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

Policy Matters Brief - June 12, 2024

June 12, 2024 · Public Policy & Regulatory Affairs Team

Florida adopts bill for presumption medical treatment

In Florida, a bill modifying how first responders receive treatment for certain compensable presumptive conditions was signed into law. The bill, SB 808, makes two significant changes to treatment. First, it allows injured workers in specific categories to seek medical treatment outside of payers’ established preferred provider organizations. Second, the bill increases reimbursement to medical specialists who treat injured workers for specific presumptive conditions such as tuberculosis, heart disease, or hypertension. Currently, these medical specialists are reimbursed at 120% of Medicare. Once the bill takes effect on October 1, 2024, reimbursement will be increased to 200% of Medicare.

New York passes bill providing injured worker pharmacy choice

The New York Legislature recently passed Assembly Bill 1219 / Senate Bill 1974 which under certain conditions would permit injured workers to utilize a pharmacy of their choice rather than one in their payer’s pharmacy benefit network. Under current New York state workers’ compensation law, a payer may establish a pharmacy benefit network, and upon meeting certain notification prerequisites, require injured workers to receive their medications from a network pharmacy. The bill would undo this current law and under certain circumstances permit injured workers to use a pharmacy of their choice and require the payer to properly reimburse the selected pharmacy at the current fee schedule. The bill has been debated at numerous sessions and always seemed to stall in one chamber or the other. This is the first time this specific language has passed both chambers. The bill now goes to the Governor for further action.

Another New Jersey bill would require workers’ comp and auto coverage of medical marijuana

Yet again, a bill was introduced last month in New Jersey to require workers' compensation, auto/PIP, and health insurance coverage for medical marijuana under certain circumstances. Assembly Bill No. 4371, requires workers’ compensation and private passenger automobile insurance carriers, as well as employers, to cover costs associated with the medical use of cannabis, except upon intervention by the federal government to enforce pursuant to the federal Controlled Substances Act. The bill also states that if payment to the medical cannabis dispensary is not feasible, the employer or carrier is to reimburse the claimant directly upon proof of payment by the claimant to the dispensary. Although prior legislative attempts have been made to require such coverage in New Jersey, they have not yet succeeded. A similar bill, Senate No. 1943, was also introduced in January but has not seen movement since its referral to committee on the same day.

California bill creating a heat-related injury presumption for certain farm workers advances

A California bill that would create a workers’ compensation presumption for heat-related injuries for certain farm workers passed out of the Senate in May. The bill, Senate Bill 1299, which is now in the Assembly, proposes a rebuttable presumption for a heat-related injury occurring within a specified timeframe after working outdoors for an employer in the agriculture industry that fails to comply with heat illness prevention standards. The bill stipulates that compensation awarded for heat-related injury to farmworkers is to include, among other things, medical treatment and disability. To fund administration of the new law, the bill would establish a Farmworker Climate Change Heat Injury and Death Fund.

Kentucky workers’ comp medical fee schedule updated via emergency rule

Applying an “emergency” rulemaking process , the Kentucky Department of Workers’ Claims (DWC) recently adopted updates to its physician/medical fee schedule that will take effect on July 1, 2024. Use of the emergency rule by the DWC was needed in order to comply with a statute requiring the fee schedule to be reviewed and updated (if appropriate) every two years and put in place by July 1 because the DWC believed the ordinary rulemaking process could not be completed in time to meet that requirement. Once this process is completed, the emergency regulation will be replaced by a proposed ordinary regulation identical to the emergency regulation.

The revised fee schedule, which is a separate document incorporated into the regulation, includes:

Recognition of mental health counselors, licensed social workers, physical therapy assistants, and occupational therapy assistants as additional “mid-level practitioners”
An increase in overall reimbursement for services billed with various mid-level practitioner modifiers

Oklahoma workers’ comp medical fee schedule updates approved and published

Updates to the Oklahoma workers’ compensation medical fee schedule by the state’s Workers’ Compensation Commission were approved by the legislature and are scheduled to take effect July 1, 2024. The final published fee schedule will include:

Updated procedure coding and reimbursement values
Miscellaneous fee schedule and coding language amendments
Amended EOB and medical dispute resolution language

More information on the fee schedule can be found online here.

Adopted Montana workers’ comp rules clean-up

In an effort to provide greater clarity, simplicity, and usability, the Montana Department of Labor & Industry (DLI) adopted in May revisions to many of its workers’ compensation rules by eliminating duplication of language already in statute, repealing outdated rules , and clarifying DLI processes. These revisions are in response to Executive Order 1-2021, which called for identification of excessive, out-of-date, and unnecessary regulations. The majority of these revisions are non-substantive. Some of the more notable medical related provisions include updating the referenced version of the CDC opioid guidelines to use in conjunction with the state’s medical treatment guidelines and removal of some prior authorization conditions for body parts not covered by those guidelines in favor of a more generalized statement that prior authorization is required for body parts not covered by the guidelines.

Washington workers’ compensation outpatient drug formulary updated

The Washington State Department of Labor & Industries (L&I) announced changes to their outpatient drug formulary effective July 1, 2024. The updates included the addition of six new drug classes. The updated formulary is available for review in this online Outpatient Drug Formulary PDF Document.

As a reminder, the state fund’s outpatient drug formulary is a list of therapeutic classes and drugs that are covered under L&I's drug benefit. Drugs or therapeutic classes listed on the formulary do not guarantee coverage and may be subject to specific L&I policy and determination of appropriateness for the accepted conditions. Although Washington is a monopolistic state, it does permit employers to self insure their workers’ comp claims. Self-insured employers are generally required to authorize treatment in accordance with L&I rules.

Washington workers’ compensation medical fee schedules updated

The Washington Department of Labor and Industries (L&I) also recently published updated medical fee schedules and related billing/payment policies effective July 1, 2024. Updates include increases to resource-based relative value scale (RBRVS) and anesthesia conversion factors, physical therapy and occupational therapy daily caps, as well as several policy changes.

As a reminder, Washington is a monopolistic state for workers’ comp. but does permit employers to self-insure their claims. Providers must follow the L&I administrative rules, medical coverage decisions, and payment policies when providing services to injured workers and when submitting bills to either the state fund or self-insurers, unless otherwise noted.

The updated fee schedules and billing/payment policies 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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