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Arizona VIEW STATE →

REGULATORY ACTIVITY:

  • Effective October 1, 2018, the use of the Official Disability Guidelines (ODG) evidence-based medicine treatment guidelines applies to all body parts and conditions.   Treatment Guideline Frequently Asked Questions (FAQs), the MRO 1.1 Medical Treatment Preauthorization Form and Instructions, and recorded webinars can be found on the Commission website: https://www.azica.gov/divisions/medical-resource-office-mro If you have questions please contact the Medical Resource Office at 602-542-6731 or mro@azica.gov.

Arkansas Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Issued Bulletin 8-2018 regarding notification of repeal of rules pursuant to the Act 781 of 2017.   The repealed rules include:
    • Rule 9 –   Corporate Minute Books
    • Rule 20 – Financial Reporting by Life Insurance Companies
    • Rule 36 – Investments in Medium Grade and Lower Grade Obligations for Domestic Arkansas Insurers
    • Rule 58 – Employee Leasing Firms and Employee Leasing Groups
    • Rule 61 – Insurer Reports of Arkansas Property and Casualty Claims Experience Pursuant to Act 166 of 1993.

To view the bulletin, go to https://www.insurance.arkansas.gov/resource-library/resources/category/bulletins/.

California VIEW STATE →

FEE SCHEDULE NEWS:

  • The DWC has adopted the Medi-Cal rates effective October 15, 2018. The next update is expected November 15, 2018.
  • The DWC adopted a new Inpatient Fee Schedule effective December 1, 2018.  The next update is expected December 1, 2019.

REGULATORY ACTIVITY:

  • The Division of Workers' Compensation (DWC) has posted a revised version of the Workers’ Compensation Information System (WCIS) California Electronic Data Interchange Implementation Guide for First and Subsequent Reports of Injury (FROI/SROI) on its rulemaking forum. Members of the public are encouraged to review the proposed regulatory revisions in the guide and submit written comments. The comment period is open until 5 p.m. on Tuesday, October 30.  California's WCIS uses electronic data interchange to collect comprehensive information from claims administrators to help the Department of Industrial Relations oversee the state's workers' compensation system. This information helps facilitate evaluation of the system and measure adequacy of benefits for injured workers and their dependents and provides statistical data for research. The revised implementation guide contains updates and corrections to the first reports of injury and subsequent reports of injury (FROI/SROI) reporting rules of the current version that took effect in March 2018. The proposed changes address the manner of transmitting data to WCIS, the filing of SROI, requirements for specific data elements and data edits.  Written comments can be emailed to DWCRules@dir.ca.gov or mailed to: Division of Workers’ Compensation P.O. Box 420603 San Francisco, CA 94142 Attn: WCIS Rulemaking Forum The forum can be found on the DWC forums web page under “current forums.”
  • The Division of Workers’ Compensation (DWC) has posted an adjustment to the inpatient hospital section of the Official Medical Fee Schedule (OMFS) to conform to changes in the 2019 Medicare payment system as required by Labor Code section 5307.1. The effective date of the changes is December 1, 2018.   Further information and adjustments to the inpatient hospital section of the Official Medical Fee Schedule can be found at https://www.dir.ca.gov/dwc/OMFS9904.htm#4.

Colorado VIEW STATE →

REGULATORY ACTIVITY:

  • Posted a notice of rule hearing regarding Rule 2:  Workers' Compensation Insurance Premium and Payroll Surcharges. Notice is given of a public hearing to afford all interested persons an opportunity to be heard prior to the adoption of proposed amendments to the Workers’ Compensation Rules of Procedure, 7 C.C.R. 1101-3 as described below.  The Director of the Division of Workers’ Compensation has the authority to promulgate rules pursuant to the Workers’ Compensation Act as set forth in section §8-47-107. Date and Time of Hearing: November 9, 2018 10:00 a.m.; Place of Hearing:   633 17th Street, Denver, CO. The public hearing will be held in accordance with the provisions of the Colorado Administrative Procedures Act, section 24-4-103, CRS.  Any interested party is invited to appear at the hearing and testify or to submit written data, arguments or position papers to Paul Tauriello, Director, Division of Workers’ Compensation, 633 17th Street, Suite 400, Denver, CO 80202.  Any written submissions should be submitted to the Director prior to the hearing. The topics to be considered are: Rule 2: Workers’ Compensation Insurance Premium and Payroll Surcharges.  The proposed rule changes will be available at the Department’s website on or before October 1, 2018.  Copies of the proposed rules will also be available by request at the Division’s Customer Service Office, 633 17th Street, 4th Floor, Denver, Colorado.  To view the notice and proposed rule, go to https://www.colorado.gov/pacific/cdle/workers-compensation-proposed-and-adopted-rules.
  • Published notice in the October 10, 2018 edition of the state register notice of adoption of Rule 16 Workers' Compensation Rules of Procedure with Treatment Guidelines. Rules become effective on January 1, 2019. To view the notice of adoption, go to https://www.sos.state.co.us/CCR/RegisterContents.do?publicationDay=10/10/2018&Volume=41&yearPublishNumber=19&Month=10&Year=2018.
  • Posted the 2019 Medical fee schedule.  To view the fee schedule, go to https://www.colorado.gov/pacific/cdle/directors-interpretive-bulletins-regarding-medical-fee-schedule.

