FEE SCHEDULE NEWS:

• The DWC has published a new file for Medi-Cal rates effective September 15, 2019. No drug information was changed in this file. The next update is expected October 15, 2019.
• The DWC has posted an adjustment to the inpatient hospital section of the Official Medical Fee Schedule (OMFS) to conform to changes in the 2020 Medicare payment system as required by Labor Code section 5307.1. The effective date of the changes is November 1, 2019.
• The (DWC) has posted an order adjusting the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) section of the Official Medical Fee Schedule to conform to the fourth quarter 2019 changes in the Medicare payment system as required by Labor Code section 5307.1.  The order, which is effective for services on or after October 1, 2019, adopts the Medicare October 2019 Quarter 4 DMEPOS Fee Schedule update.  The next update is expected January 1, 2020.
• The DWC has adopted the Official Medical Fee Schedule to conform to changes in the Medicare payment system with an effective date of October 1, 2019. The next update is expected for January 2020.
• The DWC has adopted a new Pathology and Clinical Laboratory Schedule to conform to changes in the Medicare payment system with an effective date of October 1, 2019
•  The DWC has adopted a new Outpatient and ASC fee schedule to conform to changes in the Medicare payment system with an effective date of October 1, 2019.  The next update is expected for January 2020.

REGULATORY ACTIVITY:

• The Division of Workers’ Compensation (DWC) has posted an order adopting regulations to update the evidence-based treatment guidelines of the Medical Treatment Utilization Schedule (MTUS).   The updates, effective for medical treatment services rendered on or after October 7, 2019, incorporate by reference the American College of Occupational and Environmental Medicine’s (ACOEM’s) most recent Hip and Groin Disorders Guideline (April 24, 2019) to the Clinical Topics section of the MTUS. To view the notice, go to https://www.dir.ca.gov/dwc/dwc_home_page.htm.
• The Division of Workers’ Compensation (DWC) launched an updated free online education course for physicians treating patients in the California workers’ compensation system.  “Caring for California’s Injured Workers: Using California’s Medical Treatment Utilization Schedule (MTUS) 2019” is one of a series of education modules developed for medical doctors, chiropractors and nurses. The course is also available to anyone else wishing to learn about the MTUS, and a completion certificate is available. The MTUS is the primary source of guidance for treating physicians and physician reviewers for the evaluation and treatment of injured workers. The MTUS incorporates evidence-based treatment guidelines of the American College of Occupational and Environmental Medicine (ACOEM), which are published by the Reed Group.  “All medical providers who treat injured California workers should understand and follow the MTUS. The online course is a convenient tool for providers to learn how to use the treatment guidelines and formulary that are designed to improve medical outcomes for injured workers,” said DWC Executive Medical Director Dr. Raymond Meister.  Medical doctors, chiropractors and nurses who take the course will receive up to one and a half hours of free CME credit. Qualified medical evaluators (QMEs) may report up to one- and one-half hours of credit for QME reappointment. The course is also available to anyone else wishing to learn about the MTUS, and a completion certificate is available.  The education module covers:
  • What the MTUS is, how to use it, and how you may be able to obtain free online access to the MTUS-ACOEM treatment guidelines;
  • How to navigate the MTUS-ACOEM treatment guidelines and apply recommendations for patient care;
  • The MTUS Drug Formulary;
  • When to consider recommendations outside of the MTUS guidelines for the care;
  • When to consider recommendations outside of the MTUS guidelines for the care of your patient; and
  • The role of utilization review (UR) and independent medical review (IMR) physicians.

To view additional information regarding the education module, go to https://www.dir.ca.gov/dwc/CaliforniaDWCCME.htm.

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.

