FEE SCHEDULE NEWS:

• The state has adopted changes to the Ambulance, Anesthesia, Clinical Laboratory, Dental, DME, Home Health, Inpatient Hospital, Physician Drug, Ambulatory Surgical Centers, Outpatient and Medical Provider Fee Schedule effective January 1, 2018. The next expected update is set for April 1, 2018.

REGULATORY ACTIVITY:

• North Dakota has amended the rules of procedure.  The amended rules become effective January 1, 2018. 
• Effective January 1, 2018, WSI will implement a change to the chiropractic pilot program.  The pilot program currently requires a chiropractor to obtain authorization for all chiropractic treatment extending beyond the initial office visit.  Based on preliminary data and provider feedback, WSI will alter the program to include a window period.
• WSI defines the window period as a period of initial chiropractic treatment on a claim not requiring prior authorization.  For initial treatment with a date of service on or after January 1, 2018, each claim will have one window period, which will include: 
  • 6 visits or 60 days of care, whichever comes first, including initial evaluation
  • Treatment of all body parts accepted on a claim
  • Up to two modalities per visit
• WSI offers several options for submitting a request for medications, which require prior authorization. A provider should refer to the WSI Formulary/Medication Restrictions list (link is external) to identify which medications require prior authorization.

• To request prior authorization of a medication, a provider may select one of the following options:
  • Contact WSI Customer Service at 701-328-3800 or 800-777-5033 to speak with a pharmacy technician
  • Obtain the Provider’s Request for Medication Prior Authorization (M11) form from the WSI website and fax to 888-786-8695
• WSI requires supporting medical documentation for authorization of certain medications, e.g. brand name medications.  Once WSI receives and reviews all of the necessary information, the requesting party will receive notification of the authorization status.    

REGULATORY ACTIVITY:

• With the recent information regarding COVID-19, WSI is opening the lobby to the public beginning Monday, June 22, 2020. Visitors are asked to use the doors at the south entrance of the building located off of Century Avenue. Lobby hours will be 8:30 am to 4:30 pm Monday through Friday. Visitors will be able to drop off forms or documents related to their claim or policy. The majority of WSI staff continue to work from home and can be reached through Customer Service at 800-777-5033. In late March, WSI closed its doors to the public but employees continued from home or in the office. Business continued to be conducted by appointment, over the phone, or online. WSI asks visitors to practice social distancing and to stay home if feeling sick. Many services are available online at workforcesafety.com or over the phone. To view this notice, go to https://www.workforcesafety.com/news/wsi-opening-lobby-open-public.

REGULATORY ACTIVITY:

• Issued Bulletin 2020-03 regarding the expansion of Telehealth Services.  To view the bulletin, go to https://www.nd.gov/ndins/bulletins.

REGULATORY ACTIVITY:

• The following guidelines are intended to provide guidance as to who is covered by WSI workers’ compensation coverage, and when they are covered or not covered during times of disaster including spring flooding.  A key determination as to whether flood fighters are covered by traditional workers’ compensation coverage is whether the employee is under the direction and control of their employer.  If an employee is directed by an employer to participate in flood fighting activities, WSI will deem the employee covered, even if they extend their hours beyond the normal work shift.  On the other hand, if employees are simply released by their employer, without specific direction, to help in the flood fighting activities they are not covered by worker’s compensation coverage during their flood-fighting activities.  Additionally, employees who are injured while protecting their own property will be viewed by WSI as being outside the scope of employment and those injuries will not be covered. Employers, defined as sole proprietors, partners, and corporate officers, have the option of covering themselves on their WSI worker’s compensation policies. For those employers who have secured such coverage, activities will be covered to the extent they are related to the protection of business property or assets. Organizations such as political subdivisions, civic groups, churches, etc. with volunteers may establish a volunteer policy to provide coverage for volunteers who assist in flood relief activities. Coverage must be secured, and volunteers preregistered with WSI prior to them engaging in volunteer activities. The cost for volunteer coverage is $9.93 per volunteer subject to a minimum premium of $250.

FEE SCHEDULE NEWS:

• The state has adopted changes to their rules and regulations for their medical and hospital fee schedules with an effective date of January 1, 2020. The next expected update is set for April 2020.

REGULATORY ACTIVITY:

•  Effective January 1, 2020, WSI implemented a new Fee Schedule for Long-Term Care Hospital (LTCH) charges. The LTCH Fee Schedule will require a provider to bill LTCH charges upon discharge only and will not allow for reimbursement of bills submitted as an interim stay. WSI will reimburse inpatient LTCH services based on Diagnosis Related Groups (DRGs) using the following Standard Calculation Formula: Base Rate X Medicare's MS-DRG Weights = Reimbursement Rate. For 2020, the Base Rate is $237,000.00. WSI will post the LTCH Fee Schedule Guideline under Fee Schedule Guidelines on January 1, 2020. Additional information provided in the LTCH Fee Schedule Guideline will include:
• Reimbursement Methodologies for High Cost Outlier, Short Stay Outlier, and Interrupted Stay
• Payment Parameters
• Billing Requirements
• Reimbursement Procedures

If you have questions about this article, or to request an advance copy of the LTCH Fee Schedule Guideline, please send an email to wsipr@nd.gov . To receive provider news, subscribe to our Email Updates list. To view this notice, go to https://www.workforcesafety.com/news/new-fee-schedule-long-term-care-hospitals .