Colorado Auto VIEW STATE →

REGULATORY ACTIVITY:

Connecticut VIEW STATE →

REGULATORY ACTIVITY:

  • Average Weekly Wage, Maximum Compensation Rate and Cost of Living Adjustments: Section 31-309 of the Connecticut General Statutes as amended by Public Act 93-228 sets the maximum weekly compensation rate to be the same as the average weekly earnings of all employees in Connecticut. This maximum rate applies to total disability benefits provided in § 31-307 and decedents’ dependents benefits provided in § 31-306.The State Labor Commissioner has determined that the estimated average weekly earnings of all employees in Connecticut effective October 1, 2018 will be $1,298.00. Therefore, the maximum compensation rate for total disability and decedents’ dependents will also be $1,298.00 for injuries occurring on or after October 1, 2018.The maximum compensation rate for partial disability (incapacity), i.e., benefits pursuant to § 31-308, is equivalent to the average weekly earnings of production and related workers in manufacturing in Connecticut. The State Labor Commissioner has determined that the average weekly earnings of production and related workers in manufacturing in Connecticut effective October 1, 2018 will be $1,046. To view this notice, go to https://wcc.state.ct.us/.
  • Calculating Weekly Benefit Amounts without FICA and/or Medicare Deductions: In the event that a Commissioner decides that an employee is not subject to FICA and/or Medicare taxes, he or she may exclude the equivalent amount of deduction from gross pay to determine the compensation rate. Currently, such rates are not calculated by the system, nor are the formulae for determining them manually written anywhere - on the VA or elsewhere. One method for calculating these amounts is by manually following the steps from the exhibits in the front of the rate table book but omitting the FICA and/or Medicare deductions. Since this is rather involved, the Commission has come up with some "short cut" equations.  To view this notice, go to https://wcc.state.ct.us/.
  • Workers' Compensation Benefit Rate Tables October 1, 2018-September 30, 2019:  Tables for determining the workers' compensation benefits for Connecticut workers injured between October 1, 2018 through September 30, 2019 are now available.  To view this notice, go to https://wcc.state.ct.us/.

Delaware Auto VIEW STATE →

REGULATORY ACTIVITY:

Georgia VIEW STATE →

REGULATORY ACTIVITY:

  • Effective January 1, 2019, the filing of a Form WC-1 will be required in all claims, including all “medical only” claims.  Penalties will be assessed if parties fail to timely file a WC-1 after January 1, 2019, pursuant to the provisions of O.C.G.A. §§ 34-9-12(a), 34-9-18 and Board Rules. We are pleased to report that effective August 1, 2018, ICMS is available for the filing of the WC-1 in all claims. We expect EDI to be available for the filing of the WC-1 in medical only claims on December 1, 2018. To view this notice, go to https://sbwc.georgia.gov/notice-change-wc-1-filing-requirement-“medical-only”-claims.
  • Effective December 1, 2018 the SSN/BTN numbers will be removed from our Board forms, ICMS II and our database. You will no longer have to request a BTN to file a WC-1 or WC-14. You can file them via ICMS II or EDI. The new revision of the Board forms reflecting the removal of the SSN/BTN and any other changes will be available on our website on December 1, 2018.

Idaho VIEW STATE →

REGULATORY ACTIVITY:

  • Posted notice of rulemaking regarding Rule 17.02.06 Employers Reports and Rule 17.02.07 Procedures to Obtain Compensation.   Rule 17.02.06 is being proposed to clarify the requirements for submission of Summaries of Payment and filing of closing documents to reflect Electronic Data Interchange (EDI) filing. Rule 17.02.07 is being proposed to clarify that the IAIABC EDI Claims 3.0 Implementation Guide and Trading Partner Tables referenced In the rule are the roadmaps on how to properly report claims electronically and are not part of the rule. This is being done by moving the references to these guides from the Incorporation by Reference section to the Written Interpretations section of the rule. The changes also clarify the requirements for Trading Partner Agreements and eliminate obsolete procedures for submission of paper claims.  To view the proposed rules, go to https://iic.idaho.gov/.
  • Posted notice of rulemaking regarding 17.02.10 - administrative rules of the industrial commission under the workers' compensation law " security for compensation - insurance carriers and Rule 17.02.11 - administrative rules of the industrial commission under the workers' compensation law - security for compensation ~ self-insured employers. Rule 17.02.10 is being proposed to clarify the new electronic requirements for insurance carriers on the submission of First Reports of Injury and Claims for Benefits, notices of occupational illness, and fatalities. The changes also eliminate the need to submit paper documentation in support of electronically filed initial payments.  Rule 17.02.11 is being proposed to clarify the new electronic requirements for self-insured employers on the submission of First Reports of Injury and Claims for Benefits, notices of occupational illness, and fatalities. The changes also eliminate the need to submit paper documentation in support of electronically-filed initial payments.  To view the proposed rules, go to https://iic.idaho.gov/.

