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Policy Matters Brief April 29, 2020

April 29, 2020 · Policy Matters team

To ensure workers’ compensation medical care continues during the COVID-19 pandemic, a majority of states issued either emergency declarations at the executive level or passed emergency legislative resolutions related to the delivery of general care.

Measures include:

  • Removing refill-to-soon edits on prescriptions or extending days’ supply of non-controlled medications to allow patients to obtain medications in adequate supply during quarantine.
  • Removing restrictions or promulgating emergency rules to permit the use of telemedicine, allowing injured workers’ and their medical providers to keep routine appointments while continuing to social distance.

We’re also seeing a growth in agency and/or legislative activity concerning COVID-19 related presumptions of workers’ comp coverage for first responders and front-line medical care providers.

COVID-19 related policy activities are evolving daily, and the Optum Public Policy and Regulatory Affairs team is tracking the latest developments. To stay up-to-date, please visit the Policy Matters page on our website.

Florida DWC scheduling workshop to discuss proposed rule changes
Florida’s Division of Workers’ Compensation (DWC) plans a workshop to review medical billing, filing and reporting rules, health care provider medical billing and reporting responsibilities, and insurer authorization and medical bill review responsibilities.

The DWC typically invites stakeholders to review and discuss proposed changes before moving forward with formal rule-making. To date, the proposed changes are not available to the public, but are expected to be released closer to the workshop date, currently scheduled for May 27, 2020 (9:30 a.m. EST) at the DWC office in Tallahassee.

Minnesota Workers’ Comp Advisory Council legislation impacts pharmacy reimbursement recoupment
The Minnesota Workers’ Compensation Advisory Council is recommending that the state’s Special Compensation Fund for insurers seeking recoupment of paid pharmacy bills reimburse according to the state’s established maximum allowable rate methodology, ignoring contracted reimbursement amounts that may have been originally paid by the insurer. The result would be payment at the lesser of the applicable rate in the state fee schedule or the dispensing pharmacy’s usual and customary (U&C) charge.

This recommendation is part of legislation introduced in early March, HB 4206 and SB 4130, which would also require pharmacy bills submitted to the fund include the dispensing pharmacy’s invoice showing its U&C charge at the time the medication was dispensed.

It is noteworthy, given the legislation’s use of the term “invoice,” that electronic billing is mandated across the board in Minnesota.

Ohio moving forward with proposed workers’ comp pharmacy utilization rule changes
The Ohio Bureau of Workers’ Compensation (BWC) is in the next step of their process to amend their pharmacy utilization rules. The proposed changes focus on their formulary and first-fill provisions as well as their opioid rules – all applicable for state fund claims.

Formulary revisions include:

  • Expansions to include cancer medications to treat an allowed cancer condition
  • Medication to prevent migraines when other preventative treatments have failed
  • Anti-inflammatory patches for pain and a topical spray for painful conditions
  • Removal of a tiering requirement for pregabalin

First-fill rule revisions include changes to allow the recommended therapy for injured workers that require HIV post-exposure prophylaxis and for injuries that require treatment with more than one antibiotic. Requirements for writing a first-fill prescription are also revised to simplify the program.

In addition, BWC proposes to rescind their existing rule on “Utilization of opioids in the sub-acute or chronic phases of pain treatment for a work-related injury or occupational disease” and instead adopt a new rule, “Reimbursement of opioids in the treatment of pain for a work related injury or occupational disease.”

The proposed rule is to enhance safety in the use of opioid medications prescribed to treat injured workers by asking prescribers to follow best medical practices outlined by the Ohio Medical Board. If the prescriber does not follow these best practices, BWC (for state fund claims) will not reimburse for opioids. An additional proposed rule, “Reimbursement for Services to Assist in the Discontinuation of Medications,” would allow BWC reimbursement for necessary and appropriate treatment to assist injured workers in the discontinuation of medications that may increase the risk of dependency, misuse and substance use disorder.

The proposed rules were originally published for stakeholder comment in December, and that initial input was taken into consideration. This latest public comment period is open until May 1, 2020.

Utah insurer opioid policy report due date changed
Utah has changed the due date for annual insurer opioid policy reporting to the state’s Insurance Department from September 1 to July 15. The change is among the provision in legislation signed in March 2020.

Existing law permits insurers providing prescription drug coverage, including workers’ compensation insurers, to enact policies to minimize the risk of opioid addiction and overdose and facilitate non-narcotic treatment alternatives for patients who have chronic pain, and provide medication-assisted treatment for patients who have opioid dependence disorder.

The law also requires these insurers to submit a written report to the insurance department regarding whether they have adopted a policy and a general description of that policy. The insurer’s policy should include evidence-based guidelines for prescribing opioids and may include the 2016 Center for Disease Control Guidelines for Prescribing Opioids for Chronic Pain or the Utah Clinical Guidelines on Prescribing Opioids for the treatment of pain.

The Insurance Department developed a specific form for the policy reporting, which has recently been updated to account for the new due date. Submission instructions require the form to be submitted by the insurer via the department’s secure file upload website. Clients seeking assistance with the information for this report should reach out to their clinical liaison.


Our Policy Matters webpage is another great resource for the latest on key policy issues affecting workers’ comp. and auto no-fault. Should you have questions on these or any other public policy developments, please contact our team at

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