation, has received the petition for declaratory statement from Jessup, Inc. The petition seeks the agency’s opinion as to the applicability of Section 440.02(15) (d)1., Florida Statutes (2017), as it applies to the petitioner. The petition seeks the Department’s opinion that if a provider complies with petitioner’s requirements that the provider will meet the criteria enumerated in subsections 440.02(15)(d)1.(I)-(IV), Florida Statutes. The petition seeks the Department’s opinion whether petitioner may appropriately deem the provider to be an independent contractor and not an employee. A copy of the Petition for Declaratory Statement may be obtained by contacting: Thomas Nemecek, Supervising Attorney, Office of the General Counsel, 200 E. Gaines Street, Tallahassee, Florida 32399-0333, (850)413-1606, Nemecek@myfloridacfo.com. Please refer all comments to Thomas Nemecek.

Georgia VIEW STATE →

REGULATORY ACTIVITY:

  • The WC-26, Consolidated Yearly Report of Medical Only Cases and Annual Payments on Indemnity Claims, is filed on or before March 1st following each calendar year in respect to all medical and indemnity payments for the previous year for work related injuries. File annually even if no reportable injuries or payment occurred during the reporting year.

Hawaii No-Fault VIEW STATE →

REGULATORY ACTIVITY:

Illinois VIEW STATE →

REGULATORY ACTIVITY:

Indiana Auto VIEW STATE →

REGULATORY ACTIVITY:

  • TITLE 760 DEPARTMENT OF INSURANCE; ARTICLE 1. GENERAL PROVISIONS; Rule 1. Automobile Liability Insurance–Policy Form

760 IAC 1-1-1 Disclaimer of personal injury or property damage coverage Authority: IC 27-1-3-7 Affected: IC 27-1-13-7

Sec. 1. Whenever any insurance company authorized to do business in the State of Indiana issues an automobile insurance policy providing collision or material damage coverage only and which does not provide liability coverage for personal injury or property damage, the policy or the certificate given in lieu thereof shall contain the following notation upon its face or filing back: "THIS POLICY (CERTIFICATE) DOES NOT PROVIDE LIABILITY INSURANCE FOR BODILY INJURY OR PROPERTY DAMAGE." Such notice shall appear in not less than 10 point type. It may be printed or may be made by rubber stamp impression; provided, however, that deviation from the form prescribed herein may be permitted upon the approval of the Department of Insurance of Indiana. (Department of Insurance; Reg 1; filed Dec 24, 1952, 11:20 am: Rules and Regulations 1953, p. 157; readopted filed Sep 14, 2001, 12:22 p.m.: 25 IR 530; readopted filed Nov 27, 2007, 4:01 p.m.: 20071226-IR-760070717RFA; readopted filed Nov 26, 2013, 3:43 p.m.: 20131225-IR-760130479RFA)

Kansas VIEW STATE →

REGULATORY ACTIVITY:

  • Published the notice of adopted rule Article 3 - Fire and Casualty Insurance 40-3-60 Workers' compensation; affidavit of exempt statue. Each company that underwrites workers’ compensation insurance in Kansas shall accept each executed affidavit of exempt status provided by each insured, pursuant to K.S.A. 2016 Supp. 44-5,127 and amendments thereto, unless there is sufficient evidence that the individual who signed the affidavit is required to be covered under the workers compensation act. (Authorized by and implementing K.S.A. 2016 Supp. 44-5,127; effective March 2, 2018.) Ken Selzer, CPA Insurance Commissioner.  To view the posted notice, go to  http://www.kssos.org/pubs/register/2018/Vol_37_No_07_February_15_2018_pages-113-144.pdf.
  • Published the 43rd Annual Statistical Report Fiscal Year 2017.  To view the report, go to https://www.dol.ks.gov/Files/PDF/AnnualReportFY17.pdf.

