Policy Matters Brief August 31, 2021
Kentucky pre-filed legislation would cover a COVID-19 vaccine reaction under workers’ comp
A pre-filed bill request in Kentucky for the 2022 legislative session, BR 353, would (if passed and signed into law) establish workers' compensation liability:
- If an employer requires COVID-19 vaccination as a condition of employment, and
- An employee develops an adverse reaction to the vaccine
The bill would create a rebuttable presumption that an adverse reaction was caused by the COVID-19 vaccine if it was not present prior to vaccination and arises within 14 days of receiving the vaccine.
This represents a new twist on COVID-related presumptions by seeking to tie a presumption to a reaction to the vaccine. Most prior presumption policies in various states (including Kentucky) have focused on contracting the virus. BR 353 is currently drafted to be retroactive to December 14, 2020.
California DWC adopts additional mental health guidelines
The California Division of Workers’ Compensation (DWC) added new Medical Treatment Utilization Schedule (MTUS) guidelines for the treatment of anxiety that took effect July 19, 2021. An addition to their existing MTUS, the new guidelines are the most current version of the American College of Occupational and Environmental Medicine (ACOEM) Anxiety Disorders Guidelines, which were published April 30, 2021.
The DWC’s MTUS treatment guidelines are, by law, deemed presumptively correct on the issue of extent and scope of medical treatment. However, that presumption is rebuttable and may be controverted by a preponderance of scientific medical evidence establishing that a variance from the guidelines is reasonably required to cure or relieve the injured worker from the effects of their injury or illness.
Illinois expands presumption coverage to include staph infections
The Illinois Governor recently signed into law a new presumption for first responders. HB 3662 creates a presumption for staph infections, including methicillin-resistant Staphylococcus (MRSA), for firefighters, emergency medical technicians and paramedics when the infection is related to employment. The law, which took effect August 20, 2021, adds staph infection to the list of conditions presumed compensable for first responders.
New York adopts Ambulatory Surgery Center rules
After a prolonged rule-making period, the New York Workers’ Compensation Board (WCB) has adopted permanent rules regarding provision of care and fee schedules for ambulatory surgery centers (ASC). In March 2021, the WCB adopted an emergency rule regarding ASCs as they continued their rule-making efforts. On August 4, 2021, the emergency rule was replaced by permanent rules that impact the coding, billing and reimbursement for procedures and medical services provided by ASCs to injured workers in New York.
Arizona Industrial Commission proposes fee schedule changes
The Arizona Industrial Commission recently published its proposed 2021-2022 Physicians’ and Pharmaceutical Fee Schedule. The proposal contains recommended modifications to existing fee schedule language related to proper coding, billing and reimbursement rates for all medical services.
The proposal includes:
- Changes to existing pharmacy reimbursement language
- Updates to the current Resource-Based Relative Value Scale (RBRVS) Fee Schedule
coding and rates, and
- General modifications to the existing fee schedule
Seeking the input of system stakeholders, the Industrial Commission held a public hearing on the proposed fee schedule on July 29, 2021 and allowed written comments to be filed no later than August 5, 2021. The Commission usually attempts to have a revised fee schedule adopted no later than October 1, annually.
Florida continues rule-making on medical fee schedule
The Florida Division of Workers’ Compensation continues rule-making efforts to update its medical fee schedule and has proposed additional changes be incorporated into the 2020 draft fee schedule. The current proposal, which has been undergoing rule-making for some time, is the Florida Workers’ Compensation Health Care Provider Reimbursement Manual 2020 Edition.
OWCP updates medical services fee schedule
The Federal Office of Workers’ Compensation Programs (OWCP) released an updated medical fee schedule that took effect June 30, 2021. The revised fee schedule includes updates to the most current:
- Current Procedural Terminology (CPT) & Healthcare Common Procedure Coding System (HCPCS) codes
- RVUs (Relative Value Units)
- Conversion factors used to calculate reimbursement structures and includes
- Other changes for inpatient and outpatient medical services
This updated fee schedule includes all medical services, as well as inpatient and outpatient services, home health care and DMEPOS.