Illinois VIEW STATE →

REGULATORY ACTIVITY:

  • As you may know, the Urbana Civic Center is closing at the end of 2018.  We thought we secured a seamless transition to another location in Urbana, but that location fell through.  As a result, while we continue our search for another Urbana location, as of January 1, 2019 all matters scheduled to be heard at the Urbana Civic Center will be heard at our Springfield location at the IWCC, 4500 S. Sixth St., Springfield, IL 62703. Dates and times will be posted shortly.  We will continue to update you as to our facility search when updates become available.

Kentucky VIEW STATE →

REGULATORY ACTIVITY:

  • The Department of Workers’ Claims (DWC) announced the adoption of ODG by MCG as its treatment guidelines and pharmaceutical formulary provider.  Pursuant to KRS 342.035, as amended in 2018 by House Bill 2, the commissioner of the Department of Workers’ Claims is directed to develop or adopt a pharmaceutical formulary and medical treatment guidelines for use in the treatment of work injuries and occupational diseases. In compliance with that statutory mandate, Commissioner Robert L. Swisher announces the adoption of ODG by MCG.  “We are honored to add Kentucky to the roster of ODG-mandated states, joining the neighboring states of Ohio, Tennessee, and Indiana. The Department of Workers’ Claims and the Medical Advisory Committee should be commended on a thorough, transparent evaluation of evidence-based guidelines and formulary options, placing confidence in a proven solution,” commented Phil LeFevre, Managing Director, ODG by MCG. “The ODG by MCG team is prepared and excited to work with DWC and stakeholders on a successful implementation to deliver improved outcomes for injured workers and the system. Complementary training and support will be offered including Webinars and onsite visits.” The Department of Workers’ Claims is in the process of drafting administrative regulations implementing the ODG formulary and medical treatment guidelines and establishing their effective dates.

Maine VIEW STATE →

REGULATORY ACTIVITY:

Maryland-Auto VIEW STATE →

REGULATORY ACTIVITY:

Massachusetts VIEW STATE →

REGULATORY ACTIVITY:

  • The Executive Office of Health and Human Services, pursuant to 114.1 CMR 41.05(4), issued a bulletin to publish the updated Health Safety Net Uniform Assessment for hospital outpatient workers’ compensation charges.  The revised percentage change from 0.73% to 0.69% will be effective for services rendered on or after October 1, 2018 and may be added to acute hospital charges in accordance with 114.1 CMR 41.04(1)(d). This percentage is applied to acute care hospital charges when the payment for the industrial accident patient is based on the ambulatory fees set forth in 114.3 CMR 40.00:  Rates for Services Under M.G.L. c. 152, Worker’s Compensation Act. This percentage includes hospital rates for restorative services and ambulatory surgical facility group fees.  To view the bulletin, go to   https://www.mass.gov/lists/2018-eohhs-administrative-bulletins.
  • Issued Circular Letter No. 353 regarding cost of living adjustments (COLA) Payment and Reimbursement Schedules and Requests; Maximum and Minimum Weekly Compensation Rates and Attorneys' Fee Schedule.  The circular was issued October 9, 2018 but became effective October 1, 2018.  To view the circular letter, go to https://www.mass.gov/news/circular-letter-number-353.
  • The Worcester Massachusetts Department of Industrial Accidents (DIA) is seeking applications from qualified candidates for the position of Administrative Judge (AJ). Application & instructions can be found on the DIA's website at mass.gov/dia, or by emailing: Melissa.Crosby@massmail.state.ma.us NO phone calls please.

Medicare VIEW STATE →

FEE SCHEDULE NEWS:

  • Medicare has updated the Provider Specific Files with an effective date of October 1, 2018 for all inpatient and outpatient modules. The next scheduled update is January 1, 2019.

Michigan Auto VIEW STATE →

REGULATORY ACTIVITY:

Minnesota VIEW STATE →

REGULATORY ACTIVITY:

  • Notice of availability of PC-Pricer program under Minnesota Statutes, section 176.1362, subdivision 1:  Notice is hereby given that on October 1, 2018, the applicable PC-Pricer program to be used to calculate payment for workers’ compensation inpatient hospital services, articles, and supplies based on the Medicare MS-DRG system under Minnesota Statutes, section 176.1362, subdivision 1, is the 2018 Fiscal Year PC-Pricer, version 2018.0, available on the Department of Labor and Industry’s Web site at:  dli.mn.gov/business/workers-compensation/work-comp-pc-pricer-tool-inpatient-hospital-bills.  This PC-Pricer program is the most recent version of the PC-Pricer available on Medicare’s Web site as of July 1, 2018. It is effective for patients discharged on or after October 1, 2018. Date: September 17, 2018     Ken B. Peterson, Commissioner.

Mississippi VIEW STATE →

REGULATORY ACTIVITY:

  • November - December 2018 settlement schedule changes: Please be advised that the Mississippi Workers’ Compensation Commission will NOT be processing walk-in settlement approvals on the following days:
    • November: 13 (Tues); 14 (Wed) 21 (Wed)*
    • December**: 18 (Tues); 19 (Wed); 25 (Tues); 26 (Wed)
    • JANUARY: 1 (Tues); 2 (Wed)
  • *For the week of Thanksgiving: Walk-In settlements WILL be conducted: Monday, November 19 and Tuesday, November 20.
  • Walk-In settlements will NOT be conducted: WEDNESDAY, November 21.

