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California VIEW STATE →

FEE SCHEDULE NEWS:

  • The DWC has adopted the following modules with an effective date of April 1, 2019: Official Medical Fee Schedule, National Correct Coding Edits, DMEPOS and Outpatient and ASC Hospital Fee Schedules.
  • The DWC has also published a new file for Medi-Cal rates effective March 15, 2019. The next update is expected April 15, 2019.

REGULATORY ACTIVITY:

  • The Division of Workers’ Compensation (DWC) has posted an order adopting regulations to update the evidence-based treatment guidelines of the Medical Treatment Utilization Schedule (MTUS). The updates, effective for medical treatment services rendered on or after April 18, 2019, incorporate by reference the American College of Occupational and Environmental Medicine’s (ACOEM’s) most recent treatment guidelines to the Clinical Topics section of the MTUS. The division has published the Administrative Order one month before its effective date to give the public, especially treating physicians and utilization review physicians, 30 days to prepare before these evidence-based updates become effective. To view the order and text of the regulations, go to https://www.dir.ca.gov/dwc/DWCPropRegs/MTUS-Evidence-Based-Update/MTUS-Evidence-Based-Update.htm.

California-Auto VIEW STATE →

REGULATORY ACTIVITY:

Colorado Auto VIEW STATE →

REGULATORY ACTIVITY:

Connecticut VIEW STATE →

FEE SCHEDULE NEWS:

  • The Division of Workers’ Compensation has adopted the 2019 Official Connecticut Fee Schedule for Hospitals and Ambulatory Surgical Centers with an effective date of April 1, 2019. The next expected update for this schedule is April 1, 2020.

REGULATORY ACTIVITY:

District of Columbia VIEW STATE →

REGULATORY ACTIVITY:

Florida WC VIEW STATE →

REGULATORY ACTIVITY:

Georgia VIEW STATE →

FEE SCHEDULE NEWS:

  • A new Medical and Hospital fee schedule effective April 1, 2019 has been adopted. The next expected update is in April 2020.

Idaho VIEW STATE →

LEGISLATIVE ACTIONS:

  • Senate Bill 1028

This bill identifies Post Traumatic Stress Disorder (PTSD) otherwise known as Post Traumatic Stress Injury (PTSI) as an occupational injury that affects Idaho's First Responders. Under current law, a mental injury must be accompanied by a physical injury. This changes the current statue that if a First Responder has "clear and convincing" evidence of a physiological injury, the treatment would be handled through workers’ compensation. The provision of this act shall be null, void, and of no force and effect on and after July 1, 2023. Effective Date July 1, 2019.

Illinois VIEW STATE →

REGULATORY ACTIVITY:

Illinois-Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Published bulletin 2019-02 regarding registration with the Illinois Insurance Verification System.  Pursuant to 625 ILCS 5/7-603.5, the Illinois Secretary of State is implementing the ILIVS to assist in reducing the number of uninsured motorists in Illinois.  Paragraph (a)(1) of 625 ILCS 5/7-603.5 places specific requirements on Illinois insurance companies authorized to sell motor vehicle liability insurance.  To view the bulletin, go to http://insurance.illinois.gov. /cb/CompanyBulletins.html.

Indiana VIEW STATE →

REGULATORY ACTIVITY:

  • On March 20, 2019, Indiana transitioned to EDI 3.1 reporting. This necessitated a change in many form processes. SROI reporting has shifted from the Forms Portal to EDI. Errors and bugs are expected but will be corrected as quickly as possible. Please address concerns regarding formsby email to IT@wcb.IN.gov.

Iowa VIEW STATE →

REGULATORY ACTIVITY:

  • The Workers' Compensation Division posted notice of intent to propose rule making related to payroll tax tables and providing an opportunity for public comment.  To view the register in which the notice was posted, go to https://www.legis.iowa.gov/law/administrativeRules.

Kansas VIEW STATE →

FEE SCHEDULE NEWS:

  • The Division of Workers’ Compensation has adopted a new Medical and Hospital Fee Schedule with an effective date of March 29, 2019.

REGULATORY ACTIVITY:

  • Published in the state register a permanent administrative regulation regarding release 3.1 standards for trading partner profiles, submission of data and first reports of injury.  To view the posted notice, go to http://www.kssos.org/pubs/pubs_kansas_register.asp and view the Volume 38 Number 09 of the state register dated February 28, 2019.
  • Future training sessions are planned for those interested in learning more about the Online System for Claims Administration Research/Regulation (OSCAR).  Dates, times and locations will be posted in News and Alerts on the OSCAR Information Web page, announced in the Work Comp Connection newsletter and on the KDOL Facebook. Send newsletter subscription requests to Shirley.Hastings@ks.gov.  To view this notice, go to https://www.dol.ks.gov/WC/home.
  • Workers' Compensation statute requires written notice to implead workers’ compensation fund.  Please note, the Workers’ Compensation statute (44-566a(c)(1)) requires that the commissioner of insurance must receive written notice from a party wishing to implead the workers’ compensation fund, setting forth the nature of the liability asserted.  If you are filing a motion to implead the fund in OSCAR the Fund is not automatically added as a participant on the case and will not receive notice through the system. Once they have been added to the case then OSCAR will notify them through the system. Please send your written notice to the Fund at Kansas Insurance Department, Workers’ Compensation Fund, 420 SW 9th Street, Topeka KS. 66612. For support on other OSCAR issues, contact the support team at kdol.oscar@ks.gov. To view this notice, go to https://www.dol.ks.gov/WC/home.

