Alabama VIEW STATE →

FEE SCHEDULE NEWS:

• The state has published Revision 1 updates for the 2019 Ambulatory Surgery Center Fee Schedule and for the 2019 Hospital Fee Schedule.

Alabama Auto VIEW STATE →

LEGISLATIVE ACTIONS:

• Alabama has published an amended regulation and a new regulation.  Both actions were prompted by legislation recently passed by the Alabama Legislature:
  • Regulation 125 Standards for Property and Casualty Claims amended section 4821-1-125-.07 Standards for Prompt, Fair and Equitable Settlements Applicable to All Insurers.
  • Regulation 163 is a new regulation titled Value Added Services or Product 482-1-163.

Alaska VIEW STATE →

LEGISLATIVE ACTIONS:

• Issued Regulatory Order R19-03 regarding air ambulance membership agreements. In 2014, the legislature enacted a new chapter of the insurance code (AS 21.61) regulating air ambulance membership agreements. In 2015, the Alaska Division of Insurance adopted air membership agreement regulations pursuant to AS 21.61.109. These regulations (3 AAC 31.600 – 690) describe the requirements for registration of air ambulance service providers and the contents of membership agreements. Specifically, 3 AAC 31.650(a) requires membership agreements must be filed consistent with AS 21.42.120. However, AS 21.42.120(d) authorizes the director, by order, to exempt a form or document from the filing requirements of AS 21.42.120 for a time determined by the director when, in the opinion of the director, the filing or approval of the form or document is not desirable or necessary for the protection of the public. This order exempts air ambulance agreements from the filing requirements of AS 21.42.120 and 3 AAC 31.650 as described in AS 21.61. The registration requirements and contents of the membership agreement requirements under 3 AAC 31.600 – 3 AAC 31.690 remain in effect.  To view the order, go to https://www.commerce.alaska.gov/web/ins/Resources/Orders/Regulatory.aspx.

California VIEW STATE →

FEE SCHEDULE NEWS:

The DWC has published a new file for Medi-Cal rates effective August 15, 2019. The next update is expected September 15, 2019

REGULATORY ACTIVITY:

• The Division of Workers’ Compensation (DWC) has posted proposed amendments to the Copy Service Fee Schedule to its online forum where members of the public may review and comment on the proposal. The proposed updates to the regulations include:
  • A one-time increase of the flat fee rate for copy services from $180 to $210
  • Annual cost-of-living adjustments to the flat fee for copy services
  • Mandatory billing codes, including proposed new codes for sales tax, contracted fees and additional sets and
  • Requirements that bills for both canceled services and certificates of no records include specified information regarding the request for the services, including the name of the requestor and the date of the request.

The forum can be found at https://www.dir.ca.gov/dwc/DWCWCABForum/CopyServiceFeeSchedule-July2019.htm.

• The Division of Workers’ Compensation (DWC) has posted proposed amendments to the Medical-Legal Fee Schedule to its online forum where members of the public may review and comment on the proposals. The draft regulations include:
  • A single, flat fee for comprehensive ($1,650), follow-up ($1,100), and supplemental ($275) medical-legal evaluations
  • Additional payment for review of medical records based upon the amount of pages reviewed
  • Elimination of complexity factors
  • An increase in the hourly fee for medical-legal testimony
  • An increased modifier for evaluations performed by a psychiatrist or psychologist
  • An increased modifier for evaluations performed in an underserved area
  • Standardization of the fee that can be charged for a missed appointment.

The implementation of a predominantly fixed fee for all procedure billing codes is anticipated to reduce frictional costs by establishing reimbursement that is based on objective and quantifiable criteria. The increase in the multiplier for setting fees will increase the reimbursement for the vast majority of evaluations performed by physicians. The forum can be found on the DWC forums webpage under “current forums.”  To view the posted documents, go to https://www.dir.ca.gov/dwc/DWCWCABForum/Reimbursement-of-Medical-Legal-Expenses-July-2019.htm.

Colorado VIEW STATE →

REGULATORY ACTIVITY:

• Posted the legislative update for 2019 regarding legislation enacted during the 2019 calendar year.  To view the legislative update, go to https://www.colorado.gov.
• 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: September 4, 2019 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 16: Utilization Standards Rule and 18: Medical Fee Schedule.  The proposed rule changes will be available at the Department’s website on or before July 24, 2019.  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 copy of the rules under consideration, go to https://www.colorado.gov/pacific/cdle/workers-compensation-proposed-and-adopted-rules.

Delaware VIEW STATE →

LEGISLATIVE ACTIONS:

• House Bill 94

This Act will increase payments of child support arrears or retroactive support from payments for settlements and awards from negligence, personal injury, and workers’ compensation cases by requiring that all insurers share information with an insurance claim data collection organization.  The Division of Child Support Services ("Division") uses an insurance claim data collection organization to match individuals who are in arrears on child support or who owe retroactive child support with individuals with insurance claims based upon negligence, personal injury, or workers' compensation cases. The data collection organization performs a data match  of  the  claimants  provided  by  insurers  and  child  support  obligors  provided  by  the  Division.  The data collection organization provides reports of matches to the Division so that the Division can issue a lien against the insurance claim to collect the child support arrears or retroactive support.  Currently, some insurers voluntarily submit claim information to the insurance claim data collection organization and in 2018, $424,977 in unpaid child support was collected through this process. This Act requires that all insurers submit claim  information to  the insurance  claim  data  collection  organization  and  is  expected  to collect  an  additional  $150,000 - $200,000 in unpaid child support. This Act also allows written notice of a lien or action to perfect the lien to be sent by electronically or by first class mail to conform to industry practices. This  Act  also  makes  technical  corrections  to  conform  existing  law  to  the  standards  of  the  Delaware  Legislative Drafting Manual. Effective Date September 11, 2019.