FEE SCHEDULE NEWS:

• The DWC has published a new file for Medi-Cal rates effective July 15, 2019. The next update is expected August 15, 2019.
• The DWC has adopted a new Pathology and Clinical Laboratory Schedule to conform to changes in the Medicare payment system with an effective date of July 1, 2019

REGULATORY ACTIVITY:

• The Division of Workers’ Compensation (DWC) held a meeting of the  Pharmacy and Therapeutics (P&T) Committee on Wednesday, July 24 from 12:30 to 2:30 p.m. in the Elihu M. Harris State Building, conference room #11 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 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 Division of Workers’ Compensation (DWC) Administrative Director George Parisotto has issued an order updating the Medical Treatment Utilization Schedule (MTUS) Drug List effective August 1, 2019 pursuant to Labor Code section 5307.29.  The Administrative Director’s update order adopts changes to the MTUS Drug List, based on the American College of Occupational and Environmental Medicine (ACOEM) Practice Guidelines, including the following: 
  • New drug recommendations addressed in the Post-Traumatic Stress Disorder Guideline
  • Designation of additional drugs as “special fill” eligible, due to treatment recommendation in the Post-Traumatic Stress Disorder Guideline
  • Deletion of codeine phosphate from the MTUS Drug List
  • New drug recommendations pertaining to diclofenac sodium and divalproex sodium.
• The updated MTUS Drug List v.5 and the Administrative Director order can be accessed on the DWC MTUS drug formulary web page at https://www.dir.ca.gov/dwc/MTUS/MTUS-Formulary-Orders.html. Questions and comments can be directed to Formulary@dir.ca.gov.
• The Division of Workers’ Compensation (DWC) is now accepting applications for the Qualified Medical Evaluator (QME) examination on October 19. QMEs are independent physicians certified by the DWC Medical Unit to conduct medical evaluations of injured workers. Applications for the QME exam may be downloaded from the DWC website. Applicants may also contact the Medical Unit at 510-286-3700 to request an application via U.S. mail, email or fax. The deadline for filing the exam applications is September 5, 2019.  For more information please contact the Medical Unit at 510-286-3700 or by email at QMETest@dir.ca.gov.
• The Division of Workers’ Compensation (DWC) has posted an order adopting regulations to update the evidence-based treatment guidelines of the Medical Treatment Utilization Schedule (MTUS). The updates, effective for medical treatment services rendered on or after August 11, 2019, incorporate by reference the American College of Occupational and Environmental Medicine’s (ACOEM’s) most recent treatment guidelines to the Clinical Topics section of the MTUS.   The ACOEM guidelines that are incorporated by reference into the MTUS are:
  • Low Back Disorders Guideline (ACOEM March 7, 2019)
  • Introduction to the Workplace Mental Health Guideline (ACOEM March 13, 2019).
• The administrative order consists of the order and two addenda: 
• • • Addendum one shows the regulatory amendments directly related to the evidence-based updates to the MTUS.
    • Addendum two contains hyperlinks to the updated ACOEM guidelines adopted and incorporated into the MTUS by reference.
• Health care providers treating, evaluating (QME), or reviewing (UR or IMR) in the California workers’ compensation system may access the MTUS (ACOEM) Guidelines and MTUS Drug List at no cost by registering for an account.  To view the order regulations and guidelines, go to https://www.dir.ca.gov/dwc/DWCPropRegs/MTUS-Evidence-Based-Updates-April2019/MTUS-Evidence-Based-Updates.htm.  The guidelines are effective for services provided on or after August 11, 2019.

