REGULATORY ACTIVITY:

• Posted in the state register notice regarding a regulation that applies to the benefits provided in KRS 342.020 and for which the employer’s responsibility for payment is limited to 780 weeks. This administrative regulation establishes the process by which the department will notify the employee of the right to file an application to continue the benefits provided by KRS 342.020, the method by which the employee is to make application, and the process by which an administrative law judge will determine and order a continuation of benefits for an additional time beyond the original period. To view the notice, go to https://legislature.ky.gov/Law/kar/Pages/Registers.aspx.
• Published the minutes of the March 28, 2019 Regulatory Advisory Committee meeting.  To view the minutes, go to https://labor.ky.gov/comp/Pages/default.aspx

LEGISLATIVE ACTIONS:

• House Bill 64

The enacted legislation amends the pharmacy statute to permit a pharmacist to dispense a prescription refill in the amount equal to the standard unit of dispensing for the drug without authorization by the prescribing practitioner in emergency situations in which such authorization may not be readily or easily obtained. The pharmacist may dispense up to a 72-hour supply of maintenance medication.  The legislation makes an exception to the 72-hour supply if the standard unit of dispensing for the drug exceeds  a 72-hour supply; the pharmacist dispenses a supply of the drug that is equal to the standard unit of dispensing and the drug is used for insulin therapy or treatment of chronic respiratory diseases.  Effective Date April 26, 2019.

• Senate Bill 126

The legislation is administrative in nature making a number of technical changes to a number of state agencies. No material changes were made that affect workers’ compensation.  Effective Date July 1, 2019.

FEE SCHEDULE NEWS:

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

REGULATORY ACTIVITY:

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

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

REGULATORY ACTIVITY:

• Posted notice of a proposed amendment and a newly adopted rule in the February Edition of the state register.  The proposed amendment is regarding appeal of a tax assessed by the Kentucky Claims Commission.  The new regulation is in regard to the pharmacy formulary which was adopted under emergency authority.   To view the register, go to https://legislature.ky.gov/Law/kar/Pages/Registers.aspx.
• In conjunction with the Kentucky Department of Workers’ Claims, ODG provided a live ODG Drug Formulary training webinar on Thursday, February 21, 2019 at 3:00 P.M. EST. The 30-minute webinar, taught by ODG Implementation Specialist and Clinical Educator, Jamie LaPaglia, RN, CCM, gave a quick “one-minute clinic” overview of how to use the ODG Formulary, followed by a more thorough “deeper dive” into the formulary, including Q & A.

REGULATORY ACTIVITY:

• Posted adopted rules 803 KAR 025:270 and 803 KAR 025:270E Pharmaceutical Formulary and Statement of Emergency.  These rules were adopted December 27, 2018.  The Commissioner of the Kentucky Department of Workers’ Claims (DWC) has promulgated an administrative regulation (803 KAR 25:270) adopting the ODG by MCG Health pharmaceutical formulary for use in the treatment of work-related injuries and occupational disease. The adoption and implementation of a formulary was mandated by House Bill 2 of the 2018 session of the General Assembly.  Drugs listed in the formulary are assigned “Y” or “N” status.  Drugs assigned “Y” status may be dispensed without preauthorization and do not require utilization review. Drugs assigned “N” status require preauthorization.  To view the notice and adopted rules, go to https://labor.ky.gov/comp/Pages/default.aspx. The formulary is available online at odgbymcg.com/state-formulary.   The formulary will take effect as follows:
  • For claims in which the date of injury or last exposure is on or after January 1, 2019, the formulary shall be effective July 1, 2019.
  • For claims in which the date of injury or last exposure is prior to January 1, 2019, the formulary shall be effective:
    • July 1, 2019 for a prescription that is not a refill prescription;
    • January 1, 2020 for a refill prescription of a drug initially prescribed prior to July 1, 2019.

In the coming weeks the DWC will announce and offer a formulary training webinar in conjunction with ODG.  Questions about the formulary regulation may be directed to John Mann at 502-782-4532 or JohnW.Mann@ky.gov.  Support and training is also available through the ODG Helpdesk at 800488-5548 or online at odghelp@mcg.com.

