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The latest legislative and regulatory activity that impacts you and the services we provide
Policy Matters Brief - November 16, 2022
California updates fee schedule
The California Division of Workers’ Compensation recently posted an order adjusting the hospital outpatient departments and ambulatory surgical centers section of the Official Medical Fee Schedule to conform to the current fee schedule in line with Medicare payment changes adopted in October 2022. More information on the specific modifications to the fee schedule can be found here.
Mississippi updates fee schedules
On October 13, 2022, the Mississippi Workers’ Compensation Commission published an adopted and updated version of their medical fee schedule. The new fee schedule:
- Updates current (CPT/HCPCS) codes and reimbursement rates for medical services
- Adds new codes and billing requirements related to telemedicine and Home Healthcare
The updated fees schedule also makes a significant change in the provision of pharmacy care related to lidocaine. A newly added segment of the Pharmacy Rules states:
“Topical lidocaine, including patches, must first be obtained over-the-counter (OTC). If treatment with OTC lidocaine, including patches has been tried and is ineffective, prescription strength lidocaine, or lidocaine patches, may be used. Reimbursement for prescription strength lidocaine, and patches, shall be made according to Other Special Pricing under Section V of the pharmacy rules, Special Pricing.”
As a reference, the current special pricing in the Pharmacy Rules under Section V restricts reimbursement for topical medications other than patches to $30 for a 30-day supply and for patches $70 for a 30-day supply. The new fee schedule takes effect as of November 15, 2022, and can be found here.
Tennessee proposes changes to medical fee schedule(s)
The Tennessee Department of Labor and Workforce published proposed changes to their various medical fee schedules. The changes cover medical and ancillary services, DMEPOS, and pharmacy and inpatient hospital services. As part of the proposal, the Department will hold a public hearing for comments on November 8, 2022, at 1:00 pm at their Nashville offices. The Department will also accept public comments on the proposed changes no later than the end of the business day on November 22, 2022.
Click the links below for more information about the specific changes and to view the proposed changes:
Rules for Medical Payment: 0800-02-17 (2022)
Medical Fee Schedule: 0800-02-18 (2022)
In-Patient Hospital Fee Schedule: 0800-02-19 (2022)
Newly-introduced workers’ comp and auto legislation in New Jersey
New Jersey is one of the few states still in legislative session. Here are updates on just a few of the over 100 pending bills we are tracking there that were more recently introduced.
Workers’ compensation bills Assembly No. 4832 and Senate No. 3309: If passed and signed into law, would set the maximum fee of evaluating physicians for written reports at $1,000 (an increase of $400 over the current maximum). Additionally, S 3309 would add that a psychologist, nurse practitioner, or licensed clinical social worker who provides psychological treatment may be paid a fee for a report or testimony concerning their course of treatment of the injured worker in their role as a provider of treatment.
Auto no-fault bill Senate No. 3266:If passed and signed into law, would increase the personal injury protection (PIP) coverage for basic automobile insurance policies (the max amount per accident) to $50,000 and require that every standard automobile liability insurance policy provide PIP coverage of no less than $50,000 per person per accident. Existing state law requires basic automobile insurance policies to provide PIP in an amount not to exceed $15,000 per person per accident, with no minimums required for standard automobile liability insurance policies.
For more information on several pending New Jersey bills which may be of more interest to our clients, view our Legislative and Regulatory Tracker and select New Jersey on the map.
Virginia Workers’ Compensation Commission repeals peer review regulations
The Virginia Workers’ Compensation Commission (WCC) published a repeal of existing regulations addressing medical costs peer review. A prior statute had established the parameters for peer review regulations and gave the WCC the authority to enact peer review regulations. But, in 2016, that statute was repealed, which removed the WCC’s authority to continue the peer review program. As a result, the WCC is now repealing the related regulations to conform with current statute.
Because this action is to align regulations with statute, it is considered a “fast-track” regulation. It was published in the November 7, 2022, edition of the Virginia Register of Regulations with a December 23, 2022, effective date.
SAWCA All Committee Conference
The Southern Association of Workers’ Compensation Administrators (SAWCA) is holding its 2022 All Committee Conference November 15-18, 2022, in Colorado Springs, Colorado. Adam Fowler, Optum’s Manager of Public Policy & Regulatory Affairs, is participating on an industry roundtable panel the morning of Thursday, November 17, at the conference.
SAWCA is an organization comprised of 22 state workers’ compensation agencies and several industry organizations, including Optum, that come together to share ideas, perspectives, and common concerns to improve workers’ compensation for all. We previously spoke with SAWCA’s Executive Director, Gary Davis, in one of 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.