LEGISLATIVE ACTIONS:

House Bill 82

The enacted legislation repeals an enactment clause that provides that the maximum tax rate that may be assessed on insurance carriers or self-insured employers for the purpose of funding workers' compensation benefits that are awarded against uninsured employers from the Uninsured Employer's Fund will revert from 0.5 percent to 0.25 percent on July 1, 2018. Repealing the enactment will maintain the maximum rate at its current level of 0.5 percent. Effective Date July 1, 2018.

House Bill 117

The enacted legislation provides that the commissioners of the Workers' Compensation Commission, for purposes of constituting a quorum, shall include any deputy commissioner or retired commissioner who is appointed or recalled, respectively, to fill a vacancy on the Commission. Effective Date July 1, 2018.

House Bill 531

The enacted legislation removes the provision that prevents the Workers' Compensation Commission from aggregating proof of coverage information filed with the Commission by an insurance carrier or rate service organization on behalf of an employer with the proof of coverage information filed by or on behalf of other employers. Effective Date July 1, 2018.

House Bill 558

The enacted legislation clarifies that the "medical community," when referring to providers of medical services rendered under the Virginia Workers' Compensation Act outside of the Commonwealth, shall be determined by the zip code of the principal place of business of the employer if located in the Commonwealth. If the employer's principal place of business is not in the Commonwealth, then it shall be determined by the zip code of the location where the Workers' Compensation Commission would conduct its hearing regarding a dispute concerning the medical services.  Effective Date July 1, 2018.

FEE SCHEDULE NEWS:

• Virginia has posted the final fee schedule regulations that become effective on January 1, 2018.

REGULATORY ACTIVITY:

• VWC Headquarters Relocation | Virginia Workers' Compensation Commission on December 13, 2017, The Virginia Workers’ Compensation Commission will begin full operations in its new agency headquarters, the former Media General building, located at 333 East Franklin Street in downtown Richmond, Virginia. The new VWC headquarters consolidates office space from three (3) current office locations in Richmond. Sufficient parking for employees and visitors will be available at the corner of 3rd and E. Main Street.

REGULATORY ACTIVITY:

• Published emergency regulation 18VAC85-21. Regulations Governing Prescribing of Opioids and Buprenorphine (amending 18VAC85-21-30, 18VAC85-21-40, 18VAC85-21-60, 18VAC85-21-70, 18VAC85-21-80, 18VAC85-21-130, 18VAC85-21-140, 18VAC85-21-150, 18VAC85-21-160). The emergency regulation is effective August 24, 2017 through September 14, 2017.
• In late June of this year, a notification was sent to all stakeholder groups advising that the Commission would re-implement the Variance Notification process. File audits will be conducted with an analysis of compensation due against EDI-SROI payment information received. Should a file audit reveal an underpayment of $50 or greater, a Variance Notification letter will be sent to the injured worker and claims administrator.  The Variance Notification letters will officially begin to generate on Thursday, September 21, 2017.

REGULATORY ACTIVITY:

• The Virginia Workers’ Compensation Commission is pleased to announce the opening and relocation of its Virginia Beach Regional Office. The new office is located at 281 Independence Boulevard, Suite 310, Virginia Beach, Virginia.  Individuals needing additional information on the office relocation can contact the Virginia Workers’ Compensation Commission at 877-644-2566 and questions@workcomp.virginia.gov.

REGULATORY ACTIVITY:

• The Virginia Workers' Compensation Commission and the International Workers' Compensation Foundation are jointly sponsoring an Educational Conference which is unique in Virginia. The goal of this conference is to educate all those who participate in the Virginia workers' compensation system regarding current rules, procedures, policies and forms, and to provide an opportunity for dialogue among these participants. Breakout sessions will be utilized to discuss certain topics in specific detail for a more specialized view while other topics will be presented from a more general perspective. The 2017 VWC Educational Conference will be held October 24-25 at the Richmond Convention Center.

REGULATORY ACTIVITY:

• The Virginia Beach Regional office, located at 281 Independence Blvd., Virginia Beach, VA 23462 relocated on June 5th - June 8th, and reopened for business on Friday, June 9th. The new office is located on the 3rd Floor (Suite 310) and replaces the 6th Floor suite. The new office address is 281 Independence Blvd., Suite 310, Virginia Beach, VA 23462. The office can be contacted using the same fax and phone numbers as previously used:  Phone: 757-648-7100; Fax: 757-552-1114.
• Virginia has posted medical fee schedule dispute resolution process on their web site for comments. A copy of the process is attached.  To post a comment on the process go to: https://www.surveymonkey.com/r/VA-MFS-Comment
• The Commission has published a new online from 17A Notice Terminating Prior Rejection of Coverage. To view the form, go to: https://webfile.workcomp.virginia.gov/portal/vwc-portal/Form17A.