Illinois VIEW STATE →

LEGISLATIVE ACTIONS:

• House Bill 269

Amends the Workers' Compensation Act. Permits a single commissioner to approve of enforcement actions under provisions of the Act concerning insuring an employer's ability to pay compensation, replacing the current requirement of a panel of 3 commissioners. Permits the Illinois Workers' Compensation Commission to, if an employer's business is declared to be extra hazardous, issue a work-stop order while awaiting a ruling from the Commission or while awaiting proof of insurance by the employer. Provides that investigative actions must be acted upon within 90 days of the issuance of a complaint. Raises the maximum allowable penalty for noncompliance with certain insurance requirements from $2,000 to $10,000. Doubles the maximum allowable penalties, to $1,000 per day, with a minimum penalty of $20,000, for employers found to be in noncompliance more than once. Provides that an employer with 2 or more violations may no longer self-insure or purchase an insurance policy from a private broker for one year or until all penalties are paid, during which time the employer must purchase insurance from the Assigned Risk Pool through the National Council on Compensation Insurance. Effective Date January 1, 2020.

Iowa VIEW STATE →

REGULATORY ACTIVITY:

• The Legislative Services Agency (LSA) has posted on the Iowa General Assembly website an updated version of Chapter 876 of the Iowa Administrative Code (IAC), which contains the amendments made to implement mandatory electronic filing (eFiling) on the Workers' Compensation Electronic System (WCES). These amendments were in the Iowa Administrative Bulletin (IAB) and IAC Supplement published by LSA on July 31, 2019.  To view a copy of the amended chapter, go to https://www.legis.iowa.gov/law/administrativeRules/chapters?agency=876&pubDate=07-31-2019.
• Issued an order in the matter of what date stamp governs for documents paper -filed with the agency from July 1, 2019 through August 2, 2019 and subsequently electronically filed by agency staff.  To view the order, go to https://www.iowaworkcomp.gov/order-matter-what-date-stamp-governs-documents-paper-filed-agency-july-1-2019-through-july-19-2019.
• Posted notice of adoption after emergency notification of amendments to administrative rules Chapter 2 General Provisions; Chapter 3 Forms, Chapter 4 Contested Cases, Chapter 5 Declaratory Orders, Chapter 10 Informal Dispute Resolution Procedures and Chapter 11 Electronic Data Interchange. Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on June 5, 2019, as ARC 4472C. A public hearing was held on June 25, 2019, at 9:30 a.m. in Room 106, 150 Des Moines Street, Des Moines, Iowa. No one attended the public hearing. No public comments were received. No changes from the Notice have been made. The rule became effective on July 10, 2019.  To view the rule, go to https://www.legis.iowa.gov/law/administrativeRules.
• The Iowa Division of Workers' Compensation (DWC) has released new versions of the hearing report form in Microsoft Word format. The form hearing report form 14-0047 is released in August 2019.  For additional information, go to https://www.iowaworkcomp.gov/hearing-report-form-14-0047-word-format-august-2019.
• The Iowa Division of Workers' Compensation implemented mandatory electronic filing (eFiling) on the Workers' Compensation Electronic System (WCES) effective July 22, 2019. The Iowa Workers' Compensation Commissioner issued a standing order In the Matter of Certain Deadlines for Electronic Filing on the Workers' Compensation Electronic System (WCES). To view the order, go to https://www.iowaworkcomp.gov/standing-order-matter-certain-deadlines-electronic-filing-workers-compensation-electronic-system. The Order made it so that the pre-hearing deadlines for eFiling certain documents on WCES apply to cases that go to hearing on or after September 1, 2019, including:
  • At least 14 days before hearing, counsel of record and pro se litigants must file a joint proposed hearing report in Microsoft Word format under 876 IAC 4.19(3)(f);
  • At least 14 days before hearing, counsel of record and pro se litigants must file proposed exhibits in WCES under 876 IAC 4.19(3)(d); and
  • At least 7 days before hearing, counsel of record and pro se litigants must file all written objections and motions to exclude evidence in WCES under 876 IAC 4.19(3)(d).

The deadlines for eFiling documents on WCES for hearings scheduled on or after September 1, 2019 are approaching.  To view this notice, go to https://www.iowaworkcomp.gov/reminder-mandatory-efiling-deadlines-hearings-or-after-sept-1-2019.

Kentucky VIEW STATE →

REGULATORY ACTIVITY:

• Published an important reminder regarding change of address form filing. Following resolution of a claim in which medical benefits are limited to 780 weeks, the claimant, employer, and medical payment obligor shall notify the Department of Workers’ Claims in writing of any change in the claimant’s physical mailing address or email address. [803 KAR 25:290, Section 2(2) and (3)]  The Change of Address form incorporated in the regulation is available on the Department’s website under the “Forms” tab.  The form must either be mailed to the Department or scanned and emailed to ClaimsProcessing@ky.gov.   Upon receipt, the Department will update the Litigation Management System record.  The most recent address reflected in the record will be the address to which the document advising the claimant of the right to file an application for continuation of medical benefits will be mailed pursuant to KRS 342.020 (3)(b). Changes submitted through the EDI process do not satisfy this filing requirement.  To view the reminder, go to https://labor.ky.gov/comp/Pages/default.aspx.

LEGISLATIVE ACTIONS:

• Senate Bill 107

The enacted legislation amends and reenacts R.S. 40:1374 and enacts R.S. 23:1036.1 and R.S. 33:2581.2 relative to financial security for certain public employees.  It provides for workers’ compensation for certain fire employees and provides for volunteer firefighters.  It provides for certain emergency medical services personnel, certain employees of police department and state police. It provides presumptions for posttraumatic stress injuries and includes those type injuries as compensable injuries.  Effective Date August 1, 2019. 

Maryland VIEW STATE →

REGULATORY ACTIVITY:

• NCCI created the Workers Compensation Coverage Verification (WCCV) service to provide the general public with access to information on workers compensation coverage in the event of a claim.