• The Division of Workers’ Compensation (DWC) has issued a notice of public hearing for proposed evidence-based updates to the Medical Treatment Utilization Schedule (MTUS), which can be found at California Code of Regulations, title 8, section 9792.23. The public hearing is scheduled for Monday, August 26 at 11 a.m. in the auditorium of the Elihu Harris Building, 1515 Clay Street, Oakland. Members of the public may review and comment on the proposed updates no later than August 26. The proposed evidence-based updates to the MTUS incorporate by reference the latest published guideline from American College of Occupational and Environmental Medicine (ACOEM) for the Hip and Groin Disorders Guideline (ACOEM April 24, 2019).  The proposed evidence-based updates to the MTUS regulations are exempt from Labor Code sections 5307.3 and 5307.4 and the rulemaking provisions of the Administrative Procedure Act. However, DWC is required under Labor Code section 5307.27 to have a 30-day public comment period, hold a public hearing, respond to all the comments received during the public comment period and publish the order adopting the updates online.  To view the notice, proposed regulation and guideline, go to https://www.dir.ca.gov/dwc/DWCPropRegs/MTUS-Evidence-Based-Updates-August2019/MTUS-Evidence-Based-Updates.htm.
• The Division of Workers’ Compensation (DWC) has posted the 2018 ethics advisory committee's annual report on its website. The Workers’ Compensation Ethics Advisory Committee is a state committee independent from the DWC that is charged with reviewing and monitoring complaints of misconduct filed against workers’ compensation administrative law judges. The ethics advisory committee is required to make a public report each year summarizing activities in the previous calendar year. The 2018 annual report may be viewed or downloaded at the DWC website.

FEE SCHEDULE NEWS:

• The DWC has published a new file for Medi-Cal rates effective June 15, 2019. The next update is expected July 15, 2019.
• The DWC has adopted the Official Medical Fee Schedule to conform to changes in the Medicare payment system with an effective date of July 1, 2019. The next update is expected October 1, 2019.
• A new DMEPOS Fee Schedule has been adopted with an effective date of July 1, 2019. The next update is expected October 1, 2019.
• The DWC has adopted a new Outpatient and ASC fee schedule to conform to changes in the Medicare payment system with an effective date of July 1, 2019.  The next update is expected October 1, 2019

REGULATORY ACTIVITY:

• The Division of Workers’ Compensation (DWC) has posted an order adjusting the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1.  The Physician and Non-Physician Practitioner Fee Schedule update order adopts the following Medicare changes: • CMS Medicare National Physician Fee Schedule Relative Value File RVU19C July 1, 2019 quarterly update • National Correct Coding Initiative Practitioner Procedure to Procedure (PTP) Edits July 1, 2019 quarterly update • National Correct Coding Initiative Medically Unlikely Edits July 1, 2019 quarterly update (excluding MUE “0” value codes) • CMS ZIP Code to Carrier Locality files July 1, 2019 quarterly update, for Geographic Practice Cost Index (GPCI) locality mapping    The order adopting the OMFS adjustments is effective for services rendered on or after July 1, 2019 and can be found at https://www.dir.ca.gov/dwc/OMFS9904.htm#7.  The notice can be viewed at https://www.dir.ca.gov/dwc/dwc_home_page.htm.
• The Workers’ Compensation Appeals Board (WCAB) has posted a proposed reorganization and renumbering of its Rules of Practice and Procedure (Rules) for public comment.  WCAB’s Rules are found in the California Code of Regulations, Title 8, commencing with sections 10300 - 10999. WCAB is reworking the organizational structure of the Rules which were initially adopted in 1966, as they no longer accommodate the number and complexity of Rules adopted in the modern era. The reorganization is intended to do the following:
  • Organize articles to reflect the order of events in a case
  • Eliminate duplicative rules
  • Break up complex rules
  • Simplify and modernize language of rules for clarity
  • Create additional space between rules, so that additional rules can be added without the need for decimals.

WCAB invites the public to comment on the notice, draft regulations text and initial statement of reasons on its rulemaking page prior to engaging in formal rulemaking under Labor Code sections 5307 and 5307.4. Comments may be submitted by email to WCABRules@dir.ca.gov or by mail to:  Workers' Compensation Appeals Board Attn: WCAB forums P.O. Box 429459 San Francisco, CA 94142- 9459. The forum will close on July 5. The comments received will be reviewed and considered for adoption. WCAB will then submit the complete package of reorganized and revised Rules, along with the required forms and other documentation, to the Office of Administrative Law on July 30 to begin formal rulemaking. WCAB anticipates holding a public hearing on the reorganized and revised Rules on September 24, 2019. To view this notice, go to https://www.dir.ca.gov/dwc/dwc_home_page.htm.  To view a copy of the proposed rule, go to https://www.dir.ca.gov/WCAB/ForumDocs/WCAB_Forum-Section10300.htm.

