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Policy Matters Brief February 2, 2021

February 2, 2021 · Policy Matters team

Colorado DWC schedules annual stakeholder fee schedule rule meetings
The Colorado Division of Workers’ Compensation (DWC) announced its 8th annual series of stakeholder meetings, which allow stakeholders to learn about key issues in workers’ compensation, ask questions of the DWC and weigh in on potential revisions for their medical fee schedule rule. The discussions will address all aspects of the rule, but DWC plans to highlight certain proposed topics.

The meetings will take place from 4-6 p.m. on the following dates:

  • March 25, 2021
  • April 29, 2021
  • May 27, 2021

Registration in advance is required. To register, go to this link.

Florida DWC continues rule-making efforts
The Florida Division of Workers’ Compensation (DWC) continues their rule-making efforts on various proposed changes and modifications of existing rules and fee schedules, including changes to:

  • Existing Insurer Authorization and Medical Bill Review Responsibilities, 69L-7.740, F.A.C. (hearing held January 13, 2021).
  • Utilization and Reimbursement Dispute Rules, 69L-31, F.A.C. A hearing is scheduled for February 9, 2021.

Information on the proposed rule changes and hearing information can be found here.

Proposed Indiana legislation would permit claimants to choose their workers’ comp physician
Legislation has been introduced in Indiana permitting claimants to choose their physician for their workers’ comp injury or occupational disease. House Bill 1339, provides that after June 30, 2021, the claimant is entitled to choose their attending physician regardless of their date of injury. Current law permits the employer to select the attending physician. Under the proposed legislation, if, due to the nature of the injury, the claimant is unable to select an attending physician or does not select one and the nature of the injury requires immediate treatment and care, the employer should select an attending physician. The employer should also provide an attending physician during any time that the claimant has not chosen an attending physician. When medically necessary or advisable, or at the request of the claimant, the attending physician is to consult with the claimant’s personal physician.

New York advances program developments
The New York Workers’ Compensation Board (WCB) continues development efforts on two key 2021 programs and rule-making related to a proposed new Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) fee schedule.

To update billing forms and formats to a modernized system and process, the WCB is phasing in their CMS-1500 project. Since the CMS-1500 is already used by virtually all medical providers and insurance carriers, the WCB initiative is moving this process forward for workers’ compensation. In the present phase, submittal and acceptance of CMS-1500 forms is currently voluntary and expected to become mandatory as of July 1, 2021. More information on the CMS-1500 project can be found here.

The WCB also continues development efforts for processing prior authorizations in an electronic format and developing a modernized web-based claims system called OnBoard. The Board recently published additional information, including webinars, to help stakeholders understand the new claims system and timelines implementation.

  • The initial phase taking place during Q2 of 2021 is called Limited Release, which will incorporate current paper processes for prior authorization requests (PARs) into an electronic version via the web-based system.
  • Providers requesting a PAR for any treatment or medication that deviates from the medical treatment guidelines will now submit requests online and payers will be able to review and submit determinations online as well. 
  • As the WCB continues to develop these programs, additional information on OnBoard and Limited Release can be found here.

Additionally, as the Board works to roll out the “Limited Release” version of their new OnBoard system, providers could be confused about the new MTGs as they relate to upcoming requirements to seek authorization electronically via OnBoard. The new MTGs have been delayed to an undetermined date.

Finally, and in synergy with OnBoard development, the WCB continues efforts to establish a WC-specific DMEPOS fee schedule (FS). Currently, the FS for DMEPOS is tied to the state Medicaid reimbursement rate(s) and coding, often causing confusion due to application of Medicaid rates and workers’ compensation claim rules. The WCB issued a proposed WC-specific DMEPOS fee schedule rule in late 2021 and continues to move forward during the rule-making process. The new proposed FS de-links the reimbursement from Medicaid and establishes a WC-specific reimbursement rate.

Additionally, the proposed rule includes a description of the item, a listing of HCPCS codes and a new prior authorization indicator. If the specific item on the FS list is indicated as PAR, it requires prior authorization before the item can be provided. The WCB hopes to tie this new PAR requirement to OnBoard and Limited Release.

More information on the proposed rule can be found here.

Oklahoma WCC proposes amendments to medical regulations
The Oklahoma Workers’ Compensation Commission (WCC) has proposed amendments to various regulations, including those governing medical services (chapter 15). The proposed chapter 15 revisions would provide that independent medical examiners (IMEs) should attend relevant continuing educational courses related to workers’ compensation topics and removes the requirement that the WCC must approve the specific educational programming.

The proposed revisions also correct references to the current medical fee schedule after its update in 2020, along with some other less substantive corrections and clarifications.

Written comments may be submitted before 5:00 p.m. on February 17, 2021. A public hearing will take place at 10:00 a.m. the following day.

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