REGULATORY ACTIVITY:

• WSI recently published an article about the Medical Provider Payee Registration form now being required. If a practice has not yet submitted the required form, you must do so by August 30, 2019, or WSI will deny payment.  To view this notice, go to https://www.workforcesafety.com/. WSI recently revised the Medical Provider Payee Registration form, which a practice must submit to receive payment from WSI. The requirement applies to all practices, including those previously registered with WSI under the former registration process. If a practice does not submit an updated registration form, WSI will deactivate the existing payee account and deny payment. If a practice is uncertain whether WSI has received an updated registration, contact customer service at 800-777-5033. To access the revised form and complete information about WSI's provider registration process, go to https://www.workforcesafety.com/medical-providers/provider-registration.

FEE SCHEDULE NEWS:

• New Medical Provider, Outpatient Hospital and Physician, APC and Ambulatory Surgical Centers fee schedule have been released with an effective date of July 1, 2019.

REGULATORY ACTIVITY:

• Posted notice announcing the implementation of a secure provider portal called myWSI. A provider's use of myWSI is highly encouraged, as WSI is working toward the adoption of more electronic functionality to improve efficiency.  
• Effective August 15, 2019, WSI is implementing plan limits for maximum daily dosages for Lyrica® (Pregabalin). This is applicable to both a new and existing prescription. The WSI formulary, available under Pharmacy Services, will reflect this change. Daily dosage limits of Lyrica® will be as follows: Immediate release: 25mg, 50mg, 75mg, 100mg: 3 per day; 150mg, 200mg, 225mg, 300mg: 2 per day; controlled release: 82.5mg, 165mg, 330mg: 1 per day.  If you have questions about this article, please send an email to wsipr@nd.gov. To view this notice, go to https://www.workforcesafety.com/news/implementation-maximum-daily-dosage-limits-lyricar-pregabalin.
• WSI recently revised the Medical Provider Payee Registration form, which a practice must submit to receive payment from WSI. The requirement applies to all practices, including those previously registered with WSI under the former registration process. If a practice does not submit an updated registration form, WSI will deactivate the existing payee account and deny payment. If a practice is uncertain whether WSI has received an updated registration, contact customer service at 800-777-5033.

REGULATORY ACTIVITY:

• Effective April 1, 2019, WSI will no longer require all total knee arthroplasty procedures be performed in the inpatient hospital setting. The Utilization Review (UR) department will now allow for the approval of a total knee arthroplasty described by CPT codes 27446 or 27447 in the outpatient hospital and ambulatory surgical center settings. WSI’s UR department utilizes Official Disability Guidelines (ODG) as the standard of care in the review of services requiring prior authorization. ODG includes guidelines for Knee Joint Replacement and Outpatient Joint Replacement Treatment Guidelines, which outline the clinical indications of medical necessity for this procedure.  To view this notice, go to http://www.workforcesafety.com/news/news-item/change-to-utilization-review-process-for-total-knee-arthroplasty.

LEGISLATIVE ACTIONS:

• House Bill 1064

The enacted legislation creates a new section in the workers’ compensation statute.  The legislation relates to the office of administrative hearings in regard to case processing, tracking and reporting.  It also establishes a required report. In part, the legislation establishes that the office shall track the time elapsed between the date the office receives a file from workforce safety and insurance and the date of the administrative law judge's decision, and monthly calculate a rolling six-month average of time elapsed; adopt case processing standards and policies, including provisions intended to meet a goal of an average of two hundred fifteen days or less per case. Administrative law judges have an average of two hundred fifteen days to issue a decision for any injured worker case from the date the office of administrative hearings receives a file from workforce safety and insurance. The date of the last assigned file is the date of assignment for all consolidated files. The office of administrative hearings and workforce safety and insurance shall report statistical information regarding results under the case processing standards and policies to the legislative management and the state advisory council each quarter.  Effective Date August 1, 2019.

• Senate Bill 2184

An act to amend and reenact subsection 7 of section 23-07.5-02, sections 65-01-02, 65-01-11, 65-01-15, 65-02-20, 65-02-21.1, 65-05-07, 65-05-08.1, and 65-05-08.3, subsections 5 and 12 of section 65-05-12.2, section 65-05-28, subsection 2 of section 65-05-29, section 65-05-30, subsection 3 of section 65-05-32, subsection 5 of section 65-05.1-01, subsection 6 of section 65-05.1-02, and subsection 1 of section 65-07-03 of the North Dakota Century Code, relating to the definition of allied health care professional and health care provider with respect to workers' compensation claims and benefits.  Effective Date August 1, 2019.