Effective Tuesday, July 30, 2019 they have made the following enhancements:

• A State drop down list added to allow users to gain access to all 32 states covered by NCCI
• Added a count of results and pagination
• Coverage date is defaulted to current date
• Filtering on employer name will be added to the search results

These changes should assist the general public in obtaining employer workers' compensation insurance coverage information.

• The Commission announces the upcoming retirement of Commissioner Cynthia S. Miraglia effective 9/1/19. Commissioner Miraglia has been serving on the Commission since January 1999. In addition to being a regular speaker at conferences and events, she served for several years as the Chair of the Commission’s Medical Fee Guide Committee guiding a major revision to a Medicare based reimbursement system. Commissioner Miraglia is a past president of the Women’s Bar Association of Maryland, a former board member of the Maryland Chapter of the National Association of Women Law Judges and the University of Baltimore Alumni Association. In 2009, Commissioner Miraglia was the recipient of the Rita C. Davidson award by the Women’s Bar Association of Maryland.

LEGISLATIVE ACTIONS:

• Senate Bill 646

This bill eases the eligibility criteria for a firefighter, firefighting instructor, rescue squad member, or advanced life support unit member to qualify for a cancer or leukemia disease presumption under workers’ compensation law. The bill applies prospectively and may not be interpreted to have any effect on or application to any claim filed before its October 1, 2019 effective date.  Effective Date October 1, 2019.

Medicare VIEW STATE →

FEE SCHEDULE NEWS:

• Inpatient Hospital – CMS has released the new inpatient fee schedule for FY 2020 with an effective date of October 1, 2019. The next expected update is October 1, 2020.
• Inpatient Rehab Hospital – CMS has released the new FY 2020 inpatient rehab fee schedule with an effective date of October 1, 2019. The next expected update is October 1, 2020.
• Skilled Nursing Facility – CMS has released the new FY 2020 skilled nursing facility fee schedule with an effective date of October 1, 2019. The next expected update is October 1, 2020.

Michigan VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted new Hospital Cost-to-Charge ratios effective August 09, 2019. The next update is expected in August 2020.

Michigan Auto VIEW STATE →

LEGISLATIVE ACTIONS:

• Published Bulletin 2019-11-INS regarding the legislation enacted this year.  The bulletin addresses the statutory cause of actions by a provider against a no-fault insurer that had been denied under a decision by the courts. The courts stated that health care providers did not have a cause of action. The recently passed statute establishes that a health care provider does have a cause of action.  The bulletin also addressed other aspects of the recently enacted statutes.  To view the bulletin, go to  https://www.michigan.gov/difs/0,5269,7-303-12900_12906---,00.html.

Minnesota VIEW STATE →

REGULATORY ACTIVITY:

• The Workers' Compensation Division of the Minnesota Department of Labor and Industry (DLI) will be mandating electronic data interchange (EDI) Release 3.1 XML reporting in August 2020. The adoption of this new release will coincide with the modernized Work Comp Campus. DLI made small updates to the EDI documents that are available on the DLI website. The R3.1 XML Implementation Guide can be found on the DLI website.
• Minnesota published exempt permanent rules relating to workers' compensation; 2019 Adjustment to Relative Value Fee Schedule Conversion Factors and Amendments to Rules Implementing the Workers' Compensation Relative Value Fee Schedule Tables in Minnesota Rules, Chapter 5221Under Minnesota Statutes § 176.136, subd. 1a, the workers' compensation medical fee schedule relative value units are required to be updated according to the Medicare relative value tables every three years, while the conversation factors are to be adjusted annually by no more than the change in the statewide average weekly wage. These exempt rules update the conversion factors, update the relative value units according to the 2019 Medicare relative value tables and amend the workers' compensation rules as necessary to implement the new relative value units. Published notices and comment periods: A Notice of Incorporation by Reference of the July 2019 version of the Relative Value Tables established by the Centers for Medicare and Medicaid Services was published on page 45 of the State Register on July 15, 2019 – https://mn.gov/admin/assets/SR44_3 - Accessible_tcm36-392887.pdf. Additional information about how to access the July 2019 version of the Relative Value Tables established by the Centers for Medicare and Medicaid Services is available on the department's website at dli.mn.gov/business/workers-compensation/work-comp-medical-fee-schedules-rbrvs.
• Pursuant to the exempt rule process in Minn. Stat. § 14.386 (b), no Request for Comment or Notice of Intent to Adopt Rules has been published.  To view this notice, go to http://www.dli.mn.gov/about-department/rulemaking/rulemaking-docket-minnesota-rules-chapter-5221-2019. 
• Published notice of expedited rules for treatment parameters of post-traumatic stress disorder. Minnesota Rules part 52221.670.  Pursuant to amendments to Minnesota Statutes § 176.83, subdivision 5 (b) (8), the Department of Labor and Industry (DLI) is required to adopt criteria for treatment of post-traumatic stress disorder (PTSD) in workers' compensation. The statute directs the commissioner to adopt the rules under the expedited rulemaking process in Minn. Stat. § 14.389. Published notices and comment periods: Under the expedited rule process in Minn. Stat. § 14.389, no Request for Comments was published. DLI will publish notice of the proposed rules, including a copy of the proposed rules and a citation to the specific statutory authority for the rule, in the State Register as required under Minn. Stat. § 14.389, subd. 2. Notice will also be given to persons who have signed up for the U.S. mail or electronic mail lists for workers' compensation rules. Availability of rule draft(s) and Statement of Need and Reasonableness: In drafting the rules, the commissioner consulted the Medical Services Review Board (MSRB) as required by statute. MSRB recommended draft rules to the commissioner July 18, 2019. 
  • To view a copy of the rule recommended by MSRB, with changes suggested by the Office of the Revisor of Statutes, go to http://www.dli.mn.gov/about-department/rulemaking/rulemaking-docket-minnesota-rules-chapter-52216700-2019.  Under the expedited rule process in Minn. Stat. § 14.389, there is no requirement for a Statement of Need and Reasonableness. Requests for hearing; date and place of hearing: Under the expedited rule process in Minn. Stat. § 14.389, a hearing will be held if 100 or more people request a hearing. Timetable/status of the rule proceeding; agency determinations: The Department of Labor and Industry will file the rules for approval with the Office of Administrative Hearings according to Minn. Stat. § 14.389. Date the rule was filed with the Secretary of State and the effective date of the rule as adopted: The adopted rules will be published in the State Register. For procedural questions and to submit comments, contact:  Ethan Landy, Office of General Counsel,  Email:  dli.rules@state.mn.us, Phone:  651-284-5302, Fax:  651-284-5725; For questions about the content of the proposed rules, contact: Laura Zajac, Office of General Counsel, Phone:  651-284-5432, Fax:  651-284-5725.