Kentucky VIEW STATE →

FEE SCHEDULE NEWS:

  • The Division of Workers’ Compensation has adopted new hospital cost-to-charge ratios for in state and out of state hospitals and adjustments for ambulatory surgery centers (ASC) per county with an effective date of April 1, 2019.

REGULATORY ACTIVITY:

  • The Commissioner of the Kentucky Department of Workers’ Claims (DWC) has promulgated an administrative regulation (803 KAR 25:270) adopting the ODG by MCG Health pharmaceutical formulary for use in the treatment of work-related injuries and occupational disease. The adoption and implementation of a formulary was mandated by House Bill 2 of the 2018 session of the General Assembly.  Drugs listed in the formulary are assigned “Y” or “N” status.  Drugs assigned “Y” status may be dispensed without preauthorization and do not require utilization review. Drugs assigned “N” status require preauthorization.  The formulary is available online at odgbymcg.com/state-formulary.  The formulary will take effect as follows:
    • (a) For claims in which the date of injury or last exposure is on or after January 1, 2019, the formulary shall be effective July 1, 2019.
    • (b) For claims in which the date of injury or last exposure is prior to January 1, 2019, the formulary shall be effective: (1) July 1, 2019 for a prescription that is not a refill prescription; (2) January 1, 2020 for a refill prescription of a drug initially prescribed prior to July 1, 2019.

To view this notice, go to https://labor.ky.gov/comp/Pages/default.aspx.

Kentucky Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Kentucky issued bulletin 2019-1 regarding arbitration or other procedures for out of court dispute resolution between insurers and its policy holders. To view the bulletin, go to http://insurance.ky.gov/Bulletin.aspx#Bull. 

Maryland VIEW STATE →

REGULATORY ACTIVITY:

  • The Workers’ Compensation Commission proposes to amend Regulation .01 under COMAR 14.09.11 Judicial Review Procedures. This action was considered at a public meeting held on February 7, 2019, notice of which was given by publication in 46:3 Md. R. 164 (February 1, 2019), pursuant to General Provisions Article, §3-302(c), Annotated Code of Maryland. The purpose of this action is to ensure the Commission receives notice of proceedings in which it has a vested interest.  To view this notice, go to http://www.dsd.state.md.us/MDR/4606/Assembled.htm.
  • New Form – Subpoena Duces Tecum and Request for WCC Transcript.  This form is to be used ONLY by a third party requesting a transcript when there is action pending.  This form of Subpoena is NOT to be used to subpoena any other documents and is NOT to be used for any other transcript requests.  The new form is available in fillable PDF form on our Forms and Instructions page.   The completed subpoena must be stamped by the Commission using the current policies and procedures for requesting a subpoena from the Commission.  A separate subpoena must be used for each claim number when multiple claim transcripts are being requested.  When submitting the subpoena, the original plus one copy must be brought to the Commission for stamping and Commission processing.   As a reminder, the Commission does not accept subpoena or any other form filing via email/attachment or fax.  Please begin using the new form immediately.  To view this notice, go to http://www.wcc.state.md.us/Adjud_Claims/Notices_and_Announcements/March_2019_Notices.html.  To view the form, go to http://www.wcc.state.md.us/Adjud_Claims/Forms.html#subpoena.

Massachusetts VIEW STATE →

REGULATORY ACTIVITY:

  • Notice is hereby given pursuant to M.G.L. c. 30A,  §2, that the Executive  Office of Labor and Workforce Development,  in  conjunction with the  Department  of Labor Standards  (DLS), will hold  a public hearing on the adoption of a new regulation,  454 CMR  30.00.  Recently enacted   legislation  (M.G.L.  c.   149,  sec.s   192-203)  requires  that   businesses  providing professional  employer services for  client companies,  commonly  known  as professional employer organizations or PEOs, to register with the DLS and it requires DLS to promulgate regulations  to establish the process, fee,  and incidentals  of registration.  This regulation will insure that PEOs providing outsourced human resource tasks will be adequately financed, bonded, inspected and in compliance with the new statutory requirements.  The regulation establishes an annual registration fee of $500 for PEOs and requires that they maintain their business records and submit to inspections by DLS.  To view the notice, go to http://www.sec.state.ma.us/spr/sprpub/pubhear.htm.

Medicare VIEW STATE →

FEE SCHEDULE NEWS:

  • Physician – CMS has posted new updates to the National Physician Fee Schedule Relative Value File effective April 1, 2019. The next expected update is July 1, 2019.
  • ASP Drugs – CMS has released new updates to the ASP Drugs file with an effective date of April 1, 2019. The next expected update is July 1, 2019.
  • HCPCS – CMS has posted a new update to the HCPCS module with an effective date of April 1, 2019. The next expected update is July 1, 2019.
  • ASC – CMS has released a new update to the ASC fee schedule with an effective date of April 1, 2019. The next expected update is July 1, 2019.
  • OPPS – CMS has released new updates to the hospital outpatient fee schedule effective April 1, 2019. The next expected update is July 1, 2019.

