REGULATORY ACTIVITY:

• The Department of Labor and Industry (DLI) investigates complaints from registered rehabilitation providers (vendors and qualified rehabilitation consultants) about an employer's or insurer's failure to pay or deny a rehabilitation service invoice. Substantiation of complaints may result in penalties up to $2,000.  A payer has 30 days from the receipt of a rehabilitation provider's bill to pay or deny all charges, according to Minnesota Statutes § 176.102, Minn. Stat. § 176.221 and Minnesota Rules 5220.1900. For any portion that is denied, the employer or insurer must provide written notification stating the specific service charge and the reason for denial (see Minn. R. 5220.1900). A new, fillable Penalty Request for Failure to Pay or Deny Rehabilitation Invoice form is located under "Optional forms" on the DLI Work Comp:  Forms webpage. Rehabilitation providers are reminded that all billing shall be on a Vocational Rehabilitation Invoice form prescribed by the commissioner (see Minn. Stat. § 176.102). Failure to submit an invoice to an employer or insurer covering all the points listed in the example invoice will result in the penalty request being dismissed. More information: For more information, contact Mike Hill at 651-284-5153 or hill@state.mn.us.

REGULATORY ACTIVITY:

• The Workers’ Compensation Division of the Minnesota Department of Labor and Industry will be mandating electronic data interchange (EDI) Release 3.1 XML reporting in August 2020. The adoption of this new release will coincide with the modernized Work Comp Campus. The R3.1 XML Implementation Guide can be found on the DLI website. To view the implementation guide, go to http://www.dli.mn.gov/business/workers-compensation/work-comp-electronic-data-interchange-edi-and-efroi-web-portal?utm_medium=email&utm_source=govdelivery.  For questions contact DLI at edi
• Contact Lori Herzog for help scheduling mediation sessions with the Department of Labor and Industry’s (DLI) Alternative Dispute Resolution (ADR) unit. Lori can be contacted at mediation.dli@state.mn.us or 651-284-5336. Mediation forms may also be submitted online.  Parties can contact individual mediators directly about scheduling a mediation session. A list of DLI mediators is available online. ADR offers customized mediation services at no cost to the parties. ADR mediators will travel statewide. We offer flexibility with time and place for mediation. If necessary, we also offer flexible scheduling of time slots in excess of three hours. Questions? For additional information about DLI’s mediation services, visit DLI’s website or call 651-284-5005 or 800-342-5354. Duluth and outstate parties can call our Duluth office at 218-733-7810 or 800-342-5354.

REGULATORY ACTIVITY:

• Published the March edition of the Compact Newsletter.  To view the newsletter, go to http://www.dli.mn.gov/business/workers-compensation/work-comp-compact-newsletter?utm_medium=email&utm_source=govdelivery.

REGULATORY ACTIVITY:

• Published in the state register on March 18, 2019 notice of adopted permanent rules governing workers' compensation litigation procedures: resolution of claims with interveners. To view the published notice, go to https://mn.gov/admin/assets/SR43_38%20-%20Accessible_tcm36-376146.pdf.
• Claim administrators must pay or deny rehabilitation service invoices within 30 days of receipt or the payer is subject to a penalty of up to $2,000 (Minnesota Statutes § 176.102; Minnesota Rules 5220.1900). The employer or insurer is required to pay, request additional information, or deny the charge within 30 calendar days after receiving a rehabilitation provider's bill. Partially denied charges require written notification to the rehabilitation provider stating the specifically denied service and the reason why it is excessive or unreasonable. For more information, contact Mike Hill at 651-284-5253 or mike.hill@state.mn.us.

REGULATORY ACTIVITY:

• Notice of availability of PC-Pricer program under Minnesota Statutes, section 176.1362, subdivision 1:  Notice is hereby given that on October 1, 2018, the applicable PC-Pricer program to be used to calculate payment for workers’ compensation inpatient hospital services, articles, and supplies based on the Medicare MS-DRG system under Minnesota Statutes, section 176.1362, subdivision 1, is the 2018 Fiscal Year PC-Pricer, version 2018.0, available on the Department of Labor and Industry’s Web site at:  dli.mn.gov/business/workers-compensation/work-comp-pc-pricer-tool-inpatient-hospital-bills.  This PC-Pricer program is the most recent version of the PC-Pricer available on Medicare’s Web site as of July 1, 2018. It is effective for patients discharged on or after October 1, 2018. Date: September 17, 2018     Ken B. Peterson, Commissioner.