Montana VIEW STATE →

REGULATORY ACTIVITY:

  • Notice of Public Hearing Related to the Workers’ Compensation Drug Formulary: On November 9, 2018, at 10:00 a.m., the Department of Labor and Industry will hold a public hearing in the basement auditorium at the DPHHS building, 111 North Sanders Street, Helena, Montana, to consider the proposed adoption, amendment, amendment and transfer, and transfer of the rules relating to the Montana workers’ compensation medical utilization and treatment guidelines, including a drug formulary which was adopted through Senate Bill 312.  If you have questions please contact Cindy Zimmerman at zimmerman@mt.gov or Adrianne McLean at amclean@mt.gov.

Nebraska VIEW STATE →

REGULATORY ACTIVITY:

  • The Vocational Rehabilitation meeting announcement and results of the 4/20/2018 meeting are now available.  To view the announcements and results of the 4/20/2018 meeting, go to https://www.wcc.ne.gov/home/vr-meetings
  • In advance of its transition to a new electronic reporting release standard, the Nebraska Workers' Compensation Court has launched a new website for its Electronic Data Interchange (EDI) trading partners.  The website will provide information needed by trading partners to prepare and test their claims processing systems to ensure that they will be in compliance with the new release standard when it is launched in May of 2019.   The website can be viewed at https://nwccedi.info/ .
  • The Vocational Rehabilitation quarterly meeting scheduled for 11/02/2018 has been cancelled. The schedule of quarterly meetings for 2019 is now available.  To view this notice, go to https://www.wcc.ne.gov/home/court-news.  To view the 2019 schedule, go to https://www.wcc.ne.gov/home/vr-meetings.  The next informal meeting between court staff and certified vocational rehabilitation service providers is tentatively scheduled for Friday, January 25, 2019, 10:00 AM, at the Nebraska Workers’ Compensation Court’s Administrative Offices, 1221 ‘N’ Street, Suite 402, in Lincoln.

Nevada VIEW STATE →

REGULATORY ACTIVITY:

These forms “must be used by an insurer, employer, injured employee, provider of health care, organization for managed care or third-party administrator in the administration of claims for workers’ compensation” pursuant to NAC 616A.480.  To view the revised forms, go to http://dir.nv.gov/WCS/Workers__Compensation_Forms_and_Worksheets/.

New-Hampshire-Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Posted notice of amendment to existing rating practices for auto insurance.  This proceeding amends section Ins 1403.02, entitled “Rating Practices", by inserting new paragraph (e).  Chapter Ins 1400 pertains to automobile insurance, and Part Ins 1403 regulates the voluntary market pertaining to rates, rating plans, and practices for such insurance.  New paragraph (e) allows a named insured to attest that an alleged operator is not, in fact, a resident of the named insured 's household by signing an affidavit to that effect.  This proposal also corrects an error in the sample form INS 1 “Statement of Residency Including Applicable Exemptions" in Appendix I to conform with Ins 1406.0l (b)(4) and make clear that it is false claims on the Statement of Residency form which are subject to prosecution.

New Jersey WC VIEW STATE →

REGULATORY ACTIVITY:

  • With the approval and consent of Robert Asaro-Angelo, Commissioner of Labor & Workforce Development, effective October 15, 2018, the Hon. Arthur J. Marchand has been appointed the Administrative Supervisory Judge (ASJ) for the vicinages of Bridgeton, Toms River, and Atlantic City.  ASJ Ingrid French will now supervise the Camden, Mt. Holly, and Trenton vicinages, ASJ Philip Tornetta will supervise the Newark, Hackensack, and Paterson vicinages, and ASJ Ashley Hutchinson will supervise the New Brunswick, Lebanon, and Mt. Arlington vicinages.  ASJ Lionel Simon, III, will continue to supervise the Freehold, Plainfield, and Jersey City vicinages.

New Mexico VIEW STATE →

REGULATORY ACTIVITY:

  • Insurers are required to file an annual expenditure report with the WCA's Economic Research & Policy Bureau no later than February 15 of the year following the reporting period. The report must be submitted through the AER link and must identify the carrier(s), groups, pools or self-insured employer(s) by the name and the federal employers identification number (FEIN). All expenditures reported are for the calendar year (January 1 - December 31). Failure to timely file may be penalized (Rule 11.4.2.8 D).
  • Posted the draft of the 2019 Medical Fee Schedule.  Written comments on the draft fee schedule may be submitted until the close of business on November 16, 2018, by email to Jeppson@state.nm.us; by fax to 505-841-6813; or by U.S. mail to Jared Jeppson, WCA General Counsel, PO Box 27198, Albuquerque, NM 87125-7198. The Director will take all comments into consideration. To view the notice, go to https://workerscomp.nm.gov/index.php/Communications.

New York VIEW STATE →

REGULATORY ACTIVITY:

  • Issued bulletin 046-1108 as a reminder for clarification regarding form submission guidelines.  To improve customer service for all stakeholders and to reduce system costs, the Workers’ Compensation Board issued guidelines on submitting forms and other documents on Subject No. 046-909 dated January 4, 2017. The following are an addition to, or a re-emphasis of, those guidelines.
    • Avoid Duplicate Filing of Forms

The Board asks that you refrain from submitting forms more than once or in multiple formats. The quality of customer service diminishes when resources must be dedicated to sorting through duplicate forms to resolve an issue. Duplicate filings increase the amount of time required to respond to a customer request for further action or a status update on a pending request.