• DWC Posts Adjustments to Official Medical Fee Schedule (Hospital Outpatient Departments/Ambulatory Surgical Centers):  The Division of Workers’ Compensation (DWC) has posted an order adjusting the Hospital Outpatient Departments and Ambulatory Surgical Centers section of the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1. The Hospital Outpatient Departments and Ambulatory Surgical Centers fee schedule update order adopts the following Centers for Medicare & Medicaid Services (CMS) Medicare changes: • The CMS Medicare Hospital Outpatient Prospective Payment System (OPPS) July 2019 Addendum A quarterly update • The CMS Medicare OPPS July 2019 Addendum B quarterly update • The CMS Ambulatory Surgical Center Payment System, July 2019 ASC Approved HCPCS Code and Payment Rates, Column A entitled “HCPCS Code” of “Jul 2019 ASC AA” and Column A entitled “HCPCS Code” of “Jul 2019 ASC EE” • Certain sections of the CMS Medicare OPPS July 2019 Integrated Outpatient Code Editor (I/OCE), IOCE Quarterly Data Files V20.2 quarterly update • CMS July 2019 Update of the Hospital Outpatient Prospective Payment System (OPPS), Change Request (CR) 11318 (May 24, 2019), Transmittal R4313CP. The order adopting the OMFS adjustments is effective for services rendered on or after July 1, 2019 and is posted on DWC at https://www.dir.ca.gov/dwc/OMFS9904.htm#6.

FEE SCHEDULE NEWS:

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

REGULATORY ACTIVITY:

• The State Fund of California posted notice in the April 26, 2019 of the state register regarding the amendment of its conflict of interest code.  To view the notice, go to https://oal.ca.gov/april-2019-notice-registers/.
• The Department of Industrial Relations (DIR) announced that several of its offices in Santa Ana have moved to a new address: 2 MacArthur Place, Santa Ana, CA 92707.  The Division of Labor Standards Enforcement (DLSE), or the California Labor Commissioner’s Office, is in Suite 800 of the new building. The main phone number is unchanged: (714) 558-4910.  The Division of Occupational Health and Safety (DOSH), better known as Cal/OSHA, is in Suite 720. The phone number is (714) 558-4451. The Division of Workers’ Compensation (DWC) is in Suite 600. The main phone number is unchanged: (714) 558-4121.
• The Division of Workers’ Compensation (DWC) has updated its EAMS system to require validation of uniform assigned names (UANs) when users e-file documents. Filers will receive an error if the document contains a faulty UAN, so they can correct the issue immediately. The new procedure is expected to reduce errors and processing delays. The UAN, a uniform naming convention to ensure that parties are properly associated to cases in EAMS, is currently used by attorneys, claims administrators and lien claimants. E-filers may confirm or obtain their UAN by checking the database, or by submitting a registration request on letterhead with an authorized signature by email to cru@dir.ca.gov. Emailed requests are processed and posted within 10 business days. The first document to require UAN validation is the application for adjudication of claim. DWC will update other e-forms in the coming months to include this upfront validation.