Louisiana VIEW STATE →

REGULATORY ACTIVITY:

Maryland VIEW STATE →

REGULATORY ACTIVITY:

  • In accordance with the liquidation order of the Circuit Court of the Second Judicial Circuit in and for Leon County, Florida, in the matter of the State of Florida, realtor, v. Guarantee Insurance Company, respondent, Case No. 2017 CA 2421, dated November 27, 2017 (link), all GIC policies are cancelled effective December 27, 2017, unless otherwise terminated prior to that date. In addition, while the processing and payment of pending covered claims are being transitioned by Florida to the appropriate state guaranty associations; Florida also is currently gathering claim files and claims data to forward the information to the appropriate Guaranty Associations. For Maryland policy holders, the appropriate guaranty association is the Maryland Property & Casualty Insurance Guaranty Corporation (PCIGC) (link: http://pcigcweb.com/). Please note that while PCIGC is being added to current GIC-insured claim files as “other” in order to receive notice of hearings and for processing and payment of pending covered claims, PCIGC is NOT A PARTY and SHOULD NOT BE ADDED AS A PARTY to any GIC-related claim.

Massachusetts VIEW STATE →

REGULATORY ACTIVITY:

Proposed Emergency Adoption

101 CMR 314.00: Dental Services

Medicare VIEW STATE →

FEE SCHEDULE NEWS:

  • Physician – CMS has reposted the National Physician Fee Schedule Relative Value File retroactive to January 1, 2018. This update includes the changes resulting from the SUSTAIN Care Act of 2018 that extends the Work Floor GPCI to 1.000 until 2023. The next expected update is April 1, 2018.
  • ASC – CMS has reposted a revised to the ASC fee schedule with an effective date of January 1, 2018.  The update includes revised rates for 145 codes in Addendum AA. The next expected update is April 1, 2018.
  • Ambulance – CMS reposted the 2018 ambulance fee schedule retroactive to January 1, 2018. This update includes the changes resulting from the SUSTAIN Care Act of 2018 that extends the bonus payments for urban and rural transports and the super-rural bonus.  The next expected update is scheduled for January 1, 2019.

Mississippi VIEW STATE →

FEE SCHEDULE NEWS:

  • The state has adopted the new 2018 CPT codes retroactive to January 1, 2018.

Montana VIEW STATE →

REGULATORY ACTIVITY:

  • Is holding a public hearing for the amendment of rules pertaining to classification of workers.  The hearing will be held on March 2, 2018 at 1:30 PM in Conference room A & B 1805 Prospect Helena, MT. The proposed amendments are to ARM 24.17.127 pertaining to classification of workers for heavy construction services on public works projects.

Montana-Auto VIEW STATE →

REGULATORY ACTIVITY:

Nebraska VIEW STATE →

REGULATORY ACTIVITY:

  • The Omaha office of the Nebraska Workers' Compensation Court will be temporarily relocated due to construction beginning Thursday March 1, 2018.  Office phone numbers will stay the same but will be unavailable from 4:00 p.m. to 5:00 p.m. on Wednesday February 28, 2018. During the four to six-week relocation period, the judges' assistants will contact parties prior to each trial and hearing with courtroom information.  Questions regarding this temporary relocation may be directed to the Office of the Clerk of the Court.  For more information regarding workers' compensation in Nebraska, please visit the court's web site at http:wcc.ne.gov, or call the court's information line at 1-800-599-5155 or 402-471-6468.

Nebraska-Auto VIEW STATE →

REGULATORY ACTIVITY:

Nevada VIEW STATE →

REGULATORY ACTIVITY:

  • All requests for a PPD rating physician or chiropractor, including mutual agreements and court orders, will be processed in the DIR/WCS office in Henderson, NV, effective February 12, 2018. Please note the following:
    • The D-35 Form has been revised to reflect the change in fax number and a new email for questions.
    • D-35 Forms must be faxed to 702-990-0363. D-35 Forms sent to the Carson City office will be returned to the sender so that the sender may redirect them to the Henderson office.
    • Concerns regarding D-35 Forms or PPD rater assignments/changes should be emailed to medunit@business.nv.gov and will be responded to as quickly as possible.
    • All appropriate fields on a D-35 Form, including a stable and ratable date, must be completed prior to sending to DIR/WCS for processing.
    • All D-35 Forms submitted by attorneys must be accompanied by a written and signed letter of representation.
    • Court assigned PPD raters must include a copy of the Decision and Order from the court appointed authority. To view the new form, to go http://dir.nv.gov/uploadedFiles/dirnvgov/content/WCS/d-35.pdf.
  • Has posted notice of amendments relating to industrial insurance; authorizing reimbursement from the Subsequent Injury Account for Associations of Self-Insured Public or Private Employers for the purchase of an annuity or payment of a lump sum; revising provisions governing the rating of permanent physical impairments; providing for petitions to the Board for the Administrations of the Subsequent Injury Account for Associations of Self-Insured Public or Private Employers to adopt, amend or repeal regulations; providing for petitions to the Board for the issuance of a declaratory order or advisory opinion concerning the applicability of a statute, regulation or decision of the Board; providing procedures for service upon associations, the Administrator of the Division of Industrial Relations of the Department of Business and Industry and the Board; revising provisions governing hearings before the Board and requests for continuances; and providing other matters properly relating thereto.   To view a copy of regulation, go to https://www.leg.state.nv.us/Register/2018Register/R026-18I.pdf.

