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Policy Matters Brief - June 15, 2023
Arizona proposes changes to their medical fee schedule
The Arizona Industrial Commission published its annual proposed updates/changes to their Physicians’ and Pharmaceutical Fee Schedule. Chief among the changes are updated RBRVS conversion factors as well as adoption of HCPCS codes and reimbursement values for DMEPOS. The Commission will hold an interactive stakeholder meeting on June 14, 2023, and a public hearing on June 29, 2023. Click here for more information.
Connecticut lawmakers considering expansive workers’ comp bills
A workers’ compensation PTSD expansion bill, SB 913, which would provide post-traumatic stress disorder (PTSD) coverage for all workers within the state of Connecticut has passed both houses. Upon the Governor’s signature, this law will expand PTSD coverage beyond current presumptions for first responders and other municipal workers and create the first general PTSD coverage in the nation.
Florida HB 487 ratifies workers’ comp physician dispensing rules
Florida’s governor has signed into law House Bill 487, an omnibus Department of Financial Services bill addressing numerous segments of the Insurance laws. As of July 1, 2023, the new law will ratify the final version of the Division of Workers’ Compensation rules related to dispensing practitioners (mostly physicians) and the processes required of both these dispensers and carriers. Final version of the rules would necessitate various actions by dispensing practitioners and carriers related to prior authorization. A copy of these final rules can be found here.
Florida HB 487 also ratifies the Workers’ Compensation Health Care Provider Reimbursement Manual
Florida House Bill 487 also includes an omnibus Department of Financial Services section that addresses numerous segments of the Insurance laws. In particular, as of July 1, 2023, The law will ratify the 2021 final proposed version of the Workers’ Compensation Health Care Provider Reimbursement Manual. This manual or fee schedule covers requirements for the provision of care by providers such as doctors, physical therapists, and durable medical equipment suppliers. The bill also removes the requirement that the fee schedule update be approved by the Legislature and requires the Division to update the fee schedule on an annual basis.
Tennessee lawmakers approve PTSD coverage
The Governor of Tennessee recently signed into law a Senate bill which, among other things, would create a PTSD presumption for firefighters. Senate Bill 856 will take effect as of January 1, 2024, thus creating the PTSD presumption for firefighters diagnoses with the condition after responding to incidents involving death or injuries that shock the conscience. The bill also directs the Department of Commerce and Insurance to establish a grant program to mitigate overall employers’ costs associated with providing workers’ comp related PTSD coverages.
California proposed workers’ comp treatment guideline updates
The California Division of Workers’ Compensation (DWC) proposed updates to its Medical Treatment Utilization Schedule (MTUS) 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 (ACOEM April 11, 2022)
- Work Disability Prevention and Management (ACOEM April 11, 2022)
- COVID-19 (ACOEM March 6, 2023)
California workers’ compensation law provides that the MTUS treatment guidelines are presumptively correct on the issue of extent and scope of medical treatment. However, that presumption is rebuttable and may be controverted by a preponderance of scientific medical evidence establishing that a variance from the guidelines is reasonably required to cure or relieve the injured worker from the effects of their industrial injury.
The DWC is required to have a 30-day public comment period, hold a public hearing, and respond to all the comments received prior to publishing the order adopting the updates online. Written comments are due June 26, 2023, and a virtual hearing is scheduled for that same date.
Minnesota Workers’ Compensation Advisory Council legislation signed
Legislation in Minnesota incorporating statute changes recommended by the state’s Workers’ Compensation Advisory Council was recently signed into law. Notable provisions in the bill, House File 2988, include:
- Planned reductions to overall hospital outpatient fee schedule reimbursement over a period of three years
- Clarification of reimbursement based on the “lesser of” fee schedule or total usual and customary charge for most hospital inpatient services
- Added prescribed fees for certain medical records and reports
- Clarification on injured worker ownership of customized durable medical equipment, orthotics or prosthetics
- Added provisions related to non-emergency surgery and second surgical opinions
- Added provisions related to examinations by an employer’s physician
- Requiring the Department of Labor and Industry to conduct a study to identify systemic or regulatory changes to improve the experience and outcomes of employees with work-related PTSD
Provisions within HF 2988 carry with them varying effective dates.
Virginia proposed workers’ comp medical fee schedule updates
The Virginia Workers’ Compensation Commission proposed its biennial updates to the medical fee schedules and ground rules, to take effect January 1, 2024. Most notably, the proposed changes include increasing fees by approximately 6.5% to account for two years of medical inflation and updating procedure coding. Several services – including physician dispensed, retail or mail order prescription drugs, and durable medical equipment dispensed through a retail DME provider – will continue to be excluded from the fee schedules.
Written comments will be accepted through June 30, 2023. More information, including a detailed summary of changes, can be obtained here.
Oregon expands authority of physician assistants in workers’ comp
Oregon House Bill 3412, a bill permitting an expanded role for physician assistants in the state’s workers’ compensation system, has been signed into law. The bill specifically permits physician assistants to provide compensable medical services and to authorize the payment of temporary disability benefits for 180 days from the date of the first visit on the initial claim under the same provisions currently applicable to nurse practitioners.
The bill additionally clarifies that a nurse practitioner or a physician assistant who is not a member of the managed care organization (MCO) is authorized to provide the same level of services as a primary care physician if the nurse practitioner or physician assistant meets certain criteria. The MCO may also authorize the nurse practitioner or physician assistant to provide medical services beyond the 180-day period.
Michigan legislation would create auto no-fault IME board
Michigan House Bill 4565, introduced on May 16, would (if passed and signed into law) establish a new “No-fault Independent Medical Examination Board” within the state’s Department of Insurance and Financial Services. Members of the Board are to be appointed by the governor and to include physicians in certain specialties as well as a member of the state bar who is familiar with and experienced in auto no-fault.
Under the existing auto no-fault law, if the mental or physical condition of a person is material to a claim that has been or may be made for past or future personal protection insurance benefits, at the request of an insurer the person is required to submit to mental or physical examination by a physician. This new board would be tasked with several responsibilities related to those examinations, including selecting and appointing licensed physicians and, as necessary, other licensed individuals, to conduct examinations. The IME Board would also be responsible for, as it determines necessary and appropriate, adopting procedures and standards to be used by individuals who conduct examinations, among other responsibilities.
For more information on auto no-fault regulations and legislation we are tracking this year, view our Legislative and Regulatory Tracker (select “Auto” as the Category in the drop-down menu).