Alaska VIEW STATE →

REGULATORY ACTIVITY:

• Published regulatory order number 19-04 regarding approval with modification of the 2020 workers’ compensation loss cost filing and assigned risk rate filing.  To view the order, go to  https://www.commerce.alaska.gov/web/ins/Resources/Orders/Regulatory.aspx.
• Published Bulletin No. 19-05 which contains Workers' Compensation Board's List of Second Independent Medical Examiners in accordance with AS 23.30.095(k) and 8AAC 45.092. To view the bulletin, go to http://www.labor.alaska.gov/wc/bulletins.htm

Arkansas VIEW STATE →

REGULATORY ACTIVITY:

• The Commission issued an update to Advisory 2000-1 Revised, announcing that the maximum rates for 2020 will be $711.00 for Total Disability and $533.00 for Permanent Partial Disability. To view the advisory, go to http://www.awcc.state.ar.us/news.html.
• The Commission also announced that the threshold for the Death and Permanent Total Disability Fund will no longer be updated in Advisory 2007-1. Act 5 of the Third Extraordinary Session of 2016 provides that no claims shall be made to the Death and Permanent Disability Trust Fund after June 30, 2019.

California VIEW STATE →

FEE SCHEDULE NEWS:

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

REGULATORY ACTIVITY:

• The Division of Workers’ Compensation (DWC) held a meeting of the Pharmacy and Therapeutics (P&T) Committee on Wednesday, November 20 from 12:30 to 2:30 p.m. in the Elihu M. Harris State Building, conference room #1 on the second floor, 1515 Clay Street in Oakland. The meeting was open to the public.  The Pharmacy and Therapeutics Committee was established by Assembly Bill No. 1124 (2015) as an advisory body that will consult with the DWC Administrative Director on updates to the Medical Treatment Utilization Schedule (MTUS) drug formulary. The meeting agenda and related materials are posted on the DWC P&T Committee web page https://www.dir.ca.gov/dwc/MTUS/MTUS-Pharmacy-and-Therapeutics-Committee.html. 
• Claims administrators are reminded that the annual report of inventory (ARI) must be submitted in early 2020 for claims reported in calendar year 2019. The California Code of Regulations, title 8, Section 10104 requires claims administrators to file, by April 1 of each year, an annual report of inventory (ARI) with the DWC administrative director indicating the number of claims reported at each adjusting location for the preceding calendar year. Even if no claims were reported in the prior year, the report must be completed and submitted to the DWC Audit Unit. Each adjusting location is required to submit an ARI unless its requirement has been waived by the DWC administrative director. When ARI requirements are waived, claims administrators must file an annual report of adjusting locations. This report is to be filed annually on April 1 of each calendar year for the adjusting location operations as of December 31 of the prior year.  Claims administrators are required to report any change in the information reported in the ARI or annual report of adjusting location within 45 days of the effective date of the change. Penalties of up to $500 per location for failure to timely file this Report of Inventory may be assessed under Title 8, California Code of Regulations, Section 10111.1(b) (11) or 10111.2(b) (26).  The form for 2020 can be found on https://www.dir.ca.gov/dwc/audit.html.  Questions about submission of the ARI or the annual report of adjusting locations may be directed to the Audit Unit: State of California Department of Industrial Relations Division of Workers’ Compensation – Audit Unit 160 Promenade Circle, Suite #340   Sacramento, CA 95834-2962. Email: DWCAuditUnit@dir.ca.gov, FAX 928.3183 or phone 916.928.3180.
• The Department of Industrial Relations (DIR) and its Division of Workers’ Compensation (DWC) have posted a progress report on the Department’s Independent Medical Review (IMR) program. IMR is the medical dispute resolution process for the state’s workers’ compensation system that uses medical expertise to obtain consistent, evidence-based decisions.  The report describes IMR program activity in 2018, the sixth year since the program was implemented. The Independent Medical Review Organization administering the program, Maximus Federal Services, Inc., received over 250,000 IMR applications, and issued almost 185,000 Final Determination Letters, each containing one or more medical necessity dispute.  To view this notice and report, go to https://www.dir.ca.gov/dwc/dwc_home_page.htm. 
• The Division of Workers’ Compensation (DWC) is providing an update on the development of amendments to the Medical-Legal Fee Schedule. The division is close to finalizing the fee schedule and intends to begin the regular rulemaking process by the end of the year and will hold a public hearing in early 2020. The development of the draft amendments included comprehensive review by academic stakeholders as well as those who work in and utilize California’s workers’ compensation system. The division posted proposed amendments in May 2018 and after soliciting proposals and obtaining feedback from the industry, posted a revised proposal last August incorporating input from stakeholders including medical providers, public and private employers, attorneys, insurance carriers, advocates and policymakers. The division continues to meet with stakeholders as it refines its proposed amendments and fixed fee schedule to improve the quality of medical reports, eliminate complexity factors and increase fees for medical-legal testimony. Updates on the proposed regulation including information on the public hearing will be posted on https://www.dir.ca.gov/dwc/rulemaking/dwc_rulemaking_proposed.html in the future.
• The Division of Workers’ Compensation’s (DWC) Audit and Enforcement Unit conducts a profile audit review (PAR) for all adjusting locations of California workers’ compensation claims at least once every five years, per the requirements of Labor Code sections 129 and 129.5.  Performance of the adjusting locations is measured in five areas of claims administration:
  • The payment of accrued and undisputed indemnity
  • The late first payment of temporary disability / first notice of salary continuation
  • The late first payment of permanent disability and death benefits
  • The late subsequent indemnity payments
  • The provision of notices with Qualified Medical Evaluator/Agreed Medical Evaluator advice. 

