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Policy Matters Brief - September 7, 2022
California passes a flurry of workers’ compensation bills
Several bills were passed in the final days of California’s 2022 legislative session. Of these, the following impact various areas of the workers’ compensation marketplace.
Codifies and requires the Division of Workers’ Compensation to finish a study of the current workings of the Utilization Review process by no later than July 1, 2023.
Creates an advisory committee to study the effects of heat on workers, business and the economy
Creates a presumption that skin cancer is work-related for peace officers with the state departments of Fish and Wildlife as well as the Department of Parks and Recreation.
Extends a presumption enacted in 2020 regarding COVID and work-place exposure, which was expected to sunset by the end of 2022, to now sunset as of January 1, 2024.
Texas engaging in several rule-making actions
The Texas Department of Insurance (TDI), as well as the Texas Division of Workers’ Compensation (TDWC), have issued notices of rule-making relating to the provision of physician services and medical networks.
The first TDWC notice covers the current “Designated Doctor Rules” and proposed changes to both the billing methodologies and changes to the reimbursement rates. TDWC is scheduled to hold a public meeting on September 8, 2022. More information on these proposals can be found here.
TDI is also engaged in rule-making related to general healthcare networks and requirements. Pursuant to passage of House Bill 3459, TDI must update their existing regulatory structure to be more in line with the existing statute. Thus, most recently, TDI is working on a Request for Information on possible rule changes related to requirements for certain health care preauthorization and utilization review. While we do not believe this will impact workers’ compensation, we will continue to monitor the efforts. More information can be found here.
Kentucky amends proposed workers’ comp UR and medical bill audit “ordinary” regulation changes
The Kentucky Department of Workers’ Claims (DWC) amended proposed changes to its “ordinary” regulation governing utilization review (UR) and medical bill audits.
The additional proposed amendments after comments include:
- Clarifying that a utilization reviewer must have the education, training, and experience necessary to evaluate clinical issues and services for medical necessity and appropriateness
- Clarifying that a medical bill auditor must have the education, training, or experience necessary to evaluate medical bills and statements
- Additional requirements and specifications for the annual UR report, which is required to be submitted to the DWC
- Clarifying which types of professionals may issue an initial UR approval
- Adding that UR personnel shall hold the license required by the United States jurisdiction in which they are employed
- Adding that a physician shall supervise UR personnel and authorize and ratify any UR denial
- Mirroring several amendments made earlier to the existing “emergency” regulation (such as amended timeframes)
The proposed ordinary regulation as amended must now be reviewed by the legislature. As of now, the previously adopted emergency regulation, as amended, is in place.
For more information on this and other legislation or regulations we are tracking related to UR, view our Legislative and Regulatory Tracker (select “Prior Authorization, UR or Formularies” as the Topic in the dropdown menu).
Ohio BWC adopts new spinal cord stimulator rule
The Ohio Bureau of Workers’ Compensation (BWC) adopted a new rule regarding payment for spinal cord stimulators, effective September 1, 2022. The new rule ensures the provision of best medical practices, and it governs BWC's payment for a spinal cord stimulator to treat a work-related injury or occupational disease where certain conditions are allowed in a claim. Authorization for a spinal cord stimulator will only be considered for cases meeting certain criteria.
Appended to the new rule is also an educational document titled “What BWC Wants You to Know About Spinal Cord Stimulators.” The injured worker and physician of record, treating physician, or operating surgeon will be required to review and sign the document.
IAIABC 108th Convention
The International Association of Industrial Accident Boards and Commission (IAIABC) will hold its 108th Convention the week of September 12, 2022, in Scottsdale, Arizona. Virtual participation will be an option for part of the program.
The convention includes several educational sessions and interactive discussions on workers' compensation policy, regulation, and administration, as well as various committee meetings. Last year’s meeting was attended by over 315 people, including representatives from 42 jurisdictions.
We previously spoke with IAIABC leadership in our “Policy Guys” podcast, providing 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.