Nevada Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Posted notice to amend rules relating to insurance, providing for pre-licensing education requirements for applicants for a license as an adjuster; approval of course of instruction and instructor; record retention and timely filing of compliance documentation; and continuing education and the requirements related thereto.  To view the proposed regulation, go to file:///D:/State%20Regulations/Nevada/Auto%20Regulations%202017/Nevada%20Proposed%20ADjuster%20License%20R028-18I.pdf.

New Jersey WC VIEW STATE →

REGULATORY ACTIVITY:

New Mexico VIEW STATE →

REGULATORY ACTIVITY:

  • The Advisory Council on Workers' Compensation and Occupational Disease and Disablement will meet on Thursday April 19, 2018 at 9:30 a.m. at the WCA main office, 2410 Centre SE.

New-Mexico-Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Published Bulletin 2018-002 regarding interest rate applicable to unpaid claims 45 days after required proof of loss has been furnished.  The bulletin provides for the 2018 calendar year the interest rate is set as one and one-half times 4.50%, which is equivalent to 6.75%.  This interest rate shall remain in effect until the Superintendent completes a review of the interest in January  2019 and issues a new bulletin.  To view the bulletin, go to https://www.osi.state.nm.us/InsuranceBulletins/docs/Bulletin2018-002.pdf.

New York VIEW STATE →

REGULATORY ACTIVITY:

  • The state issued Bulletin Subject Number 150-18.1 on February 14, regarding change in rate of reimbursement to injured workers for travel by automobile. The mileage rate for reimbursement to injured workers for travel by automobile on or after January 1, 2018, is 54.5 cents per mile.  In accordance with the Board resolution adopted on February 20, 1990, the mileage rate for reimbursement to injured workers for travel by automobile is the same rate that Management/Confidential state employees are reimbursed for travel by automobile. In those instances where injured workers are entitled to reimbursement for travel expenses, insurers will reimburse injured workers for travel in accordance with this rate. To view the bulletin, go to http://www.wcb.ny.gov/content/main/SubjectNos/sn150_18_1.jsp.
  • Posted notice of emergency rule making regarding Option to Self-Insure for Jockey Fund.  This amendment adopted as an emergency measure because time is of the essence. On April 10, 2017, the New York Legislature adopted Chapter 59 of the Laws of 2017, which, among other things, significantly altered the New York Jockey Injury Compensation Fund, Inc. (hereinafter, Jockey Fund or Fund) (see Racing, Pari-Mutuel Wagering and Breeding Law section 221[6][b], as amended by L 2017, Ch. 59, part SS). Under Racing, Pari-Mutuel Wagering and Breeding Law section 221(6), the Jockey Fund is required to secure workers’ compensation coverage for the benefit of all jockeys, apprentice jockeys, and exercise persons licensed pursuant to Racing, Pari-Mutuel Wagering and Breeding Law articles two and four. Under the amended law, the Jockey Fund may now elect to secure workers’ compensation insurance coverage through a form of self-insurance (see id.). This amendment to the Jockey Fund took effect immediately (see L 2017, Ch. 59, part SS, section 12). Therefore, it is imperative that the Board adopt emergency regulations regarding the procedure the Jockey Fund must follow to self-insure before the Fund elects to become self-insured. To view the rule, go to https://docs.dos.ny.gov/info/register/2018/feb28/pdf/rulemaking.pdf.  The emergency rule will remain in effect through May 13, 2018.