Missouri VIEW STATE →

REGULATORY ACTIVITY:

• Posted notice of adoption of rule 8 CSR 20-2.010 General Rules Governing Rules;  8 CSR 20-3.030 Review of Awards or Orders Issued by Administrative Law Judges; 8 CSR 20-3.060 Policy of the Commission; 8 CSR 20-4.010 Review Applications; and 8 CSR 20-8.010 Review of Decisions Issued by the Division of Workers' Compensation in Tort Victims' Compensation Cases.  All of these adopted rules amend existing rules. The notice of the proposed amendments was posted in the state register on May 15, 2019.  The adoption notice was posted in the state register dated September 2, 2019.  The adopted rules become effective on October 2, 2019.  To view the notice, go to https://www.sos.mo.gov/adrules/moreg/moreg.asp.

Montana-Auto VIEW STATE →

LEGISLATIVE ACTIONS:

• Montana issued an advisory memorandum regarding notice of policy changes for property and casualty insured compliance with Section 33-15-1106 MCA.

Nebraska VIEW STATE →

REGULATORY ACTIVITY:

• The Nebraska Workers’ Compensation Court has activated its web-based data entry application for Diagnostic Related Group (DRG) reports Hospitals and payers may report for themselves , or they may allow a third party to report for them.  Section 48-120.04 of the Nebraska Worker’s Compensation Act requires covered hospitals, workers’ compensation insurers, self-insured employers, and risk management pools to report claim and stop-loss threshold counts by Diagnostic Related Group (DRG) to the court. Recent changes to the reporting statute also require reporters to identify bills that dealt with trauma services. Hospitals and payors may report for themselves, or they may allow a third party to report for them.  To view this notice, go to https://www.wcc.ne.gov/home/court-news.

Nevada VIEW STATE →

LEGISLATIVE ACTIONS:

• Assembly Bill 492

An act relating to industrial insurance; authorizing compensation under industrial insurance for posttraumatic stress disorder suffered by a first responder under certain circumstances; exempting a claim for posttraumatic stress disorder suffered by a first responder from certain provisions governing certain other stress-related claims; exempting a claim for posttraumatic stress disorder suffered by a first responder from certain prohibitions on compensation for an injury and temporary disability; exempting a claim for posttraumatic stress disorder suffered by a first responder from certain provisions governing the calculation of compensation for a permanent partial disability; and providing other matters properly relating thereto. Effective Date July 1, 2019.

New Hampshire VIEW STATE →

REGULATORY ACTIVITY:

• Please be advised that the New Hampshire Department of Labor has submitted the proposed rule dealing with requirements to ensure compliance with RSA 277:15 -a and RSA 277:15-b as adopted by Chapter 29 of the Laws of 2019 (HB 406) effective 7/14/19. The public hearing for the proposed rules will be held at the New Hampshire Department of Labor on Thursday September 12, 2019 at 2 pm.  To view the notice and rule, go to https://www.nh.gov/labor/index.htm.

New Jersey No-Fault VIEW STATE →

LEGISLATIVE ACTIONS:

• Published the second quarter report for 2019.  To view the report, go to https://www.state.nj.us/dobi/pipinfo/aicrapg.htm.

New Mexico VIEW STATE →

REGULATORY ACTIVITY:

The Summer 2019 issue of the NM WCA’s Quarterly Bulletin is now available at https://workerscomp.nm.gov/NMWCA-Publications.

LEGISLATIVE ACTIONS:

• House Bill 539

Relating to licensing; amending, repealing and enacting sections of the social work practice act to clarify licensure requirements and allow for telesupervision and telehealth; clarifying conflict of interest for board members; providing for electronic examinations. Effective Date June 14, 2019.

New York VIEW STATE →

REGULATORY ACTIVITY:

• The New York State Workers’ Compensation Board proposes to adopt Medical Treatment Guidelines for: Hip/Groin Injuries; Foot/Ankle Injuries; Elbow Injuries; and Occupational Interstitial Lung Disease. These Guidelines will be added to the Board’s existing set of Medical Treatment Guidelines for the treatment of Mid and Low Back Injuries, Neck Injuries, Knee Injuries, Shoulder Injuries, Carpal Tunnel Syndrome and Non-Acute Pain. Consistent with previous Guidelines, these new Guidelines have been prepared in consultation with the Board’s Medical Advisory Committee. The proposed Medical Treatment Guidelines are available on the Board’s website. The proposed regulations to support the additional Medical Treatment Guidelines have been published in the State Register Link to External Website on July 31, 2019.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 comment on these Guidelines. Please submit your comments on or before September 29, 2019, to regulations@wcb.ny.gov. To view the proposed guidelines, go to http://www.wcb.ny.gov/content/main/wclaws/MTG-Amendment-324-2/. To view this announcement, go to http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1196.jsp.