FEE SCHEDULE NEWS:

• The Division of Workers’ Compensation has published new fee schedules for the following modules with an effective date of April 1, 2019: APC, ASC, Clinical Laboratory, DMEPOS, Medical Provider Fee Schedule and Outpatient Hospital.

REGULATORY ACTIVITY:

• During natural disasters, such as flooding, WSI sees an increase of questions about workers’ compensation coverage for employees injured in disaster relief while doing their jobs. The following guidelines on workers’ compensation coverage should help clarify who is covered and when coverage applies.

A key to determining if employees injured in disaster relief while doing their jobs are covered by traditional workers’ compensation coverage is whether the employee is under the direction and control of their employer.

• If an employer directs an employee to participate in flood relief activities, WSI will deem the employee covered, even if their work hours extend beyond the normal work shift.
• If an employer releases an employee, without specific direction, to help in flood relief activities, the employee is not covered by workers’ compensation.
• If an employee is injured while protecting their own property, it is outside the scope of employment and injuries are not covered.
• If an employer (defined as sole proprietors, partners, and corporate officers) has Elective Coverage covering themselves on their WSI workers’ compensation policy, the employer is covered if the injury is related to the protection of business property or assets.
• Organizations such as political subdivisions, civic groups, churches, etc. with volunteers may establish a volunteer policy to provide coverage for volunteers assisting in flood relief activities. Coverage must be secured and volunteers preregistered with WSI prior to them engaging in volunteer activities. Volunteer coverage is $10.58 per volunteer, subject to a minimum premium of $250.

For additional information on workers’ compensation coverage during a natural disaster, contact WSI at 800-777-5033.

• Published Documentation Requirements for Prior Authorization of an Elective Lumbar Fusion:

March 2019, WSI has recently received an increase in incomplete prior authorization requests for elective lumbar fusion surgeries. For services requiring prior authorization, WSI’s UR department utilizes Official Disability Guidelines (ODG) as the standard of care. A provider must submit documentation of the following pre-operative clinical surgical indications, as outlined by ODG:

• Documented failure of conservative care
• Imaging reveals spinal instability, or nerve root impingement correlated with symptoms and exam findings
• Recommended levels of fusion, not to exceed two
• Psychosocial screen completed, with confounding issues addressed
• Cotinine screening completed with negative result at six weeks and one week prior to scheduled surgery date
• Patient awareness of alternative treatment options, risks and benefits of the procedure

For additional information on WSI requirements for the approval of an elective lumbar fusion, a provider should refer to the Lumbar Fusion Guidelines.  If you have questions about this article, please send an email to wsipr@nd.gov.  To view a copy of the above notice, go to http://www.workforcesafety.com/news/news-item/documentation-requirements-for-prior-authorization-of-an-elective-lumbar-fusion.

LEGISLATIVE ACTIONS:

• House Bill 1062

This legislation makes adjustments to the appointment and length of service of workforce safety and insurance board members.  Effective Date July 1, 2019.

• House Bill 1072

The legislation creates and enacts a new subsection to section 65-04-27.2 of the North Dakota Century Code, relating to cease and desist orders; to amend and reenact section 65-01-02, subsection 4 of section 65-01-08, sections 65-01-10, 65-04-04, 65-04-06, 65-04-19, 65-04-22, 65-04-24, and 65-04-26.2, subsection 3 of section 65-04-32, section 65-04-33, and subsection 1 of section 65-09-01 of the North Dakota Century Code, relating to definitions, the removal of the word "annual", off-setting premiums, the organizational seal, payroll reports, payment of premiums, premiums in default, notice of premium owing, liability of a general contractor, notices of decision, noncompliance of employers, and liability of uninsured employers; to repeal section 65-06.2-09 of the North Dakota Century Code, relating to safety and performance reviews; to provide a penalty; and to provide for an application. Effective Date August 1, 2019.

• House Bill 1073

The legislation creates and enacts a new section to chapter 65-01 and a new section to chapter 65-05 of the North Dakota Century Code, relating to a pilot program to assess alternative forms of dispute resolution and the electronic submission of medical billings; to amend and reenact section 65-01-02, subsection 3 of section 65-01-15.1, sections 65-02-21.1, 65-05-09 and 65-05-10, and subsection 4 of section 65-05-28 of the North Dakota Century Code, relating to functional capacity examinations, medical examinations for full-time paid firefighters and law enforcement officers, licensing required for allied health care professionals, average weekly wage upon recurrence of disability, combined partial disability benefits, and medical noncompliance; to repeal section 65-02-07 of the North Dakota Century Code, relating to the organization seal; to provide a continuing appropriation; and to provide for application.  Effective Date August 1, 2019.

• House Bill 1240

The legislation creates and enacts a new section to chapter 65-01 of the North Dakota Century Code, relating to workforce safety and insurance pilot program; to amend and reenact section 65-05.1-06.3 of the North Dakota Century Code, relating to rehabilitation services pilot programs; and to provide for a report to the legislative management.  Effective Date August 1, 2019.