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Policy Matters


The latest legislative and regulatory activity that impacts you and the services we provide

Policy Matters Brief - March 1, 2023

March 1, 2023 · Public Policy & Regulatory Affairs Team

Several California workers’ comp bills introduced

Several new workers’ compensation bills have been filed this year in California.

  • AB 1278 would add that if regulations of the California Division of Workers’ Compensation (DWC) require a medical provider network (MPN) to notify an employee that an injury is subject to an MPN, or an employee with an existing injury is required to transfer treatment to an MPN, the injured employee may request that a copy of the notification be provided to the treating physician or other designee of the injured employee by electronic means.
  • SB 636 would, in the workers’ compensation system, require a psychologist to be licensed by California state law. It would also require utilization review physicians involved in modifying, delaying, or denying requests for authorization of medical treatment for reasons of medical necessity to be licensed by California state law.
  • SB 697 would require the DWC to conduct a study on the viability of linking health care reimbursement in workers’ compensation claims to the value of care provided to injured workers, and the regulatory steps that would be required. It would also require that study to include a discussion of the viability of developing and adopting an accountable care organization model to manage claims.

These are just a few of the workers’ compensation bills filed in California so far this year. For more details on these bills and others, view our Legislative and Regulatory Tracker (in the Category field, select “Workers’ Compensation”; in the Disposition field, select “Pending Legislation.” Then, select “Display” and click on California on the map).

Colorado workers’ comp stakeholder meetings

The Colorado DWC announced its 10th annual series of stakeholder meetings. These meetings will allow stakeholders to weigh in on potential revisions to the DWC’s medical fee schedule rule (Rule 18) in advance of the formal rule-making process that typically takes place later in the year.

In the meetings, the DWC plans to highlight the following proposed topics, among others:

  • Physician dispensing limits (opioids/scheduled controlled substances and benzodiazepines must be filled through a pharmacy)
  • Telehealth place of service codes
  • Conversion factor updates
  • Adoption of 2023 E&M guidelines for inpatient services
  • Electronic data interchange (EDI) billing option for interpreters

There will be two one-hour meetings this year: one on April 20 and the other on May 18. Prior registration is required. For more information, including information on how to register, click here.

Connecticut legislation to require notification of end of pharmacy treatment

In a recently filed bill, the Connecticut Legislature seeks to add a provision to statute requiring workers’ compensation payers to notify an injured worker when the payer intends to reduce or discontinue payment for medication treatment. The language of House Bill 6550 would require “insurers, employers, or any other entity acting on behalf of the insurer or employer to send written notification to both the claimant and the prescribing doctor when it plans to either discontinue or reduce payment for ongoing prescribed medication therapy.” The bill also contains other specific information regarding the language that must be included in the written notification and how the notification is to be delivered. The bill is currently in the House and can be found here.

New Jersey legislation would provide supplemental workers’ comp benefits to first responders with COVID-19

New Jersey A 5136, a bill introduced on February 6, would (if passed and signed into law) establish a First Responders COVID-19 Supplemental Benefits Program to provide supplemental benefits to eligible first responders. The stated intent is to assist first responders, whose public service has rendered them particularly vulnerable to COVID-19, by alleviating long-term economic hardships due to COVID-19. The bill particularly points out cases where first responders become unable to work for long periods of time because of "long COVID."

The program would be administered by the New Jersey DWC and would provide supplemental benefits as long as the first responder is unable to work due to COVID-19, but not more than 180 weeks. “First responder,” as used in the bill, means a law enforcement officer; paid or volunteer firefighter; paid or volunteer member of a duly incorporated first aid, emergency, ambulance, or rescue squad association; or any individual who, in the course of employment, is dispatched to the scene of a motor vehicle accident or other emergency situation for the purpose of providing medical care or other assistance. The bill appropriates $20 million from the General Fund to the Second Injury Fund for the program.

New York Legislature looks to undo workers’ compensation pharmacy direction of care

A bill related to the ability of payers to direct pharmacy care in workers’ compensation, which has seemed to gain more traction year-over-year, is once again moving its way through the legislative pipeline. A rather simple bill, Senate Bill 1974, would modify existing statutory language that allows “the employer or carrier to require a claim to obtain all prescribed medications from the pharmacy with which it has contracted” by changing the statute to say “the employer or carrier may encourage claimants...” In general, this would terminate any and all pharmacy direction of care programs an employer or carrier may be utilizing in New York and in the future prohibit the ability of employees or carriers to deny bills from a non-network pharmacy. At present, the bill has passed the Senate and currently resides in the Assembly and can be found here.

New York Legislature looks to expand opioid controls

In a recently filed bill, the New York Legislature looks to expand the state’s existing opioid prescribing controls as related to the age of the patient who is receiving an opioid prescription. Assembly Bill 1133 would add language to the existing seven-day restrictions on initial prescriptions for any Schedule II, III, or IV opioids. The bill would apply these existing restrictions to any patient who is 20 years of age or older while inserting new language that would restrict initial prescriptions of Schedule II, III, or IV opioids to a three-day supply for any patient who is 19 years of age or younger. The bill is currently in the Assembly and can be found here.

North Dakota first responder presumption bill signed

North Dakota House Bill 1279, a first responder presumption bill, was signed into law on February 6, 2023. HB 1279 amended the existing state law providing for a presumption for full-time paid firefighters and law enforcement for conditions of lung or respiratory disease, hypertension, heart disease, or an exposure to a bloodborne pathogen if they have completed five years of continuous service.

The main amendment adds that the five years of continuous service requirement may include full-time paid service outside the state. The bill also creates a new rebuttable presumption of compensability for cardiac events for this same group of first responders. The bill applies retroactively to claims filed after October 1, 2021, regardless of date of injury, and permits an impacted first responder who submitted a claim between that date and the effective date of the bill to resubmit the claim if the initial claim was denied for not being a compensable injury.

For more information on bills and regulations we are tracking related to workers’ compensation presumptions, view our legislative and regulatory tracker. (In the Category field, select “Workers’ Compensation”; in the Topic field, select “Presumptions.”)


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