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Policy Matters Brief - April 10, 2024

April 10, 2024 · Public Policy & Regulatory Affairs Team

Georgia adopts updated fee schedule – addresses topical drugs

The Georgia Board of Workers’ Compensation (BWC) released its annual fee schedule, which updates CPT and HCPCS codes for both inpatient and outpatient medical goods and services as well as reimbursement for these specific codes. More importantly, the updated fee schedule includes new reimbursement caps, categories, and billing codes under the pharmaceutical segment addressing utilization of topical medications. The fee schedule took effect on April 1 and is available for purchase via the BWC website.

Kansas again debates medical marijuana

The Kansas Legislature continues to debate the issue of legalizing medical marijuana. Senate Bill 555, currently in the Senate, would create the Medical Cannabis Pilot Program, which allows the use of medical cannabis for certain conditions. Similar bills in 2021 and 2022 failed to pass both houses. Like SB 555, these bills would not have required workers’ compensation to cover the cost or would have penalized workers with valid prescriptions who test positive after a workplace injury.

Louisiana focused on creating medical fee schedule

The Louisiana Legislature continues to move bills related to creation of medical fee schedules for provision of medical services to injured workers.

House Bill 863 would require that by Jan. 1, 2026, the reimbursement schedule include fees based on Medicare ”with variable service aid reimbursement levels that shall be reasonable when compared to the workers compensation reimbursement schedule of states that surround and have similar characteristics to this state and the reimbursement of private health claim.“

House Bill 870, would set that reimbursement rate at one and half times what Medicare charges and states, “If there is no Medicare fee schedule reimbursement amount for a particular care, service, treatment, drug, or supply, the reimbursement amount shall be one hundred sixty-two percent, if such reimbursement is reasonable and in accordance with the legislative intent” and that the.”

At present both bills remain in the House.

Maryland General Assembly passes presumption bill

The Maryland General Assembly House of Delegates recently passed Senate Bill 476, creating a presumption for certain diseases suffered by firefighters. The bill, if approved by the Governor, will create a presumption for thyroid, colon and ovarian cancer as being caused by continued contact with toxic substances in the line of duty for firefighters, instructors, rescue squad members, ALS units and fire marshals. The bill now goes to the Governor for final action.

South Carolina adopts updated fee schedule

The South Carolina Workers’ Compensation Commission (WCC) released its annual fee schedule, which updates existing CPT and HCPSC coding as well as reimbursement maximums for these specific codes. It also contains updated state modifier codes and other codes related to the provision of telehealth. The new fee schedule took effect on April 1 and is available for purchase via the WCC website.

Texas proposes changes to complaint process

The Texas Division of Workers’ Compensation (DWC) issued a proposed rule amendment to modify 28 TAC Section 180.2 to ensure that health care providers or their agent(s) can use the current DWC complaint process to bypass the existing medical fee dispute resolution regulations found in Section 133.307(c). The restriction would not apply to a healthcare provider who submits an actual compliant pursuant to Insurance Code chapter 1305. The comment period for interested stakeholders ends at the close of business on April 16. More information can be found on the TDI website.

New Virginia workers’ comp law removes timely medical payment dispute ‘loophole’ for older dates of service

A Virginia bill removing a provision applying a one-year time limit to a health care provider’s ability to dispute a medical bill payment with the Workers’ Compensation Commission (WCC) to only services rendered after July 1, 2014 was signed into law in late March. House Bill 205 also removes a similar provision that applied a one-year time limit to an employer or insurer’s recovery of a payment made to a provider for services rendered only after July 1, 2014. Both of these revisions will enforce the same one-year time limits regardless of the date of service, removing what some have viewed as a loophole for older dates of service. HB 205 is scheduled to take effect July 1, 2024.

West Virginia, Wyoming expand workers’ comp firefighter cancer coverage

A number of workers’ comp firefighter cancer coverage bills are moving through state legislatures. Two states, West Virginia and Wyoming, recently passed and signed such legislation.

West Virginia Senate Bill 170 added bladder cancer, mesothelioma, and testicular cancer as conditions presumed compensable to the state’s existing workers’ comp firefighter presumption law. The bill also states that the presumption for these three added types of cancer will expire July 1, 2027, unless extended by the Legislature. The existing law included a rebuttable presumption for firefighters who develop leukemia, lymphoma, or multiple myeloma.