FEE SCHEDULE NEWS:

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

REGULATORY ACTIVITY:

• The Division of Workers’ Compensation (DWC) has issued a notice of public hearing for proposed evidence-based updates to the Medical Treatment Utilization Schedule (MTUS), which can be found at California Code of Regulations, title 8, section 9792.23. The public hearing is scheduled for Monday, May 6 at 10 a.m. in the auditorium of the Elihu Harris Building, 1515 Clay Street, Oakland. Members of the public may review and comment on the proposed updates no later than Monday, May 6, 2019. The proposed evidence-based updates to the MTUS incorporate by reference the latest published guidelines from American College of Occupational and Environmental Medicine (ACOEM) for the following:
  • Low Back Disorders Guideline (ACOEM March 7, 2019)
  • Introduction to the Workplace Mental Health Guideline (ACOEM March 13, 2019)

The proposed evidence-based updates to the MTUS regulations are exempt from Labor Code sections 5307.3 and 5307.4 and the rulemaking provisions of the Administrative Procedure Act. However, DWC is required under Labor Code section 5307.27 to have a 30-day public comment period, hold a public hearing, respond to all the comments received during the public comment period and publish the order adopting the updates online. To view the proposed updates, go to https://www.dir.ca.gov/dwc/DWCPropRegs/MTUS-Evidence-Based-Updates-April2019/MTUS-Evidence-Based-Updates.htm.

• The Department of Industrial Relations (DIR) and its Division of Workers’ Compensation (DWC) posted a progress report on the department’s Independent Bill Review (IBR) program. IBR is a process used to resolve billing disputes for medical treatment and medical-legal services provided to injured workers. The “2018 Independent Bill Review (IBR) Report: Analysis of 2013-2017 Application Filings” summarizes the activity of an essential component of Senate Bill 863, providing an evaluation of the program during the first five years following its enactment. The report accounts for all applications filed to dispute payments not resolved through Second Bill Review during this time period. Highlights of the report include:
  • The number of IBR applications received averaged 165 filings per month;
  • Seven of 10 decided cases resulted in additional payment for the provider and nearly $12.3 million was awarded in overturned case decisions.

A copy of the progress report is located at https://www.dir.ca.gov/dwc/IBR.htm.

• The Division of Workers’ Compensation (DWC) held a meeting of the  Pharmacy and Therapeutics (P&T) Committee on Wednesday, April 24 from 12:30 to 2:30 p.m. in the Elihu M. Harris State Building, conference room #11 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 were posted on the DWC P&T Committee at https://www.dir.ca.gov/dwc/MTUS/MTUS-Pharmacy-and-Therapeutics-Committee.html. DWC welcomes comment from the public on the formulary drug list. All correspondence should be directed to Formulary@dir.ca.gov.

FEE SCHEDULE NEWS:

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

REGULATORY ACTIVITY:

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

FEE SCHEDULE NEWS:

• The DWC has adopted the Medi-Cal rates effective February 15, 2019. The next update is expected March 15, 2019.

REGULATORY ACTIVITY:

• The Division of Workers’ Compensation (DWC) announced that medical providers who treat injured California workers can now have free online access to the State’s Medical Treatment Utilization Schedule (MTUS) guidelines.  “Medical providers in California should ensure that treatment decisions for injured workers are based on the best available evidence,” said George Parisotto, DWC Administrative Director. “By providing these guidelines free of charge, we are removing barriers that we expect will improve quality of care and reduce friction in the utilization review process.” Licensed healthcare providers who treat California injured workers can use MDGuidelines: CA MTUS-ACOEM Edition to quickly search the latest evidence-based recommendations incorporated into the State’s MTUS. Providers who perform qualified medical evaluations, utilization review or independent medical review can also register to use the online tool free of charge. The MTUS, a set of regulations based on the principles of evidence-based medicine, has adopted treatment guidelines developed by the American College of Occupational and Environmental Medicine (ACOEM). In most cases, medical treatment that is reasonable and necessary to cure or relieve an injured worker from the effects of injury means treatment that is based upon the ACOEM treatment guidelines. Providers must register in order to gain access to the site administered by the Reed Group. The site includes online training webinars and instructions. Users can email MTUS@reedgroup.com for more information. The Division of Workers’ Compensation monitors the administration of workers’ compensation claims and provides administrative and judicial services to assist in resolving disputes that arise in connection with claims for workers' compensation benefits.  To view this announcement, go to https://www.dir.ca.gov/dwc/dwc_home_page.htm.