Duplicate submissions may be deemed to be raising or continuing an issue without reasonable grounds, will never result in higher fees being granted, and may subject the sender to penalties under Workers’ Compensation law § 114-a (3).

  • Forms Applicable to Multiple Claims for the Same Claimant

Forms may reference more than one WCB Claim Number for the same claimant, but the submitter is required to submit a separate copy of the form for each claim (with the relevant WCB Claim Number listed first and/or underlined/circled) to ensure that a copy is placed in each case folder. Failure to submit a copy for each claim and properly identify the WCB Claim Number may result in duplicate filings to the same claim and therefore a penalty.

  • If you experience technical difficulty with the electronic submission of forms, please contact the WCB Customer Support Unit by email at WCBCustomerSupport@wcb.ny.gov or by phone at (844) 337-6305. For assistance with forms submitted through the Web Upload Link, please email nywcb.helpdesk@conduent.com.  To view the bulletin, go to http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1106.jsp.
  • Published bulletin subject number 046-1108 regarding public comment period for revised medical fee schedule.  The New York State Workers’ Compensation Board has prepared a revision to the proposed Medical Fee Schedule announced in Subject Number 046-1071, Board Announces Public Comment Period for Proposed Medical Fee Schedule on June 6, 2018. The changes have been made in response to comments and feedback from our stakeholders. The proposed revision was published in the State Register on October 3, 2018, and the Board will accept comments from the public for 30 days. Please note, these are proposed changes and have not yet been formally adopted. Therefore, the current fee schedule, adopted on June 1, 2012, continues to remain in effect. The Board encourages the public, injured workers, employers, self-insured employers, insurance carriers, third-party administrators, attorneys, medical providers, and labor and business organizations to provide comment. Please submit your comments on or before November 1, 2018, to regulations@wcb.ny.gov. Following the public comment period, the Board will evaluate all comments received, and consider any necessary revisions. When final regulations are adopted, the Board will announce an effective date for the new schedule.  To view this bulletin, go to http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1108.jsp.
  • Pursuant to WCL §151, the Chair of the Workers' Compensation Board shall annually establish an assessment rate for all employers by November 1 of each year, to be effective January 1 of the subsequent calendar year. For calendar year 2019, the rate shall be 12.6% of the standard premium or premium equivalent. Please contact the Workers’ Compensation Board by email at: WCBFinanceOffice@wcb.ny.gov with any questions on the assessment rate.  To view the announcement, go to http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1111.jsp.
  • The Division of Workers’ Compensation (DWC) has posted the 2017 DWC Audit Unit annual report on its website. The Audit Unit annual report provides information on how claims administrators audited by the DWC performed and includes the Administrative Director’s ranking report for audits conducted in calendar year 2016.   The 2017 Audit Unit annual report details the results of audits conducted in 2016 and provides the name and location of each insurer, self-insured employer, and third-party administrator audited during that time. This report to the Legislature summarizes audits conducted in accordance with Labor Code sections 129 and 129.5 to assure that injured workers, and their dependents in the event of their death, are provided with all benefits due them in an expeditious manner. The audit findings, by law, must detail the number of files audited, the number and type of violations cited, and the amount of an undisputed compensation found due and unpaid to the injured worker. The audit findings presented in this report are statistical and do not identify any individual injured worker. The Labor Code provides that contents of the claim files and the Audit Unit working papers are confidential.  Performance of insurers, self-insured employers, and third-party administrators subject to profile audit review and full compliance audit is rated in accordance with the performance standards set annually by the Administrative Director. The DWC Administrative Director’s 2017 Audit Ranking Report lists, in ascending order by performance rating, the administrators audited in calendar year 2016.   The Audit Unit report can be found at https://www.dir.ca.gov/dwc/audit.html.
  • Published Bulletin subject number 046-1112 regarding revised New York State Workers' Compensation Drug Formulary Regulations.  The New York State Workers' Compensation Board (Board) has prepared a revision to the proposed NYS Workers' Compensation Drug Formulary (Formulary) announced in Subject Number 046-1012, Board Announces Draft Regulations for New York State Pharmacy Formulary on December 28, 2017. The proposed revision is in the October 17, 2018 State Register, and the Board will accept comments for 30 days. The revised proposed regulations are also available on the Board's website. The Board substantially expanded the list of drugs on the Formulary, clarified the criteria for when certain drugs are on the Formulary and more fully defined the prior authorization process for drugs that are not listed on the Formulary. The Board encourages the public, injured workers, employers, self-insured employers, insurance carriers, third-party administrators, attorneys, medical providers, and labor and business organizations to provide comment. Please submit your comments on or before November 16, 2018, to regulations@wcb.ny.gov. The Board will evaluate all comments received and will consider necessary revisions as the process advances.  To view the bulletin, go to http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1112.jsp.  To view the associated documents, go to http://www.wcb.ny.gov/drug-formulary-regulation/.

