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Policy Matters Brief - December 14, 2021

December 14, 2021 · Public Policy & Regulatory Affairs Team

California DWC updates low back treatment guideline
The California Division of Workers’ Compensation (DWC) updated their Medical Treatment Utilization Schedule (MTUS) to incorporate by reference the Low Back Disorders Guideline from the American College of Occupational and Environmental Medicine (ACOEM). This replaced the previously adopted March 7, 2019 Guideline and became effective November 23, 2021.
The MTUS is the primary source to determine standards of care in California’s workers’ compensation system. Adopted treatment guidelines are considered to be presumptively correct on the extent and scope of medical treatment. However, this presumption is rebuttable and may be controverted by a preponderance of scientific medical evidence.

Michigan cancer presumption fund extended to more firefighters
Legislation signed in Michigan adds certain forest firefighters to those who are eligible to claim workers’ compensation benefits from the state’s First Responder Presumed Coverage Fund. House Bill 4171 added language that states, beginning January 1, 2022, a forest fire officer or fire/crash rescue officer who is in active service, has 60 months or more in active service at the time the cancer manifests itself, and is exposed to the hazards incidental to fire suppression, rescue, or emergency medical services in the performance of work-related duties may claim benefits from the First Responder Presumed Coverage Fund for any respiratory tract, bladder, skin, brain, kidney, blood, thyroid, testicular, prostate, or lymphatic cancer.

New York adopts modifications to billing dispute rules
The New York Workers’ Compensation Board (WCB) recently adopted changes to existing Title 12 NYCRR 325-1.25 known as the medical billing rules. Adopted modifications are in synergy with roll-out of the CMS-1500 medical billing project. Modified rules require all objections – including Legal, Valuation and Treatment objections – to medical bills to be made simultaneously. Additionally, modified rules call for future utilization of existing dispute forms – including the currently paper formats of the C-8.1 and/or the C-8.4 – to be converted to a format prescribed by the Chair. This will eventually be part of the electronic billing covered by the CMS-1500 project. All modified changes go into effect for dates of service on or after November 1, 2021.

SAWCA holds 2021 All-Committee Conference
The Southern Association of Workers’ Compensation Administrators (SAWCA) held its 2021 All-Committee Conference the week of November 15, 2021. The in-person conference hosted multiple panels and interactive committee discussions on workers' compensation policy, regulation, and administration. At present over 26 jurisdictions are members of SAWCA with many states sending regulators to attend. 
We recently spoke with SAWCA’s Executive Director, Gary Davis, in our “Policy Guys” podcast, where he was able to provide an overview of the importance of SAWCA to the workers’ compensation community and how it connects regulators and industry professionals. Click here to listen to that episode.

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