DWC annually establishes profile audit review and full compliance audit (FCA) standards in accordance with Labor Code sections 129(b)(1) and (2) and California Code of Regulations, title 8 (8 C.C.R.), section 10107.1. The 2020 standards are based on the audit results of calendar years 2016 through 2018. The PAR performance standard for audits conducted in 2020 is 1.32020. Audit subjects with PAR performance ratings of 1.32020 or lower will be required to pay any unpaid compensation, but no administrative penalties will be assessed. If an audit subject’s PAR performance rating is 1.32021 or higher, the audit will expand to a FCA, and an additional sample of indemnity claims will be audited. The FCA performance standard for audits conducted in 2020 is 1.60183. Audit subjects with an FCA performance rating of 1.60183 or less will be required to pay any unpaid compensation and administrative penalties will be assessed for all violations involving unpaid and late paid compensation. If an audit subject’s full compliance audit performance rating is 1.60184 or higher, an additional sample of denied claims as well as the expanded sample of indemnity claims will be audited. Penalties will be assessed for all violations as appropriate pursuant to 8 C.C.R. sections 10111 through 10111.2. The Severity Rate standard for 2020 is $108.11. More information on the performance standards that will be in use for the profile audit reviews and full compliance audits during calendar year 2020 will be posted on the DWC Audit and Enforcement Unit web page.  To view this notice, go to https://www.dir.ca.gov/dwc/dwc_home_page.htm.  For additional information regarding the audit, go to https://www.dir.ca.gov/dwc/audit.html.

Colorado VIEW STATE →

FEE SCHEDULE NEWS:

• A new version of the Medical and Hospital Fee Schedule effective 1/1/2020 has been released. The next expected fee schedule is in January 2021.
• Posted notice of adoption of Rule 16 Utilization Standards and Rule 18 Medical Fee Schedule.  Both of the adopted rules become effective January 1, 2020.  To view the adopted rules, go to https://www.colorado.gov/pacific/cdle/workers-compensation-proposed-and-adopted-rules.

REGULATORY ACTIVITY:

• Posted notice of adoption of Rule 5 Claims Adjusting Requirements in the November 10, 2019 Edition of the state register.  The adopted rules become effective November 30, 2019.  To view the adopted rule, go to https://www.sos.state.co.us/CCR/RegisterContents.do?publicationDay=11/10/2019&Volume=42&yearPublishNumber=21&Month=11&Year=2019.
• Has published a list for Level I Accredited Physician Assistants and Nurse Practitioners. To view the posting, go to https://www.colorado.gov/pacific/cdle/fee-schedule-rule-18. The list is updated on the 1st and 15th of each month.

Colorado Auto VIEW STATE →

REGULATORY ACTIVITY:

• Posted a copy rule 5-2-3 concerning Requests for Commercial or Personal Automobile Policy Information from A Complainant or Complainant's Attorney. The adopted rule can be viewed at https://www.colorado.gov/pacific/dora/regulations-adopted-not-yet-effective. The rule becomes effective on January 1, 2020.
• Posted a copy of rule 5-2-12 concerning Automobile Insurance Consumer Protections.  The adopted rule can be viewed at https://www.colorado.gov/pacific/dora/regulations-adopted-not-yet-effective.  The rule becomes effective on January 1, 2020
• Issued Bulletin Number B-5.26 regarding requirements related to Disputed Claims Subject to Appraisal.  The bulletin was issued for informal public comments. Comments must be received by December 2, 2019.  The bulletin is expected to become effective on January 1, 2020.  To view the bulletin, go to  https://www.colorado.gov/pacific/dora/draft-bulletins-informal-public-comment.

Florida WC VIEW STATE →

REGULATORY ACTIVITY:

• The Department proposes the development of rule amendments to clarify requirements and procedures for resolution of medical reimbursement disputes by the Florida Department of Financial Services pursuant to section 440.13(7) (e). To view the proposed rule, go to https://www.flrules.org/gateway/ruleNo.asp?id=69L-31.002.