North Carolina VIEW STATE →

REGULATORY ACTIVITY:

  • Beginning on November 1, 2018, health care providers will be required to review the Controlled Substances Reporting System ("CSRS") when prescribing a targeted controlled substance to an injured worker with a workers’ compensation claim. Health care providers must document in the injured worker’s medical record the review and any potential contraindications to prescribing a targeted controlled substance found in the CSRS. The relevant North Carolina Industrial Commission Rules are 11 NCAC 23M .0201(k), .0202(k), and .0203(k). For more information on the North Carolina Industrial Commission Rules for the Utilization of Opioids, Related Prescriptions, and Pain Management in Workers’ Compensation Claims and the Companion Guide, go to http://www.ic.nc.gov/OpioidRulesResourcePage.html.
  • On August 29, 2018, the North Carolina Rate Bureau filed a proposed average 17.2 percent decrease in its residual market rate filing. As part of the proposed decrease, the Rate Bureau proposed a 15.9 percent decrease in loss costs, one of the key variables used to calculate insurance rates.
  • In Fiscal Year 2017-18, the Employee Classification Section’s work with the Compliance and Fraud Investigation Section of the North Carolina Industrial Commission to identify businesses engaged in employee misclassification resulted in the assessment of over $4.5 million in penalties. There were $576,501 in adjustments, and the Commission collected $611,742 of the penalties assessed. The remaining $3.3 million in assessments are pending and/or in litigation within the Industrial Commission. The Employee Classification Section also continues to work with the United States Department of Labor, the NC Division of Employment Security, the N.C. Department of Labor, and the N.C. Department of Revenue to identify non-compliant businesses.
  • Notice is hereby given in accordance with G.S. 150B-21.2 that the Industrial Commission intends to adopt the rules cited as 11 NCAC 23B .0105; 23L .0105, amend the rules cited as 11 NCAC 23B .0101-.0104, .0202-.0205, .0208, .0302, .0307, .0308, .0310, .0402, .0501, and repeal the rules cited as 11 NCAC 23B .0303 and .0305. Pursuant to G.S. 150B-21.17, the Codifier has determined it impractical to publish the text of rules proposed for repeal unless the agency requests otherwise.  The text of the rule(s) are available on the OAH website at http://reports.oah.state.nc.us/ncac.asp.  Link to agency website pursuant to G.S. 150B-19.1(c):  http://www.ic.nc.gov/proposedtortrules.html. Proposed Effective Date:  February 1, 2019. Oral comments on the proposed rules may be made at the Public Hearing before the Industrial Commission: Date:  November 29, 2018 Time:  10:00 a.m. Location:  Room 245, 2nd Floor, Department of Insurance, Albemarle Building, 325 North Salisbury Street, Raleigh, NC 27603. Written comments may be submitted to  Ashley B. Snyder, 1233 Mail Service Center, Raleigh, NC 27699-1233; phone (919) 8072524; email snyder@ic.nc.gov. Comment period ends:  December 14, 2018. Reason for Proposed Action:  On its own initiative, the Industrial Commission conducted an internal review of its rules governing State tort claims.  The proposed adoptions, amendments, and repeals represent changes necessary to improve and clarify the rules, provide for increased efficiency, or to update the rules to reflect current processes. The Commission also proposes to adopt Rule 11 NCAC 23L .0105 which codifies a new form, the T-42, required in the proposed amendments to Rule 11 NCAC 23B .0203.  To view the notice, go to http://www.ic.nc.gov/proposedtortrules.html.

Ohio VIEW STATE →

REGULATORY ACTIVITY:

Oregon VIEW STATE →

REGULATORY ACTIVITY:

  • After considering public testimony, the Workers’ Compensation Division has published a final rule, OAR 436-070-0010. Rule 0010 lowers the Workers’ Benefit Fund assessment rate from 2.8 cents per hour worked to 2.4 cents per hour worked, effective Jan. 1, 2019. Link to rule: https://wcd.oregon.gov/laws/Documents/New_rules/70-18060-final.pdf. A summary of public testimony and the agency’s responses is posted here: https://wcd.oregon.gov/laws/Documents/Proposed_rules_and_testimony/Div-070-2018-09-20/70-18060-TNR.pdf.   To view the rule, go to https://wcd.oregon.gov/laws/Pages/new-rules.aspx.
  • The Workers’ Compensation Division is considering making changes to the process described in OAR 436-001, for preparing and providing exhibits for hearing in cases within the director’s jurisdiction under ORS 656.704(2), to make the process more consistent with the Workers’ Compensation Board’s process under OAR 438-007-0018. We would appreciate feedback from parties and attorneys who have previously participated in hearings within the director’s jurisdiction. We will be scheduling a one-hour meeting that can be attended in person or by phone in early November. More details to come. Your response will ensure you are contacted when we schedule the meeting and otherwise ask for your advice. Please contact me directly: fred.h.bruyns@oregon.gov or 503-947-7717.
  • Posted a notice in the state register regarding a missing paragraph in rule 436-060-0025 Worker's Weekly Wage Calculation and Rate of Temporary Disability Compensation.  The missing paragraph return preceding OAR 46-060-0025(40(c) has been restored.  To view the notice, go to https://secure.sos.state.or.us/oard/displayBulletin.action?bulltnRsn=242
  • Issued Bulletin 367 regarding 2019 premium assessment rates.  This bulletin provides the workers’ compensation premium assessment rate to be applied against premium earned during the calendar year 2019. This bulletin replaces Bulletin 367 issued Oct. 20, 2017.  To view the bulletin, go to  https://wcd.oregon.gov/forms/Pages/bulletins.aspx.

