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Policy Matters Brief - September 13, 2023
September 13, 2023 · Public Policy & Regulatory Affairs Team
California workers’ comp medical treatment guidelines updated
The California Division of Workers’ Compensation (DWC) adopted updates to its Medical Treatment Utilization Schedule (MTUS) treatment guidelines, effective August 10, 2023. The adopted updates incorporate the latest published guidelines from the American College of Occupational and Environmental Medicine (ACOEM) for the following topics:
- Work Disability Prevention and Management (ACOEM April 11, 2022)
- Shoulder Disorders (ACOEM February 6, 2023)
- COVID-19 (ACOEM March 6, 2023)
According to California workers’ compensation law, the MTUS treatment guidelines are presumptively correct concerning the extent and scope of medical treatment. However, that presumption may be controverted by a preponderance of scientific medical evidence that establishes a variance from the guidelines is reasonably required to cure or relieve the injured worker from the effects of their industrial injury.
Michigan DIFS updates guidance on retroactive application of auto fee schedule provisions
As expected, the Michigan Department of Insurance and Financial Services (DIFS) issued a bulletin updating its guidance to insurers and providers following the recent Michigan Supreme Court ruling that affirmed a prior appeals court ruling which invalidated retroactive application of certain portions of the state’s 2019 auto no-fault reform law fee schedule provisions. The updated bulletin essentially repeats guidance previously provided by DIFS after last year’s appeals court ruling. It covers issues such as bill re-processing, timely payment, utilization review orders, applicability of pre-existing “reasonable amount” language to claims, and billing/coding disputes. For more background on the court ruling(s), refer back to our last Policy Matters Brief.
For more information on recent legislation and regulations regarding auto no-fault, view our Legislative and Regulatory Tracker and select “Auto” under “Select a Category” in the drop-down menu.
Maine passes cardiovascular presumptions
Maine Governor Janet Mills recently signed into law a bill that, in part, creates a cardiovascular presumption for certain law enforcement officers injured on the job. The bill, Senate Bill 457 sets forth a rebuttable presumption that a law enforcement officer received the injury or contracted the disease arising out of and in the course of employment. As defined in the bill, the law enforcement officer must have been an active member of an agency for at least two years prior to the cardiovascular injury or onset of cardiovascular or pulmonary disease.
Maine Governor Janet Mills recently signed into law a bill that, in part, creates a cardiovascular presumption for certain law enforcement officers injured on the job. The bill, Senate Bill 457 sets forth a rebuttable presumption that a law enforcement officer received the injury or contracted the disease arising out of and in the course of employment. As defined in the bill, the law enforcement officer must have been an active member of an agency for at least two years prior to the cardiovascular injury or onset of cardiovascular or pulmonary disease.
The bill took effect as of July 26, 2023.
Missouri implements PTSD legislation
As part of a larger workers’ compensation bill, the Missouri General Assembly enacted a change to statutes by defining post-traumatic stress disorder (PTSD) as an occupational disease for first responders. Although Senate Bill 24 allows first responders diagnosed with PTSD to file a workers’ compensation claim even if they didn’t suffer a physical injury, it does require claimants to demonstrate by clear and convincing evidence that their PTSD resulted in the course and scope of employment as a result of certain qualifying events.
Senate Bill 24 was signed into law by Governor Mike Parson on July 7, 2023, and took effect as of August 28, 2023.
Washington updates outpatient formulary
The Washington State Department of Labor & Industries announced changes to its outpatient drug formulary effective October 1, 2023. The updates include adding diclofenac 1% gel, removing diclofenac potassium 25mg tablet/capsule and adding new drug classes. The changes are available for review in this online Outpatient Drug Formulary PDF document.
IAIABC 109th Convention
The International Association of Industrial Accident Boards and Commission (IAIABC) is holding its 109th Convention the week of September 11, 2023, in Denver, Colorado. 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 included representatives from 41 jurisdictions. Optum is a sponsor of this event, and Adam Fowler, Public Policy and Regulatory Affairs Manager with Optum, will be participating with other industry experts in a panel on “Trends Impacting Medical Care in Workers' Compensation” on September 14.
The IAIABC is the largest trade association of workers' compensation jurisdictional agencies in North America, and its membership includes workers’ compensation agencies (in the U.S. and internationally) as well as many other associate or EDI members from the industry, including Optum. We previously spoke with IAIABC leadership in our “Policy Guys” podcast on the importance of IAIABC to the workers’ comp community and how it connects regulators and industry professionals. Click here to listen.
