The State of the States

Regulatory Review

A round-up of nationwide regulatory changes affecting the workers’ compensation industry.
By: | December 7, 2015

Idaho

Electronic Data Interchange
The Industrial Commission proposed rules regarding implementing EDI Claims Release 3. EDI would allow the submission of all relative workers’ compensation claims information to be reported electronically to the Commission and would alleviate repetitive data entry. The rule amendments would allow the commission to adopt and incorporate by reference in rule the industry standard of the current International Association of Industrial Accident Boards and Commissions EDI Claims Release 3.0 Implementation Guide, published Jan. 1, and located on the IAIABC website; and Version 1.2 of the Idaho Industrial Commission Claims EDI Implementation Guide and Tables. Updates to the EDI Guide and Tables would be made available on the IIC website. The amendments would set forth the requirements of sureties to provide information in accordance with EDI reporting standards. The rules would also allow the electronic submission of a notice of change of status in a workers’ compensation claim be submitted to the commission through EDI rather than submission in the current paper form. The proposed amendment defines a claims administrator who adjusts workers’ compensation claims and clarifies the adjustor is a resident of Idaho. The proposed rule amendment would also clarify the reports by claims administrators to the commission.

Medical Fees
The Industrial Commission proposed changes to a rule regarding medical fees. The changes clarify how outpatient hospital procedures are to be paid in the presence or absence of comprehensive ambulatory payment classification codes. The coding guidelines published by the Centers for Medicare & Medicaid Services and the American Medical Association are adopted as a standard reference for facility charges. The standard for reimbursement of rehabilitation hospitals will be changed to the same as other noncritical access hospitals.

New Hampshire

Claims
The Department of Labor proposed amendments to rules regarding claims. The rules instruct carriers as to what is necessary for medical authorization and allow carriers to submit electronic wage information. The rules also clarify that the carrier has the responsibility of telling the injured worker what benefits are provided under the law. The rules instruct carriers to pay benefits on the same day of the week each week. The department scheduled a public hearing on Nov. 6.

Insurance Coverage
The Department of Labor proposed amendments to rules regarding insurance coverage and self-insured employers. The rules provide self-insured employers instructions for when and what forms must be filed to confirm coverage. The rules were updated to conform to electronic filings by carriers. The self-insurance rules clarify that a group of political subdivisions must supply a guarantee to self-insure. The existing rules were scheduled to expire on Nov. 1 but were subject to an extension.

California

Benefit Notice Manual

The audit unit of the Division of Workers’ Compensation proposed draft revisions to the benefit notice manual and sample benefit notices. The “safe harbor” provision of the regulations provides that benefit notices using the sample notices available on the division’s website are presumed to be adequate notice to the worker and unless modified shall not be subject to audit penalties. The division accepted comments until Oct. 9. The division noted that the revised notices may not be used until the regulations take effect on Jan. 1, 2016.

Connecticut

FICA Deductions
The Workers’ Compensation Commission issued a memorandum regarding calculating weekly benefit amounts without FICA and Medicare deductions. In the event that a commissioner decides that a worker is not subject to FICA or Medicare taxes, he can exclude the equivalent amount from deduction from gross pay to determine the compensation rate. The commission provided equations for calculating the compensation rate. The commission noted that statutory maximums and minimums apply.

Maine

Medical Fee Schedule
The Workers’ Compensation Board announced that a new medical fee schedule went into effect on Oct. 1.

Massachusetts

Cost-of-Living Adjustments

The Department of Industrial Accidents issued a circular letter regarding cost-of-living adjustments, maximum and minimum weekly compensation rates, and the attorney’s fees schedule. For injuries occurring on or after Oct. 1, the maximum weekly compensation rate is $1,256, and the minimum weekly compensation rate is $251. Recipients of total disability benefits are eligible for a COLA if the date of injury was at least two years before Oct. 1. COLAs for those receiving partial benefits are payable only to workers with an injury date on or after Jan. 1, 1986, but before Dec. 24, 1991. Insurers are entitled to quarterly reimbursements from the workers’ compensation trust fund for COLAs. The schedule of adjusted attorney’s fees is contained in the circular letter. The new rates apply to cases involving injuries on or after Dec. 24, 1991.

Christina Lumbreras is a Legal Editor for Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at [email protected]

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