Rhode Island Auto VIEW STATE →

REGULATORY ACTIVITY:

South Carolina VIEW STATE →

REGULATORY ACTIVITY:

Tennessee VIEW STATE →

REGULATORY ACTIVITY:

  • The Tennessee Workers' Compensation Bureau conducted a Public Rule-making Hearing for the Uninsured Employer Fund Benefits on October 16, 2018.
  • The Tennessee Workers' Compensation Bureau conducted a Public Rule-making Hearing for Court of Workers' Compensation Claims and Alternative Dispute Resolution Rules on October 20th.  To view the Bureau Annoucements, go to https://www.tn.gov/workforce/injuries-at-work/bureau-announcements.html. 

Texas VIEW STATE →

REGULATORY ACTIVITY:

  • The Texas Department of Insurance, Division of Workers’ Compensation (DWC) is accepting comment on the proposed Fiscal Year 2019 Research Agenda of the Workers’ Compensation Research and Evaluation Group (REG).  Texas Labor Code §405.0026 requires the REG to publish a proposed research agenda annually in the Texas Register for commissioner review and approval.  Under Texas Labor Code §405.0026, the commissioner must accept public comments on the proposed research agenda and hold a public hearing on the research agenda if a hearing is requested. Under Texas Labor Code §405.0025, the REG is charged with conducting professional studies and research related to:  1) the delivery of benefits; 2) litigation and controversy related to workers’ compensation; 3) insurance rates and ratemaking procedures; 4) rehabilitation and reemployment of injured employees; 5) the quality and cost of medical benefits; 6) employer participation in the workers’ compensation system; 7) employment health and safety issues; and 8) other matters relevant to the cost, quality, and operational effectiveness of the workers’ compensation system.  To view the notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.
  • Commissioner of Workers’ Compensation Cassie Brown announced Debra Knight as the new Deputy Commissioner of Compliance and Investigations.  This program area at the Division of Workers’ Compensation (DWC) monitors compliance and investigates fraud and administrative violations. It is also responsible for enforcement efforts, and criminal prosecutions through DWC’s embedded prosecutor unit in the Travis County District Attorney’s office. Knight is an accomplished attorney with 22 years of experience.  She has been with the Texas Department of Insurance since 2013 where she was director for the Policy Development Counsel, and most recently Associate Commissioner for Legal.  Knight has a Bachelor of Science degree from the University of Houston and a juris doctorate from the South Texas College of Law. During her career, Knight served in the United States Army Reserve, doing tours in Iraq and Ethiopia and retiring with the rank of Lieutenant Colonel. Knight’s new role with DWC begins November 1.
  • The Texas Department of Insurance, Division of Workers' Compensation (DWC) is accepting public comments on a proposed amendment to 28 TAC §132.7, relating to duration of death benefits for eligible spouse. The proposed amendment implements House Bill (HB) 2119 of the 85th Legislature. HB 2119 amended Texas Labor Code §408.183 to allow eligible spouses of first responders to remain eligible for death benefits for life after remarrying, if the first responder died as a result of an injury in the course and scope of employment or while providing services as a volunteer, regardless of the date on which the death of the first responder occurred.  Amended 28 TAC §132.7(f) deletes the words, “This subsection only applies to claims based on a compensable injury that occurs on or after September 1, 2015,” and adds the following words and new language, “This subsection applies to: (1) eligible spouses who remarry on or after September 1, 2017; and (2) eligible spouses who remarried between September 1, 2015, and August 31, 2017, if the claim is based on a compensable injury that occurred on or after September 1, 2015.”  The amendments do not alter the distribution of death benefits under 28 TAC §132.11 or the redistribution of death benefits under 28 TAC §132.12. If there is an eligible child or grandchild and an eligible spouse, death benefits continue to be divided between the beneficiaries, with half paid to the eligible spouse and half paid in equal shares to the eligible children. The proposal was to be published in the October 12, 2018, issue of the Texas Register and will be available at sos.state.tx.us/texreg/index.shtml once published. A courtesy copy will also be available on the TDI website at www.tdi.texas.gov/wc/rules/2018rules.html. If you want to comment on the proposal or request a public hearing, submit your written comments and or request by 5 p.m. Central time on November 12, 2018. 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 Ashley Hyten Workers' Compensation Counsel MS – 4D 7551 Metro Center Drive, Suite 100 Austin, Texas 78744-1645.  If a hearing is held, DWC will consider written comments and public testimony presented at the hearing. To view the notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.  To view the proposed rule, go to https://www.tdi.texas.gov/wc/rules/2018rules.html.
  • On July 30, 2018, the Texas Department of Insurance, Division of Workers’ Compensation (DWC) solicited and received constructive input from workers’ compensation system participants on the proposed Neuromuscular Testing Plan-Based Audit (Plan-Based Audit). DWC appreciates the input provided by system participants. All comments were carefully considered and discussed. The Commissioner of Workers’ Compensation Cassie Brown approved the Plan-Based Audit on October 11, 2018.  All medical quality reviews initiated on or after January 1, 2018, will follow the approved Medical Quality Review Process (Process) in effect. The Process and Plan-Based Audit are posted on the TDI website at:  tdi.texas.gov/wc/hcprovider/medadvisor.html.  If you have any questions regarding this memo, contact Mary Landrum at 512-804-4814 or Mary.Landrum@tdi.texas.gov.
  • Posted notice in the state register regarding proposed amendments to Chapter 132 Death Benefits-Death and Burial Benefits. To view the proposed rule, go to https://www.sos.state.tx.us/texreg/sos/index.html.
  • On October 11, 2018, Commissioner of Workers' Compensation Cassie Brown adopted amendments to 28 Texas Administrative Code (TAC) §134.600, Preauthorization, Concurrent Utilization Review, and Voluntary Certification of Health Care. The adopted amendments were filed with the Office of the Secretary of State on October 12, 2018, and will be published in the October 26, 2018, issue of the Texas Register. When published, the adopted amendments may be viewed on the Secretary of State’s website at sos.state.tx.us/texreg/index.shtml. A courtesy copy of the adoption is available on the Texas Department of Insurance website at www.tdi.texas.gov/wc/rules/2018rules.html. The amendments to 28 TAC §134.600 remove references to the preauthorization exemption for Commission on Accreditation of Rehabilitation Facilities (CARF) accredited programs related to work conditioning (WC) and work hardening (WH) services. These amendments are in response to the amendment of Texas Labor Code §413.014, Preauthorization Requirements; Concurrent Review and Certification of Health Care, by Senate Bill 1494, 85th Legislature, Regular Session.  As amended, Labor Code §413.014(c)(2) now requires preauthorization and concurrent review of all WC and WH services and grants the commissioner discretion to exempt from preauthorization and concurrent review WC and WH services “provided by a health care facility credentialed by an organization designated by commissioner rule.” These amendments exercise that discretion by not designating a credentialing organization for preauthorization exemption.  As part of this rulemaking, DWC had also proposed amendments to 28 TAC §134.230, Return to Work Rehabilitation Program, relating to fees for WC and WH services. In response to comments, DWC is formally withdrawing those proposed amendments at this time. DWC will evaluate the fee schedule for WC and WH services in the future to ensure that the fees are fair, reasonable, and designed to not only ensure quality medical care but to also achieve medical cost control.  

