REGULATORY ACTIVITY:

• The Tennessee Bureau of Workers’ Compensation’s Rules regarding Electronic Medical Billing for Workers Compensation Claims have been filed with the Secretary of State and will become effective July 1, 2018. These rules provide a legal framework for electronic billing, processing, and payment of medical services and products provided to an injured employee and data reporting required by Tennessee Code Annotated § 50-6-202 and can be found here.  The Companion Guide to these Rules can be found here.  In preparation of the full implementation of the rules, payers should be able to exchange data electronically by January 1, 2018 and healthcare providers or their agents should be able to exchange this data by June 1, 2018.  However, in response to public comment regarding questions about these dates, the mandatory implementation date for all parties was changed as is reflected in the final section of the rules, which reads as follows:  0800-02-26-.10 Effective Date (1) These Rules are required for all medical services and products provided on or after July 1, 2018. For medical services and products provided prior to July 1, 2018, medical billing and processing shall be in accordance with the rules in effect at the time the health care was provided unless both payer and provider elect to comply with these Rules.

LEGISLATIVE ACTIONS:

• Senate Bill 2189 This bill makes the exemption for out-of-state employees who are temporarily located in Tennessee inapplicable to construction services providers and requires that construction services providers maintain workers' compensation coverage throughout the duration of the time that they work in Tennessee. A construction services provider who does not obtain coverage as required by this bill will be subject to a penalty of up to the greater of: (1) $1,000; or (2) 1.5 times the average yearly workers' compensation premium for the construction services provider based on applicable factors described in detail in the full text of this bill. Under present law, a construction services provider is subject to a penalty in the amounts described in the preceding (1) and (2) if the employer misclassifies employees to avoid proper classification for premium calculations by concealing any information pertinent to the computation and application of an experience rating modification factor or by materially understating or concealing payroll information, number of employees, or employees' duties. An individual or entity that is not a successor-in-interest or a principal of a construction services provider who is so penalized is not liable for the monetary penalties. This bill makes a successor in interest to a construction services provider liable for a monetary penalty for misclassification or noncompliance with insurance requirements. This bill defines "successor in interest" to mean, for purposes of determining liability for a monetary penalty based on misclassification or noncompliance with insurance requirements only, a successor in ownership of all, or substantially all, of a business or enterprise that is carried on and controlled in substantially the same manner as the penalized construction services provider. This bill extends to a successor in interest the right to appeal a monetary penalty based on misclassification or noncompliance with insurance requirements. This bill authorizes the chief administrative officer of the bureau of workers' compensation of the department of labor and workforce development to waive a penalty against a successor in interest that is based on misclassification or noncompliance with insurance requirements for good cause. Effective Date June 15, 2020.

• Senate Bill 2190 Requires an injured worker, subject to workers’ compensation coverage, whose treating physician has determined that such worker be referred to a specialist, be provided with a panel of specialists, rather than such panel only be provided upon the employer’s request. Establishes a minimum period of 180 days for an injured worker to request additional benefits following such worker reaching maximum medical improvement. Lowers the minimum impairment rating, from 10 percent to 9 percent, for increased benefit eligibility in extraordinary cases. Deletes requirement that a full and final hearing of the Court of Workers’ Compensation be provided to an employee who has filed a claim against an employer for workers’ compensation benefits no more than 60 days after the notice of hearing has been filed. Effective Date June 22, 2020. 

LEGISLATIVE ACTIONS:

• House Bill 1727/Senate Bill 1649 The legislation as enacted extends the advisory council on workers’ compensation to June 30, 2021.  Effective Date April 1, 2020.

REGULATORY ACTIVITY:

• The Tennessee Department of Commerce and Insurance requests carriers provide employers and individuals with as much flexibility as practicable during the period of the COVID-19 public health crisis. Carriers should work with policyholders who have concerns about their ability to timely pay a premium to ensure that policyholders can maintain their existing insurance coverage. Carriers across all lines of business, upon request or upon calls about coverage, should explain to consumers affected by COVID- 19 options to maintain continuous coverage during this difficult time.  Carriers should explain existing applicable grace periods that may allow policyholders to delay premium payments without losing coverage.  Additionally, carriers should explore ways to eliminate late fees, non-sufficient funds fees, and installment fees.  Carriers should also work with employers or individuals to find the best ways to address concerns with the timing of premium payments in order to delay any cancellation of coverage for non-payment and collection activity.  Finally, carriers should explore ways to streamline administrative processes and paperwork to facilitate continuous coverage and ease burdens on policyholders.

REGULATORY ACTIVITY:

•  Issued an advisory for case managers concerning face-to-face meetings. For workers' compensation claims that involve case managers, the face-to-face meeting in all catastrophic cases should occur within 14 days of the injury. For non-catastrophic injuries, the face-to-face meeting should occur within 14 days of the Case Manager’s assignment to the case. To view the advisory, go to https://www.tn.gov/workforce/injuries-at-work/bureau-announcements.html .

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.

REGULATORY ACTIVITY:

• The Medical Advisory Committee is comprised of practitioners in the medical community having experience in the treatment of workers’ compensation injuries, representatives of the insurance industry, employer representatives, and employee representatives to assist the administrator in the development of the treatment guidelines and advise the administrator on issues relating to medical care in the Workers’ Compensation system. The Medical Advisory Committee was meeting on November 5, 2019 from 1:00 p.m. to 3:00 p.m. in the Tennessee Room 1^st Floor, Side A 220 French Landing Drive, Nashville, Tennessee.
• Medical Advisory Committee's Utilization Review Working Group met Friday, November 1, 2019, 8:00 AM - 9:00 AM CDT. This meeting is open to the public and will be held in the Workers' Compensation Large Conference Room, 1st Floor, Side B, 220 French Landing Drive, Nashville, TN 37243
• Posted notice of rulemaking regarding amendments to rule Chapter 0800-02-22 Workers' Compensation Appeals Board.  The public hearing will be held on December 12, 2019 at 1:00 p.m. in the TOSHA Hearing Room at 220 French Landing Drive, 1-A Nashville, TN 37243.

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.

LEGISLATIVE ACTIONS:

• House Bill 539

As enacted, requires the consideration of the 20-factor test in IRS Revenue Ruling 87-41 to determine whether an employer-employee relationship exists in certain employment arrangements. - Amends TCA Title 50.  Effective Date January 1, 2020.

REGULATORY ACTIVITY:

• Published a general overview of workers' compensation legislation passed by the 2019 session of the 111th General Assembly.  To view the overview, go to https://www.tn.gov/workforce/injuries-at-work/bureau-announcements.html.
• Posted notice of proposed amendment to rule chapter 0800-02-19 Inpatient Hospital Fee Schedule.  The proposed amendment was posted on June 12, 2019.  The proposed rule has a projected effective date of September 10, 2019.  No public meeting has been set at this time.  To view the posted notice, go to https://tnsos.org/rules/PendingRules.php.
• Posted notice of proposed amendment to rule 0800-02-19 Rules for Medical Payment.  The proposed amendment was posted on June 12, 2019.  The proposed rule has a projected effective date of September 9, 2019.  No public meeting has been set at this time.  To view the posted notice, go to https://tnsos.org/rules/PendingRules.php.