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Policy Matters Brief - March 22, 2023
California considers workers’ compensation legislation
The California Legislature is considering several workers’ compensation bills this session, two of which could impact the provision of medical and pharmacy services to injured workers.
First, Assembly Bill 699 would add full-time members of the San Diego Fire-Rescue Department’s Boating Safety Unit eligible for presumptions of compensability for conditions including hernias, pneumonia, heart trouble, cancer, tuberculosis, bloodborne pathogens as well as skin cancer, and post-traumatic stress disorder (PTSD). The bill is currently pending in the Assembly Insurance Committee.
Second, Assembly Bill 1278 would modify the existing requirements relating to filing and approval of an MPN plan or modifications to the MPN plan with the intent to speed up and simplify the process. The bill would authorize the MPN to provide a listing of network providers via internet posting and permit an employee to request that a copy of a specified notification be provided to the treating physician, or other designees of the employee, by electronic means. The bill is currently pending in the Assembly Insurance Committee.
New York considers halting pharmacy direction of care in workers’ compensation
The New York Legislature is currently considering two pieces of legislation that would make a significant modification to existing regulations which grant employers or insurers the ability to direct pharmacy care for workers’ compensation claimants. At present, under established regulation, an employer or insurer is permitted to establish a pharmacy benefit network in New York and then require their claimants to receive pharmacy care from any of the pharmacies included within the established and filed pharmacy network.
Senate Bill 1974 would modify the existing language from “employer or carrier may require claimants to obtain all prescribed medications from the pharmacy with which it has contracted” to “employer or carrier may encourage claimants to obtain all prescribed medications...
SB 1974 has passed the Senate and is currently pending in the Assembly Labor Committee while AB 1219 is also pending in the Assembly Labor Committee.
Alabama workers’ compensation fee schedules updated
The Alabama Workers’ Compensation Division (WCD) posted annual updates to its pharmacy, ancillary, and medical fee schedules, effective March 1, 2023. The revisions included increases to reimbursement for most listed services and items, including pharmacy dispensing fees.
The WCD does not typically go through the formal rule-making process to make these routine annual updates. For more information on formal bills and regulations related to fee schedules, view our Legislative and Regulatory Tracker (select the particular fee schedule category you are interested in as the Topic in the drop-down menu).
California proposed workers’ compensation treatment guideline updates
The California Division of Workers’ Compensation (DWC) has proposed updates to its Medical Treatment Utilization Schedule (MTUS) — its adopted medical treatment guidelines. The proposed updates incorporate by reference the latest published guidelines from the American College of Occupational and Environmental Medicine (ACOEM) for the following:
- Work Disability Prevention and Management
- Shoulder Disorders
The DWC is required to have a 30-day public comment period, hold a public hearing, and respond to all comments received during the public comment period prior to adopting the updates. To that end, a public hearing on the proposed updates is scheduled for April 10, 2023, with written comments due on the same date.
Minnesota workers’ compensation and auto no-fault timely filing legislation
Minnesota House File 2145 and Senate File 2079 would, if passed and signed into law as currently written, extend the medical bill timely filing requirement that applies to providers in both the workers’ compensation and auto no-fault systems. Among other provisions, the bills increased the timely filing requirement from six months to 12 months. Health care providers would be required to submit their charges to a payer within 12 months from the date of service, or the date the provider knew or was informed of the correct name and address of the responsible payer, whichever is later. Both bills were introduced in late February.
Minnesota “affordable” auto insurance legislation for low-income drivers
Minnesota House File 2245 and Senate File 2258 (introduced in late February) would, if passed and signed into law, require the state’s Department of Commerce to establish the “Minnesota Lifeline Automobile Insurance Program” to offer affordable motor vehicle insurance policies to eligible low-income Minnesota drivers. Among the various provisions, these bills would require that the new program include a low-cost policy with a length of six or 12 months that includes, among other benefits, basic economic loss benefits that provide reimbursement for all loss suffered through injury arising out of the maintenance or use of a motor vehicle, subject to any applicable deductibles, exclusions, disqualifications, and other conditions, and provide a minimum of $10,000 for loss arising out of the injury of any one person. That $10,000 coverage amount would consist of:
- $5,000 of personal injury protection (PIP) coverage for medical claims; and
- $5,000 for income loss, replacement services loss, funeral expense loss, survivor's economic loss, and survivor's replacement services loss arising out of the injury to any one person.
Montana workers’ compensation vaccine injury legislation
Montana Senate Bill 369 proposes to add that "injury,” as defined under the state workers’ compensation law, would include a serious adverse event experienced by an employee after receiving a vaccine mandated by an employer. The bill defines “serious adverse event” to mean death or a life-threatening illness; hospitalization or the prolongation of an existing hospitalization; a persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions; or a medical event that, based on appropriate medical judgment, may jeopardize the individual and may require medical or surgical intervention to prevent one of those aforementioned outcomes. SB 369 passed the Senate on March 3, 2023 and is pending further action in the House.
Physician choice legislation introduced in Montana and Iowa
Montana House Bill 719, workers’ compensation treating physician choice legislation, was formally introduced on February 21, 2023. Existing law provides that prior to the insurer's designation or approval of a treating physician, or a referral to a managed care organization (MCO) or preferred provider organization (PPO), an injured worker may choose a treating physician for initial treatment. This bill would, with respect that initial choice, add that an insurer, MCO or PPO, or health care provider organization may not require an injured worker use a particular treating physician or engage in any act or practice of intimidation, coercion, or threat for or against an injured worker to use a particular treating physician. HB 719 was tabled in the House Human Services Committee on February 28, 2023.
Iowa Senate File 365, also related to physician choice, was introduced February 22, 2023. It would amend the state’s workers’ compensation law to allow an injured employee to predesignate their physician for workers’ compensation treatment if that physician is a primary care provider who has previously provided medical treatment to the employee and has retained the employee’s medical records. Otherwise, the employer would have the right to choose the care (something permitted under existing law). The employer or the employer’s insurer would also be prohibited from coercing or otherwise attempting to influence an injured employee’s choice of a physician.
If the employer or employee is dissatisfied with the care chosen by the other party, the dissatisfied party should communicate the basis of dissatisfaction to the other party, in writing if requested, and the parties may agree to alternate care reasonably suited to treat the injury (if the parties cannot agree, the dissatisfied party may make an application for alternate care to the state).
For more information on bills and regulations like these related to direction of care and networks, view our Legislative and Regulatory Tracker (select “Provider Choice, Networks or MCOs” as the Topic in the drop-down menu).