Georgia VIEW STATE →

REGULATORY ACTIVITY:

• A tentative rollout date of November 30, 2019 has been scheduled for “Track Policy.”  This new coverage verification enhancement system will allow users to be notified by email if a cancellation or subsequent reinstatement transaction is received for a chosen insurance policy.  There will be no charge to the user for utilizing the system. More information will be forthcoming.

Idaho VIEW STATE →

REGULATORY ACTIVITY:

• Updated the Judicial Rules of Practice under the Idaho Workers' Compensation Law. The updated rules became effective October 9, 2019.  To view the rules, go to https://iic.idaho.gov/.
• Published the draft minutes of the August 14, 2019 meeting of the Workers' Compensation Advisory Committee.  To view the draft minutes, go to https://iic.idaho.gov/.
• Posted notice in the state register of adoption of Rules 17.10.01 Administrative Rules under Crime the Victims Compensation Act and 17.11.01 Administrative Rules of Peace Officer and Detention Officer Temporary Disability Act.  The rules are now pending review by the 2020 Idaho State Legislature for final approval.

Illinois VIEW STATE →

FEE SCHEDULE NEWS:

• The state has posted an update to the Trauma Centers by Region with an effective date of 11/04/2019.

REGULATORY ACTIVITY:

• On October 29, 2019, a Chapter 11 Voluntary Petition for Bankruptcy was filed in the matter of Murray Energy Holdings Co., et al, Case No. 19-56885 (JEH) pending in the United States Bankruptcy Court for the Southern District of Ohio Western Division.  Please consult the Docket of this case for information.  Of note is the entry of an Order on October 31, 2019 granting certain relief from the Automatic Stay in Bankruptcy (particularly paragraph 7 on page 4 addressing Workers' Compensation Claims). To view the notice, go to https://www2.illinois.gov/sites/iwcc/Pages/default.aspx.  To view a copy of the order, go to https://www2.illinois.gov/sites/iwcc/resources/Pages/BankruptcyNotices.aspx.

Indiana VIEW STATE →

REGULATORY ACTIVITY:

• Published the 2019 Second Injury Fund Status Report.  To view the report, go to https://www.in.gov/wcb/2343.htm.
• EDI 3.1 Demystified Webinar/Seminar for Attorneys/Adjusters was held on Thursday, November 21st from 1 pm - 3 pm EST. This was an overview of FROI/SROI reporting as well as a review of common Indiana EDI filing issues and changes.

Kentucky VIEW STATE →

REGULATORY ACTIVITY:

• A public hearing was to be held in the Oscar Morgan Conference Room at the Department of Workers’ Claims, 657 Chamberlin Avenue, Frankfort, Kentucky, on November 21, 2019, at 10:00 a.m. ET to receive comment regarding the medical treatment guideline regulation,  803 KAR 25:260.
• Posted the discount rate order and tables.  The order and tables are effective for the calendar year 2020.  To view the order, go to https://labor.ky.gov/comp/Pages/default.aspx.
• Pursuant to KRS 342.265(3), upon lump-sum settlement of future periodic payments, the discount rate used in the calculation of the settlement amount shall be fixed by the commissioner. Before January 1   of each year,  the commissioner shall fix the discount rate to be used in the succeeding calendar year based at one-half of  one percent (0.5%)  below the interest rate paid upon ten (10) year United States Treasury Notes as of August 1 of the preceding year.   However, upon lump-sum settlement of future periodic  payments in weekly amounts that are forty dollars ($40) or less, the commissioner shall fix the discount rate used in the succeeding calendar year based at the interest rate paid upon ten (10) year United States Treasury Notes as of August 1   of the preceding year. Accordingly, for the calendar year 2020, the discount rate for lump-sum settlements  of  future  periodic  payments  in  weekly  amounts  that  are  forty  dollars ($40.00) or less, is fixed at one and five-eighths  percent (1.625%). The discount rate for lump-sum settlements of future periodic payments in weekly amounts greater than forty dollars ($40.00) is fixed at one and one-eighth percent (1.125%). To view the order, go to https://labor.ky.gov/comp/Pages/default.aspx.

Maryland VIEW STATE →

FEE SCHEDULE NEWS:

• The state has adopted new specific Conversion Factors/Percentage Multiplier information for the fee schedule effective January 1, 2020.

REGULATORY ACTIVITY:

• The Department of Labor, Licensing and Regulation of the State of Maryland has advised this Commission that the Average Weekly Wage of workers covered by Maryland Unemployment for the fiscal year ending June 30, 2019 is $1,080.00.  The Calendar Year 2020 Maryland Workers' Compensation Commission Maximum Rate of Benefits PDF is posted at http://www.wcc.state.md.us/Adjud_Claims/Comp_Rates.html.
• The Commission's Fiscal Year 2019 Annual Report is available.  To view the report, go to http://www.wcc.state.md.us/.