Michigan VIEW STATE →

REGULATORY ACTIVITY:

Minnesota VIEW STATE →

REGULATORY ACTIVITY:

  • Published in the state register on March 18, 2019 notice of adopted permanent rules governing workers' compensation litigation procedures: resolution of claims with interveners. To view the published notice, go to https://mn.gov/admin/assets/SR43_38%20-%20Accessible_tcm36-376146.pdf.
  • Claim administrators must pay or deny rehabilitation service invoices within 30 days of receipt or the payer is subject to a penalty of up to $2,000 (Minnesota Statutes § 176.102; Minnesota Rules 5220.1900). The employer or insurer is required to pay, request additional information, or deny the charge within 30 calendar days after receiving a rehabilitation provider's bill. Partially denied charges require written notification to the rehabilitation provider stating the specifically denied service and the reason why it is excessive or unreasonable. For more information, contact Mike Hill at 651-284-5253 or mike.hill@state.mn.us.

Mississippi VIEW STATE →

REGULATORY ACTIVITY:

  • The Mississippi Workers’ Compensation Commission contracted with FAIR Health Inc., to assist with the development and distribution of the fee schedule beginning in 2019. Please note the updated contact information for obtaining the fee schedule:  Fee schedules will be available for pre-order beginning April 1, 2019.  If you have questions about ordering fee schedules or the status of your order: FAIR Health Client Services Phone: 855 301-3247 Email: service@fairhealth.org. If you have questions about the fees or content of the fee schedule, please contact: Connie Mills at the Mississippi Workers’ Compensation Commission  Phone: 601 987-4280 or  Email: cmills@mwcc.ms.gov.
    To view this notice, go to https://mwcc.ms.gov/#/home.

Missouri VIEW STATE →

REGULATORY ACTIVITY:

  • Announced that the 25th Annual Missouri Division of Workers' Compensation Educational Seminar is now open for registration.  The conference is being held May 2-3, 2019 at Tan-Tar-A Resort in Osage Beach Missouri.  For additional information or to register, go to  https://labor.mo.gov/DWC-Conference.

Nebraska VIEW STATE →

REGULATORY ACTIVITY:

 

  • Notice is hereby given of a public hearing scheduled for April 11, 2019, beginning at 9:30 a.m., in Courtroom 1, 1010 Lincoln Mall, Suite 100, Lincoln, Nebraska, for the purpose of accepting testimony regarding the adoption of revised Rules of Procedure in accordance with NEB. REV. STAT. § 48-163 and Rule 68 of the Workers’ Compensation Court Rules of Procedure, specifically: Amend Rule 2, Filings; Rule 3, Pleadings; Rule 47, Lump Sum Settlement; and Addendum 2, U.S. Life Table. Notice is also hereby given of a public meeting scheduled for April 11, 2019, immediately following the public hearing in Courtroom 1, 1010 Lincoln Mall, Suite 100, Lincoln, Nebraska, for the purpose of adopting the above-referenced revisions.  To view the notice, agenda, and proposed rules, go to https://www.wcc.ne.gov/home/public-hearings-and-public-meetings.
  • NWCC has posted the Nebraska EDI Claims Release 3.1, Version 1.1 EDI Requirement Tables that are immediately available for download at https://nwccedi.info/.  You will find the updated tables under the “EDI Requirements” links on the left-hand side of the page.  To view the notice, go to https://nwccedi.info/news.
  • With ongoing delays of U.S. Postal Service deliveries in the wake of recent flooding, the Nebraska Workers’ Compensation Court is taking steps to ensure that filings and other communications will continue to be received and delivered in a timely manner (https://www.wcc.ne.gov/home/court-news/2019-3-news).  To view this notice, go to https://www.wcc.ne.gov/home/court-news.

New Hampshire VIEW STATE →

REGULATORY ACTIVITY:

  • Please be advised that the Vocational Rehabilitation Provider Advisory Board will hold a meeting at the New Hampshire Department of Labor on Thursday March 14, 2019 at 2:30 pm. This meeting may include a non-public session.

New York VIEW STATE →

FEE SCHEDULE NEWS:

  • The Workers’ Compensation Commission has adopted a new Medical Fee Schedule with an effective date of April 1, 2019.

REGULATORY ACTIVITY:

  • The new Medical Fee Schedule (Pathology and Laboratory section, Ground Rule 12), updating the reimbursement for services to injured workers, takes effect April 1, 2019. An excerpt of the Non-Acute Pain Medical Treatment Guideline criteria is provided as a reference. This communication is intended to clarify that the Non-Acute Pain Medical Treatment Guidelines recommendations govern urine drug testing.  The new Medical Fee Schedule incorporates standards from the Board’s 2014 Non-Acute Pain Medical Treatment Guidelines and offers guidance as to the frequency of urine drug testing based on the level of risk for each patient. The updated rules do not contain the same level of detail, medical analysis and instructions as are contained in the Board’s Non-Acute Pain Medical Treatment Guidelines. Every medical provider should always use any applicable Medical Treatment Guideline when providing treatment and care to a workers’ compensation patient.  The Medical Fee Schedule states in every section that the Medical Treatment Guidelines set forth the standard of care and will prevail when there is a conflict between the two documents.   In Ground Rule 12, the Medical Fee Schedule identifies low/moderate/high risk test results and behavior and provides guidance as to how frequently urine drug testing may be performed in a medical provider’s office. The chart in the Ground Rule indicates that testing should be performed at different frequencies depending on a patient’s level of risk. The NAP-MTG on page 54 includes a similar chart. The chart in the NAP MTG sets forth that urine drug testing should be performed at least the annual allowable indicated for the applicable level of risk. The NAP MTG provide more detail and set forth the medical standards required for managing patients being treated for non-acute pain management.