FEE SCHEDULE NEWS:

• The DWC has adopted the Medi-Cal rates effective January 15, 2019. The next update is expected February 15, 2019.
• The Division of Workers’ Compensation (DWC) has posted adjustments to the Hospital Outpatient Departments and Ambulatory Surgical Centers section of the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1 effective February 15, 2019.
• The Division of Workers’ Compensation (DWC) has posted an order adjusting the Pathology and Clinical Laboratory section of the Official Medical Fee Schedule (OMFS) to conform to relevant 2019 changes in the Medicare payment system as required by Labor Code section 5307.1.  The order is the second Administrative Director order for the January 2019 annual update to the Pathology and Clinical Laboratory Fee Schedule. The Centers for Medicare and Medicaid Services issued a revised 2019 Pathology and Clinical Laboratory Fee Schedule file on January 15, 2019. The revised file corrects various technical errors and supersedes the original file.   The Administrative Director update order dated January 16, 2019 adopting the OMFS adjustment is effective for services rendered on or after January 1, 2019.

REGULATORY ACTIVITY:

• The Division of Workers’ Compensation (DWC) Administrative Director George Parisotto has issued an Order updating the Medical Treatment Utilization Schedule (MTUS) Drug List effective February 15, pursuant to Labor Code section 5307.29. The Administrative Director’s update Order adopts changes to the MTUS Drug List, based on the American College of Occupational and Environmental Medicine (ACOEM) Practice Guidelines, including the following:
  • Addition of drugs addressed in the Traumatic Brain Injury Guideline
  • New and Revised Drug Recommendations (related to the Traumatic Brain Injury Guideline)
  • Designation of additional drugs as “special fill” eligible, due to treatment recommendation in the Traumatic Brain Injury Guideline

Additional information regarding the MTUS drug formulary may be found on the MTUS Drug Formulary webpage https://www.dir.ca.gov/dwc/MTUS/MTUS-Formulary.html.  To view the notice, go to https://www.dir.ca.gov/dwc/dwc_home_page.htm.

• The Division of Workers’ Compensation (DWC) has issued a notice of public hearing for proposed evidence-based updates to the Medical Treatment Utilization Schedule (MTUS), which can be found at California Code of Regulations, title 8, section 9792.23.  The public hearing is scheduled for Friday, February 15 at 10 a.m. in the auditorium of the Elihu Harris Building, 1515 Clay Street, Oakland. Members of the public may review and comment on the proposed updates no later than February 15.  The proposed evidence-based updates to the MTUS incorporate by reference the latest published guidelines from American College of Occupational and Environmental Medicine (ACOEM) for the following:
  • Cervical and Thoracic Spine Disorders Guideline (ACOEM October 17, 2018)
  • Elbow Disorders Guideline (ACOEM August 23, 2018)
  • Hand, Wrist, and Forearm Guideline (ACOEM January 7, 2019)
  • Ankle and Foot Disorders Guideline (ACOEM July 16, 2018)
  • Workplace Mental Health: Posttraumatic Stress Disorder and Acute Stress Disorder Guideline (ACOEM December 18, 2018)

The proposed evidence-based updates to the MTUS regulations are exempt from Labor Code sections 5307.3 and 5307.4 and the rulemaking provisions of the Administrative Procedure Act. However, DWC is required under Labor Code section 5307.27 to have a 30-day public comment period, hold a public hearing, respond to all the comments received during the public comment period and publish the order adopting the updates online.  The proposed updates can be viewed at https://www.dir.ca.gov/dwc/DWCPropRegs/MTUS-Evidence-Based-Update/MTUS-Evidence-Based-Update.htm.

