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Policy Matters Brief - March 9, 2022
New York WCB adopts new Medical Treatment Guidelines
The New York Workers’ Compensation Board adopted amendments to 12 NYCCR 324.2 to incorporate three new Medical Treatment Guidelines (MTGs). The guidelines are now fully adopted into rule but are not effective until May 2, 2022. The MTGs are as follows:
- New York Eye Disorders
- New York Traumatic Brain Injury
- New York Complex Regional Pain Syndrome
Determinations for pharmacy, ancillary and medical care should not be made utilizing these MTGs until on or after May 2,2022. More information on the new MTGs, including PDF copies can be found here.
New York WCB announces OnBoard form changes
On February 24, 2022, the New York Workers’ Compensation Board (WCB) announced modifications to specific Request for Assistance Forms to align usage with the pending implementation of OnBoard. All three of the following Request for Assistance Forms request Adjudication Review during the prior authorization process. The Board has added checkboxes to align these forms for scenarios where Adjudication Review is appropriate.
- Request for Further Action by Legal Counsel (Form RFA-1LC)
- Request for Assistance by Injured Worker (Form RFA-1W)
- Request for Further Action by Insurer/Employer (Form RFA-2)
The WCB will start accepting the new versions of the forms on May 2, 2022, the same day as the third phase of OnBoard: Limited Release launches. Use will become mandatory on June 6, 2022. Advanced draft copy of these forms prior to the May 2, 2022, implementation date can be requested from the WCB by emailing: email@example.com. Further information on the form modifications can be found here.
Minnesota’s workers’ comp COVID-19 presumption reinstated
On February 3, 2022, Minnesota’s prior workers’ compensation COVID-19 coverage presumption was reinstated by House File 1203 and signed into law. Among other provisions, HF 1203 reinstates the COVID-19 presumption from HB 4537 (2020) as extended by HF 2253 (2021) to last through January 13, 2023. The presumption applied to specific occupations – including doctors, nurses, paramedics, firefighters, police, correctional officers and child care workers – had expired at the end of 2021.
HF 1203 states that employees with dates of injury that occurred between January 1, 2022 and February 2, 2022, (the day before the presumption was enacted again) and then on or after January 14, 2023, are not entitled to the presumption. However, they are not precluded from claiming an occupational disease or personal injury as provided in other areas of law.
Legislation to address this gap period has been introduced in both chambers. Pending HF 3165 and SF 2955 would create a workers' compensation COVID-19 presumption reimbursement fund to reimburse employees in job classifications otherwise entitled to the presumption but whose COVID-19 claim is denied at least in part due to unavailability of the presumption between January 1, 2022 and February 2, 2022.
For more on COVID-19 presumptions in workers’ comp, we encourage review of our presumptions map.
Oregon workers’ comp modernization program focuses on notices and forms
The Oregon Workers’ Compensation Division’s (WCD) modernization program has begun a process improvement project to evaluate and analyze notice language, forms and publications required by rule. As part of this, a virtual meeting was scheduled for March 8, 2022, in order to get stakeholder advice about best methods for notifying workers and employers about their rights and responsibilities. With this advice, the WCD will develop agenda items for further discussion with rulemaking advisory committees. More information can be found on the WCD’s training and events webpage.
Pending Utah legislation loosening up physician dispensing restrictions
Pending legislation in Utah would, if passed and signed into law, loosen up restrictions around the practice of physician dispensing. House Bill 301, as recently amended, would permit a “dispensing practitioner” (specified physicians, surgeons, advanced practice registered nurses, or physician assistants) who practices at a “licensed dispensing practice” to dispense, under certain criteria, for a condition that is not expected to last longer than 30 days and for which the patient has been evaluated by the physician on the same day on which they dispense the drug. The bill includes new requirements for licensure as a licensed dispensing practice.
Most notably for insurers, HB 301 states that a dispensing practitioner may not make a claim against workers' compensation or automobile insurance for a drug dispensed for outpatient use unless the dispensing practitioner is contracted with a pharmacy network established by the claim payer. Additionally, a dispensing practitioner may not dispense a controlled substance, a drug or drug class designated by the Division of Occupational and Professional Licensing as not to be dispensed, gabapentin, or a drug that exceeds a 30-day supply.
When a dispensing practitioner dispenses a drug to the patient, the bill would also require they disclose to the patient verbally and in writing that the patient is not required to fill the prescription through the licensed dispensing practice and that the patient has a right to fill the prescription through a pharmacy.
Legislative and Regulatory Tracker
Legislation can be reviewed using our legislative and regulatory tracker. Updated daily, this tool enables you to search through many of the bills and regulations we are tracking for more detailed information.
Our Policy Matters webpage is another great resource for the latest on key policy issues affecting workers’ comp. and auto no-fault. Should you have questions on these or any other public policy developments, please contact our team at OWCAPolicyMatters@optum.com.