Massachusetts VIEW STATE →

REGULATORY ACTIVITY:

• Posted notice of the December 2019 Meeting of the Health Care Services Board to be held on December 7, 2019 at 9:30a.m. to 12:00 p.m. at Lafayette City Center, 2 Avenue de Lafayettee, Boston Massachusetts. The Health Care Services Board (HCSB) will convene at 9:30 AM.  The Board will vote on the minutes of previous meeting and review the Neck and Back Treatment Guideline draft.  The Department of Public Health, Occupational Health Surveillance Program representative will present the findings from the recently completed study. The HCSB Treatment Guideline Subcommittee will meet prior to the full Board meeting at 8:00 AM to review and discuss the most recent draft of the Neck and Back Treatment Guideline. To view the notice, go to https://www.mass.gov/event/health-care-services-board-december-2019-meeting-2019-12-07t093000-0500-2019-12-07t120000.

Medicare VIEW STATE →

FEE SCHEDULE NEWS:

• Physician – CMS has released the new 2020 1^st Quarter Physician data set effective January 1, 2020.
• ASP Drugs - CMS has released the new 2020 ASP Drugs, 1^st Quarter, effective January 1, 2020 and reposted the January, April and July 2019 ASP Drug files.
• CCI and MUE Edits – CMS has released the new 2020 1^st Quarter CCI and MUE data code sets with an effective date of January 1, 2020.

Michigan Auto VIEW STATE →

REGULATORY ACTIVITY:

• Posted bulletin 2019-24-INS regarding choice of bodily injury liability coverage limits form and personal injury protection choice forms.  To view the bulletin, go to https://www.michigan.gov/difs/0,5269,7-303-12900_12906---,00.html
• Published bulletin 2019-25-INS regarding catastrophic claims association reporting. The bulletin was published on November 21, 2019.  The bulletin supersedes Bulletin 2007-04-INS which is also rescinded.  To view the bulletin, go to https://www.michigan.gov/difs/0,5269,7-303-12900_12906---,00.html.

Minnesota VIEW STATE →

REGULATORY ACTIVITY:

• Expedited rules for treatment of post-traumatic stress disorder (PTSD); Minnesota Rules part 5221.6700: 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. DLI published notice of the proposed expedited 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. The comment period for these rules ends at 4:30 p.m. on Thursday, Dec. 12, 2019. 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. The proposed rules were published in the State Register on Nov. 12, 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. Requests for hearing must be made in writing to the agency contact person below by 4:30 p.m. on Thursday, Dec. 12, 2019. To view this notice, go to http://www.dli.mn.gov/about-department/rulemaking/rulemaking-docket-minnesota-rules-chapter-52216700-2019.

Missouri VIEW STATE →

REGULATORY ACTIVITY:

• Published notice of Workers'  Compensation Administrative Tax,  Administrative Surcharge,  Second  Injury  Fund Surcharge, and  Second Injury  Fund  Supplemental Surcharge for  the  2020 Calendar Year Rates.  The notice was published on October 31, 2019.  The rates for 2020 are Administrative Tax (authorized under Sec. 690) - 1.0 percent; Administrative Surcharge (authorized under Sec. 287.716) - 1.0 percent, Second Injury Fund Surcharge (authorized under Sec. 287.715) - 3.0 percent, and Second Injury Fund Supplemental Surcharge (authorized under Sec. 287.715.6) - 2.0 percent.  If you have questions or need additional information, contact the Division of Workers' Compensation at 800-775-2667 or the Missouri Department of Commerce and Insurance at 800-394-0964.  To view the notice, go to https://labor.mo.gov/DWC/notices.

Montana VIEW STATE →

REGULATORY ACTIVITY:

• Posted notice of hearing for the drug formulary. The hearing will be held in conference rooms A and B Beck Building 1805 Prospect Avenue, Helena, MT. To view the notice, go to http://erd.dli.mt.gov/.

Nebraska VIEW STATE →

REGULATORY ACTIVITY:

• Posted proposed amendments to workers' compensation rules.  The rules proposed to be amended are Rule 2, 26, 29, 30 and 47 also amend addendum 2 and addendum 3.  A copy of the proposed rules can be viewed at https://www.wcc.ne.gov/home/public-hearings-and-public-meetings/proposed-rule-amendments.
• Effective January 1, 2020, the maximum weekly income benefit under the Nebraska Workers’ Compensation Act will increase to $882.00. This amount applies to work-related injuries and illnesses occurring on or after January 1, 2020.  To view this notice, go to https://www.wcc.ne.gov/legal-practice-statutes-and-rules/benefit-rates/benefits-news-release.

Nevada VIEW STATE →

REGULATORY ACTIVITY:

• The Administrator of the Division of Industrial Relations has revised D-1 Information Form, effective November 1, 2019 required by SB 493 and NAC 616A.4.
• Posted a notice to insurers and TPAs regarding legislation enacted impacting COLA adjustments.  To view the notice, go to http://dir.nv.gov/WCS/Home/.

