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The latest legislative and regulatory activity that impacts you and the services we provide
Policy Matters Brief - November 15, 2023
November 15, 2023 · Public Policy & Regulatory Affairs Team
Massachusetts updates hearing services rules
The Massachusetts Department of Industrial Relations recently published and adopted updated rates for hearing services for workers’ compensation claims. The updated fees/rates took effect on November 1, 2023 and can be found here.
Maine adopts updated reimbursement rates for CPT and HCPCS codes
The state of Maine has published an updated coding and reimbursement list for their fee schedule. The list, effective October 1, 2023, includes an update to the most current CPT and HCPCS codes as well as the state-specific Maximum Allowable Reimbursement (MAR) rate for each code.
The revised and updated coding and reimbursement information can be found here.
Pending Michigan bill would apply false claims law to PIP
Pending House Bill 5193 in Michigan would (if passed and signed into law) subject auto insurance personal injury protection (PIP) claims to the state’s existing Health Care False Claim Act, which addresses areas such as fraud in obtaining certain health insurance benefits or payments, and prohibits kickbacks or bribes.
The bill was introduced on October 24 and referred to the House Committee on Insurance and Financial Services. For more information on this and other legislation we have been tracking this year in the auto insurance space, visit our Legislative and Regulatory Tracker (select “Auto” for the Category and “All Legislation” in the Disposition drop-down menu).
Michigan workers’ comp health care rules updated
Updates to health care services rules adopted by the Michigan Workers’ Compensation Agency (WCA) took effect immediately upon filing on October 12, 2023. These changes were previously discussed during the rule-making process here.
.The more notable adopted changes include:
- Updates to procedure coding and reimbursement source documents
- Removal of remaining state-specific dispensing fee billing codes
- Addition of a definition for “acquisition cost,” affecting reimbursement of certain unlisted or non-fee-scheduled durable medical equipment (DME), custom compounded drugs exceeding $600, and commercially manufactured topical medications
- Additional instructions for billing and reimbursement of unlisted or non-fee scheduled rental DME
- Additional billing modifiers to use (with instructions) for occupational therapy assistant and physical therapy assistant services.
Additional rule-making documentation can be viewed here. After the immediate effective date, the WCA also posted an updated provider manual and related supplemental fee schedule documents, which can be viewed here.
New Jersey workers’ comp MCO rules readopted with technical updates
The New Jersey Department of Banking and Insurance (DOBI) readopted its Workers’ Compensation Managed Care Organization (WCMCO) rules, with a few technical amendments that took effect November 6, 2023. Prior to this readoption, these rules were scheduled to expire on November 7. Beyond readopting the existing rules and text, additional technical amendments were approved to account for updated DOBI contact information and web addresses for use by WCMCOs when sending information (such as various filing and reporting requirements) to the state. The readopted WCMCO rules, with technical amendments, will remain in effect for a seven-year period.
New Mexico workers’ comp provider fee schedule and billing changes proposed
The New Mexico Workers’ Compensation Administration (WCA) proposed changes to its Health Care Provider Fee Schedule and Billing Instructions for 2024. Proposed changes include:
- Updated CPT codes and fee schedule rates based on the usual update methodology (no significant changes this year) and updated hospital ratios.
- Added state-specific EOB code for untimely billing to account for rule changes made in late 2022 (this would also change the numbering of all state-specific EOB codes listed after it).
- Amended several provisions (such as amended reconsideration bill language, corrected DME preauthorization timeframe language, and removed “upon the payer’s request” language from invoice submission requirements) to align with existing statutes or rules.
- Updated medical cannabis reimbursement rate and added language stating that cost for a medical cannabis card may be reimbursed by the payer.
- Removed some “billed amount” references not consistent with how the fee schedule is applied in disputes.
The WCA will accept written public comments through close of business, Friday, November 17, 2023. Written comments can be sent via email to the attention of the WCA general counsel at gc.clerk@state.nm.us. Any adopted changes would take effect on January 1, 2024. Additional information and documentation can be viewed on the WCA website here.
New York looking to update DMEPOS fee schedule
The New York Workers’ Compensation Board recently released a notification regarding its DMEPOS fee schedule. In the notification, the Board stated that they plan to apply a rule-making process to update the existing fee schedule and codes. While the WCB did not give a specific timeline for rulemaking, they did mention that proposed changes would be published soon in the State Register and on the WCB’s website.
Ohio approves recreational marijuana
On Tuesday, November 7, Ohio voters voted to legalize the use of recreational marijuana in the state. Approval of the referendum will allow people over the age of 21 to use, grow or sell marijuana under a “regulation and tax” program imposed by the state. Ohio now becomes the twenty-fourth state to embrace legalization of recreational marijuana, with the measure taking effect within 30 days of the election date.
Virginia workers’ comp medical fee schedule updates in final state of rule-making
Biennial updates to the medical fee schedules and ground rules proposed and then adopted earlier this year by the Virginia Workers’ Compensation Commission (WCC) are in the final stage of rule-making, which involves publication in the Virginia Register of Regulations and a public comment forum open through December 6, 2023. The updates are scheduled to take effect on January 1, 2024. Most notably, the adopted changes include updated procedure coding and increased fee schedule rates to account for two years of medical inflation. Several services – including, retail, mail order and physician dispensed prescription drugs, as well as DME dispensed through a retail DME provider – will continue to be excluded from the fee schedules. More information on the 2024 fee schedules and ground rules can be obtained on the WCC website on this page.
Washington updates outpatient formulary
The Washington State Department of Labor & Industries (DLI) announced changes to its outpatient drug formulary effective January 1, 2024. The changes are available for review in this online Outpatient Drug Formulary PDF document.
Washington workers comp mental health provider list updated
The Washington DLI also amended its Mental Health Services rules (WAC 296-21-270) to add master’s level therapists (MLTs) to the list of providers eligible to furnish mental health services. According to the DLI, this will help address the shortage of mental health providers offering appropriate services on accepted mental health conditions. MLTs include qualified licensed independent clinical social workers, licensed marriage and family therapists, and licensed mental health counselors. This rule change becomes effective January 1, 2024. A link to the adoption language can be viewed online here.
