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Policy Matters Brief - June 22, 2022

June 23, 2022 · Public Policy & Regulatory Affairs Team

Oklahoma workers’ comp medical fee schedule updates approved

Updates to the Oklahoma workers’ compensation medical fee schedule by the Workers’ Compensation Commission were approved by the state’s legislature and governor. These updates will take effect July 1, 2022. State law requires the fee schedule be reviewed and updated and all updates be approved by the legislature before becoming effective.

The fee schedule updates include the following:

  • Updates reimbursement values and procedure coding for many medical services and items
  • Adds Medi-Span as a backup average wholesale price (AWP) publication source if an AWP is not available in RED BOOK
  • Adds home health care procedure codes and rates
  • Adds state-specific durable medical equipment, prosthetics, orthotics and supplies fee schedule rate tables, rather than just referring to Medicare (rates are still based on 90% of Medicare)
  • Adds telemedicine provisions
  • Includes a statement clarifying that procedure codes or reimbursement amounts in the fee schedule for COVID-19 testing or treatment do not necessarily mean, nor do they create a presumption that, COVID-19 is compensable

For more information on this and other legislation or regulations we are tracking that relate to fee schedules, visit our Legislative and Regulatory Tracker webpage (select the specific fee schedule category under “Select a Topic” in the dropdown menu).


California MPN bill amended to apply to IBR

California Assembly Bill 399, a workers’ compensation bill originally introduced in February of 2021, to address medical provider networks has gone through another major amendment in the still-pending legislative process. In May, an amendment to the bill via a Senate committee would instead address independent bill review (IBR). Per the amended bill, the Legislature declares the lack of a genuine independent medical bill review process causes an increase in the frictional costs of the workers' comp system through liens and petitions as a result of IBR for payment dispute adjudication. For context, the Division of Workers’ Compensation (DWC) currently contracts with a third-party to act as its IBR organization (IBRO) in the IBR process. The IBRO reviews and resolves medical bill payment disputes between providers and payers on behalf of the DWC.

The amended bill language limits the IBRO fee to $50 to determine the eligibility of a request and authorizes additional fees for a request that is reviewable. If the IBRO finds that an employer owes the medical provider, the IBRO would bill the employer for the additional review fees. If the employer is found to not owe the provider, the IBRO would bill the provider for the additional review fees. The bill would also require employers to pay any additional amounts found owed within 30 days of the final determination.

For more on the history of AB 399 and prior amendments to it, review our related updates in past Policy Matters Brief editions here and here.


Minnesota bill requires study of injured police officer benefits

Minnesota Senate File 3540, signed May 22, 2022, includes a provision requiring the state’s Department of Labor and Industry to study the adequacy of current benefits available to disabled or injured police officers. The study is to consider workers' compensation, disability and pension benefits. The new law requires at least one public hearing to be held, and the department is required to issue a report to the legislature no later than January 15, 2023. The legislature appropriated a one-time amount of $125,000 from the general fund for costs associated with conducting this study.


New York to propose pharmacy rule changes

At present, insurers and other payers with workers’ compensation claims can utilize a pharmacy network (pursuant to existing statute and Workers’ Compensation Board (WCB) regulation) to direct injured workers into utilizing a pharmacy that is part of that network. These networks must be established with the WCB and there are numerous regulatory requirements around notification and provision of pharmacy care. Recently, the WCB published an informational bulletin notifying all stakeholders of their intent to engage in rule-making related to existing regulations. Specifically, the WCB stated they intend to update Section 440.8 of the Pharmacy Network Regulations as it relates to notification of network participants. The WCB has not yet released proposed rule language.

Optum expects proposed rule language to be published shortly by the WCB in the New York State Register and on the WCB website. The proposed language will undergo the rule-making process over the next 60- to 90-day period with a public comment period being offered upon publication. The Optum Public Policy and regulatory Affairs team will continue to monitor the proposals by the WCB and provide our clients with all necessary information if they wish to provide feedback to the WCB during the rule-making process. 


Texas adopts revised/updated HCN rules

Pursuant to rule-making authority, the Texas Division of Workers’ Compensation (TDWC) has reviewed and adopted updated regulations under §28 Texas Administrative Code Chapter 10. TDWC has reviewed and readopted current health care network (HCN) rules under 28 TAC Chapter 10.  Under this section of the code, TDWC governs the general provisions of and for the utilization of a “certified” HCN in Texas by insurers and other payers.

The updated rule:

  • Brings changes to the certification, contracting provisions, network requirements and network operations regulatory structure. 
  • Brings the new regulations more in line with past legislative changes to the Texas Insurance Code Chapter §1305. 
  • Bring changes to the existing Utilization Review requirements and definitions. 

Carriers and other payers that utilize an HCN in Texas to provide medical services for their injured workers, as well as other entities engaged with an HCN and utilization review agents should take the time to review the updated rules to ensure compliance.  A copy of the rules can be found here.


SAWCA to hold 74th annual convention

The Southern Association of Workers’ Compensation Administrators (SAWCA) is set to hold its 74th Annual Convention July 11-15 in Manalapan, Florida. Kevin Tribout, Executive Director of Public Policy and Regulatory Affairs for Optum, will participate in an industry roundtable panel. Dr. Robert Hall, Corporate Medical Director for Optum, will participate in a panel on mental health, long COVID, and telemedicine.

SAWCA is an organization comprised of 21 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 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.

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