Policy Matters Brief May 18 2021

Florida Legislature enacts “No Fault” auto insurance reforms
After many years of wrangling over reforms to the Florida auto insurance structure, the legislature recently passed legislation that changes the way auto insurance is carried by all Florida drivers. The changes include several additional reforms which impact drivers, insurance carriers and healthcare providers. 
Senate Bill 54:

• Repeals the current “No Fault” structure of auto insurance
• Repeals the requirement that Florida drivers carry a minimum of $10,000 Personal Injury Protection (PIP) coverage
• Requires drivers to carry a minimum of $25,000 for bodily-injury/death of one person and a minimum of $50,000 for bodily-injury/death of two or more people in an accident
• Modifies existing coverage requirements for property damage and liability
  

The bill passed both chambers of the Florida Legislature on the last day of session, April 29, 2021, and is currently awaiting action by the Governor. The law takes effect January 1, 2022. Once fully effective, it will end the provision of healthcare for an accident under the $10,000 PIP coverage and will convert Florida from a no-fault state.

New York pushing to undo pharmacy direction of care requirements
The New York legislature continues to push legislation that would diminish the ability of an insurer, self-insured employer or TPA (payer) to utilize a workers’ compensation-specific pharmacy benefit network (PBN) in the state.

Current regulatory structure permits payers with New York claimants to develop a PBN network and to file that network with the state Workers’ Compensation Board. Once properly filed, the payer can direct their claimants to use such a network pharmacy to receive their workers’ compensation prescriptions.

Senate Bill 1026, which recently passed the Senate and is now in the Assembly, will undo the regulatory structure and remove payers’ ability to direct injured workers to a network pharmacy. Specifically, SB 1026 changes existing language from “…such employer may require claimants to obtain all prescribed medicines from the pharmacy with which it has contracted“ to “encourage.” 

If passed, the bill would negate one of the cost savings drivers related to pharmacy care in New York. The legislation is currently assigned to the Assembly Labor Committee.

Policy makers move forward on marijuana usage
Approvals of recreational and medical marijuana usage continue as a hot topic during 2021 legislative sessions. Numerous states and even federal policy makers have taken up the charge for expanding patients’ ability to use medical marijuana and have addressed voter-passed referendums on recreational marijuana.

Actions include:

• The U.S. House of Representatives passed HR 1996 or the “Safe Banking Act,” which creates a safe harbor for financial institutions engaging in business relationships with state-licensed cannabis companies.
• New Hampshire State Supreme Court held that an injured worker can be reimbursed by their insurer for medical marijuana use.
• New Jersey Assembly Bill 21 permits the possession, cultivation and utilization of recreational marijuana effective February 22, 2021.
• New Mexico House Bill 2a permits the possession, cultivation and utilization of recreational marijuana effective April 12, 2021.
• New York State Appellate court upheld a Workers’ Compensation Board ruling that granted a variance for medical marijuana treatment provided to an injured worker as part of his workers’ compensation claim.
• New York Senate Bill 854 permits the possession, cultivation and utilization of recreational marijuana effective March 31, 2021.

Policy expansion regarding medical and recreational marijuana usage is certain to remain a hot topic. Many state workers’ compensation agencies are seeing more claims for coverage of medical marijuana and expanding treatment categories permitting medical marijuana use – such as chronic pain and PTSD – which will impact workers’ compensation. 

For ongoing updates on this issue, please visit our Policy Matters page.

New Minnesota law revises several workers’ comp provisions
Minnesota HF 2253 includes several recommendations from the state’s Workers’ Compensation Advisory Council. Signed into law in late April 2021, notable provisions include:

• New penalties for providers who improperly collect or attempt to collect payment from injured workers
• Updated, revised and modified provisions governing inpatient hospital and ambulatory surgical center reimbursement and reimbursement rate sources
• Revised and added prohibited practices concerning insurers, adjusters and other payers/payer agents
• Extension of the sunset date for the COVID-19 presumption enacted in 2020

The COVID-19 presumption provision extends the presumption originally enacted in 2020 for certain workers to now sunset on December 31, 2021. It previously was to sunset on May 1, 2021. This change also adds that employees with dates of injury on or after January 1, 2022 are not entitled to the presumption, but they are not precluded from claiming an occupational disease or a personal injury as provided in other parts of the law.

More information on HF 2252, including the full text, can be viewed here. To learn more on COVID-19 presumptions across the country, including the one in Minnesota, we encourage review of our presumptions map.

Oklahoma Workers’ Comp Commission seeks input on medical fee schedule
The Oklahoma Workers’ Compensation Commission and their vendor are seeking written comments on potential revisions to their current Medical Fee Schedule and ground rules for 2022, which were last amended in May of 2020. The law requires the commission to review and submit a proposed updated fee schedule to the legislature every two years.

Written comments must be submitted via email to okfeedback@fairhealth.org by Friday, May 21, 2021. Further opportunities to comment will be provided once the draft is completed. The current 2020 Fee Schedule can be viewed here.

Wisconsin workers’ comp legislation adds provider billing requirements and limited mental injury coverage
Wisconsin SB 11, enacted in late April, amends several areas of the state’s workers’ compensation law. Notable amendments include provisions governing healthcare provider billing and coverage for PTSD in law enforcement officers and firefighters.

Prior to the amendments, the law stated any health care provider shall, within a reasonable time after written request by the worker's comp insurer or its representative, provide the requestor with any information or written material reasonably related to any injury for which the employee claims compensation.

SB 11 adds, if the request is from a representative of a workers’ comp insurer for a billing statement, the provider shall, within 30 days after receiving the request, provide a complete copy of an itemized billing statement or a billing statement in a standard billing format recognized by the federal government. These new billing provisions took effect April 29, 2021.

This bill also added coverage provisions (with conditions) for a mental injury that is not accompanied by a physical injury and that results in a PTSD diagnosis in a law enforcement officer or firefighter. No individual may receive compensation for a claim of this type of mental injury more than three times in their lifetime, irrespective of whether they become employed by a different employer or in a different position with the same employer.

Additionally, their employer is liable for the employee's treatment for no more than 32 weeks after the injury is first reported, and the period of disability may not exceed 32 weeks after the injury is first reported.