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The latest legislative and regulatory activity that impacts you and the services we provide
Policy Matters Brief - October 4, 2023
October 4, 2023 · Public Policy & Regulatory Affairs Team
Colorado workers’ comp medical fee schedule rule updated, further limiting physician dispensing
The Colorado Division of Workers’ Compensation (DWC) adopted annual updates to its medical fee schedule rule (Rule 18) and related exhibits, effective January 1, 2024. Most notably for pharmaceuticals, the changes further limit physician dispensing.
Updates to the rule include amending prior language stating that “opioids/scheduled controlled substances prescribed for longer than three days shall be provided through a pharmacy” to instead state that “opioids/scheduled controlled substances, including benzodiazepines, shall only be provided through a pharmacy (calling out benzodiazepines, removing the three-day window and adding “only”). As previously discussed, this tightening of the existing dispensing limit stemmed from concerns raised with benzodiazepines being dispensed concurrently with opioids and some physicians circumventing the existing three-day limit by dispensing multiple three-day quantities.
Other highlights from the fee schedule rule changes include updated medical billing codes and reimbursement sources, along with updated reimbursement values for a variety of medical services and items. Some reimbursement rates have increased, while others have decreased.
California workers’ comp bill requiring in-state licensure for UR physicians on hold
California Senate Bill 636 would add in-state licensure requirements for certain workers’ compensation providers with respect to claims involving private employers. The bill would require that physicians modifying, delaying, or denying requests for authorization of medical treatment for reasons of medical necessity (as part of the utilization review process) be licensed by state law. An earlier version of the bill would have also required a psychologist to be licensed by state law. However, the bill was amended in the California State Assembly in late August to remove the psychologist in-state licensure requirement.
A few days later, the bill was placed in the “inactive” file (denoting legislation ready for floor consideration but considered dormant). The bill would need to pass the Assembly and return to the Senate to concur with the Assembly amendments in order to proceed to the governor for final action. Since the Assembly adjourned for the year on September 14, pending bills will be carried over and can be taken up next year.
Arizona Fee Schedule adoption features new DMEPOS requirements
The Industrial Commission of Arizona (ICA) released an updated fee schedule for 2023-2024, which also features a coding and reimbursement structure for DMEPOS. On September 15, 2023, pursuant to rule-change proposals and a public hearing, the ICA adopted and published the updated fee schedule for stakeholders, which will be in effect from October 1, 2023 through October 1, 2024.
While the normal procedure by the ICA is to update and tweak various reimbursement levels and billing/processing codes, the 2023-2024 fee schedule contains a new coding and reimbursement structure for DMEPOS and home healthcare. It also includes the most current CPT and HCPCS codes as well as reimbursement updates for most medical services. The new, state-specific DMEPOS fee schedule is based upon HCPCS codes because state-associated Maximum Allowable Reimbursement (MARs) are assigned to each HCPCS code, which is a change from the previous “cost plus” fee schedule model for DMEPOS. It also addresses reimbursement processes for items with a HCPCS code but lacking a state MAR or an item not listed on the fee schedule. The updated DMEPOS section also sets forth new billing requirements and addresses reimbursement rates for home healthcare. More information on the fee schedule can be found here.
Tennessee activates Certified Physician Program (CPP)
On September 12, the Tennessee Bureau of Workers’ Compensation (BWC) introduced the Certified Physician Program (CCP) as part of its Return Employees to Work And Reduce Disabilities (REWARD) program. REWARD was suspended on October 28, 2022, because the attorney general suspected that the BWC does not have authority to create the program’s rules. The issue was resolved on January 19, 2023, when the Tennessee General Assembly provided the necessary authority. The legislation passed both House and Senate and was signed into law April 13, 2023. The rules went before the Government Operations Committee on August 21,2023 and after a favorable review, will be active on November 1, 2023.
CPP website page is where additional links can be found for the training applications, Registry Data, and other related links.
New York PTSD expansion bill moves on
The New York State Senate has moved a bill to the State Assembly that would significantly change the impact of PTSD on the state’s workers compensation system. Senate Bill 6635 would amend existing statutes that currently prohibit the Workers’ Compensation Board (WCB) from disallowing mental injury claims. Currently, the WCB can disallow such claims on the grounds that workers were not exposed to stress greater than what is typical for a given work environment.
The legislature passed several bills over the past few years, which has lifted this exemption and expanded PTSD coverage for numerous categories of employees such as first responders, police, and fire fighters. By removing the disallowance, SB 6635 would expand coverage to nearly all workers in the state and enable them to receive benefits for PTSD. While the bill passed the Senate, movement in the Assembly is not assured as the Governor vetoed a similar bill late last year.
Virginia WCC to host first Medical Fee Schedule Symposium
Coinciding with its annual Educational Conference and Exhibition in Richmond, the Virginia Workers’ Compensation Commission (WCC) will also host its first Medical Fee Schedule Symposium on October 18, 2023. The Symposium will include presentations and discussions surrounding the state’s medical fee schedules and related topics. More information on the symposium can viewed here. Information on the conference can be found here.
For more information on recent legislation and regulations regarding fee schedules that we are tracking, view our Legislative and Regulatory Tracker and select the type of fee schedule under “Select a Topic” in the drop-down menu.