FEE SCHEDULE NEWS:

• The Minnesota Department of Labor and Industry has adopted a new Outpatient Hospital Fee Schedule with an effective date of October 1, 2018. Some of newly adopted regulations are:
  • The Hospital Outpatient Fee Schedule (HOFS) applies to all outpatient hospital services with the exception of hospitals designated by Medicare as Critical Access Hospital (CAH).
  • Reimbursement for outpatient services is divided into two categories. Non-Critical Access Hospitals with 100 or fewer licensed beds and hospitals with greater than 100 licensed beds.
  • The HOFS for outpatient surgical, emergency room and clinic services is based on Medicare’s Hospital Outpatient Prospective Payment System (OPPS) Addenda A and B in addition to corresponding code “status indicators”.
  • If the bill includes a charge where the Status Indicator = “J1” or “J2”, then reimbursement is made at the value listed within the HOFS.
  • If the bill does not include a charge where the Status Indicator = “J1” or “J2”, and if the service is covered, charge is to be paid based upon the relative value fee schedule. If the service is not covered under the relative value fee schedule, then reimbursement is made at 85% of the hospital’s usual and customary charge.

REGULATORY ACTIVITY:

• A new August/September edition of COMPACTis now available at dli.mn.gov/business/workers-compensation/work-comp-compact-newsletter.

FEE SCHEDULE NEWS:

• New Medical Fee Conversion factors have been adopted with an effective date of October 1, 2018. The next update is expected for October 2019.

REGULATORY ACTIVITY:

• Exempt rules updated the workers' compensation independent medical examination fees and workers' compensation conversion factors; Minnesota Rules parts 5219.0500 and 5221.4020.  The rules provide the annual adjustments to the maximum workers' compensation independent medical examination fees (IME) as provided in Minnesota Rules 5219.0500 and the workers' compensation conversion factors for the workers' compensation fee schedule as required by Minnesota Statutes 176.136, subd. 1a (c) and (d). The IME fees and conversion factors are adjusted by the percent change in the Producer Price Index for Offices of Physicians for 2017, which was 0.45 percent.

LEGISLATIVE ACTIONS:

House Bill 3873

• The enacted legislation makes changes to the workers’ compensation statute, which was recommended by the Workers’ Compensation Advisory Council. The legislation adjusts the salary of judges of the Workers’ Compensation Court of Appeals. The legislation established a quorum necessary for the Court of Appeals Court.  The legislation requires that a panel be made up of no less than or no more than 3 members. The statute allows that in the case where the number of Appeal Court judges available is insufficient to constitute a quorum, the Chief Judge may assign a judge retired from the Court of Appeals or the Office of Administrative Hearings. The statute establishes that information contained in reports filed with the commissioner may be used in hearings.  The reports filed with the commissioner are available for examination by the employer, insurer, employee or dependent of a deceased employee or any person who furnishes signed authorization from any of the parties mentioned above. The legislation established a new section in the statute entitled coordination of the office of administrative hearings’ case management system and the workers’ compensation imaging system.  This new section of the statute governs filing requirements pending completion of the workers’ compensation modernization program and access to documents and data in the office’s case management system, the workers’ compensation Informix imaging system and the system that will be developed as a result of the workers’ compensation modernization program.  These sections of the statute become effective June 1, 2018.
• The enacted legislation establishes a new section entitled Workers’ Compensation Hospital Outpatient Fee Schedule. This section of the statute sets forth the requirements for the state to establish a hospital outpatient fee schedule. The statute identifies 4 terms critical to the establishment of the fee schedule: Use of OPPS APC for CY 2018; OPPS Payment by HCPCS Codes for CY 2018; HCPCS code and Hospital.  The statute sets forth specific requirements that the agency must take in establishing the fee schedule. The statute also establishes requirements for outpatient billing, payment and dispute resolution. It also establishes requirements for Ambulatory Surgical Center payments setting forth specific criteria that the state must use in establishing payment regulations. These sections of the statute become effective October 1, 2018.
• The enacted legislation addresses benefits available for certain individuals suffering from post-traumatic stress disorder. Employees covered by this definition of occupational disease include licensed police officer, firefighter, paramedic, emergency medical technician, licensed nurse employed to provide emergency services outside of a medical facility, a public safety dispatcher, officer employed by the state or political subdivision at a corrections, detention, or secure treatment facility, a sheriff or full-time deputy sheriff or a member of the state patrol. The statute states that if any of the above-mentioned individuals are diagnosed with post-traumatic stress disorder and have not been diagnosed with a mental impairment previously, then the mental impairment is presumptively an occupational disease. This section of the statute shall become effective for employees with dates of injury on or after January 1, 2019.
• The enacted legislation increases temporary partial compensation benefits from 225 weeks to 275 weeks or after 450 weeks after the date of injury, whichever occurs first. The enacted legislation increases the amount of benefits paid for permanent partial disability. The enacted legislation increases the age at which disability ceased from 67 years old to 72 years old except when an employee is injured after the age of 67, which direct that the benefits will cease after five years of those benefits being paid. This section of the legislation becomes effective on June 1, 2018.
• To view the bill, go to https://www.revisor.mn.gov/bills/text.php?number=HF3873&version=latest&session=ls90&session_year=2018&session_number=0.