As set forth on page 54 of the Non-Acute Pain Medical Treatment Guidelines, Risk Category (Score) and Random UDT Frequency:

    • Low Risk patients should be tested at least once per year
    • Moderate Risk patients should be tested at least twice per year
    • High Risk patients should be tested at least 3-4 times per year
    • Any patient demonstrating aberrant behavior should be tested at the time of visit.
  • Issued bulletin Subject No. 150-18.1 regarding change in rate of reimbursement to injured workers for travel by automobile.   This bulletin supersedes the same bulletin issued February 14, 2018.The mileage rate for reimbursement to injured workers for travel by automobile on or after January 1, 2019, is 58 cents per mile, in accordance with the Board resolution adopted on February 20, 1990.  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 this updated version of 150-18.1, go to http://www.wcb.ny.gov/content/main/SubjectNos/sn150_18_1.jsp. 

North Carolina VIEW STATE →

REGULATORY ACTIVITY:

  • Beginning March 1, 2019, Melanie Wade Goodwin will serve the Commission as Chief Deputy Commissioner. Goodwin, who earned her J.D. from Campbell University School of Law, will bring years of experience to the role, having served as a Deputy Commissioner since 2011. The Commission thanks Sumit Gupta for his dedication and significant contributions to the Commission as Chief Deputy Commissioner, as well as for the contributions he will continue to make as he returns to the courtroom. Additionally, Robert J. Harris will begin serving as Senior Deputy Commissioner effective March 1, 2019. In this role, he will assist Chief Deputy Commissioner Goodwin and will oversee the administration of tort claims in Raleigh and the regional offices. Harris, a graduate of the University of North Carolina School of Law, has served the Commission in various capacities since 2003.
  • The Industrial Commission is pleased to announce that Vicki Hewitt-McNeil has joined the Commission as a Medical Rehabilitation Nurse Consultant. The Commission’s Medical Rehabilitation Nurse Consultant is available to provide temporary assistance in cases with difficult medical challenges, thus supporting ongoing case management efforts provided by private industry. The Nurse Consultant will also perform specific rehabilitation activities as ordered by hearing officers within the Commission. Ms. Hewitt has been a registered nurse for more than 25 years and has been a certified case manager advocating for injured workers in the workers’ compensation system for 12 years. She is also certified in working with traumatic brain injuries and other catastrophic injuries. In addition, Ms. Hewitt has significant experience with URAC Accreditation, Quality Management Programs, Safety Programs, HIPAA Compliance, and Nursing Education.
  • The Industrial Commission is pleased to announce that Mark Tyler has joined the Commission as its Chief Operating Officer. Mr. Tyler brings 26 years of North Carolina State government experience to the Commission in the areas of finance and budget, strategic planning, performance management, project management, and information technology. Most recently, Mr. Tyler served as the Director of Strategy Research and Planning for the Department of Transportation, Division of Motor Vehicles. Previously, Mr. Tyler served as the Director of Budget and Planning for the Department of Insurance and as the Director of Administrative Analysis for the Department of Public Safety. Mr. Tyler received his B.S. degree in Business Administration from East Carolina University.
  • Changes to Tort Rules, Effective March 21, 2019: On December 13, 2018, the Rules Review Commission approved amendments to Rules 11 NCAC 23B .0206 and .0503 and the repeal of 11 NCAC 23B .0207. However, the rules received more than ten letters of objection, resulting in legislative review, pursuant to N.C. Gen. Stat. § 150B-21.3. No bills objecting to the rules were filed, making the rule changes effective March 21, 2019, the 31st legislative day of Session. To view the notice, go to http://www.ic.nc.gov/news.html#hot.

North Dakota VIEW STATE →

FEE SCHEDULE NEWS:

  • The Division of Workers’ Compensation has published new fee schedules for the following modules with an effective date of April 1, 2019: APC, ASC, Clinical Laboratory, DMEPOS, Medical Provider Fee Schedule and Outpatient Hospital.

REGULATORY ACTIVITY:

  • During natural disasters, such as flooding, WSI sees an increase of questions about workers’ compensation coverage for employees injured in disaster relief while doing their jobs. The following guidelines on workers’ compensation coverage should help clarify who is covered and when coverage applies.

 

A key to determining if employees injured in disaster relief while doing their jobs are covered by traditional workers’ compensation coverage is whether the employee is under the direction and control of their employer.

