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The latest legislative and regulatory activity that impacts you and the services we provide
Policy Matters Brief - July 5, 2023
Connecticut Governor signed bills expanding coverage for PTSD and medical plan determination requirements
Governor Ned Lamont signed a workers’ compensation post-traumatic stress disorder (PTSD) expansion bill, SB913 which would provide PTSD coverage for all workers within the state of Connecticut. This expansion of current PTSD coverage beyond first responders and other municipal workers will create the first general PTSD coverage in the nation, allowing all workers – regardless of their occupation or employer – to file PTSD claims starting January 1, 2024.
The Governor also signed HB 6797, which adds language mandating that all employer or insurer medical plans include “an administrative process that permits an employee to seek, without limitation, a determination of the necessity or appropriateness of medical and health care services recommended by providers of a medical care plan and the payment for such appropriate, medically necessary health care services.” The effective date is October 1, 2023.
The bill also creates two study groups to review provisions of the general statutes on legislative recommendations regarding medical records and to review partial permanent disability payments available to injured employees under chapter 568 of the general statutes on or before August 15, 2023
Arizona Industrial Commission proposes fee schedule changes
As part of their annual process to review and update the Physicians’ and Pharmaceutical Fee Schedule, the Industrial Commission of Arizona (ICA) has published for public review and comment the 2023/2024 Staff Fee Schedule Proposal. The general fee schedule and various tables can be found here.
While the proposal makes minor changes to medical provider conversion factors, billing requirements, and reimbursement allotments, the major proposed change in the fee schedule affects the provision of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). Although past DMEPOS fee schedules were based upon a cost plus model, the proposed changes would now require utilization of HCPCS codes for billing and establish a state-specific Maximum Allowable Reimbursement (MAR) as established by the State. The proposed reimbursement for most DMEPOS services would be the lesser of the billed charge or the MAR established for the specific HCPCS code. This proposal also provides reimbursement and billing requirements for items that lack a HCPCS code or a state-established MAR.
These proposed changes are currently in the rule-making process. A public hearing was held on June 29th at the ICA offices and public comments will be accepted by the ICA until July 9, 2023.
New York adopts changes to workers' comp telehealth
The New York Workers Compensation Board recently adopted additional language to its existing telehealth regulations. These additions include updates to definitions, various types of treatment permitted via telehealth as well as options for specific providers. Notice of adoption of the changes was published on June 28, 2023, and the additional language and requirements will go into effect on July 11. The Board also stated that although telehealth appointments scheduled prior to the effective date do not need to be changed to in-person visits in order to conform with the adoption changes, appointments scheduled after July 11 must conform with the new language.
Information on the adopted changes can be found here.
Montana workers’ comp treatment guidelines and formulary updated
The Employment Relations Division of the Montana Department of Labor & Industry adopted updates to its medical treatment guidelines and drug formulary based on the Montana Utilization and Treatment Guidelines, 8th Edition for medical services provided on or after July 1, 2023, and the April 2023 edition of the ODG Drug Formulary for prescriptions written on or after July 1, 2023.
Revisions to the treatment guidelines include low back pain and cervical spine injury procedures. The update to the ODG drug formulary has minimal practical effect, as the Department is required by law to formally adopt a drug formulary annually. Existing regulations already state that the most current monthly version of the adopted formulary should be used.
Proposed Colorado workers’ comp rule changes would further limit physician dispensing
The Colorado Division of Workers’ Compensation (DWC) has proposed annual updates to its medical fee schedule rule (Rule 18). While several revisions have been proposed, the proposed expansion of the existing physician dispensing limitation is of particular note. The current rule states that opioids and other scheduled controlled substances prescribed for longer than three days must be provided through a pharmacy. The proposed amendment states that opioids and scheduled controlled substances (including benzodiazepines) must be provided through a pharmacy, thus removing the three-day window and calling out benzodiazepines.
This potential expansion of the physician dispensing limit was discussed in a virtual stakeholder meeting held by the DWC in April. According to DWC staff, benzodiazepines are being dispensed concurrently with opioids in a concerning manner, and it was also noted that physician dispensers may skip the state’s prescription drug monitoring program (PDMP) reporting that can detect when such medications are dispensed concurrently. Additionally, some physicians appear to be circumventing the three-day limit by dispensing multiple three-day quantities.
Written comments on the proposed rule changes will be accepted until August 15, 2023 (the date of the virtual public hearing). Any changes adopted would take effect on January 1, 2024.
Colorado legislation amends various workers’ comp medical provisions
Colorado House Bill 1076, which makes a number of changes to workers’ compensation law, was signed into law in early June. Some of the more notable changes in the bill include:
- Increasing the limit on medical impairment benefits based on mental impairment from 12 weeks to 36 weeks.
- Removing language authorizing an injured worker to petition the Division of Workers’ Compensation prior to receiving a replacement of any artificial member, glasses, hearing aid, brace, or other external prosthetic device (including dentures)
- Specifying that when a physician recommends medical benefits after maximum medical improvement, the benefits admitted by the insurer or self-insured employer are not limited to any specific medical treatment
- Limiting medical records required to be provided by an insurer with respect to an independent medical exam to records relevant to the injury
Minnesota renews electronic eligibility transaction exemption for workers’ comp and auto payers
The Minnesota Department of Health (MDH) published a notice renewing the limited exception from state requirements for the standard, electronic exchange of eligibility transactions for payers not subject to certain federal regulations. This exception continues to apply only to exchanges of the ASCX12/005010X279A1 Health Care Eligibility Benefit Inquiry and Response (270/271) transaction with health care group purchasers (payers) not subject to federal HIPAA transactions and code sets regulations (specifically workers’ compensation, auto, and property and casualty insurers), and only through June 30, 2024.
Although Minnesota law mandates electronic medical billing and processing requirements that generally apply to all payer types (including workers’ comp and auto), MDH can exempt certain payers from these requirements. This limited exception is typically reviewed annually, with the next review scheduled for April-May 2024. For more information on this latest exemption renewal, see pp. 1175 and 1176 in the Minnesota State Register here.
New Jersey legislation may shorten workers’ comp medical dispute timeframe
New Jersey legislation would, if passed and signed into law, reduce the period in which disputes over workers’ compensation medical fees may be contested. Senate No. 3905 proposes to reduce the statute of limitations for workers’ compensation medical fee disputes from six years to two years from the date a payment or notice of denial of payment was received by a claimant. This bill was introduced on June 1 and referred to the Senate Labor Committee.
For more information on recent legislation and regulations regarding disputes view our Legislative and Regulatory Tracker (select “Disputes and Appeals” as the Topic in the drop-down menu).