• The Workers’ Compensation Board is offering new resources to assist in the transition to Form CMS-1500, which will streamline medical billing and reduce the paperwork requirements currently in the workers’ compensation system. To help you prepare, the Board has developed a training video to show health care providers, and all others who will be using Form CMS-1500, how to use the form and the required narrative reports to bill for their services to workers’ compensation patients. The Board will also hold two follow-up Q&A webinars so that you can get answers to any questions you may have after viewing the training video and reading the CMS-1500 FAQ on the Board’s website. To view the training video, follow this link: https://www.youtube.com/watch?v=CHJwAvSJ_eM

The webinars will be held on: September 17, 2019 8:30 a.m. - 9:30 a.m.   September 18, 2019 4:00 p.m. - 5:00 p.m. Please direct questions to CMS1500@wcb.ny.gov

• In support of the new Drug Formulary, the Board is developing an electronic Drug Formulary Prior Authorization System.  This system will be accessed on the Board’s website through the Medical Portal and will:
  • Allow providers to request prior authorization from payers (i.e., insurance carriers, third-party administrators (TPAs) and self-insured employers) for medications that deviate from the published Drug Formulary.
  • Provide a dashboard feature that will enable users to track and respond to submitted requests.
  • Include an administrative feature where user access, roles, and contact information can be maintained and updated.
  • Claim administrators may update on behalf of the payer.
• The Drug Formulary Prior Authorization System will have a web-based application for administrators.  This web application will be populated by the payer using each payer's existing eClaims Trading Partner information. When the application becomes available, each payer’s administrator will be notified. The administrator must then log into the application using their NY.gov ID and password to identify their organization’s contacts described below. What Should be Done Now? Identify Contacts: The Drug Formulary regulations were adopted on May 21, 2019, with an effective date of June 5, 2019.  As part of the regulations, payers must identify Level 1, Level 2, and Order of the Chair contacts for their organization, as well as an electronic mailbox for each. These contacts will be used for required review of requests for prior authorization.
  • Level 1 contact – May be claim administrator of insurance carrier or TPA, or Pharmacy Benefit Manager (PBM) if designated.
  • Level 2 contact – Must be the Medical Director of insurance carrier or TPA. Order of the Chair (OOC) contact – Insurer and Claim administrator of insurance carrier or TPA.

Effective September 1, 2019, payers (or their designee) will need to access the online Formulary administration application and enter the above described contacts. It will be the payer’s responsibility to update and maintain the accuracy of these contacts. The electronic mailboxes will be used by the Formulary Prior Authorization system to automatically route provider prior authorization requests to the payer-designated contact. If a payer designates a PBM as their Level 1 contact, the PBM must register and identify their users, using the online registration process that the Board is developing before a payer can select them as the Level I contact in the administration web application. The Level 2 contact will be used if the provider wishes to appeal a Level 1 denial or partial approval. The OOC contact will be used by the system to notify the payer and their designee that an OOC has been issued due to either non-response to provider-submitted prior authorization requests for a Level 1 or Level 2 request, or for a Level 3 (WCB Medical Director’s Office) approval of a Level 2 denial or partial approval. The electronic mailbox address will also be utilized to route requests to a user-specific dashboard.  Additionally, each payer must identify individuals within the organization to administer the workload and reviewers to respond to requests. If contacts are not identified, the payer may be subject to the following: Orders of the Chair approving prior authorization requests submitted when the name and contact information is missing, incomplete or incorrect. Penalties issued pursuant to Section 114-a of the Workers’ Compensation Law for every case where prior authorization was requested. For More Information See Subject Number 046-1157 that was issued on April 17, 2019. Updates about the system, the online Formulary Administration application and registration process will be posted on the Board’s website as it becomes available; please watch for more information.

• New York published bulletin 046-1198 regarding planning for drug formulary implementation. The Chair adopted a Drug Formulary on June 5, 2019. This Subject Number outlines important information regarding the implementation of the Drug Formulary and the transition of prescriptions to Drug Formulary medications. New Prescriptions: As of December 5, 2019, any newly prescribed drug must be for a Drug Formulary medication. As of that date, a medical provider must obtain prior authorization for any non-formulary drug prior to writing a new prescription. A new prescription means a prescription for a drug that the patient is not currently taking (different drug or different strength or frequency). Note: A newly written prescription for continuation/renewal of a medication (same drug, strength and frequency) that the patient is taking is considered a renewal prescription and must follow the process described below.
  • Refills and Renewals

Insurers, self-insured employers and third-party administrators must notify medical providers and injured workers by December 5, 2019, that a currently prescribed drug is not included on the Drug Formulary. These notifications must be in the format required by the Chair. On or after June 5, 2020, all refills or renewals of prescriptions must use a Drug Formulary medication unless prior authorization has been obtained before the date of the refill or renewal. A refill means any subsequent fill of a prescription when the number of refills is explicitly included in the original prescription. A renewal means a prescription that the injured worker has been taking but for which there are no available refills.

• Narcotics/Opioids

The Drug Formulary does not include narcotics/opioids after the first 30 days following an injury (except in the immediate pre- and post-operative period). It is important to understand that:

• On or after December 5, 2019, during the 30 days following an injury, narcotics/opioids may not exceed a single seven-day supply; and,
• Prior to June 5, 2020, medical providers and injured workers must plan for a transition to a Drug Formulary medication. If such a transition is not medically appropriate, the medical provider must obtain prior authorization for a refill or renewal of a non-formulary narcotic/opioid well in advance of June 5, 2020.

To view the bulletin, go to http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1198.jsp.