• The Division of Workers’ Compensation (DWC) is now accepting applications for the Qualified Medical Evaluator (QME) examination on April 13. QMEs are independent physicians certified by the DWC Medical Unit to conduct medical evaluations of injured workers. Applications for the QME exam may be downloaded from   https://www.dir.ca.gov/dwc/MedicalUnit/QME_page.html. Applicants may also contact the Medical Unit at 510-286-3700 to request an application via U.S. mail, email or fax. The deadline for filing the exam applications is February 28. For more information, please contact the Medical Unit at 510-286-3700 or by email at QMETest@dir.ca.gov.
• The Division of Workers’ Compensation (DWC) has posted the 2018 DWC Audit Unit annual report on its website. The Audit Unit annual report provides information on how claims administrators audited by the DWC performed and includes the Administrative Director’s ranking report for audits conducted in calendar year 2017.  The 2018 Audit Unit annual report details the results of audits conducted in 2017 and provides the name and location of each insurer, self-insured employer, and third-party administrator audited during that time. This report to the Legislature summarizes audits conducted in accordance with Labor Code sections 129 and 129.5 to assure that injured workers, and their dependents in the event of their death, are provided with all benefits due them in an expeditious manner. The audit findings, by law, must detail the number of files audited, the number and type of violations cited, and the amount of an undisputed compensation found due and unpaid to the injured worker. The audit findings presented in this report are statistical and do not identify any individual injured worker. The Labor Code provides that contents of the claim files and the Audit Unit working papers are confidential. Performance of insurers, self-insured employers, and third-party administrators subject to profile audit review and full compliance audit is rated in accordance with the performance standards set annually by the Administrative Director. The DWC Administrative Director’s 2018 Audit Ranking Report lists, in ascending order by performance rating, the administrators audited in calendar year 2017.  The Audit Unit report can be found at https://www.dir.ca.gov/dwc/audit.html.

FEE SCHEDULE NEWS:

• The Division of Workers’ Compensation (DWC) has posted an order adjusting the Physician Services/Non-Physician Practitioner Services section of the Official Medical Fee Schedule (OMFS) to conform to relevant 2019 changes in the Medicare payment system as required by Labor Code section 5307.1. The Administrative Director update order adopting the OMFS adjustments effective for services rendered on or after January 1, 2019, can be found at the DWC website’s https://www.dir.ca.gov/dwc/OMFS9904.htm#7.  The next update is expected in April 2019.
• The Division of Workers’ Compensation (DWC) has posted an order adjusting the Ambulance Services section of the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1. The update order is effective for services rendered on or after January 1, 2019 and can be found at the DWC website’s https://www.dir.ca.gov/dwc/OMFS9904.htm.  The next update is expected January 2020.
• The DWC has adopted a new DMEPOS fee schedule to conform with the changes in the Medicare payment system effective January 1, 2019. The next update is expected in April 2019.
• The DWC has adopted the Medi-Cal rates effective December 15, 2018. The next update is expected January 15, 2019.

REGULATORY ACTIVITY:

• The Division of Workers’ Compensation Announces 2019 Profile Audit Review and Full Compliance Audit Performance: Labor Code sections 129 and 129.5 require the Audit and Enforcement Unit of the Division of Workers’ Compensation (DWC) to conduct a profile audit review (PAR) for all adjusting locations of California workers’ compensation claims at least once every five years. 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 2019 standards are based on the audit results of calendar years 2015 through 2017.
• Performance standards for 2019

The PAR performance standard for audits conducted in 2019 is 1.36133. Audit subjects with PAR performance ratings of 1.36133 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 1.36134 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 2019 is 1.66166. Audit subjects with an FCA performance rating of 1.66166 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 1.66167 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.

• Severity Rate standard for 2019

The Severity Rate standard for 2019 is $104.97.  More information on the performance standards that will be in use for the profile audit reviews and full compliance audits during calendar year 2019 will be posted on the DWC Audit and Enforcement Unit https://www.dir.ca.gov/dwc/audit.html.

