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The latest legislative and regulatory activity that impacts you and the services we provide

Policy Matters Brief - May 22, 2024

May 22, 2024 · Public Policy & Regulatory Affairs Team

New Oklahoma workers’ comp law expands mental health coverage to first responders but limits treatment

An Oklahoma bill signed into law earlier this month exempts certain first responders from an existing requirement in the state workers’ compensation law stating that a mental “injury or illness” is not compensable unless caused by a physical injury (an exemption which previously which applied only to violent crime victims). This will open up coverage to these so-called “mental-mental” claims (not caused by a physical injury) for full-time law enforcement officers, firefighters, and emergency medical technicians employed by a municipality, county, or the state while responding to an emergency.

The bill, SB 1457, takes effect January 1, 2025, and also places the following treatment limits on this population of new claimants:

If the Oklahoma Workers' Compensation Commission finds that a first responder has suffered post-traumatic stress disorder (PTSD) not accompanied by a physical injury, the employer shall provide reasonable and necessary medical treatment for such injury, subject to the Oklahoma Workers' Compensation Commission's Fee Schedule, for a period not longer than one year.
The employer shall not be responsible for medical treatment in the form of prescription medicine in excess of $10,000.

SB 1457 provides a detailed definition for PTSD and requires that employers pay to maintain first responders’ health insurance coverage during any period in which they are temporarily unable to perform their jobs.

NCOIL updates model drug pricing reporting law, will consider re-adopting model workers’ comp formulary law

In April, the National Council of Insurance Legislators (NCOIL) Health Insurance & Long Term Care Issues Committee re-adopted its model law on drug pricing transparency with technical amendments to exclude workers’ compensation and auto/PIP lines of insurance. The model law mostly addresses manufacturer, PBM, and health insurer reporting to state insurance departments and is intended to serve as a model for state legislators in contemplating similar laws for their own states. The technical amendments to exclude workers’ comp and auto were made at the request of the American Association of Payers, Administrators and Networks (AAPAN), which was seeking to clarify the original intent of the drafters to not include those limited insurance lines given that they differ considerably from health insurance. There were concerns raised that some states may have applied the model law’s requirements more broadly than intended by its drafters.

At this summer’s meeting, NCOIL’s Workers’ Compensation Insurance Committee plans to consider its existing model workers’ compensation drug formulary law for re-adoption. That meeting will take place July 17 – 20, 2024, in Costa Mesa, California.

NCOIL is an organization comprised principally of legislators serving on state insurance and financial institutions committees around the nation. Its activities include writing model insurance laws and serving as an educational forum for public policy makers and interested parties. More information about NCOIL can be viewed online here.

AAPAN is a national association providing a unified, integrated voice for payers, administrators, networks, and care management organizations operating in the commercial/government health and workers’ compensation markets. Optum Workers’ Comp and Auto No-Fault is an AAPAN member, and in an episode of our “Policy Guys” podcast earlier this year we featured Lisa Anne Hurt-Forsythe, VP of Government Affairs for AAPAN, who discussed the advocacy work AAPAN performs in collaborating with state legislatures and regulatory agencies.

New Virginia law requires patient counseling prior to prescribing opioids

Virginia House Bill 699, signed into law in April, requires that various state medical provider licensing boards amend their regulations to mandate that practitioners provide patient counseling prior to issuing a prescription for any opioid to treat acute or chronic pain. The bill provides a specific list of topics that patient counseling is to include. The amended regulations also require providers to document in the medical record that the patient has discussed with the provider the risks of developing a physical or psychological dependence on the controlled dangerous substance and alternative treatments that may be available. An exception to the counseling requirement must be included for patients receiving hospice care or who are in treatment for an active cancer, sickle cell disease, substance abuse, or opioid dependence, as well as residents of a long-term care facility.

Oklahoma Legislature approves updated workers’ comp medical fee schedule

Oklahoma House Joint Resolution 1035, signed on May 8, 2024, approved the Oklahoma Workers’ Compensation Commission (WCC) proposed changes to its medical fee schedule for 2024. The WCC formally proposed the required biennial update and released a copy in late February, followed by a written comment period and public hearing in March. The proposed changes included updated procedure coding, reimbursement sources, and reimbursement rates, as well as added provisions related to WCC-appointed independent medical examiner fees. Having been approved by HJR 1035, these changes should take effect on July 1, 2024. We expect more communication on this from the WCC.

Proposed Montana workers’ comp medical rules clean-ups and updates

The Montana Department of Labor and Industry proposed amendments and updates to various rules related to workers’ compensation medical fee schedules and utilization. Many of the amendments are intended to clarify, simplify, and ease usability of the rules. They eliminate duplication of statutes, repeal inapplicable and invalid rules, and clarify departmental processes. These changes are in response to an executive order calling for identification of excessive, outdated, and unnecessary regulations. The proposed amendments also incorporate required annual updates to the medical fee schedule, treatment guidelines, and prescription drug formulary. A public hearing to receive comment via Zoom is scheduled for June 4, 2024, and the written comment deadline is June 7, 2024. More information can be found online here.

Annual Colorado workers’ comp medical rules stakeholder meetings concluding this month

The Colorado Division of Workers’ Compensation’s 11^th annual series of stakeholder meetings to learn about workers’ compensation issues and consider revisions to its rules governing the medical fee schedule and utilization guidelines will be concluding this month. The final meeting on May 23, 2024, will include a discussion on conversion factors and any other issues that may arise. Prior registration is required to attend, and stakeholders can register here. Topics discussed in the two prior meetings included, among other items, prohibiting physician dispensing of gabapentin and reviewing the role of mid-level providers in injured workers' claims. After these stakeholder meetings, the Division typically proposes formal changes in the summer, approves and adopts the changes in the fall, and then implements them on January 1 of the following year.

Idaho workers’ comp rules under review

In response an executive order related to “zero-based” regulation, the Idaho Industrial Commission is reexamining its workers’ compensation regulations. The Commission says it is striving to prevent the accumulation of costly, ineffective, and outdated regulations and reduce regulatory burden to achieve a more efficient operation of government. As part of the process, the Commission will host negotiated rulemaking meetings throughout 2024 to allow stakeholders to provide feedback regarding the current regulations and recommend potential changes to improve effectiveness and reduce regulatory burden. After these meetings, the Commission will hold two public hearings, tentatively scheduled for September 16 and October 2, 2024, to receive final public testimony and comments. The Commission is accepting written comments until August 1, 2024. More information on the rule-making process and how to submit comments can be viewed here.

Upcoming Alaska workers’ comp Medical Services Review Committee meetings

The Alaska Workers’ Compensation Division’s Medical Services Review Committee will hold a series of public meetings this summer to finalize recommended updates to the medical fee schedule for 2025. Public comment will be solicited at each meeting at specified times, and written comments may also be submitted in advance. More information, including the meeting dates and comment submission instructions, can be viewed online here.

Additional Optum resources:

For more information on these policy developments and others we have been tracking this year, be sure to visit our Legislative and Regulatory Tracker. Bills or regulations can be filtered by insurance line, topic, status and jurisdiction.

If you have questions on these or any other public policy developments, please contact our team at OptumWC.PolicyMatters@optum.com.

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