• Published information regarding the recently adopted statute that imposes an excise tax on opioids.  Article 20-D of the New York State Tax Law, enacted in April of 2019, imposes an excise tax on the first sale of every opioid unit in New York State. The tax imposed by the law is paid by the “registrant” (i.e., manufacturer, wholesaler, or outsourcing facility) making the first sale (Tax Law § 498[a]). The law explicitly excludes from the definition of sale the dispensing of opioids pursuant to a prescription to an ultimate consumer (Tax Law § 497[h]). In Workers’ Compensation cases, an injured worker who receives opioid prescription medications is the ultimate consumer. As such, an injured worker receiving opioids prescription medications is not responsible for the cost of the excise tax and the tax is not payable per the Medical Fee Schedule or Drug Formulary. Injured workers should not pay the opioids excise tax, and any workers who are told to do so should contact the Workers’ Compensation Board immediately. Additional information can be found at: https://health.ny.gov/professionals/narcotic/opioid_excise_tax.htm.  To view this notice, go to http://www.wcb.ny.gov/content/main/hcpp/hcpp.jsp#opioid-excise-tax.

New York No-Fault VIEW STATE →

LEGISLATIVE ACTIONS:

• Posted on notice of adoption of 34th Amendment to 11 NYCRR 68 regarding charges for professional health services. This rule sets forth the maximum reimbursement levels for charges incurred for medical services provided under automobile insurance.  This maximum reimbursement amounts set forth in the rule shall take effective October 1, 2020.  To view a copy of the notice and rule, go to https://www.dfs.ny.gov/industry_guidance/regulations/final_adoptions_insurance.

North Dakota VIEW STATE →

REGULATORY ACTIVITY:

• WSI recently published an article about the Medical Provider Payee Registration form now being required. If a practice has not yet submitted the required form, you must do so by August 30, 2019, or WSI will deny payment.  To view this notice, go to https://www.workforcesafety.com/. WSI recently revised the Medical Provider Payee Registration form, which a practice must submit to receive payment from WSI. The requirement applies to all practices, including those previously registered with WSI under the former registration process. If a practice does not submit an updated registration form, WSI will deactivate the existing payee account and deny payment. If a practice is uncertain whether WSI has received an updated registration, contact customer service at 800-777-5033. To access the revised form and complete information about WSI's provider registration process, go to https://www.workforcesafety.com/medical-providers/provider-registration.

Oklahoma VIEW STATE →

REGULATORY ACTIVITY:

• The WCC has announced the appointment of John Blodgett to the position of Administrative Law Judge (ALJ), effective September 3rd, 2019. He will be filling a newly created ALJ position in Oklahoma City. He will report to Chief ALJ Shane Curtin and the three Commissioners of the WCC. The WCC currently employs five administrative Law Judges and administered over 7,900 cases in 2018. Blodgett will begin hearing workers’ compensation cases in Oklahoma City as a part of his duties with the WCC.  Chairman Mark Liotta said, “We look forward to having John join our team here at our Oklahoma City offices. We continuously review our case volume, and it was clear we could improve our service to the people of Oklahoma by adding another ALJ position. He has the right experience and the right temperament to fill that position.”  John will be leaving his position at the law offices of R. Ted Leslie, PLLC when he joins the WCC in September. For the last ten years John has focused his career on workers’ compensation law, representing respondents in workers’ comp cases as well as having some limited experience representing claimants. John received his bachelor’s degree in elementary education from Cameron University. After a few years of teaching in Lawton he matriculated to the University of Oklahoma to earn his Juris Doctorate. He currently lives in Norman with his wife Holly and two daughters. Oklahoma’s workers’ compensation system was reformed in 2013, establishing the Administrative Workers’ Compensation Act (Act). The Act created the Workers’ Compensation Commission (WCC) which became fully operational effective February 1, 2014.The WCC provides a forum for workers’ compensation hearings and appeals, ensures compliance with relevant statutes by employers, and regulates organizations who wish to self-fund their workers’ compensation obligations.  For additional information, contact: Director of Communications and Administration Collin Fowler at (405) 522-8606 Communications@wcc.ok.gov.

Oregon VIEW STATE →

REGULATORY ACTIVITY:

• The Quarterly Fatality report for the second quarter 2019 (4/01/2019-6/30/2019) is now available. In the second quarter 2019, DCBS received notification of ten fatalities accepted for workers’ compensation benefits; the same total as in the same period a year earlier. Of the 24 fatalities accepted by insurers in the first two quarters, nine were to workers who died in years prior to 2019. The Quarterly Fatality Report presents compensable fatalities grouped by industry. The previous year’s counts are included for comparison. Please note the 2019 data are preliminary until the final count is released in the spring of next year. To view the report, go to https://www.oregon.gov/dcbs/reports/protection/Pages/compensable-fatalities.aspx.
• Published the latest issue of News and Case Notes. The July 2019 Edition can be viewed at https://www.oregon.gov/wcb/Pages/news-notes.aspx.
• Published revised bulletin number 345 regarding employer reimbursement of medical service costs.  The revised bulletin becomes effective January 1, 2020.  This bulletin instructs insurers and self-insured employers how to apply employer-reimbursed medical service costs for individual claims and provides updated maximum reimbursement amounts. This bulletin replaces Bulletin No. 345 dated Aug. 21, 2018.  To view the bulletin, go to https://wcd.oregon.gov/forms/Pages/bulletins.aspx.
• Registrations are now being accepted for the 2019 Workers’ Compensation Educational Conference. The registration packet is available online at: https://wcd.oregon.gov/training/conference/Pages/index.aspx. This conference is designed for everyone involved in the Oregon workers’ compensation system. General Sessions will provide information for the entire industry, and concurrent workshops are designed to accommodate specific areas of interest. There will be basic workshops for those new to Oregon Workers’ Compensation and advanced workshops with updates for those more familiar with the system.
• The Oregon Workers’ Compensation Division, with sponsorship from the International Workers’ Compensation Foundation, coordinates an annual Educational Conference for participants in the Oregon workers’ compensation system. The year’s 2019 Workers’ Compensation Educational Conference is the 17th conference in Oregon. It is designed to enhance understanding of the workers’ compensation system and improve processes and services that affect injured workers and employers. This year’s conference is being held in Portland at the Red Lion on the River – Jantzen Beach and offers all the following:
  • A variety of concurrent sessions and informational booths so participants can get the answers they need
  • The latest in services, equipment, and materials from participating vendors
  • Educational credit hours.