• Posted notice to all insurers authorized to transact workers' compensation in California regarding Fiscal Year 2018/2019 Assessments for: Workers’ Compensation Administration Revolving Fund (WCARF) • Uninsured Employers Benefits Trust Fund (UEBTF) • Subsequent Injuries Benefits Trust Fund (SIBTF) • Occupational Safety and Health Fund (OSHF) • Labor Enforcement and Compliance Fund (LECF) • Workers’ Compensation Fraud Account (FRAUD). To view the notice, go to https://www.dir.ca.gov/dwc/dwc_home_page.htm.
• NOTICE IS HEREBY GIVEN that the Acting Di- rector (“Director”) of the Department of Industrial Relations (“Department”) proposes to add a new section 15203.11 and to amend sections 15203.2 and 15251 of Title 8 of the California Code of Regulations, for purposes of implementing recent amendments to Labor Code Section 3702.2(a). Those amendments require the Director to obtain detailed information needed to evaluate the administrative costs, expenditures, solvency, and performance of public self−insured employer workers’ compensation programs. The Director also proposes to make non-substantive changes to section 15430 to bring that section into conformity with other recent statutory and regulatory amendments. To view the notice, go to https://oal.ca.gov/december-2018-notice-registers/.
• The Office of Self-Insurance Plans (OSIP) has posted proposed regulations that will require self-insured public entities to file annual reports providing demographic, claim and financial data regarding their workers’ compensation programs. The proposed regulations, mandated by Governor Edmund G. Brown Jr.’s 2012 workers’ compensation reforms, will allow for greater transparency of the solvency and viability of self-insured workers’ compensation programs and the true liabilities of public entities. As specified by Labor Code section 3702.2(a), the changes would require public entities to report portions of their financial statements pertaining to workers’ compensation liabilities. Public entities would also be required to provide aggregate information as a point of reference for other public entities. The proposed regulations were developed in accordance with the recommendations of a 2014 report conducted by the Commission on Health and Safety and Workers’ Compensation, Examination of California Public Sector Self-Insurance Workers’ Compensation Program. The notice and text of the regulations can be found on the proposed regulations web page. A public hearing on the proposed regulations has been scheduled for 10 a.m. January 23, 2019, in Room 11 at the Elihu M. Harris State Building, 1515 Clay Street, Oakland, 94612. To view a copy of the notice, go to https://www.dir.ca.gov/dwc/dwc_home_page.htm.  To view a copy of the proposed rules, go to https://www.dir.ca.gov/osip/rulemaking/osip_rulemaking_proposed.html.
• The Division of Workers’ Compensation (DWC) has posted a draft of amendments to the physician reporting and utilization review regulations on its online forum, and invites members of the public to review and provide comment. The proposed changes, which will update the treating physician reporting requirement and implement the provisions of Senate Bill 1160, are intended to: Expedite appropriate evidence-based medical treatment for injured workers; Increase meaningful communication between treating physicians and utilization review physicians, and Improve the overall quality of utilization review services in workers’ compensation.
• The proposed regulatory amendments will be made pursuant to the rulemaking provisions of the Administrative Procedure Act. To view a copy of the notice, go to https://www.dir.ca.gov/dwc/dwc_home_page.htm.  To view a copy  of the forum documentation on this proposal, go to https://www.dir.ca.gov/dwc/DWCWCABForum/UR-Regulations.htm.
• The Division of Workers’ Compensation (DWC) is announcing the increase of the mileage rate for medical and medical-legal travel expenses by 3.5 cents to 58 cents per mile effective January 1, 2019. This rate must be paid for travel on or after January 1, 2019 regardless of the date of injury. Labor Code Section 4600, in conjunction with Government Code Section 19820 and the Department of Personnel Administration regulations, establishes the rate payable for mileage reimbursement for medical and medical-legal expenses and ties it to the Internal Revenue Service (IRS).  IRS bulletin Number IR-2018-251 dated December 14, 2018 announced the rate increase. The updated mileage reimbursement form is posted on the DWC website.