The State of the States

Regulatory Review

A round-up of nationwide regulatory changes affecting the workers' compensation industry.
By: | August 5, 2016

California

Medical Fee Schedule

The Division of Workers’ Compensation adjusted the durable medical equipment, prosthetics, orthotics, and supplies portion of the official medical fee schedule to conform to changes to the Medicare payment system.

Effective for services rendered on or after July 1, the maximum reasonable fees for durable medical equipment, prosthetics, orthotics, and supplies must not exceed 120 percent of the applicable California fees set forth in the Medicare calendar year 2016 “Durable Medical Equipment, Prosthetics/Orthotics, and Supplies Fee Schedule.”

For more information, visit www.dir.ca.gov/dwc/FeeSchedules/DMEPOS_FeeSchedule/July-2016/Order.pdf.

Colorado

Utilization Standards

The Division of Workers’ Compensation proposed amendments to rules regarding utilization standards and the medical fee schedule.

The proposed rules include a new definition for the term “telehealth,” which is defined as a mode of delivery of health care services through telecommunications systems, including information, electronic and communication technologies, to facilitate the assessment, diagnosis, consultation, treatment, education, care management, or self-management of an injured worker’s health care while the injured worker is located at an originating site and the provider is located at a distant site.

The term includes synchronous interactions and store-and-forward transfers. The term does not include the delivery of health care services via telephone, facsimile machine, or electronic mail systems.

The rules also provide a notification process. Providers may, but are not required to, utilize the notification process to ensure payment for medical treatment that falls within the purview of the medical treatment guidelines.

Therefore, lack of response from the payer will not prohibit the provider from proceeding with treatment consistent with the medical treatment guidelines. The division scheduled a public hearing 9 a.m., Aug. 17, at 633 17th Street, Denver. Send written submissions to the director before the hearing.

For more information, visit www.colorado.gov/pacific/sites/default/files/NOTICE.pdf.

Connecticut

Practitioner Fee Schedule

The Workers’ Compensation Commission announced the 2016 workers’ compensation fee schedule, which went into effect July 15.

The new schedule includes revisions and clarification of some rules and the new 2016 current procedural terminology codes. This new publication is effective for medical services rendered on or after July 15 regardless of the date of injury that are payable to health care providers authorized or permitted to render care under the workers’ compensation law.

For more information, visit http://wcc.state.ct.us/memos/2016/2016-03.htm.

Florida

Reimbursement Manual

The Division of Workers’ Compensation proposed amendments to a rule regarding the reimbursement manual for hospitals.

The 2016 edition of the manual increases the per diem reimbursement rates for surgical and non-surgical hospital inpatient services and the threshold dollar amount triggering stop-loss reimbursement above reimbursement allowances specified in the 2014 edition of the manual.

The 2016 edition also provides an updated fee schedule for various categories of hospital outpatient services based on the current procedural terminology line level charge data with an adjustment of the maximum reimbursement allowance based on the geographic location of the service provider.

Those with questions should email  [email protected]. For more information, visit www.flrules.org/gateway/ruleNo.asp?id=69L-7.501.

New Jersey

Workers’ Compensation Rate

The Division of Workers’ Compensation announced the 2017 workers’ compensation rate. The maximum is $896 and the minimum is $239.

For more information, visit http://lwd.dol.state.nj.us/labor/wc/wc_index.html.

New Mexico

Safety inspections

The Workers’ Compensation Administration proposed amendments to rules regarding requirements for annual safety inspections; the electronic filing of employers’ first report of injury or illness; and notices of benefit payment.

The administration also proposed rules regarding a page limit for fax filing, a process for consolidating cases, attorney liens, the sealing of WCA claims files, and the admission of medical evidence.

The administration proposed rules concerning case management and peer review; self-insurers’ guarantee fund commission, and the filing of exemption forms with the director.

The administration scheduled a public hearing Aug. 11. Comments should be sent to [email protected]. For more information, visit www.workerscomp.state.nm.us/notice_hearing.pdf.

New York

Maximum weekly benefit rate

The Workers’ Compensation Board set a new weekly maximum benefit rate.

The maximum weekly benefit rate for workers’ compensation claimants is two-thirds of the New York State average weekly wage for the previous calendar year as determined by the New York State Department of Labor.

The Department of Labor reported to the superintendent of the Department of Financial Services that the New York State AWW for 2015 was $1,296.48. Accordingly, for workers’ compensation claims with dates of accident or dates of disablement during July 1 – June 30, 2017, the maximum weekly benefit rate will be $864.32.

For more information, visit www.wcb.ny.gov/content/main/SubjectNos/sn046_864.jsp.

Ohio

Opioids

The Bureau of Workers’ Compensation scheduled a public hearing 1 p.m., Aug. 18 to consider the enactment of a new rule regarding the utilization of opioids in the subacute or chronic phases of pain treatment for a work-related injury or occupational disease.

The rule would go into effect Oct. 1 for claims with a date of injury on or after Sept. 1 and for all claims on or after Jan. 1, 2017.

The bureau is also considering amendments to rules regarding provider access to the health partnership programs and provider decertification procedures, the pharmacy and therapeutics committee, and the stakeholders’ health care quality assurance advisory committee.

Written comments should be sent to [email protected] before the public hearing. For more information, visit www.registerofohio.state.oh.us/pdfs/phn/4123_NO_299939_20160713_0821.pdf.

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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