  • If an employer directs an employee to participate in flood relief activities, WSI will deem the employee covered, even if their work hours extend beyond the normal work shift.
  • If an employer releases an employee, without specific direction, to help in flood relief activities, the employee is not covered by workers’ compensation.
  • If an employee is injured while protecting their own property, it is outside the scope of employment and injuries are not covered.
  • If an employer (defined as sole proprietors, partners, and corporate officers) has Elective Coverage covering themselves on their WSI workers’ compensation policy, the employer is covered if the injury is related to the protection of business property or assets.
  • Organizations such as political subdivisions, civic groups, churches, etc. with volunteers may establish a volunteer policy to provide coverage for volunteers assisting in flood relief activities. Coverage must be secured and volunteers preregistered with WSI prior to them engaging in volunteer activities. Volunteer coverage is $10.58 per volunteer, subject to a minimum premium of $250.

For additional information on workers’ compensation coverage during a natural disaster, contact WSI at 800-777-5033.

  • Published Documentation Requirements for Prior Authorization of an Elective Lumbar Fusion:

March 2019, WSI has recently received an increase in incomplete prior authorization requests for elective lumbar fusion surgeries. For services requiring prior authorization, WSI’s UR department utilizes Official Disability Guidelines (ODG) as the standard of care. A provider must submit documentation of the following pre-operative clinical surgical indications, as outlined by ODG:

  • Documented failure of conservative care
  • Imaging reveals spinal instability, or nerve root impingement correlated with symptoms and exam findings
  • Recommended levels of fusion, not to exceed two
  • Psychosocial screen completed, with confounding issues addressed
  • Cotinine screening completed with negative result at six weeks and one week prior to scheduled surgery date
  • Patient awareness of alternative treatment options, risks and benefits of the procedure

For additional information on WSI requirements for the approval of an elective lumbar fusion, a provider should refer to the Lumbar Fusion Guidelines.  If you have questions about this article, please send an email to wsipr@nd.gov.  To view a copy of the above notice, go to http://www.workforcesafety.com/news/news-item/documentation-requirements-for-prior-authorization-of-an-elective-lumbar-fusion.

LEGISLATIVE ACTIONS:

  • House Bill 1062

This legislation makes adjustments to the appointment and length of service of workforce safety and insurance board members.  Effective Date July 1, 2019.

  • House Bill 1072

The legislation creates and enacts a new subsection to section 65-04-27.2 of the North Dakota Century Code, relating to cease and desist orders; to amend and reenact section 65-01-02, subsection 4 of section 65-01-08, sections 65-01-10, 65-04-04, 65-04-06, 65-04-19, 65-04-22, 65-04-24, and 65-04-26.2, subsection 3 of section 65-04-32, section 65-04-33, and subsection 1 of section 65-09-01 of the North Dakota Century Code, relating to definitions, the removal of the word "annual", off-setting premiums, the organizational seal, payroll reports, payment of premiums, premiums in default, notice of premium owing, liability of a general contractor, notices of decision, noncompliance of employers, and liability of uninsured employers; to repeal section 65-06.2-09 of the North Dakota Century Code, relating to safety and performance reviews; to provide a penalty; and to provide for an application. Effective Date August 1, 2019.

  • House Bill 1073

The legislation creates and enacts a new section to chapter 65-01 and a new section to chapter 65-05 of the North Dakota Century Code, relating to a pilot program to assess alternative forms of dispute resolution and the electronic submission of medical billings; to amend and reenact section 65-01-02, subsection 3 of section 65-01-15.1, sections 65-02-21.1, 65-05-09 and 65-05-10, and subsection 4 of section 65-05-28 of the North Dakota Century Code, relating to functional capacity examinations, medical examinations for full-time paid firefighters and law enforcement officers, licensing required for allied health care professionals, average weekly wage upon recurrence of disability, combined partial disability benefits, and medical noncompliance; to repeal section 65-02-07 of the North Dakota Century Code, relating to the organization seal; to provide a continuing appropriation; and to provide for application.  Effective Date August 1, 2019.

  • House Bill 1240

The legislation creates and enacts a new section to chapter 65-01 of the North Dakota Century Code, relating to workforce safety and insurance pilot program; to amend and reenact section 65-05.1-06.3 of the North Dakota Century Code, relating to rehabilitation services pilot programs; and to provide for a report to the legislative management.  Effective Date August 1, 2019.

Ohio VIEW STATE →

REGULATORY ACTIVITY:

  • Posted notice that rule 4123-6-01.2 Provisional treatment reimbursement approval - pilot program is being considered for review.  The rule is in draft form and has not been posted for adoption but only under consideration for review.  To view the notice and proposed rule, go to https://www.bwc.ohio.gov/basics/guidedtour/generalinfo/OACInReview.asp.
  • Posted notice that Self-insuring Employer Rules are being considered for review.  The rules included in the possible review are:
    • 4123-19-03 Where an employer desires to secure the privilege to pay compensation, etc., directly;
    • 4123-19-05 Where an employer is a self-insuring risk and desires to become a state risk;
    • 4123-19-08 Renewal of self-insuring risks;
    • 4123-19-09 In regard to complaints filed by employees against self-insuring employers under the provisions of section 4123.35 of the Revised Code;
    • 4123-19-13 Self-insuring employers evaluation board;
    • 4123-19-14 Self-insured review panel;
    • 4123-19-15 Assessment for self-insuring employers’ guaranty fund and
    • 4123-19-16 Self-insured construction projects.

To view the notice and rules, go to https://www.bwc.ohio.gov/basics/guidedtour/generalinfo/OACInReview.asp.

