Policy Matters Brief - January 19, 2022
California MPN bill amended significantly
California legislation, Assembly Bill 399, originally introduced last year, was significantly amended by the author on January 3. The original bill would have imposed new requirements on workers’ compensation medical provider networks (MPNs) and further limit the ability of payers and networks to negotiate contracted rates.
The amended bill replaced most of the prior provisions with a provision that would:
- Authorize an injured employee to request the MPN name and identification number when an employer objects to the employee's physician selection because they are outside of the MPN.
- Require the employer to provide the MPN name and ID number within five business days of the request. The employer’s failure to provide this notice would not be not a basis for the employee to treat outside the MPN, unless it is shown that the failure to provide notice resulted in a denial of medical care. An employer would be in compliance if they provide to the employee or selected physician the MPN name and ID in writing, including on an explanation of benefits forms or posted on a public website.
North Carolina workers’ comp medical state reporting discontinued
The North Carolina Industrial Commission (NCIC) announced that, as of January 1, 2022, it is discontinuing its medical electronic data interchange (EDI) reporting program. With this change:
- Medical EDI trading partners will no longer by required to submit medical EDI reports
- Medical EDI transactions submitted on or after January 1, 2022 will not be acknowledged or processed.
The NCIC claims EDI program is not affected and will continue as normal.
Virginia WCC announces pilot medical treatment authorization petition program
The Virginia Workers’ Compensation Commission (WCC) announced a pilot program for petitioning authorization of medical treatment, beginning January 1, 2022. The goal of the program is to expedite the decision on the delivery of medical care (surgery, diagnostic testing, physical therapy, medication, etc.). Initially, the program will be available for cases where an award has been entered, a treating physician is established, both the claimant and the employer are represented by counsel, and the request is for medical care or treatment only.
All petitions for authorization of medical treatment are to be filed with the WCC’s Claims Services Department and must include the documentation supporting the care requested. The respondent will have seven calendar days to advise the WCC and the requesting party of whether the care is authorized or denied. If no response is made in the prescribed time, a telephone conference will be scheduled with the Chief Deputy Commissioner (or designee) and the parties to determine the status of the request.
Following that telephone conference, an order will be entered either affirming the authorized care or referring the request to the WCC’s Evidentiary or On-the-Record Hearing Docket.