New Mexico VIEW STATE →

REGULATORY ACTIVITY:

• The New Mexico Workers' Compensation Administration is soliciting competitive sealed proposals for case management services. This request for proposals (RFP) will be issued on October 31, 2019. Sealed proposals must be received by the WCA procurement manager no later than 3 p.m. MST/MDT on December 6, 2019. Any proposal received after this date and time will be returned unopened. All proposals must be clearly marked RFP #20-632-PS-00443 on the sealed box, envelopes or packages containing all proposal binders. The proposer shall assume full responsibility for the timely hand delivery (no electronic submissions) of the proposal. Any proposal not clearly marked RFP # 20-632-PS-00443 will be disqualified. The proposals can be hand delivered to: New Mexico Workers' Compensation Administration, Attn: Mark Brannen, 2410 Centre Avenue SE, Albuquerque, NM 87106.
• The NMWCA Albuquerque office will NOT hold its regular Lump Sum Tuesday event on the following dates: November 26, December 24 or December 3.

New York VIEW STATE →

FEE SCHEDULE NEWS:

• A new change in reimbursement rates for Inpatient Psychiatric Exempt Unit Services retroactive to July 1, 2018 has been adopted by the state of New York.
• New reimbursement rates for Acute per Case Inpatient Hospital Rates, Exempt Hospitals, Exempt Units and Detoxification Inpatient rates have been adopted by the state of New York with an effective date of January 1, 2019.

REGULATORY ACTIVITY:

• Published bulletin subject number 046-1223 announcing the 2020 Assessment Rate. Pursuant to WCL §151, the Chair of the Workers' Compensation Board shall annually establish an assessment rate for all employers by November 1 of each year, to be effective January 1 of the subsequent calendar year. For calendar year 2020, the rate shall be 12.2% of the standard premium or premium equivalent. To view the bulletin, go to http://www.wcb.ny.gov/content/main/SubjectNos/subjectNos.jsp.
• Published bulletin subject number 046-1224 adopting amendments to 12 NYCRR 317.20. The Chair has adopted the amendment of Section 317.20 of 12 NYCRR to provide assistance with inactive but not insolvent group self-insured trusts to purchase assumption of liability policies (ALPs) to wind down liabilities. The Notice of Proposed Rule Making was published in the May 29, 2019 edition of the State Register. The amendments were effective upon publication of the Notice of Adoption in the October 30, 2019 edition of the State Register. To view the bulletin, go to http://www.wcb.ny.gov/content/main/SubjectNos/subjectNos.jsp.
• The Chair has adopted on an emergency basis an amendment to 12 NYCRR 441.2, and proposed the amendment to 12 NYCRR 441.2 to create Special Consideration #4 for the New York Workers’ Compensation Formulary (NY WC Formulary) that provides for prescription and dispensing of formulary drugs when there is no New York Workers’ Compensation Medical Treatment Guideline (NY WC MTG), or for a condition directly associated with an established/accepted body part, but not specifically addressed in the NY WC MTG. There are also several changes to the drugs included in the NY WC Formulary. For a specific description as to what has changed, go to NY WC Formulary Changes. A Notice of Emergency Adoption and Proposed Rulemaking will be published in the November 20, 2019, edition of the State Register. This emergency rulemaking will be effective for 90 days from its filing on November 5, 2019. Comments on the proposal will be accepted for 60 days after publication. Please submit comments by emailing regulations@wcb.ny.gov.  To view the information, go to http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1227.jsp.
• Published bulletin subject number 046-1226 on November 7th.  On November 6, 2019, the New York State Workers' Compensation Board released proposed amendments to sections 300.19, 325-1.24, 325-1.25, 440.8 and 442.3 to incorporate the 2019 changes of the Workers' Compensation Law (WCL) section 13-g into the existing regulations. Public comments will be accepted for 60 days through January 6, 2020 and may be sent to regulations@wcb.ny.gov. To view a copy of the bulletin, go to wcb.ny.gov/content/main/SubjectNos/sn046_1226.jsp.
• The New York Workers’ Compensation Board Drug Formulary (NY WC Formulary) becomes effective on December 5, 2019 for all new prescriptions. Starting that day, all new prescriptions for injured workers in New York State must be listed within the NY WC Formulary unless an alternative medication has been approved through the NYS Workers’ Compensation Board’s new prior authorization process. The new electronic prior authorization process will soon be available through the Board’s Medical Portal; please watch for the notification. Please visit the Board’s Drug Formulary Overview webpage for:
  • An overview of the NY WC Formulary and the prior authorization process;
  • The latest version of the NY WC Formulary (effective 11/5/19);
  • A video overview for Medical Providers;
  • A Quick Guide to the NY WC Formulary; and
  • An NY WC Formulary Dashboard Guide for Medical Providers.

Information and resources related to requesting prior authorization through the Board's Medical Portal can be found on the Board’s Medical Portal Overview webpage http://www.wcb.ny.gov/content/main/hcpp/DrugFormulary/overview.jsp.