REGULATORY ACTIVITY:

• Virginia has proposed a Medical Fee Schedule for Adoption.  Comments may be provided until May 10th. From April 10-May 10, 2017 the public has the opportunity to review the medical fee schedule and to provide comments to the Medical Fee Schedule Regulatory Advisory Panel via the Commission. A Public Hearing will be held on May 23 at 8:30 a.m. at the Virginia Workers’ Compensation Commission, 1000 DMV Drive, Richmond, Virginia 23220, in Courtroom A, as well. The public hearing provides another opportunity for the public to provide comments on the Medical Fee Schedule.
• New Mailing Address for Roanoke Office: Effective May 1, 2017, the mailing address for the Roanoke office will be 3959 Electric Rd., Ste. 425, Tanglewood West, Roanoke, VA 24018.

REGULATORY ACTIVITY:

• Posted an updated Medical Fee Schedule Project Timeline.
• Virginia has published the maximum compensation rate; minimum compensation rate and COLA rate that will become effective on July 1, 2017.  The maximum compensation rate will be $1,043.0.  The minimum compensation rate will be $260.7.  The COLA rate will be 2.05%.

LEGISLATIVE ACTIONS:

• House Bill 1571
  The enacted legislation provides that the pecuniary liability of an employer for a medical service provided for the treatment of a traumatic injury or serious burn includes liability for any professional service rendered during the dates of service of the admission or transfer to a Level I or Level II trauma center or to a burn center, as applicable. The measure increases the initial charge outlier threshold, which under the stop-loss feature allows hospitals to receive payments or reimbursements that exceed the fee schedule amount for certain claims, from 150 percent of the maximum fee for the service set forth in the applicable fee schedule to 300 percent of such amount. The measure allows the Workers' Compensation Commission to adjust the charge outlier threshold percentage; under existing law, it is allowed only to decrease the percentage. The measure also (i) expands the definition of codes, as used in the provision directing the Commission to establish fee schedules for scheduled medical services, to include revenue codes, which are defined in the bill; (ii) clarifies the definition of "HCPCS codes"; (iii) directs the Commission to use the regulatory advisory panel on all matters involving or related to the fee schedule as deemed necessary by the Commission; (iv) adds a definition of "new type of technology"; and (v) extends the deadline by which the regulatory advisory panel is required to meet, review, and make recommendations to the Commission from July 1, 2017, to July 1, 2018. The bill contains an emergency clause. Effective Date: March 13, 2017.
• House Bill 1659 and Senate Bill 1175
  The enacted legislation requires that any arbitration proceeding regarding the exercise of an employer's right of subrogation to an employee's claim against a third party shall be limited solely to arbitrating the amount and validity of the employer's lien and shall not affect the employee's rights in any way. Such arbitration shall not be held unless (i) any contested expenses remaining have been submitted to the Virginia Workers' Compensation Commission (the Commission) for a determination of their validity and the Commission has made such determination of validity prior to the commencement of the arbitration; (ii) prior to the commencement of such arbitration the employer has provided the injured employee and his attorney, if any, with an itemization of the expenses associated with the lien that is the subject of the arbitration; (iii) upon receipt of the itemization of the lien, the employee shall have 21 days to provide a written objection to any expenses included in the lien to the employer, and if the employee does not do so any objections to the lien to be arbitrated shall be deemed waived; and (iv) the employer shall have 14 days after receipt of the written objection to notify the employee of any contested expenses that the employer does not agree to remove from the lien, and if the employer does not do so any itemized expense objected to by the employee shall be deemed withdrawn and not included in the arbitration. Effective Date: July 1, 2017.
• Senate Bill 904
  The enacted legislation provides an exception from the prohibition against carrying a weapon into courthouses in the Commonwealth for a commissioner or deputy commissioner of the Workers' Compensation Commission while in the conduct of official duties. Effective Date: July 1, 2017.
• Senate Bill 1201
  The enacted legislation authorizes the Workers' Compensation Commission to require an employer to provide funds for the purchase of a suitably equipped automobile for an incapacitated employee if it finds that it is medically necessary and that modification to the employee's automobile are not technically feasible or will cost more than the funds available for a replacement automobile. The total of the costs of the automobile and of any bedside lifts, adjustable beds, and modification of the employee's principal home are limited to $42,000, which is the amount of the existing cap on expenses for modifications to the injured employee's automobile and home. Effective Date: July 1, 2017.