REGULATORY ACTIVITY:

• The Department of Labor and Industry has posted a Notice of Intent to Adopt Rules Without a Public Hearing Unless 25 or More Persons Request a Hearing, and Notice of Hearing if 25 or More Requests for Hearing Are Received.  The commissioner of the Minnesota Department of Labor and Industry (DLI) intends to adopt rules governing Workers' Compensation Vocational Rehabilitation Fees, Minnesota Rules, Part 5220.1900.  Please see the Dual Notice:  Notice of Intent to Adopt Rules Without a Public Hearing Unless 25 or More Persons Request a Hearing, and Notice of Hearing if 25 or More Requests for Hearing Are Received (Dual Notice), which is available at dli.mn.gov/Pdf/docket/5220_1900_dualnotice.pdf. The Dual Notice provides details about the rulemaking process, including how to submit comments and how to request a hearing via the agency contact person. A copy of the proposed rules is available at www.dli.mn.gov/Pdf/docket/5220_1900_proposedappvdrules.pdf.
• Published notice in the state register of proposed rule.  The proposed rules are amendments to the rules governing fees for vocational rehabilitation services provided to injured workers. Specifically, the proposed rules eliminate the fee reduction for lengthy and costly rehabilitation plans and adjust the maximum hourly rate for qualified rehabilitation consultant (QRC) services so that total QRC costs remain neutral as of the effective date of the rules. The proposed rules also increase the hourly limit on QRC services when a person other than the QRC is providing job development or job placement services. Next, the proposed rules provide clarity to rehabilitation providers and insurers about billing and payment for certain types of services and activities. Finally, the rules reference penalty authority that exists under the workers’ compensation statutes for an insurer’s failure to timely pay or deny a rehabilitation provider’s bill.  The statutory authority to adopt the proposed rules is Minnesota Statutes 2016, section 176.102, subdivision 2(a), which grants the commissioner of DLI the authority to adopt rules regarding rehabilitation fees, and Minnesota Statutes 2016, section 176.83, subdivisions 1 & 2, which grant the commissioner the authority to adopt “rules necessary to implement and administer section 176.102” and adopt, amend, or repeal rules to carry out the provisions.

REGULATORY ACTIVITY:

• The Minnesota Department of Labor and Industry is considering amendments to Minnesota Rules 5220.1400 through 5220.1700 concerning vocational rehabilitation. A draft of the possible amendments was recently added and can be accessed from the workers' compensation rulemaking docket webpage in "Minnesota Rules, Chapter 5220; Workers' compensation vocational rehabilitation". A copy of the notice can be viewed at: http://www.dli.mn.gov/RulemakingWC.asp. To view the rule, go to: dli.mn.gov/Pdf?docket/5220draft1410-1700.pdf.