• Pursuant to WCL §151, the Chair of the Workers' Compensation Board shall annually establish an assessment rate for all employers by November 1 of each year, to be effective January 1 of the subsequent calendar year. For calendar year 2020, the rate shall be 12.2% of the standard premium or premium equivalent. Please contact the Workers’ Compensation Board by email at: WCBFinanceOffice@wcb.ny.gov with any questions on the assessment rate.

Oklahoma VIEW STATE →

REGULATORY ACTIVITY:

• Oklahoma Workers’ Compensation Commission (WCC): The Commissioners of the WCC have hired Lauren Hammonds Johnson as the agency’s new General Counsel effective November 1st, 2019. The General Counsel will work directly under Commissioners Mark Liotta, Jordan Russell and Megan Tilly.

South Carolina VIEW STATE →

REGULATORY ACTIVITY:

• Published the full agenda for the commission meeting on November 18, 2019.  To view the notice and agenda, go to https://wcc.sc.gov/news/2019-11/full-commission-business-meeting-agenda-november-18-2019.

Tennessee VIEW STATE →

REGULATORY ACTIVITY:

• Posted notice that the Medical Advisory Committee will meet on January 28, 2020 from 1:00 p.m. to 3:00p.m. central standard time.  The meeting is being held in the Tennessee Room First Floor Side A at 220 French Landing Drive, Nashville, TN.

Texas VIEW STATE →

FEE SCHEDULE NEWS:

• New Medical Fee Guideline conversion factors have been adopted with an effective date of January 1, 2020. For services provided in calendar year 2020, the new Medical Fee Guideline conversion factors are $60.32 and $75.70. The conversion factor of $60.32 applies to service categories of evaluation and management, general medicine, physical medicine and rehabilitation, radiology, pathology, anesthesia, and surgery when performed in an office setting. The conversion factor of $75.70 applies to surgery when performed in a facility setting.

REGULATORY ACTIVITY:

• The Texas Department of Insurance, Division of Workers’ Compensation (DWC) seeks input for the 2020 Medical Quality Review Annual Audit Plan; specifically, input regarding the proposal for categories within the annual plan.  The annual plan sets the priorities for the Medical Quality Review Panel (MQRP) audits during the upcoming year. This includes the scope, methodology, selection criteria, and program area responsibilities described in the Medical Quality Review Process. Information about the process and the proposed annual plan is on the TDI website at tdi.texas.gov/wc/hcprovider/medadvisor.html.   The medical advisor is responsible for developing the annual plan, which is adopted by the commissioner of workers’ compensation. The medical advisor evaluates annual plan suggestions using the following criteria:
  • Does it relate to the responsibility of the medical advisor or the MQRP under Texas Labor Code §§413.0511 and 413.0512? (e.g., the quality of health care provided by doctors or other health care providers treating injured employees; or the quality and timeliness of decisions made by utilization review agents, insurance carriers, designated doctors, or independent review organizations).
  • Is the data to select audit participants available to DWC, or is it easily obtained and reasonable to complete the audit?
  • Does DWC have enough resources to complete the audit within the calendar year?

You can submit suggestions for this proposed annual plan by email to OMA@tdi.texas.gov by 5 p.m., Central time on Friday, December 6, 2019.

• The Texas Department of Insurance, Division of Workers’ Compensation (DWC) has adopted a new form: DWC Form-029, Request for Standard Detailed Data Reports, effective November 4, 2019. DWC posted the draft DWC Form-029 online on August 23 and did not receive any comments. 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 through a secure file transfer protocol (SFTP) box. The reports provide the detail related to the insurance carrier performance scorecards for:
  • timely payment of initial temporary income benefits and EDI reporting;
  • timely processing of medical bills and EDI reporting; and
  • timely processing of reconsideration medical bills and EDI reporting.

Requests for standard detailed data reports through DWC’s open records portal will continue to be accepted until Monday, December 2, at which time requestors will be directed to use the new form and SFTP process.   To view this notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.  To view the form, go to https://www.tdi.texas.gov/forms/form20numeric.html.

• The Texas Department of Insurance, Division of Workers’ Compensation is asking for input on the 2020 Insurance Carrier PBO Assessment and the 2021 Health Care Provider PBO Assessment.  The methodology papers set the measures, scope, selection, tier structure, placement, and assessment process. Copies of the proposed 2020 and 2021 PBO Assessment methodology papers are on the TDI website.
• The Texas Department of Insurance, Division of Workers’ Compensation (DWC) is accepting comments on proposed amendments to 28 Texas Administrative Code (TAC) §129.5 to implement House Bill (HB) 387, 86th Legislature. HB 387 amends Texas Labor Code §408.025(a-1) to include licensed advanced practice registered nurses as the persons to whom a treating doctor may delegate the authority to complete, sign, and file a work status report (DWC Form-073) and became effective September 1, 2019.  Proposed 28 TAC §129.5 will:
  • conform DWC rules to HB 387, allowing a treating doctor to delegate authority to complete, sign, and file a work status report to a licensed advanced practice registered nurse;
  • provide that the delegating treating doctor is responsible for the acts of the licensed  advanced practice registered nurse under Labor Code §408.025(a-1) and Texas Occupations Code Chapter 301, Nurses; and
  • provide that the delegating treating doctor is responsible for the acts of the licensed  advanced practice registered nurse under Labor Code §408.025(a-1) and Texas Occupations Code Chapter 301, Nurses; and
  • include minor updates and editorial corrections.