To view additional information, go to https://wcd.oregon.gov/training/conference/Pages/index.aspx.

Oregon-Auto VIEW STATE →

LEGISLATIVE ACTIONS:

• The Department of Consumer and Business Services, Division of Financial Regulation (DFR) is issuing this memorandum to remind auto insurers of their responsibility to provide required disclosures1 regarding a vehicle total loss in a timely manner. ORS 742.554 requires that total loss disclosures be provided at the time “an insurer declares a motor vehicle a total loss and offers to make a cash settlement.” This means that when a settlement offer is made in writing, the disclosure must be provided simultaneously. When the offer is communicated to the consumer orally, the disclosure must be provided in writing and mailed or delivered electronically within one business day.  Delaying the disclosure until after the settlement offer is a violation of 742.554 and may result in an enforcement action and civil penalties.

Rhode Island VIEW STATE →

LEGISLATIVE ACTIONS:

Legislative News

• House Bill 6134 and Senate Bill 909

Provide employer pays any excess damages for an injured minor/clarifies liability of employer for violation of continuation of health care benefits for injured employee caused by employer/repeals obsolete/inapplicable workers' compensation laws.  Effective Date July 15, 2019.

Tennessee VIEW STATE →

FEE SCHEDULE NEWS:

• New Medical and Hospital Fee Schedules have been adopted by the state with an effective date of September 10, 2019.

REGULATORY ACTIVITY:

• Tennessee posted notice of a meeting of the Telehealth Working Group held on Monday, August 19, 2019 at 1:00 pm central time.
• Posted notice of a MAC Utilization Review Working Group Meeting held on August 30, 2019 at 8:30 am - 9:30 am.

Texas VIEW STATE →

REGULATORY ACTIVITY:

• The Texas Department of Insurance, Division of Workers’ Compensation (DWC) is accepting comments on an informal working draft of rule amendments for 28 Texas Administrative Code §§2, 124.3, 180.8, and 180.26 to implement Senate Bill (SB) 2551, 86th Legislature (2019).Rule 124.2 outlines the amended process for claim notification pursuant to SB 2551.The amendments to Rule 124.3 describe an insurance carrier’s obligation to investigate when it receives notice of an injury for which a presumption may apply on a claim and the process they must follow when investigating a presumption claim under Chapter 607 of the Texas Government Code. Rule 180.8 relates to the assessment of administrative penalties in claims where the insurance carrier provided notice under Section 409.021(a-3). Rule 180.26 is amended to include the additional factors to be considered when determining sanctions.  Additional editorial corrections are made throughout to align them with current style and usage. Under SB 2551, DWC is required to adopt all rules necessary no later than January 1, 2020. The informal working draft of the rules would establish that under certain circumstances, an insurance carrier is not required to comply with the 15-day deadline to either initiate benefit payments in response to a claim or provide notice of refusal. To qualify for this exemption, the insurance carrier must send to both the claimant and DWC, within 15 days, a notice describing the steps it has taken to investigate the employee’s injury and any evidence it believes is reasonably required for it to complete its investigation of the compensability of the injury. The changes in law made by SB 2551 apply to a claim for benefits filed on or after June 10, 2019. Rule 124.2
  • Adds new Subsection (f) and (g) to establish the notice requirements provided for under Labor Code §409.021(a-3).
  • Provides additional denial notice requirements in Subsection (i) if the denial relates to a written notice of injury where a presumption under Government Code Chapter 607, Subchapter B, may be applicable.
  • Adds a new Subsection (r) to establish minimum standards for plain language notices. 2 Rule 124.3
  • Adds a new Subsection (b) to provide that if an insurance carrier receives written notice of injury where a presumption under Government Code Chapter 607, Subchapter B, may apply, the insurance carrier is required to investigate each element thoroughly in addition to investigating the compensability of the injury, the insurance carrier’s liability for the injury, and the accrual of benefits.
  • Adds a new Subsection (c) to provide for the filing of a notice of denial as required by Labor Code §409.022 (relating to Refusal to Pay Benefits; Notice; Administrative Violation) and Rule 124.2. Subsection (c) also conforms existing rule language governing an insurance carrier’s liability for any benefits that accrue and the insurance carrier’s duty to initiate benefits with changes made by SB 2551.
  • Deletes obsolete penalty provisions in what is now Subsection (c) (4) (A).
  • Deletes obsolete transition language in existing Subsection (f).Rule 180.8
  • Conforms the requirements for notices of violations with the changes made by SB 2551 by including a description of the underlying facts considered by DWC for each of the factors listed in Labor Code §415.021(c) and (c-2), if applicable in the statement of the basis for each proposed sanction. Rule 180.26
  • Adds a new Subsection (f) to establish when determining which sanction to impose against a system participant and the severity of that sanction in claims where the insurance carrier provided notice under Labor Code §409.021(a-3).
• The Texas Department of Insurance, Division of Workers’ Compensation (DWC) is accepting public comment on a proposed new form:  DWC Form-029, Request for Standard Detailed Data Reports.  Insurance carriers, including certified self-insurers, certified self-insurer groups, and governmental entities, may submit the new form to ask for claim-level data they have already submitted to DWC. The data will be made available to them or another entity on their behalf. The reports provide the detail related to the insurance carrier performance scorecards for:
  • timely payment of initial temporary income benefits (TIBs) and EDI reporting;
  • timely processing of medical bills and EDI reporting; and
  • timely processing of reconsideration medical bills and EDI reporting.