LEGISLATIVE ACTIONS:

  • Assembly Bill 1620
    • The purpose of this bill is to require that insurance carriers provide conditional renewal notices to workers' compensation policyholders when the premium will increase more than ten percent upon renewal with an affiliated insurance company that is under common control with the previous insurer.  This legislation amends the workers' compensation law by adding a subdivision 5b to section 54 of the workers compensation law. Effective Date April 30, 2018.

North Carolina VIEW STATE →

FEE SCHEDULE NEWS:

  • The state has updated the Professional, DME and Laboratory Fee Schedule rates with an effective date of January 1, 2018. The next update is expected in 2019.

REGULATORY ACTIVITY:

  • Beginning February 1, 2018, the Full Commission will begin issuing Workers’ Compensation Opinions and Awards and Tort Claim Decisions and Orders with electronic signatures to modernize Commission filings and institute more efficient internal practices. The Full Commission will follow the format used by the Court of Appeals of North Carolina, documenting the names of concurring and dissenting panel members at the end of each opinion. To further streamline the Commission’s internal filing system, the Clerk’s Office will also begin electronically file stamping Full Commission Opinions and Awards and Decisions and Orders.
  • As part of the Commission’s effort to increase efficiency, Full Commission orders will be served via e-mail to the attorney of record beginning 5 February 2018. Mail or certified mail will only be used to provide notice when an attorney’s email address is unknown or when a party is appearing pro se. Additionally, the Full Commission will begin issuing orders with conformed signatures.
  • Governor Roy Cooper has nominated Robert J. Harris for appointment as a Commissioner to the North Carolina Industrial Commission for a six-year term, pending confirmation by the North Carolina General Assembly. For a brief biography of DC Harris, please click here. Governor Cooper nominated Harris to the seat presently occupied by Commissioner Tammy R. Nance. Commissioner Nance and Deputy Commissioner Harris will continue to serve in their current positions until Harris’ confirmation process is complete and he has been sworn in.
  • The Industrial Commission has withdrawn the proposed rule amendment to 04 NCAC 10E .0203, Fees Set by the Commission. Notice of this proposed amendment was published in the North Carolina Register on November 15, 2017 and was posted on the Commission’s website here. Through prudent management of financial resources and the cooperation of the Department of Insurance, the Industrial Commission is pleased to announce that the temporary fee increase in the proposed rulemaking will not be necessary. Now that the Commission’s funds are wholly transferred from the Department of Commerce to the Department of Insurance, the Industrial Commission will not move forward with the proposed rule amendment. To review more detailed information, go to http://www.ic.nc.gov/proposed10E0203PermRule.html.
  • On February 19, 2018, the Industrial Commission will take another step towards modernizing and streamlining its internal practices. Deputy Commissioners will begin serving orders via e-mail to the attorney of record. Mail or certified mail will only be used to provide notice when an attorney’s e-mail address is unknown or when a party is appearing pro se. Additionally, Deputy Commissioners will file orders with conformed signatures.
  • The Industrial Commission has made minor revisions to the form 24 application to terminate or suspend payment of compensation. Please use the updated form, beginning in February 2018.  To view the updated form, go to http://www.ic.nc.gov/forms/form24fillable.pdf.

Ohio VIEW STATE →

REGULATORY ACTIVITY:

Oregon VIEW STATE →

REGULATORY ACTIVITY:

Affected rules: OAR 436-060, Claims Administration, rules 0005 and 0025 http://wcd.oregon.gov/laws/Documents/New_rules/60-18050t.pdf

To:  Oregon workers, employers, workers’ compensation insurers, self-insured employers, service companies, attorneys, and other interested people.  Stakeholders have made us aware that the wage averaging method in effect since January 1, 2017, has had the effect of harming some workers who have had wage increases during the preceding year. Based on advisory committee recommendations that represent a consensus of labor and management representatives on the committee, we are issuing temporary rules. These rules impact workers with irregular wages who have experienced a pay increase or decrease during the 52 weeks before the injury. We are distributing these rules in advance of their effective date, so you will have some time to prepare for the change. These rules are effective Feb. 21, 2018. Under OAR 436-060-0003(2) and ORS 656.202(2), these rules apply to dates of injury on and after Feb. 21, 2018. If you have questions about how to apply the rules – contact the Division’s Audit Unit:

  • Barb Belcher, Barbara.Belcher@oregon.gov, 503-947-7687;
  • Troy Painter, Troy.J.Painter@oregon.gov, 503-947-7701; or
  • askanauditor@oregon.gov.