  • Posted notice of two rules being published for public comment.  The rules are 4123-6-21.3 Outpatient medication formulary (proposed effective June 1, 2019) and Chapter 6-Lumbar fusion surgery, HABI and medical treatment reimbursement (no proposed effective date).  The two rules are open for comment through April 24, 2019.  To view the proposed rules, go to https://www.bwc.ohio.gov/basics/guidedtour/generalinfo/OACInReview.asp.

Oregon VIEW STATE →

FEE SCHEDULE NEWS:

  • The Workers’ Compensation Division has published new rules for the Oregon Medical Fee Services with an effective date of April 1, 2019. The next update is expected in April 2020.
  • The Division has published new cost-to-charge ratios for hospitals with an effective date of April 1, 2019.

REGULATORY ACTIVITY:

  • Oregon announced revisions to Workers’ Compensation Insurance Test Audit Program: ​Rules affected: OAR 836-043-0125, 836-043-0130, 836-043-0135, 836-043-0145, 836-043-0150, 836-043-0155, 836-043-0165. Need for Rules: ORS 737.318 directs the Department of Consumer and Business Services (DCBS) to establish and administer a continuing test audit program for workers’ compensation insurers. The proposed rule makes adjustments to the test audit program to better meet the needs of Oregon’s workers’ compensation insurance market. The number of insurance policies audited is determined by a risk-based formula that takes into account the premium size of the insurer and the error rates found in past audits. The proposed rule:
    • Simplifies the program by reducing the number of premium size tiers used to categorize insurers;
    • Reduces the audit rates for insurers who meet the test audit performance standard of 20% error rate for the premium size tiers greater than $2,500;
    • Adjusts the formula for determining an insurer’s error rate by giving equal weight to the statewide error rate and the insurer’s specific error rate and excluding payroll reports and non-productive audits and
    • Improves the error rate and test audit standards by including only the policies in which insurer the insurer performed an audit.

Insurers that do not meet test audit performance standards are required to meet with the DCBS director or a designee to report on its remediation plans. Performance standards vary by the number of policies audited. The proposed rule would simplify the program so that there are fewer tiers used to determine performance standards. The proposed rule also makes technical changes relating to forms provided by DCBS, the timing and manner of reports provided to DCBS, and the frequency of examinations of the audit program.  Filed: February 26, 2019; Public hearing: March 25, 2019, 10:00 a.m.  Last day for public comment: April 1, 2019, 5 p.m.  To view the notice and proposed rule, go to https://dfr.oregon.gov/laws-rules/Pages/proposed-rules.aspx.

Summaries of public testimony on proposed rule changes and the agency’s responses have been posted:

Posted an industry notice regarding continuation of benefits for 14 days after enrollment in a managed care organization.  To view the notice, go to https://wcd.oregon.gov/Pages/index.aspx. WCD published the following industry notice: Exhibits for director hearings: https://wcd.oregon.gov/IndustryNotices/03-26-19-IN-exhibits.pdf  WCD wants to make sure parties are aware of rule changes that will affect the preparation and submission of exhibits for hearings within the director’s jurisdiction under Oregon Revised Statute (ORS) 656.704(2)(a) and Oregon Administrative Rule (OAR) 436-001. These hearings generally relate to disputes regarding medical services; medical treatment; medical fees; managed care organizations; vocational assistance benefits; or penalties and fees under ORS 656.262(11).  To view the notice, go to https://wcd.oregon.gov/Pages/industry-notices.aspx.

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 April 1, 2019. The next expected update is for July 2019.

South Carolina VIEW STATE →

REGULATORY ACTIVITY:

  • Published the full commission business meeting agenda for March 18, 2019.  To view the agenda, go to https://wcc.sc.gov/news.
  • The South Carolina Workers' Compensation Commission has opened registration for the Nuts & Bolts workshop on April 30, 2019. The workshop is for individuals responsible for processing, managing, filing and adjudicating claims in the State workers’ compensation system including claims administrators, adjusters, insurance carriers, legal assistants, paralegals, attorneys and employers.  This workshop will lead you from the initial injury to settlement of the claim. Participants will receive a comprehensive overview of South Carolina’s workers’ compensation system and a detailed explanation of the Commission’s requirements for filing a claim, proper completion of required forms, reporting requirements of the workers’ compensation laws and regulations. This workshop will introduce the basics of the workers’ compensation process. Commission staff will participate in the presentations and will be available during the workshop to respond to questions. To view this notice, go to https://wcc.sc.gov/news/2019-03/nuts-bolts-workshop-april-30-2019-0.  To register, go to http://events.r20.constantcontact.com/register/event?oeidk=a07eg724eaxec4d3011&llr=ycp54mhab.

LEGISLATIVE ACTIONS:

  • Senate Bill 326

A joint resolution to direct the state law enforcement division to distribute two hundred fifty thousand dollars to the South Carolina state firefighter’s association to provide for post-traumatic stress disorder insurance and programs.  Effective Date March 20, 2019.