The new form will replace the current process for requesting standard detailed data reports through DWC’s open records portal. DWC will establish a secure file transfer protocol (SFTP) box to provide data to the requestor.   The proposed form is available on the TDI website at www.tdi.texas.gov/wc/rules/drafts.html. Written comments on the form may be submitted by email to RuleComments@tdi.texas.gov, or by mailing or delivering your comments to Cynthia Guillen Office of General Counsel, MS - 4D  Texas Department of Insurance, Division of Workers’ Compensation 7551 Metro Center Drive, Suite 100 Austin, Texas 78744-1645.  To view a copy of the notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.  To view a copy of the form, go to https://www.tdi.texas.gov/wc/rules/drafts.html.

Washington VIEW STATE →

REGULATORY ACTIVITY:

• Posted notice in the state register notice of rule adoption. Effective Date of Rule: Immediately upon filing. Purpose: The purpose is to amend WAC 296-14-400 Re-openings for benefits, as a result of the State of Washington court of appeals decision Ronald V. Ma'ae v. State of WA Dept of Labor And Industries, 2019 WL 1492822 that found the department cannot prohibit non-MPN providers from submitting reopening applications. This rule amendment allows the department to be in compliance with the Ma'ae decision and is effective upon filing per RCW 05.380 (3) (a). Date Adopted: July 23, 2019. To view the notice and rule, go to http://lawfilesext.leg.wa.gov/law/wsr/2019/15/19-15-121.htm.
• Posted notice of possible rule making regarding the evaluation of actual losses (occupational disease date of injure for experience rating Chapter 296-17 WAC.  To view this notice, go to http://lawfilesext.leg.wa.gov/law/wsr/2019/15/19-15-122.htm.
• The Department of Labor & Industries (L&I) is taking the next step in preventing unnecessary work disability by proposing new administrative rules that support vocational recovery. The new rules would mean vocational recovery services are the first provided by private-sector vocational rehabilitation counselors (VRCs) in most State Fund cases. The intent is to better align the rules with the state law that places a high priority on returning a worker to employment. L&I’s proposed rules establish certain expectations for vocational firms and clarify when VRCs and vocational firms may be subject to corrective actions or sanctions. The draft rules also spell out what those sanctions include.  Vocational services are a critical part of helping our state’s injured workers heal and return to work. In recent years, L&I has made significant improvements to reduce process delays so that vocational providers can more effectively engage injured workers, employers, and medical providers before long-term disability sets in. Results include higher return-to-work rates and reduced costs.  The rulemaking process includes opportunities for the public to provide input, in writing or at a public hearing at 10 a.m. on Oct. 2 at the Department of Labor and Industries in Tumwater. Input on the proposed rules will also be accepted by email, mail, or fax through 6 p.m. on Oct. 4. L&I will consider all input before preparing the final rules this fall. The proposed rules are available for review on L&I’s website for rule development. Submit input: Email: Grytness@Lni.wa.gov, Fax: 360-902-6706, Mail: Laurinda Grytness, Department of Labor & Industries, PO Box 44329, Olympia WA 98504-4329.  To view the hearing notice and proposed rule, go to http://www.lni.wa.gov/LawRule/WhatsNew/Proposed/default.asp?RuleID=267&utm_medium=email&utm_source=govdelivery.
• This rulemaking adopts a new rule, WAC 296-15-232, which creates standardized medical bill reporting expectations for self-insured employers, to support the collection of quality data, and to create a reporting exemption for qualifying employers. This rulemaking ensures: self-insured employers are required to report medical bills through the medical bill electronic data interchange (EDI); self-insured employers are required to report bills accurately and timely; and under limited circumstances, self-insured employers can be provided an exception, which means that they are exempt from reporting. Standardized reporting will build data integrity, improve industry bench marking, and inform and support policy conversations and decisions. The changes were adopted 8/20/2019 and will be effective on 1/1/2020.To view the adoption order and the adopted rule, go to http://www.lni.wa.gov/LawRule/WhatsNew/Proposed/default.asp?RuleID=263.

West Virginia VIEW STATE →

REGULATORY ACTIVITY:

• Published workers' compensation assigned risk rates by class effective November 1, 2019.  To view the publication, go to https://www.wvinsurance.gov/Workers-Compensation.

West-Virginia-Auto VIEW STATE →

LEGISLATIVE ACTIONS:

Posted a notice to all insurance carriers doing business in West Virginia. The  West  Virginia  Offices  of the  Insurance  Commissioner (OIC)  has  become  aware  of an  influx of property damage  claims due  to  recent  instances  of  severe  weather  in  our state  during the  spring and  summer.  The  purpose of this  Notice is  to  provide  continued  guidance  from  the  OIC  regarding the  handling of total  and  partial  loss  claims.  One  of the  central  purposes of West Virginia's  Unfair  Claims  Settlement Practices Act is to  assure timely action on  claims and require  insurers  to  have  meaningful  communication with  claimants  so they  are  kept  apprised  of  the  status  of their  claims.  Pursuant to W.Va.  Code§ 33-11-4(9), "[n]o person  shall  commit or  perform  with  such  frequency as  to  indicate a general business  practice  any of  the  following:  ...  (b)  [f]ailing  to  acknowledge  and  act  reasonably  promptly  upon communications with  respect to  claims  arising under  insurance  policies,  (c)  [f]ailing to  adopt  and implement  reasonable  standards  for  the  prompt  investigation  of  claims  arising  under  insurance policies."  To view a copy of the notice, go to https://www.wvinsurance.gov/

Wisconsin VIEW STATE →

LEGISLATIVE ACTIONS:

Assembly Bill 56 The enacted legislation is the overall state budget bill however in the bill it transfers workers’ compensation claims adjudicatory functions of DHA to the Division of Workforce Development.  Effective Date January 1, 2020.