Vermont VIEW STATE →

REGULATORY ACTIVITY:

  • Effective 10/22/18, Workers’ Compensation (WC) Specialist II Sue Courchaine and WC Specialist I Shirley Houghton will be assigned all claims with State File Numbers ending in -9 (e.g.: LL-00729). Other WC Specialists will finish up certain older claims ending in -9 for which they have had substantial responsibility to date, however, Sue should receive all correspondence related to claims ending in -9 and we will decide whether Sue will be assigned these or whether your filings will be redistributed to another Specialist.  WC Specialist I Shirley Houghton will continue to provide support for -1 and -2 claims in addition to -9 claims.

For the sake of simplicity, please direct all correspondence and phone calls to the WC Specialists assigned to the State File Numbers ending in the digits listed below unless otherwise instructed:

Assigned Specialist II                                          Assigned Specialist I                    

-1        Anne Coutermarsh                                                Shirley Houghton

-2        Anne Coutermarsh                                                Shirley Houghton

-3        Mary Sarazin                                                          Muriel Landis

-4        Mary Sarazin                                                          Muriel Landis

-5        Julie Mercier                                                          Muriel Landis

-6        Julie Mercier                                                          Wendell Sargent

-7        Paula Liberty                                                          Wendell Sargent

-8        Paula Liberty                                                          Wendell Sargent

-9        Sue Courchaine                                                     Shirley Houghton

 

Please note: For the time being, this reassignment plan contemplates the continued abandonment of State File Numbers ending in –0.  Therefore, any State File Numbers ending in -0 (e.g.: HH-67250) will be assigned to staff member based on the next number immediately preceding the -0 (e.g.:  HH-67250 would go to Julie Mercier as a -5 claim).  We will let you know by future notification if there are further re-assignments.

Virginia VIEW STATE →

REGULATORY ACTIVITY:

  • On September 18, 2018, the Commission adopted a proposed final E-billing regulation and Companion Guide. After consideration of comments received during the public comment period, the initial proposed regulation has been revised to: (a) change the mandatory effective date from December 31, 2018 to July 1, 2019; (b) clarify and broaden the small provider exemption; (c) add an exemption for small payers; (d) clarify the requirements for electronic payment; and (e) make the regulation consistent with the provisions of the prompt-pay statute (Va. Code. 65.2-605.1). The Companion Guide has been revised to update the Commission’s address and contact numbers and to clarify the requirements for electronic payment.

Virginia Auto VIEW STATE →

REGULATORY ACTIVITY:

Wyoming VIEW STATE →

REGULATORY ACTIVITY:



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