REGULATORY ACTIVITY:

• Virginia has published two new FQA for two new online forms 61A and 16A.
• Virginia has published an updated Medical Fee Schedule Time line.
• Virginia has released a copy of the proposed MFS for comment and feedback.

FEE SCHEDULE NEWS:

• The state of Virginia released an emergency regulations effective January 11, 2016 that includes redefined Communities (reduced from 15 to 5), as well as Out-of-State provider region determination.

REGULATORY ACTIVITY:

• The Division has published a medical fee schedule project update.

LEGISLATIVE ACTIONS:

• House Bill 44
  The enacted legislation establishes presumptions in claims under the Virginia Workers’ Compensation Act that the accident arose out of and in the course of employment if (i) the employee dies with there being no evidence that he ever regained consciousness after the accident, (ii) dies at the accident location or nearby, or (iii) is found dead where he is reasonably expected to be as an employee. These presumptions will exist in the absence of a preponderance of evidence to the contrary and where the factual circumstances are of sufficient strength from which the only rational inference to be drawn is that the accident arose out of and in the course of employment. Effective Date: July 1, 2016.
• House Bill 378; Senate Bill 631
  Both of the pieces of legislation have been passed and enacted into law and they are identical. The legislation directs the Workers’ Compensation Commission (the Commission) to adopt regulations establishing fee schedules setting the maximum pecuniary liability of the employer for medical services provided to an injured person pursuant to the Virginia Workers’ Compensation Act, in the absence of a contract under which the provider has agreed to accept a specified amount for the medical service. The regulations implementing the fee schedules shall become effective on January 1, 2018. The initial fee schedules will set amounts based on a reimbursement objective, which is the average of all amounts paid to providers in the same category of providers for the medical service in the same medical community. The Commission is required to retain a firm to assist it in establishing the initial fee schedules. The firm will recommend a methodology that will provide statistically valid estimates of the reimbursement objective for fee scheduled medical services within the medical communities. Reimbursements for medical services provided to treat traumatic injuries and serious burns are excluded from the fee schedules and liability for their treatment costs will be based, absent a contract, on 80 percent of the provider’s charges. However, the required reimbursement will be 100 percent of the provider’s charges if the employer unsuccessfully contests the compensability of the claim. The Commission is required to review and revise the fee schedules in the year after they become effective and biennially thereafter. The liability of the employer for certain medical services not included in a fee schedule will be set by the Commission. A stop-loss feature allows hospitals to receive payments or reimbursements that exceed the fee schedule amount for certain claims when the total charges exceed a charge outlier threshold, which initially is 150 percent of the maximum fee for the service set forth in the applicable fee schedule. Providers are prohibited from using a different charge master or schedule of fees for any medical service provided for workers’ compensation patients than the provider uses for health care services provided to patients who are not claimants. The measure requires the Commission, when determining whether the employee’s attorney’s work with regard to a contested claim resulted in an award of benefits that inure to the benefit of a third-party insurance carrier or health care provider, and in determining the reasonableness of the amount of any fee awarded to an attorney, to consider only the amount paid by the employer or insurance carrier to the third-party insurance carrier or health care provider for medical services rendered to the employee through a certain date and not to consider additional amounts previously paid to a health care provider or reimbursed to a third-party insurance carrier. The Commission shall have an independent, peer-reviewed study conducted every two years. The regulations setting fee schedules are exempt from the Administrative Process Act if the Commission utilizes a regulatory advisory panel to assist in the development of such regulations and provides an opportunity for public comment on the regulations prior to adoption. The measure prohibits certain practices involving the use by third parties of contracts whereby a provider agrees to accept payment of less than the fee scheduled amount, including restricting the sale, lease, or other dissemination of information regarding the payment amounts or terms of a provider contract without the express written consent and prior notification of all parties to the provider contract and prohibiting an employer from shopping for the lowest discount for a specific provider among the provider contracts held in multiple PPO networks. The regulatory advisory panel is directed to make recommendations to the Commission prior to July 1, 2017, on workers’ compensation issues relating to (i) pharmaceutical costs not previously included in the fee schedules; (ii) durable medical equipment costs not previously included in the fee schedules; (iii) certain awards of attorney fees; (iv) peer review of medical costs; (v) prior authorization for medical services; and (vi) other issues that the Commission assigns to it. The existing peer review provisions are repealed.   Effective Date: March 7, 2016.