Policy Matters Brief November 23, 2021
Michigan workers’ comp fee schedules updated
Health care services rules updates adopted by the Michigan Workers’ Compensation Agency (WCA) were approved and became effective November 1, 2021. The more notable changes include:
- Updates to procedure coding and reimbursement source documents
- Expansion of an existing reimbursement cap on over-the-counter (OTC) topical medications to prescription topical medications
- New provisions governing ground ambulance services
Expanded topical medication provisions
The amended rules expand existing provisions governing topical medications that are not a “custom compound” to all commercially-manufactured topical medications not meeting the definition of “custom compound” – not just those that are OTC or contain OTC ingredients as previously stated in the rules. This expands the language to prescription topical medications that are not a “custom compound.”
These topical medications are not to be dispensed in excess of a 30-day supply, and reimbursement is to be at a maximum of the provider’s acquisition cost plus a single $8.50 dispensing fee. Additionally, the provider is to only be reimbursed one dispensing fee per topical medication in a 10-day period.
New provisions for ground ambulance services
The amended rules also remove ground ambulance services from the list of services billed and reimbursed “by report.” Instead, new billing and reimbursement provisions for ground ambulance services were added that are similar to existing provisions related to air ambulance services.
Several days after approval of the updated rules, the WCA also published an updated Health Care Services Manual and other supplemental fee schedule documents. Those can be viewed here.
More legislation introduced to modify Michigan’s 2019 auto no-fault reform law
More legislation has been introduced in Michigan to modify provisions in the state’s 2019 auto no-fault reform law. Two new bills specifically target the fee schedule and utilization review (UR) provisions in the law.
House Bill 5500 would add "medical" in front of "treatment" everywhere it is referenced in the auto no-fault fee schedule law and then define that new "medical treatment" term to expressly exclude certain services and items including:
- Prescriptions, medications or pharmaceutical supplies
- Durable medical equipment
- Attendant care services, regardless of who renders those services
- Transportation services
- Modifications to a vehicle or residence
- Case management services
- Other similar non-medical products, services or accommodations
House Bill 5498 would amend UR provisions in the law by adding the term "medically accepted standards." “Medically accepted standards” would be defined as “standards or guidelines that are generally relied on by medical professionals in rendering medical treatment and developed by the federal government or national or professional medical academies, associations, boards, or societies.” This is similar to a definition adopted in the UR regulations but, notably, this definition would further state that “medically accepted standards does not include any set of standards or guidelines developed by private, for-profit corporations for commercial gain.”
These two bills are added to a longer list of previously-introduced legislation this year seeking to modify certain parts of the reform law given various concerns from several stakeholders, particularly those concerned with implementation of certain fee schedule provisions.
California DWC schedules stakeholder meeting on efficiency and quality of care
The California Division of Workers’ Compensation (DWC) has scheduled a public meeting to hear ideas to improve the efficiency and quality of care provided to injured workers. DWC hopes that a variety of interested stakeholders will share their thoughts regarding providing quality care and an efficient, cost effective system that offers fair compensation and minimizes frictional costs.
The meeting will be held virtually November 30, 2021 from 12 to 2 pm (pacific). More information can be obtained here.
IAIABC Holds 107th Convention
The International Association of Industrial Accident Boards and Commission (IAIABC) held its 107th Convention virtually the week of October 25th. It was filled with several educational sessions and interactive discussions on workers' compensation policy, regulation, and administration.
We recently spoke with IAIABC Executive Director, Jennifer Wolf, in our “Policy Guys” podcast, where she was able to provide an overview of the importance of IAIABC to the workers’ comp. community and how it connects regulators and industry professionals. Click here to listen to that episode.