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The latest legislative and regulatory activity that impacts you and the services we provide
Policy Matters Brief - April 14, 2023
Florida adopts updated ASC fee schedule
The Florida Division of Workers’ Compensation (DWC) recently issued a bulletin regarding the adoption of a revised medical fee schedule. The modified fee schedule, Florida Workers' Compensation Reimbursement Manual for Ambulatory Surgical Centers, 2020 Edition (Rule Chapter 69L-7.100, Florida Administrative Code), will become effective July 1, 2023.
The official notice was published on March 28, 2023, and can be found here. A copy of the Reimbursement Manual for Ambulatory Surgical Centers, 2020 Edition, can be found here.
Florida court rules on physician dispensing rulemaking challenge
As the Florida DWC continues to move forward with rulemaking relating to physician dispensing, the Florida Division of Administrative Hearings (DOAH) recently ruled on a challenge to the rulemaking. The challenge was filed against the rulemaking shortly after the rule proposal, claiming — in short — the DWC did not have the authority to engage in the rulemaking as well as make the specific changes they were proposing. In the ruling, the DOAH ordered “…that the petition to determine the invalidity of the Proposed Rules is Dismissed.”
Barring any issuance of a stay on the DOAH decision or an appeal, the DWC is now able to move forward with their rulemaking efforts. A copy of the ruling can be found here.
Kentucky legalizes medical marijuana
On March 31, 2023, the Governor of Kentucky signed into law a bill that legalizes the use of medical marijuana. The bill permits the use of medical marijuana for the treatment of specifically listed conditions such as cancer, severe pain, multiple sclerosis, PTSD, and others. Under the requirements of the law, doctors will need to be certified to recommend cannabis for their patients, treatment via the usage of smoking medical marijuana is prohibited, and the state is allowed a two- year period to develop a medical marijuana program. The bill also contains language that will protect workers’ compensation insurers from having to reimburse a person for the cost associated with the use of medical cannabis.
Senate Bill 47 can be found here.
South Carolina adopts updated fee schedule
The South Carolina Workers’ Compensation Commission (WCC) recently approved and adopted a revised fee schedule, which took effect as of April 1, 2023. As part of their ongoing processes, the WCC annually reviews and, if necessary, updates their medical fee schedule to ensure that providers and payers are offering streamlined and cost-efficient care for injured workers.
The changes in the revised fee schedule include updating the CPT and HCPCS codes, implementing new Evaluation and Management codes, and adjusting conversion factors for specific medical services. Payers and providers who serve injured workers in South Carolina should review the updated fee schedule to make sure all processes are compliant with the new requirements. The full fee schedule may be purchased on the WCC website, but an executive synopsis of the changes can be found here.
Oregon workers’ comp medical rules updated
The Oregon Workers’ Compensation Division (WCD) adopted updates to their rules governing medical fees, payment, and services effective April 1, 2023. The most notable relevant changes included updated procedure coding and fees for medical and ancillary services. Additional notable changes include elimination of the “Pharmaceutical Clinical Justification for Workers’ Compensation” form, clarification on reimbursement to out-of-state hospitals, and clarification on telehealth coding.
The Pharmaceutical Clinical Justification for Workers’ Compensation form (now updated to state it is only applicable for drugs prescribed before April 1, 2023) was required to be completed by the prescribing provider and submitted to the insurer when prescribing more than a five-day supply of specifically listed drugs. The form listed seven “high-cost” drugs and “some equally effective and less expensive alternative drugs,” but the list of drugs has not been updated since 2014. The regulations stated that insurers could not challenge the adequacy of the clinical justification; however, they could challenge whether the medication was “excessive, inappropriate, or ineffectual.” The WCD’s Medical Advisory Committee discussed the form and recommended it be eliminated.
Utah workers’ comp legislation clarifies medical award calculations and requires a study of firefighter cancers
Utah Senate Bill 159, workers’ compensation legislation signed in March, clarifies how awarded medical expenses are to be calculated and requires a study of cancer types commonly contracted in the course of a firefighter's employment.
The amended law states that medical expenses awarded as part of a medical claim are to be calculated in accordance with the amount the carrier is required to pay under the medical fee schedule. If the medical expenses awarded are not set forth in the medical fee schedule, they are to be calculated based on the amount the carrier paid or is contractually required to pay to the medical provider, whichever is greater.
The new law also requires the Division of Industrial Accidents to conduct a study to determine whether cancers other than the cancers listed in the existing presumptive cancer law are commonly contracted in the course of a firefighter's employment. The Division is required to provide a report to the Legislature’s Business and Labor Interim Committee summarizing the results of the study and any recommendations for legislation before November 30, 2024. For context, the current list of presumptive cancers includes pharynx, esophagus, lung, and mesothelioma.
Virginia workers’ comp cancer presumption & anxiety disorder bills signed
Several bills in Virginia expanding workers’ compensation presumptive coverage for cancer and coverage for anxiety disorder in certain professions were recently signed into law.
House Bill 1410 and Senate Bill 1038 add arson and bomb investigators employed by the Department of State Police and members of the State Police Officers' Retirement System who collect, analyze, or handle hazardous materials, infectious biological substances and radiological agents, fentanyl or fentanyl analogs, or methamphetamine, to the list of those eligible for the existing workers’ compensation cancer presumption provisions. The amended law also conditions the cancer presumption on the person having completed five years of service in their position. These amendments will become effective July 1, 2023.
House Bill 1408 and Senate Bill 906 add bladder and thyroid cancer to the existing list of presumptive cancers in certain first responders. The presumption for these two additional cancers will not apply to any individual who was diagnosed with the conditions before July 1, 2023.
House Bill 1775 and Senate Bill 904 add that an anxiety or depressive disorder incurred by a law-enforcement officer or firefighter be compensable on the same basis as a post-traumatic stress disorder under existing law. The coverage for anxiety or depressive disorder will apply to any qualifying incident or exposure occurring in the line of duty on or after July 1, 2023.
For more information on bills and regulations we are tracking this year related to presumptive coverage, view our Legislative and Regulatory Tracker (select “Presumptions” as the Topic in the drop-down menu).
AAPAN Innovations Retreat
The American Association of Payers, Administrators and Networks (AAPAN) will be holding its annual Innovations Retreat on April 17–18, 2023, in Tucson, Arizona. AAPAN is a national association providing a unified, integrated voice for payers, administrators, networks, and care management organizations operating in the commercial/government health and workers’ compensation markets. Its mission is to serve as an advocate that respects and balances the unique business needs of its members so that both sectors may more effectively provide patient access to appropriate, quality health care.
Optum Workers’ Comp and Auto No-Fault is an AAPAN member, and our latest “Policy Guys” podcast episode features a conversation with Julian Roberts, AAPAN President and CEO. In this episode, Julian discusses AAPAN’s mission and how it advocates for the industry, engages with government, and serves as a resource for its members. Click here to listen.
The International Association of Industrial Accident Boards and Commission (IAIABC) will hold its 2023 Forum on April 24–27, 2023, in Clearwater, Florida. The forum will include several educational sessions and interactive discussions on workers' compensation policy, regulation, and administration, as well as various committee meetings.
Optum Workers’ Comp and Auto No-Fault is an IAIABC member. In a previous episode of our “Policy Guys” podcast, we spoke with IAIABC leadership, who provided an overview of the importance of IAIABC to the workers’ comp community and how it connects regulators and industry professionals. Click here to listen.