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Policy Matters Brief - July 27, 2022
Updated CPT and HCPCS codes in Connecticut’s new medical fee schedule
The Connecticut Workers’ Compensation Commission recently published an updated medical fee schedule effective July 15, 2022. The fee schedule implements minor changes including:
- The most current 2022 CPT and HCPCS codes
- Updated fees within the RBRVS-based fee schedule
The fee schedule is available for purchase on the WCC website.
Florida initiates rule-making process on two important regulations
The Florida Division of Workers’ Compensation (DWC) posted a notice on their website indicating intention to engage in rule-making on two important regulations.
- Section 69L-7.730 related to health care provider medical billing
- Section 69L-7.740 related to insurer authorization and medical billing review
Also, the DWC rescinded a March 2020 bulletin, which addressed prescription dispensing by physicians from their office. To engage with all stakeholders, the DWC immediately issued the notice of rule-making. The initial rule-making hearings will take place at the DWC offices in Tallahassee Florida on September 29, 2022, at various times. More information regarding the notice and potential draft rule language can be found here.
Louisiana passes modified cancer presumption for firefighters
On June 16, 2022, the Governor of Louisiana signed into law House Bill 854, which makes several changes to the existing cancer presumption for firefighters. The bill, which goes into effect August 1, 2022, makes changes to the service time-frames and the time-frame for application of a presumption for firefighters diagnosed with certain cancers that are often related to exposure to heat, smoke, and other toxic chemical substances. The bill also implements an employer requirement to furnish necessary care, including medications and supplies, at a rate that is tied to the Medicare rate.
New York adopts emergency telemedicine rules
The New York Workers’ Compensation Board recently adopted emergency amendments to existing 12 NYCRR 325, 329, 333 and 348 permitting the utilization of telemedicine in certain circumstances when providing treatment to workers’ compensation claimants. The new emergency rules exist to provide treatment while maintaining social distancing requirements due to COVID-19. The July 12, 2022, rules supersede any previous emergency telemedicine adoptions. More information on the latest emergency rules can be found here
Tennessee implements updated Utilization Review rules
The Tennessee Department of Labor and Workforce/Bureau of Workers’ Compensation recently adopted and published vised rules related to the provision of Utilization Review for workers’ compensation claims. The adopted changes impact numerous segments of the Utilization Rules Chapter 0800-02-06, including updating the definitions, modifying existing UR requirements, and adding new language related to Peer-to-Peer communications and filing of an Annual Report by UR vendors. All entities engaged in UR or who utilize a UR entity for Tennessee claims should examine the revised rules to ensure compliance by the effective date. The revised rules were published on July 1, 2022, take effect as of September 29, 2022, and can be found here
Colorado enacts injured worker mental health record disclosure and privacy requirements
Colorado House Bill 1354, a bill addressing the disclosure of injured workers’ mental health records, was signed into law in June. The new law prohibits disclosure of mental health records by an insurer to anyone not necessary for medical evaluation, adjustment or adjudication of a claim. It also limits disclosures of such records to employers to work restrictions and requires self-insured employers to establish clear policies and training to ensure privacy is protected. Self-insured employers will need to maintain separate files for mental health records, distinct from personnel records.
For more information on this and other legislation or regulations we are tracking related to privacy, view our Legislative and Regulatory Tracker (select “Privacy or Ex Parte” as the Topic in the dropdown menu).
Iowa workers’ comp prosthetics coverage bill enacted
Iowa House Bill 2411, a workers’ compensation bill amending provisions governing replacements of permanent prosthetic devices for injured workers, was signed into law in mid-June. Prior law stated that an employer was required to furnish reasonable and necessary crutches, artificial members and appliances but was not required to furnish more than one set of permanent prosthetic devices. HF 2411 amends the law to provide exceptions and address other coverage and funding provisions for prosthetics, including implications for settlements.
Kentucky emergency UR and bill audit regulation amended
The Kentucky Department of Workers’ Claims (DWC) amended their emergency utilization review (UR) and medical bill audit regulation, effective June 14, 2022. The amendments were in response to initial stakeholder comments.
- Changed several timeframes related to UR and medical bill audits
- Clarified which entity is responsible for submitting the annual UR report
- Clarified qualifications for UR reconsideration reviewers
- Made other less-substantive changes
As noted previously, the DWC plans to replace the emergency regulation with an ordinary (permanent) regulation after going through the full required rule-making process. A public hearing on the proposed permanent regulation was held June 23, 2022.
Montana workers’ comp timely provider bill submission deadline and formulary source update adopted
The Montana Department of Labor & Industry adopted workers’ compensation rule amendments to add a timely medical billing requirement and to update the drug formulary source.
The amendments state that a medical provider will only be paid if their bill is “timely” received by the employer or appropriate payer. Absent a showing of good cause, timely received means actually received either within 365 days of:
- The date of service, or
- The date the provider knew the treatment or service was related to a workers’ comp claim.
Additionally, the Department updated the drug formulary source language in the rules to meet an annual statutory requirement. The amended language references use of the April 2022, edition of the ODG Drug Formulary for prescriptions written on or after July 1, 2022. It is important to note the rules contain an automatic monthly update process/provision to keep the referenced edition of the formulary updated throughout the year.
New Jersey bills would prohibit health insurance coverage from being primary PIP payer
Two similar bills pending in New Jersey would remove a provision under current state law, which allows the selection of health insurance coverage as the primary payer for personal injury protection (PIP) coverage. The bills would, instead, prohibit that practice.
Senate No. 2254 and Assembly No. 4271 would require the PIP coverage of the named insured to be their primary coverage and also the primary coverage for any resident relative in their household who is not a named insured under an auto insurance policy of their own.
The current law provides that policies issued or renewed on or after January 1, 1991, are required to include the option that other health insurance coverage or benefits of the insured, including health care services provided by a health maintenance organization and any coverage or benefits provided under any federal or State program, be the primary coverage.
S 2254 was introduced March 8, 2022, and passed out of the Commerce Committee on June 20, 2022. A 4271 was introduced June 16, 2022, and is still pending committee action. For more information on these and other auto no-fault bills or pending regulations we are tracking, view our Legislative and Regulatory Tracker (select “Auto” as the Category in the dropdown menu).