Temporary rules may only remain in effect for 180 days, so we will soon begin permanent rulemaking to replace them. This will be an opportunity for you to provide advice and testimony, and we will contact you again within the next few months to invite your participation.

  • Published an industry notice regarding supplemental disability benefits-request for verifiable documentation requirements.  This industry notice provides information about the requirement for insurers and self-insured employers to send workers seeking supplemental disability benefits (SDB) a request for verifiable documentation. Under OAR 436-060-0035(4)(b)(A), within five business days of notice or knowledge that a worker may be eligible for SDB, the insurer or self-insured employer must send the worker a request for verifiable documentation of the worker’s wages from any secondary jobs. In addition to informing the worker of what documentation must be submitted to determine eligibility for SDB, the request must clearly state that if the documentation isn’t received within 60 days of the mailing date of the request, the insurer or self-insured employer will determine the worker’s temporary disability rate based only on the job at which the injury occurred, and the worker will be found ineligible for SDB.  To view the notice, go to http://wcd.oregon.gov/IndustryNotices/02-22-18-IN-SDB.pdf.
  • The Workers’ Compensation Division has adopted temporary changes to OAR 436-120, Vocational Assistance, to be effective Feb. 23, 2018 through Aug. 21, 2018. Summary of changes:
    • Revised rule 0147: Describes the process for determining a worker’s weekly wage when the worker held multiple jobs at the time of injury, to reflect the Court of Appeal’s decision in Chu v. SAIF 290 Or App 194 (2018);
    • Clarifies that the adjusted weekly wage must consider the total of all of the weekly wages from section (3) of the rule; and
    • Clarifies which version of OAR 436-060-0025 should be used when determining the weekly wage.
  • Need for the Temporary Rule(s): Temporary rules are needed because the Court of Appeals found that certain provisions in OAR 436-120-0147 are inconsistent with statute.  To view the notice, go to http://wcd.oregon.gov/laws/Documents/New_rules/120-18051t-short.pdf. The temporary rule became effective on February 23, 2018.
  • Posted an industry notice regarding supplemental disability benefits- request for verifiable documentation requirements.  To view the notice, go to http://wcd.oregon.gov/IndustryNotices/02-22-18-IN-SDB.pdf.

Rhode Island Auto VIEW STATE →

REGULATORY ACTIVITY:

South Carolina VIEW STATE →

REGULATORY ACTIVITY:

Tennessee VIEW STATE →

REGULATORY ACTIVITY:

  • The Insurance Rate Service Organization designated for Bureau purposes that include the filing of insurance policy provisions and coverages and the determination of job classifications for applicable Bureau Rules is the National Council on Compensation Insurance (NCCI).
  • Posted notice regarding Chapter Number 0800-02-21 Mediation and Hearing Procedures Rule Number 0800-02-21-08 The rule establishes the form that pursuant to TCA Section 50-6-244 the department will use for settlements approved by the court of workers' compensation claims involving injuries occurring on or after July 1, 2014.  A copy of the notice which includes the form can be viewed by going to http://publications.tnsosfiles.com/rules_filings/02-06-18.pdf.
  • The new Form SD-2, the replacement form for the current Statistical Data Form SD-1, will go into effect May 6, 2018.  The change to the new form is reflected in recently adopted rule 800-02-21-.08 Mediation and Hearing Procedures -  Forms.  To view the adopted rule, go to http://publications.tnsosfiles.com/rules_filings/02-06-18.pdf. To view the new form, go to https://www.tn.gov/content/dam/tn/workforce/documents/injuries/SD-2%20Final.pdf.
  • Posted notice of amendment to rule 800-02-20 Medical Impairment Rating Registry Program - Peer Review. Rule 0800-02-20-.12 Peer Review is amended by deleting the prior subsections (1) and (2) and replacing subsections (1) and (2) as follows: (1) All MIR Reports are subject to peer review for appropriateness and accuracy by a physician designated by the Administrator.  (2) The peer review shall be completed within ten (10) business days of referral from the Program Coordinator. The peer review physician may recommend an MIR Report for reconsideration by the examining MIR physician if the peer review physician deems the report to be incomplete, inaccurate, or unclear pursuant to the requirements of Rule 0800-02-20-.11. Reconsideration and any revision shall be completed by the examining MIR physician within ten (10) business days of referral from the Program Coordinator. Authority: T.C.A. §§ 4-5-202 and 50-6-204 (2005).  Administrative History: Public necessity rule filed June 15, 2005; effective through November 27, 2005. Public necessity rule filed November 16, 2005; effective through April 30, 2006. Original rule filed January 30, 2006; effective April 15, 2006. Repeal and new rule filed March 25, 2013; effective June 23, 2013.  This proposed rule is scheduled to become effective May 9, 2018.  To view the posted notice, go to http://publications.tnsosfiles.com/rules_filings/02-13-18.pdf.