The proposed rule was published in the October 11, 2019, issue of the Texas Register at 44 TexReg 5878 and is available at www.sos.state.tx.us/texreg/index.shtml.  A courtesy copy is also on the TDI website.  Written comments or public hearing requests may be submitted to RuleComments@tdi.texas.gov, or by mailing or delivering your comments to:  Cynthia Guillen, Office of the General Counsel, MS-4D Texas Department of Insurance, Division of Workers' Compensation, 7551 Metro Center Drive, Suite 100, Austin, Texas 78744-1645.  DWC has extended the public comment period for the proposed rules. Comments must be received by 5 p.m., Central time, on Monday, December 23, 2019.  Any requests for a public hearing must be submitted by the comment deadline.  In conjunction with the proposed rule, Commissioner Brown has finalized revisions to DWC Form-073, Work Status Report. The revised DWC Form-073 includes a new box to allow licensed advanced practice registered nurses to complete and sign the form. DWC encourages system participants to continue accepting the prior DWC Form-073 through the end of the calendar year to allow doctors, licensed physician assistants, and licensed advanced practice registered nurses time to transition to the updated form.   To view this notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html. To view the rule, go to  https://www.tdi.texas.gov/wc/rules/2019rules.html.

• The Texas Department of Insurance, Division of Workers’ Compensation is accepting comments on the proposed Fiscal Year 2020 Research Agenda of the Workers’ Compensation Research and Evaluation Group (REG).  Comments or public hearing requests must be received in writing no later than 5 p.m., Central time, December 30, 2019.  Comments  may be submitted  by email to RuleComments@tdi.texas.gov, or by mail to:  Cynthia Guillen Office of the General Counsel, MS-4D Texas Department of Insurance, Division of Workers' Compensation 7551 Metro Center Drive, Suite 100, Austin, Texas 78744-1645  The proposed agenda was published in the November 29, 2019, issue of the Texas Register and is available at sos.state.tx.us/texreg/index.shtml once published.  Copies of the proposed research agenda are at https://www.tdi.texas.gov/reports/wcreg/index.html#wcresearch.  To view the notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.
• The Texas Department of Insurance, Division of Workers’ Compensation (DWC) is adopting rules to implement Senate Bill (SB) 935, 86th Legislature.   The rules establish requirements for processing medical bills for services provided to an injured employee by a federal military treatment facility (FMTF), as well as a separate medical dispute resolution process designed to address disputes over charges billed by FMTFs. The change in law made by SB 935 applies to health care services provided to an injured employee on or after January 1, 2020, regardless of the date of injury.   Rule 134.150. Reimbursement of Services Provided by a Federal Military Treatment Facility:
  • Establishes applicability of rules in subsections (a)-(b).
  • Clarifies bill processing requirements in subsection (c)-(d).
  • Clarifies that an insurance carrier may only deny a medical bill based on medical necessity, compensability, extent of injury, or liability in subsection (e).
  • Requires carriers to report the first bill received from an FMTF to DWC.
  • Clarifies that unreported bills are subject to a request for information under Rule 102.9 in subsection (g).

Rule 134.155. Federal Military Treatment Facility Disputes:

• Provides that disputes for medical necessity will be adjudicated under Rule 133.308, except that an injured employee may initiate a dispute,  may request reconsideration,  and the insurance carrier will be responsible for all independent review organization fees in subsection (a)(1).
• Provides that all other disputes will be handled under the existing process for benefit review conferences in subsection (a) (2).
• Notes that a first responder may request expedited dispute resolution in subsection (c).

The adopted rules will be published in the December 6, 2019, issue of the Texas Register and will be available at www.sos.state.tx.us/texreg/index.shtml  once published. A courtesy copy is on the TDI website.  As required under Rule 134.150 (f), insurance carriers are required to report the first bill received from an FMTF to DWC. Instructions about where to submit the first bill can be found on the TDI website.