Wyoming, House Bill 66, dubbed the “Aaron Booker Firefighter Cancer Screening Act,” adds a provision to the law stating that firefighters shall be presumed to have been exposed to cancer causing agents during the course and scope of their employment. These exposures are to be considered work-related injuries for which cancer screenings are to be provided as an award. Although the bill also states that no other injury or award shall be presumed or required to be provided, it does not prohibit the application of any other presumption or prohibit qualification for any other award. HB 66 lists out the types of cancer screenings to be provided and states that the compensable workplace injury and cancer screenings award are to continue for not more than ten years after the cessation of the firefighter’s employment. The new law is scheduled to take effect July 1, 2024.

Oklahoma bill expanding mental health coverage to first responders advances

A bill expanding mental health coverage to certain first responders is progressing through the Oklahoma legislature. Senate Bill 1457 would, if signed into law, exempt certain first responders from the requirement in the state workers’ compensation law that a mental injury or illness is not compensable unless caused by a physical injury. Currently, this exemption applies only to violent crime victims. If the Oklahoma Workers' Compensation Commission (WCC) finds that a first responder has suffered post-traumatic stress disorder (PTSD) not accompanied by a physical injury, the bill states that the employer must provide reasonable and necessary medical treatment (subject to the WCC's medical fee schedule) for no more than one year, and the employer would not be responsible for prescription medications in excess of $10,000. SB 1457 passed the Senate and is pending in the House.

Minnesota workers’ comp PTSD study informational meetings

As previously discussed, the Minnesota Department of Labor and Industry (DLI) will conduct a study to identify systemic or regulatory changes to improve the experience and outcomes of employees with work-related PTSD, as required by legislation signed in 2023., The DLI will host two virtual informational meetings on April 24 and 29 to update stakeholders about the scope and status of the study. Attendees are encouraged to email questions in advance to ptsdstudy.dli@state.mn.us. There will also be an opportunity to submit questions during the meetings. For more information or to sign up for updates about the study, visit this webpage.

More on PTSD

In a recent Optum Policy Guys podcast, Optum Workers’ Comp Corporate Medical Director Dr. Robert Hall discussed the complexities workers’ comp PTSD coverage and treatment. In addition, a recently released Optum white paper on workers’ comp PTSD coverage policy is available to download.

More details on the current PTSD legislation we are tracking can be found on our Legislative and Regulatory Tracker, which allows users to filter legislation by industry, topic and disposition (status). Use the tracker to research recently enacted or pending workers’ comp presumption legislation. The tracker’s interactive map will help you narrow down and view legislation by state.

Ohio expands workers’ comp coverage for post-exposure testing

Ohio Senate Bill 106 expands the state’s existing workers’ compensation post-exposure testing law covering diagnostic testing for specified safety officers under certain conditions to also include a physician, registered nurse, or other licensed health care professional staffing a rotorcraft or fixed wing air ambulance for a licensed air medical service organization (including transporting a patient from an incident scene or medical facility into an air ambulance, or when transporting a patient from an air ambulance to the entrance of a hospital). The bill requires the Bureau of Workers' Compensation (for state fund claims) or a self-insuring public employer to pay for post-exposure medical diagnostic services to help determine if the person sustained an injury or occupational disease after coming into contact with the blood or other body fluid of another person in the course of and arising out of the employee's employment. Such post-exposure diagnostic tests are covered if they are consistent with the standards of medical care existing at the time of exposure and the employee is exposed to a drug or other chemical substance in the course of employment. SB 106 is scheduled to take effect June 12, 2024.

Alabama bill would permit providers to bill health insurance first for workers’ comp treatment

A recently introduced Alabama bill would, if signed into law, permit a provider to bill an injured worker’s health insurer first for a compensable workers’ compensation claim. House Bill 391 states that if an injured worker is covered by a health insurance policy, a health care provider authorized by the employer may bill that health insurer for any medical care certified as medically necessary by an employer or a qualified utilization review entity. If the health insurer covers the claim, the employer's workers' compensation insurance will reimburse the health insurer. In this scenario, the legislation would require the employer to reimburse all amounts paid by the health insurance plan on the claim to the health insurer or injured worker, as applicable, and all amounts to the injured worker for any out-of-pocket payments made under the terms of the health insurance plan (including deductibles, copayments or coinsurance).

Additional Optum resources:

For more information on these policy developments and others we have been tracking this year, be sure to visit our Legislative and Regulatory Tracker. Bills or regulations can be filtered by insurance line, topic, status and jurisdiction.

If you have questions on these or any other public policy developments, please contact our team at OptumWC.PolicyMatters@optum.com.

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