Texas VIEW STATE →

REGULATORY ACTIVITY:

  • The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) finalized revisions to DWC Form-005, Notice of No Coverage or Termination of Coverage. Revisions to DWC Form-005 change the way that required information is arranged to make it easier for employers to know what is needed on the form.  The information requested on the form is the same information that was requested in the previous form.  The frequently asked questions portion is updated to include questions that are currently on the division’s website, but not currently on the form. Specifically, the FAQs being incorporated into the form are: “How do I determine my filing period start date?”; “How do I determine my filing period end date?”; “What is a NAICS code?”; and “Are any fields on the DWC Form-005 optional?”.  The proposed version of the DWC Form-005 also removes the requirement that an employer file a Termination of Coverage notice by certified mail to align with HB 2112 (85th Legislature, Regular Session, 2017), which amended Texas Labor Code § 406.007(a) and removed that requirement.  Finally, the notice at the bottom of the form that is required by Texas Govt. Code § 559.003 is updated to include the current approved language and provide a link to the procedure to correct information.  An informal working draft of DWC Form-005 was posted on the TDI-DWC website on November 17, 2017, and the informal comment period ended on December 1, 2017. The finalized DWC Form-005 is available on the TDI-DWC website at: tdi.texas.gov/forms/form20employer.html#dwc005, and is effective February 1, 2018.
  • On March 1, 2018, Texas workers’ compensation insurance carriers must use the new and revised plain language notices. The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) recently revised plain language notices PLN-1, PLN-2, and PLN-4 through PLN-12; and created new notices PLN-3a, PLN3b, and PLN-3c.   Insurance carriers may not use older versions of the plain language notices on or after March 1, 2018. TDI-DWC will remove all previous versions from its website. The new and revised plain language notices are available at tdi.texas.gov/forms/form20plain.html.  TDI-DWC’s goal is to improve the notices insurance carriers use to communicate with injured employees. Generally, the purpose of the new and revised plain language notices is to provide consistency in language and formatting and to provide an emphasis on plain language. The revisions were made 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, and that it is provided in a simple, easy to understand manner.  If you have any questions, please contact Emily McCoy at Emily.McCoy@tdi.texas.gov. For more information, visit www.tdi.texas.gov/wc/forms/documents/plns0917m.pdf.
  • Texas has updated their home health and dental fee schedules effective February 7, 2018.  To view the updated fee schedules, go to http://public.tmhp.com/FeeSchedules/StaticFeeSchedule/FeeSchedules.aspx.
  • Texas has posted notice of the division's informal rule process regarding Amending 28 TAC § 180.26, regarding criteria for imposing, recommending and determining sanctions; other remedies, and amending §180.8, regarding notices of violation; notices of hearing; default judgments.  To view the notice, go to http://www.tdi.texas.gov/wc/rules/documents/dr1800218m.pdf.  To view the draft of the proposed rule amendments, go to http://www.tdi.texas.gov/wc/rules/documents/dr1800218.pdf.  Comments on the proposed rules must be received by March 7, 2018.
  • The Texas Department of Insurance, Division of Workers’ Compensation (DWC) seeks informal input from workers’ compensation system participants on a new procedure for evaluating designated doctor performance. The evaluation procedure provides for a review of the quality of designated doctor decisions, as required by law. DWC may take necessary action to deny renewal of a designated doctor's certification based on the integrity of these decisions. The evaluation procedure will also help DWC increase training and testing quality by identifying areas for Designated Doctor performance improvement.  Information about the proposed evaluation procedure, including selection criteria, is available at tdi.texas.gov/wc/hcprovider/medadvisor.html.  The Medical Advisor is responsible for developing the performance review procedure, which is adopted by the Commissioner of Workers’ Compensation. The Medical Advisor will evaluate system participant suggestions.   You may submit suggestions for this procedure to OMA@tdi.texas.gov by 5 p.m. Central Time on, March 8, 2018.  To view the draft procedure, go to http://www.tdi.texas.gov/wc/hcprovider/documents/ddreview0218.pdf.
  • The Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) is accepting public comments on proposed new 28 Texas Administrative Code (TAC) §133.30. The proposal will be published in the March 2, 2018, issue of the Texas Register and available at sos.state.tx.us/texreg/index.shtml, once published. A courtesy copy of the proposal will also be available on the TDI-DWC website at www.tdi.texas.gov/wc/rules/2018rules.html. If you want to comment on the proposal, submit your written comments by 5:00 p.m. Central time on April 2, 2018. A request for a public hearing must be sent separately from your written comments. Send written comments or hearing requests by email to Rulecomments@tdi.texas.gov or by mail to:   Texas Department of Insurance, Division of Workers’ Compensation Maria Jimenez Workers’ Compensation Counsel MS - 4D 7551 Metro Center Drive, Suite 100 Austin, Texas 78744 -1645. If a hearing is held, TDI-DWC will consider written comments and public testimony presented at the hearing.   New §133.30 expands access to 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.  To view a copy of the notice, go to http://www.tdi.texas.gov/wc/rules/proposedrules/documents/pr133tmed0218m.pdf.  To view a copy of the proposed rule,  go to http://www.tdi.texas.gov/wc/rules/proposedrules/documents/pr133tmed0218.pdf.