Texas Auto VIEW STATE →

REGULATORY ACTIVITY:

• Issued bulletin B-0012-19 regarding Texas Automobile Insurance Association Rates. The Commissioner of Insurance has approved changes in the rates for private passenger and commercial automobile insurance for the Texas Automobile Insurance Plan Association (TAIPA). The changes are effective March 1, 2020, for new and renewal business by Commissioner’s Order No. 2019-6138. The new rates represent an overall increase of 4.9% in private passenger automobile rates and an overall increase of 4.8% in commercial automobile rates.  Specifically, for private passenger automobile insurance, the new rates represent increases of 5.0% for bodily injury liability, 4.9% for property damage liability, 4.0% for personal injury protection, 4.3% for uninsured/underinsured motorist bodily injury liability, and 1.7% for uninsured/underinsured motorist property damage liability.  For commercial automobile insurance, the new rates represent increases of 4.8% for bodily injury liability, 5.0% for property damage liability, 1.3% for personal injury protection, 3.6% for uninsured/underinsured motorist bodily injury liability, and 3.2% for uninsured/underinsured motorist property damage liability rates.  For questions about this bulletin, contact the Property and Casualty Actuarial Office by phone at 512-676-6700 or by email at pcactuarial@tdi.texas.gov.  To view the bulletin, go to https://www.tdi.texas.gov/bulletins/index.html. 
• Issued Commissioner's Bulletin Number B-0014-19 regarding disallowed expensed data call for calendar year 2018 experience.  The Texas Department of Insurance (TDI) issues the attached mandatory data call under Insurance Code Chapter 2251, Subchapters A and B. This call collects information about "disallowed expenses," which are defined in Insurance Code Section 2251.002(1-a). This data call applies to licensed companies that wrote premium in 2018 for any of the following lines of insurance in Texas: fire, allied lines, private crop, farm owners’ multiple peril, homeowners’ multiple peril, commercial multiple peril, inland marine, medical malpractice, other general liability, product liability, private passenger automobile, commercial automobile, fidelity, or surety. You must complete and return this data in accordance with the general instructions no later than January 31, 2020. TDI requests you keep all underlying data, individual source documents, and any information used to develop your data call response for a minimum of two years after your submission to TDI.  To view the bulletin, go to https://www.tdi.texas.gov/bulletins/index.html. 

Utah WC VIEW STATE →

REGULATORY ACTIVITY:

• Posted notice in the November 15th issue of the state's bulletin of amendments to three rules: Rule R590-267 PIP Relative Values; R612-300 Medical Care and R612-400-5 WC Insurance Premiums.  The projected effective date for all three of the rules is December 23, 2019.
• R590-267 updates the conversion factors and publications for use in 2020 and 2021 with respect to personal injury protection services. This change adds conversion factors and publications for physicians, dentists, and  chiropractors to use when determining the reasonable value of services provided to patients on or after January 1, 2020 and removes the factors and publications that were to be used from 2016 through 2017.
• R612-300 - The purpose of this amendment is to adopt, with modifications, the Optum 2019   Essential   Resource-Based Relative Value Schedule (RBRVS), 2019 1st Quarter Update, and to adjust the conversion factors regarding certain medical specialties. The amendment incorporates by reference current versions of the RBRVS and adjusts certain conversion factors related to anesthesiology from $62 to $68 and other surgery from $43 to $53 per unit.
• R612-400-5 - Workers' compensation insurance premiums in Utah include assessments to fund the   Employer's Reinsurance Fund (ERF) and the Uninsured Employers' Fund (UEF).  These assessment rates are reviewed annually, and amended as appropriate, in order to ensure the funds, remain viable and are fully funded. These proposed changes establish these assessment rates for the 2020 calendar year.

Virginia VIEW STATE →

FEE SCHEDULE NEWS:

• Posted notice in the state register that the Virginia Workers' Compensation Commission has finalized the regulation adopting a new fee schedule for 2020.  The regulation becomes effective December 25, 2019.  The fee schedule is effective from January 1, 2020 through December 31, 2021.  To view the notice in the register, go to http://register.dls.virginia.gov/toc.aspx?voliss=36:07.

REGULATORY ACTIVITY:

• Published administrative insurance order 12089 regarding approval of  NCCI Item Filing E-1406 Revisions to the ERM-14 Form and Rule 3-A in the Experience Rating Plan Manual for use with policies effective on or after 2/01/2020. This item filing also revises rule 3 A, to reflect the ERM-14 form's revised title. To view the order, go to https://www.scc.virginia.gov/boi/adminords/2019.aspx.

West Virginia VIEW STATE →

REGULATORY ACTIVITY:

• On Monday, November 18, 2019, the West Virginia Offices of the Insurance  Commissioner  (WVOIC)  will  begin  the  process  of upgrading our technology and preservation of the claim and policy records of the former Workers’ Compensation Commission.  During this time, you may experience a delay in the processing of your file request.  We ask for your patience, as this upgrade will allow the WVOIC to maintain the integrity of the old records in our repository, as well as provide more timely responses to file requests.  If you have any questions, please call the West Virginia Offices of the Insurance Commissioner Claim Services Division at 304-558-8538 or toll free at 1-888-879-9842.