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Policy Matters Brief - May 24, 2023
Connecticut lawmakers considering expansive workers’ comp bills
A workers’ compensation PTSD expansion bill, SB 913, would provide post-traumatic stress disorder (PTSD) coverage for all workers within the state of Connecticut. Expanding PTSD coverage beyond current presumptions for first responders and other municipal workers would create the first general PTSD coverage in the nation upon passage of the bill. SB 913 has passed the Senate and currently awaits action in the House.
A second workers’ compensation bill, HB 6550, would require employers or their carriers to provide notification to injured workers, in the form of a certified letter, when prescription benefits are reduced. The bill also allows workers a period of 15 days to request a hearing before benefits are reduced. Similar legislative efforts have been attempted in the past with little success and HB 6550 remains in the House.
Illinois legislature taking late push at a drug formulary
A recently filed bill, HB 4087, would establish the ground rules for creation of a workers’ compensation drug formulary. This most recent bill is related to several other bills that were filed but never moved, which were efforts by several lawmakers to control the cost and utilization of prescription drugs in the state’s workers’ comp market. The recent House bill has been referred to the House Rules Committee and, if passed, would require the Workers’ Compensation Medical Advisory Board to adopt an evidence-based drug formulary by September. Various legislative efforts since the 2019 session have attempted to establish a drug formulary in Illinois, and the late filing of this bill may indicate that these efforts will stall again in the soon to end 2023 legislative session.
Tennessee Legislature passes PTSD bill
Recently and after unanimous passage, the Tennessee Legislature sent SB 856 to the Governor for action. The bill would create a presumption that PTSD is compensable for firefighters diagnosed with the condition after certain conditions. The conditions would include at present responding to incidents involving death or injuries that shock the conscience. The bill would also direct state agencies to establish a grant program to mitigate employers’ costs associated with providing benefits to those who qualify under the conditions. The bill currently awaits action by the Governor.
Proposed amendments to Michigan workers’ comp health care services rules
The Michigan Workers’ Disability Compensation Agency (WDCA) proposed amendments and updates to its health care services rules. Highlights of the proposed changes include:
- Removal of the last remaining requirements to use WDCA-specific medication dispensing fee codes in dispensing provider billing
- Addition of a definition for “acquisition cost” with implications mostly for reimbursement of certain unlisted or non-valued durable medical equipment (DME)
- Additional instructions for billing and reimbursement of unlisted or non-valued rental DME
- Additional billing modifiers to use (and instructions) for occupational and physical therapy assistant services
- Overall updated references to billing code and reimbursement rate sources
A public hearing on the proposed changes will be held and written public comments can be submitted until May 24, 2023, 5 p.m. local time. For additional context, the notice of proposed changes can be viewed here (see Register pp. 94-105).
Montana workers’ comp firefighter presumption law expanded
A Montana bill expanding presumptive workers’ comp coverage for certain cancers in firefighters was recently signed into law. Senate Bill 310 adds cervical cancer after 15 years and testicular cancer after 10 years to the existing list of diseases in firefighters considered presumptive occupational diseases proximately caused by firefighting activities, provided that the evidence of the disease becomes manifest after the specified number of years of employment and within 10 years of the last date on which the firefighter was engaged in firefighting activities for an employer. The list of diseases already presumptively covered included (among others) several other cancers, myocardial infarction, and mesothelioma or asbestosis.
Washington adds workers’ comp PTSD presumptive coverage for certain nurses
Washington Senate Bill 5454, a bill adding workers’ comp presumptive coverage for post-traumatic stress disorder (PTSD) in certain nurses, was recently signed into law. The bill, effective January 1, 2024, adds another exception to the provision in law that claims based on mental conditions or disabilities caused by stress do not fall within the definition of occupational disease. This new exception is specifically for certain direct care registered nurses and adds that there exists a prima facie presumption that PTSD is an occupational disease. But this only applies to an individual who has PTSD that develops or manifests itself after they have been employed on a fully compensated basis as a direct care registered nurse in the state for at least 90 consecutive days. The presumption is rebuttable by a preponderance of the evidence.
For more information on legislation and regulations we have been tracking lately related to presumptive coverage, view our Legislative and Regulatory Tracker (select “Presumptions” as the Topic in the drop-down menu).
Washington workers’ comp bill clarifies provider roles
Washington House Bill 1197, a bill clarifying the role of providers in performing certain services in the workers’ compensation system, was recently signed into law. The bill adds a definition for “attending provider” as a person who is a member of the health care provider network, is treating injured workers within the person's scope of practice, and is licensed under state law in one of the following professions: Physicians, osteopathy, chiropractic, naturopathy, podiatric medicine and surgery, dentistry, optometry, physician assistants, and licensed advanced registered nurse practitioners. Most notably, HB 1197 also adds that “attending provider” includes a licensed psychologist in the case of claims solely for mental health conditions. The bill makes further amendments to various areas of law clarifying provider roles and responsibilities, including a provision stating that any health service provider who examined or treated an injured worker may be required to testify in hearings, actions, or proceedings.