  • Senate Bill 358

The legislation amends section 38-31-30, code of laws of South Carolina, 1976, relating to the application of the South Carolina property and casualty insurance guaranty association, so as to apply the provisions of chapter 31, title 38 to a claim or loss covered by self-insurance that occurred prior to the acquisition of a block of business by a licensed insurer; and to amend section 42-5-20, relating to insurance requirements for workers' compensation, so as to prohibit a self-insurer from participating in or obtaining benefits from the South Carolina property and casualty insurance guaranty association and to require the South Carolina workers' compensation commission to secure an actuarial opinion before approving the transfer of a self-insurer to a licensed insurer.  Effective Date July 1, 2019.

South Dakota VIEW STATE →

LEGISLATIVE ACTIONS:

  • Senate Bill 36

The enacted legislation revises the membership of the state’s workers’ compensation advisory council. The total number of members is increased from 8 members to 9 members. Effective Date July 1, 2019.

Texas VIEW STATE →

FEE SCHEDULE NEWS:

  • New Home Health and Dental modules have been published with an effective date of April 1, 2019. The next update is expected in July 2019.

REGULATORY ACTIVITY:

  • Posted the Designated Doctor Performance Review Procedure on the state's web site. The Commissioner of Workers’ Compensation has adopted a revised procedure for evaluating designated doctor performance effective immediately.   The evaluation procedure provides for the review of the quality of designated doctor decisions, as required by law. The Division of Workers’ Compensation (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 evaluation procedure, including selection criteria, is available at tdi.texas.gov/wc/hcprovider/medadvisor.html.   If you have questions, contact Mary Landrum at 512-804-4814 or Mary.Landrum@tdi.texas.gov.  To view the notice and procedure, go to https://www.tdi.texas.gov/wc/hcprovider/medadvisor.html.
  • The Texas Department of Insurance, Division of Workers' Compensation has determined that any interest or discount provided for in the Texas Workers' Compensation Act shall be at the rate of 6.02 percent. The rate shall be effective April 1, 2019, through June 30, 2019. The rate is computed by using the treasury constant maturity rate for one-year treasury bills issued by the United States Government, as published by the Federal Reserve Board for March 17, 2019, plus 3.5 percent. For more information regarding calculation of the Discount Rate and Interest Rate, contact CompConnection at 800-252-7031, option 3. Issued in Austin, Texas, on March 19, 2019. To view this notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.

Utah WC VIEW STATE →

LEGISLATIVE ACTIONS:

  • House Bill 154

The enacted legislation establishes a working group to study a first responder's workers' compensation claim due to mental stress.  The legislation defines first responder.  The legislation establishes a temporary working group to study a first responder’s workers’ compensation claim due to mental stress.  The working group at its’ conclusion shall make a report to the legislature. Effective Date March 22, 2019.

  • Senate Bill 76

The enacted statute enacts provisions related to add-on fees in workers' compensation cases.
This bill repeals provisions authorizing the Labor Commission to award attorney fees; defines terms; in certain workers' compensation cases, authorizes the Labor Commission to award an add-on fee to a claimant to be paid by the workers' compensation insurance carrier; and if the Labor Commission awards an add-on fee, establishes the amount of the add-on fee.  Effective Date March 11, 2019.

Virginia VIEW STATE →

REGULATORY ACTIVITY:

  • The Commission’s new Self-Insurer Web File system for reporting of the 2020 Annual Survey is entering its testing phase with a Beta Group of self-insured stakeholders. The testing phase will run from March 2019 thru October 2019. Web File users outside of the Beta Group are welcomed to continue viewing its reported data on record through Web File. Please refrain from initiating the Annual Survey or Change Request during the test period.  To view this notice, go to http://www.vwc.state.va.us/news/Self-Insurer-Special-Notice.  If you have any questions please email Selfinsurance@workcomp.virginia.gov.

LEGISLATIVE ACTIONS:

  • House Bill 1804

The enacted legislation adds cancers of the colon, brain, or testes to the list of cancers that are presumed to be an occupational disease covered by the Virginia Workers' Compensation Act when firefighters and certain employees develop the cancer. The measure will become effective if reenacted by the 2020 Session of the General Assembly. The measure also directs the 2020 Session of the General Assembly, in considering and enacting any legislation relating to workers' compensation and the presumption of compensability for certain cancers, to consider any research, findings, and recommendations from the Joint Legislative Audit and Review Commission's review of the Virginia Workers' Compensation program. The provisions of this bill do not become effective unless reenacted by the 2020 Session of the General Assembly. Effective Date July 1, 2019.

  • House Bill 2022

The enacted legislation provides that if an employer has received notice of an accident resulting in compensable injury to an employee and the employer has paid compensation or wages to such employee during incapacity for work resulting from such injury or the employer has failed to file the report of said accident with the Virginia Workers' Compensation Commission or otherwise has under a workers' compensation plan or insurance policy furnished or caused to be furnished medical service to such employee, the statute of limitations applicable to the filing of a claim shall be tolled until the last day for which such payment of compensation or wages or furnishment of medical services is provided and that occurs more than six months after the date of accident. The measure provides that no such payment of wages or workers' compensation benefits or furnishment of medical service occurring after the expiration of the statute of limitations applies to this provision. The measure also provides that (i) if the employer has failed to file a first report, the statute of limitations shall be tolled during the duration thereof until the employer filed the first report of accident and (ii) if more than one of the above tolling provisions applies, whichever of those causes the longer period of tolling shall apply.  Effective Date July 1, 2019. 