REGULATORY ACTIVITY:

• Settlement agreements must be submitted electronically beginning Jan. 1, 2019. As previously announced, as of Jan. 1, 2019, all Settlement Agreements (Form 110) must be submitted electronically through LMS. The Department of Workers' Compensation (DWC) will not accept nor process paper Settlement Agreements after Jan. 1, 2019. To access the PowerPoint presentation regarding the process for submission of Settlement Agreements electronically please go to the 'Forms, Documents, Publications, and Reports' tab on the DWC website and type in the words “settlement agreements” in the keyword search bar.  The first option will be titled “Electronic Submission of Settlement Agreements PowerPoint.”  Open that document for a detailed explanation of the process of electronic submission of Settlement Agreements in claims assigned to ALJs and pre-litigation/post-litigation Settlement Agreements.  For further assistance, please contact the DWC at Laborkywclms.technicalsupport@ky.gov. Additional information is available at http://labor.kentucky.gov/workersclaims. Department of Workers' Claims is located at 657 Chamberlin Ave, Frankfort, KY 40601. Other questions concerning Department of Workers' Claims can be addressed by calling (502) 564-5550.

REGULATORY ACTIVITY:

• Published the Workers' Compensation Benefit Schedule for 2019.  The increase in maximum income benefits under all provisions of the Workers' Compensation Act for the year 2017 over the year 2016 did amount to $2.00 or more; therefore, the maximum weekly indemnity benefits for calendar year 2019 shall be $955.32. There was an increase of $1.00 or more in minimum income benefits; therefore, the minimum weekly indemnity benefits, where applicable under the Act, shall be $173.69 for calendar year 2019.
• 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 Jan. 1 of each year, the commissioner shall fix the discount rate to be utilized in the succeeding year based at one-half of one percent (0.5%) below the interest rate paid upon 10-year United States Treasury Notes as of Aug. 1 of the preceding year. However, upon lump-sum settlement of future periodic payments in weekly amounts that are $40 or less, the commissioner shall fix the discount rate used in the succeeding year based at the interest rate paid upon 10-year United States Treasury Notes as of Aug. 1 of the preceding year. Accordingly, for the calendar year of 2019, the discount rate for lump-sum settlements of future periodic payments in weekly amounts that are $40 or less is fixed at 2.875 percent.  For the calendar year of 2019, the discount rate for lump-sum settlements of future periodic payments in weekly amounts greater than $40 is fixed at 2.375 percent.

REGULATORY ACTIVITY:

• The Department of Workers’ Claims (DWC) announced the adoption of ODG by MCG as its treatment guidelines and pharmaceutical formulary provider.  Pursuant to KRS 342.035, as amended in 2018 by House Bill 2, the commissioner of the Department of Workers’ Claims is directed to develop or adopt a pharmaceutical formulary and medical treatment guidelines for use in the treatment of work injuries and occupational diseases. In compliance with that statutory mandate, Commissioner Robert L. Swisher announces the adoption of ODG by MCG.  “We are honored to add Kentucky to the roster of ODG-mandated states, joining the neighboring states of Ohio, Tennessee, and Indiana. The Department of Workers’ Claims and the Medical Advisory Committee should be commended on a thorough, transparent evaluation of evidence-based guidelines and formulary options, placing confidence in a proven solution,” commented Phil LeFevre, Managing Director, ODG by MCG. “The ODG by MCG team is prepared and excited to work with DWC and stakeholders on a successful implementation to deliver improved outcomes for injured workers and the system. Complementary training and support will be offered including Webinars and onsite visits.” The Department of Workers’ Claims is in the process of drafting administrative regulations implementing the ODG formulary and medical treatment guidelines and establishing their effective dates.