Utah WC VIEW STATE →

REGULATORY ACTIVITY:

  • It has come to our attention that there was a mistake in the recent filing of R612-300-4 with the Utah Office of Administrative Rules.-  Specifically, R612-300-4(C)(1), published as part of our yearly Medical Fee Standards update, incorrectly raises the allowable charge for one unit (15 minutes) of anesthesiology to $65.  The amount agreed upon by the Medical Committee and approved by the Workers’ Compensation Advisory Council is $62.  The correct rule has been re-filed with the Office of Administrative Rules and should be made effective shortly after the 30-day notice period.  Though the rule currently states otherwise, I would encourage providers to bill, and payors to pay, the $62 per unit for anesthesiology services as intended.

Vermont VIEW STATE →

REGULATORY ACTIVITY:

  • Posted notice that two forms have been updated: Form 32 and Form 25.  The new forms can be found on the website at: http://labor.vermont.gov/forms/#comp.
  • Effective January 1, 2018 the Workers’ Compensation mileage reimbursement rate increased from $.535 to $.545 per mile.  The mileage reimbursement rate as determined by Rule 4.1310 is for mileage traveled for medical treatment, to attend an employer’s independent medical examination or attend a vocational rehabilitation meeting.  The rate is the rate that is in effect for classified state employees.

Washington VIEW STATE →

REGULATORY ACTIVITY:

  • Posted notice of updates to the Medical Aid Rules update regarding Rule WAC 296-20-135, WAC 296-23-220 and WAC 293-23-230.  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. This rulemaking proposes to:
    • Change the conversion factor used to calculate payment levels for services payable through the Resource Based Relative Value Scale (RBRVS) fee schedule;
    • Change the conversion factor used to calculate payment for anesthesia services; and
    • Increase the maximum daily payment for physical and occupational therapy.

To view the notice, go to http://www.lni.wa.gov/LawRule/WhatsNew/Proposed/default.asp?RuleID=268.  Comments on the proposed rules are due by March 28, 2018.

Washington-Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Posted notice of amendments to rule R2017-04.  This rule creates new and amended existing sections of WAC 284-17-123 to clarify education alternatives to adjuster training. It would also establish the Office of the Insurance Commissioner’s interpretation of the breadth of the activities to be licensed under the definition of adjuster. This is the second draft of the rule.  A copy of the second draft can be viewed by going to https://www.insurance.wa.gov/sites/default/files/2018-01/r_2017-04_second_stakeholder_draft.pdf.

Wisconsin VIEW STATE →

FEE SCHEDULE NEWS:

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


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