  • Senate Bill 1729

The enacted statute prohibits a health care provider from submitting a claim to the Workers' Compensation Commission seeking additional payment for medical services rendered to a claimant before July 1, 2014, if the health care provider has previously accepted payment for the same medical services pursuant to the federal Longshore and Harbor Workers' Compensation Act. The measure prohibits the Commission from adjudicating any such claim.  Effective July 1, 2019.

Washington VIEW STATE →

REGULATORY ACTIVITY:

  • The Washington State Department of Labor & Industries announces changes to the Outpatient Drug Formulary and Selected Preferred Drug List effective April 1, 2019.  The changes are available for review in the online Outpatient Drug Formulary and Selected Preferred Drug List PDF documents.  To view the formulary, go to http://www.lni.wa.gov/ClaimsIns/Files/Providers/DrugFormulary.pdf?utm_medium=email&utm_source=govdelivery.  To view the selected drug list, go to http://www.lni.wa.gov/ClaimsIns/Files/Providers/SelectedPDLforworkers.pdf?utm_medium=email&utm_source=govdelivery.
  • Legislation in 2018 (SSB 6245) required Labor & Industries to review its procurement process for interpreter services for injured workers and crime victims.  After reviewing the options and gathering feedback from interpreters, providers, and workers, L&I has decided to contract with one or more scheduling organizations. This means we will be purchasing in-person spoken language interpreter services through a new scheduling system by September 2020. There are still more decisions to make, including the functions of the scheduling system.  To help us answer these questions, we will be reaching out to interpreters, providers, and workers.

West Virginia VIEW STATE →

REGULATORY ACTIVITY:

  • The West Virginia Offices of the Insurance Commissioner and the International Workers’ Compensation Foundation are jointly sponsoring an educational conference, which is unique in West Virginia.  The goal of this conference is to educate those who participate in West Virginia’s workers’ compensation system regarding current rules, procedures, policies and forms and to provide an opportunity for dialogue among these participants. Breakout sessions will be utilized to discuss certain topics in specific detail for a more specialized view, while other topics will be presented from a more general perspective. To view additional information, go to https://www.wvinsurance.gov/Portals/0/pdf/wc/Brochure%20WV19FF.pdf?ver=2019-03-20-085248-250.

LEGISLATIVE ACTIONS:

  • Senate Bill 531

The enacted legislation amends and reenacts §23-5-7 of the Code of West Virginia, 1931, as amended, relating to compromise and settlement of certain workers’ compensation claims; and providing that occupational hearing loss and hearing impairment claims are not orthopedic occupational disease claims for the purpose of the requirement that a claimant be represented by counsel in a settlement for medical benefits.  Effective Date June 4, 2019.

Wyoming VIEW STATE →

LEGISLATIVE ACTIONS:

  • House Bill 6

The enacted legislation relates to physical therapy modifying the scope of practice of physical therapists.  The legislation permits a physical therapist to initiate physical therapy with or without a prescription from a licensed physician or other health care provider. Effective date July 1, 2019.

  • House Bill 63

The legislation defines pharmacy benefit manager in Wyoming Statutes as "an entity that contracts with a pharmacy on behalf of an insurer or third-party administrator to administer or manage prescription drug benefits" (W.S. 26-52-102(a) (vii)). The enacted legislation prohibits a pharmacy benefit manager from prohibiting or penalizing a pharmacy or pharmacist from telling an insured person about any alternatives that may be less costly than paying for a prescription drug through the person's prescription drug benefit.  Effective Date February 26, 2019.

  • House Bill 194

The enacted legislation authorizes the Department of Health, with the consent of the Governor, to expand Medicaid coverage of air ambulance transport services to all Wyoming residents. It authorizes the Department of Health to limit coverage under this act to specified additional groups of Wyomingites, which may be necessary to obtain federal approval. The legislation establishes a framework for the payment and administration of claims for expanded Medicaid air ambulance coverage under this act, including copays, agreements and the creation of an account.  It requires state agencies who provide coverage for air ambulance transport services to use the expanded coverage established by this act, including the Department of Workforce Services (Workers’ Compensation) and the Department of Administration and Information (Employees' Group Insurance), while also requiring these agencies to provide reimbursement to the Department of Health for air ambulance transports of covered individuals. The legislation establishes a three-quarter percent (.75%) premium assessment on health insurers to fund this program.  It provides that an air ambulance provider is required to accept payment from Medicaid as full satisfaction of all charges for services for covered air ambulance transports if the provider otherwise provides services under Medicaid independent of this act.  The legislation requires the Department of Health to adopt rules to administer the program, including co-pay requirements and payment rates based on Medicare rates applicable to rural Wyoming. Effective Date April 1, 2019.

  • Senate File 46

The enacted statute prohibits the prescription or dispensing of any opioid or combination of opioids to an opioid naive patient for more than a seven (7) day supply in a seven (7) day period.  It authorizes the State Board of Pharmacy to establish reasonable exceptions in consultation with other professional licensing boards that license practitioners, including exceptions for chronic pain, cancer treatment, palliative care and other clinically appropriate exceptions. The legislation defines "opioid naive patient" as a patient who has not had an active opioid prescription in the preceding forty-five (45) day period. Effective Date July 1, 2019.



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