REGULATORY ACTIVITY:

• Posted notice of proposed amendments for 803 KAR 50:010 Hearings, Procedure; deposition and 803 KAR 30:010 Special Fund Assessments in the September register of the state of Kentucky.  To view a copy of the proposed amendments, go to http://www.lrc.ky.gov/kar/contents/registers/registers.htm.
• Published the following notice regarding potential violation of certificates for companies certified for medical bill audit review: The Department of Workers’ Claims (DWC) has discovered that some Medical Bill Audit (MBA) plans that are approved and certified through DWC are utilizing other vendors to further review and, at times, improperly reduce a statement for services from a provider.  These other entities do not have an MBA plan on file with DWC and are, therefore, not approved to perform medical bill audits. The term “Medical Bill Audit” is defined as the review of medical bills for services which have been provided to assure compliance with the adopted fee schedules.  803 KAR 25:190 Section 1 (4). When an MBA Plan Administrator submits a Medical Bill Audit plan to the Department of Workers’ Claims for certification, the plan is reviewed to ensure that all regulations and criteria are satisfied.  The Commissioner will approve the application only if the plan appropriately documents the policies and procedures to be followed and other required criteria. If approved, the plan will remain effective for four years.  The plan may have contracts with a provider to allow a lesser fee than the fee schedule.  The Commissioner approves only the plan as submitted and expects that the applicant is completing the reviews and not utilizing other entities to complete reviews.  A Statement for Services billed on a HCFA 1500 must be reimbursed by applying the Schedule of Fee for Physicians. A Statement for Services billed on a UB04 must be reimbursed by applying the assigned cost to charge ratio for that facility.  The total charges (including implants) are multiplied by the assigned cost to charge ratio for the correct reimbursement.  A Medical Bill Audit vendor is required, per Section 1 (4) cited above, to assure that charges for services billed comply with the adopted Hospital Fee Schedule and, therefore, the cost-to-charge ratio. The reduction of a medical bill which is inconsistent with the pertinent regulation is unauthorized, inappropriate and puts at risk the certification of the vendor performing MBA services.

REGULATORY ACTIVITY:

• Published the workers' compensation benefit schedule for 2019.  The announcement is dated August 17, 2018. The Education and Workforce Development Cabinet, Office of Employment and Training, has certified that the average weekly wage for Kentucky for calendar year 2017 was $868.47. Based upon that information and in accordance with KRS 342.143, the following determinations are made:
  • The increase in maximum income benefits under all provisions of the Workers' Compensation Act for the year 2017 over the year 2016 did amount to $2.00 or more; therefore, the maximum weekly indemnity benefits for calendar year 2019 shall be $868.47.
  • There was an increase of $1.00 or more in minimum income benefits; therefore, the minimum weekly indemnity benefits, where applicable under the Act, shall be $173.69 for calendar year 2019.

REGULATORY ACTIVITY:

• Published the minutes from the July 9th Regulatory Advisory Meeting. Judge Gott reviewed the three missions of the committee, to establish regulations for extension of benefits beyond the statutory 780 weeks, to adopt regulations for implementation of a pharmaceutical formulary, and to adopt regulations for implementing treatment guidelines, both of the latter of which are to be developed by the Medical Advisory Committee.  He noted that the committee will accept public comments from those present at the meeting.  Anyone listening via telephonic conference was invited to attend the next meeting in person as well as to submit any questions or concerns via email to any member of the committee.
• The Department of Workers’ Claims is considering revising 803 KAR 25:092, the Pharmacy Fee Schedule, regarding reimbursement methodology and will hold a stakeholders’ meeting to receive input on this issue.  The meeting was held on July 31, 2018.  
• Beginning September 5, 2018, the Department of Workers’ Claims will accept optional electronic submission of Settlement Agreements in LMS.  Electronic submission of Settlement Agreements will become mandatory January 1, 2019.  The DWC will present an instructional Webinar with a live demonstration of the submission process on Friday, August 10, 2018, at 10:00 a.m.  The link and audio connection to access the webinar are as follows:
  • https://meetings.webex.com/collabs/#/meetings/detail?uuid=MAGS42F5URGL4I5ZWR7XNUWM2W-1AFV&rnd=96422.574614  
  • Meeting Number: 191 169 618
  • Audio Connection Call In: 1-415-655-0001