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

Policy Matters Brief - August 22, 2024

August 22, 2024 · Public Policy & Regulatory Affairs Team

Florida continues fee schedule review

The Florida Division of Workers’ Compensation continues to refine proposed changes to its Healthcare Provider Reimbursement Manual. At its initial workshop on July 24, 2024, the Division considered comments and feedback from numerous system stakeholders. Since this is the first revamp of the manual without legislative oversight, we expect the Division to continue workshop discussions as the final version of the manual is required to be adopted no later than July 1, 2025. We urge interested entities to continue to monitor developments on the DWC website.

Texas proposed cleanup to workers' comp pharmacy rules

The Texas Division of Workers’ Compensation (TDWC) has proposed to remove obsolete and outdated language in its pharmacy benefit rules contained within the last iteration of rule changes. The proposed revised pharmacy services rule deletes language no longer relevant and is inconsistent with other regulations. Most of the language dealt with initiating and transitioning to a “closed formulary”, which is no longer needed. Proposed changes can be found on the TDWC website. Stakeholder comments should be filed no later than 5 p.m. Central time on September 23, 2024.

Delaware to post guidelines on website

The Delaware Department of Labor is now posting its Workers’ Compensation Oversight Panel’s health care practice guidelines on its website. In May, the Department proposed repealing regulations that codified the guidelines and substituting new language with a web link to the guidelines. Neither the proposal nor the order adopting the new rules explain why the department proposed the change. The Department said it received no written comments regarding this development.

The practice guidelines are available here.

Idaho workers’ comp draft fee schedule changes

The Idaho Industrial Commission held another stakeholder meeting on July 29, 2024, to review its draft rule changes and gather input. As previously noted, the Commission is reexamining its workers’ compensation regulations and hosting meetings throughout 2024 to allow stakeholders to comment on current regulations and recommend changes to improve effectiveness as well as reduce regulatory burden.

The latest rule changes draft from the July 29, 2024, meeting included these provisions for medical billing and reimbursement:

Reimbursement for any drug or topical agent for which a significantly lower-cost therapeutic equivalent is available (including over-the-counter), shall be limited to 50% above the cost of the therapeutic equivalent
Added DME rental provisions:
- Payers can rent or purchase DME within 30 days of equipment use
- Rented equipment shall be considered purchased once the rental charges exceed the purchase price, which may not exceed 10% of the invoice cost
- If purchased , the DME shall become the property of the claimant
Except for certain listed circumstances, payment for medical services is forfeited when the charges are not billed within 12 months from the date of service and may not be balance billed.

With the initial stakeholder meetings and comment period now closed, the Commission plans to initiate the formal rulemaking process and hold two public hearings (tentatively scheduled for October 7 and 24, 2024) to receive public testimony and comments. More information on the rulemaking process can be found here.

NCOIL model workers’ comp drug formulary bill readopted

The National Council of Insurance Legislators (NCOIL) Workers’ Compensation Insurance Committee met on July 20 to readopt its Model Workers’ Compensation Drug Formulary Act. First approved in 2019, this model act serves as a guide or template for states to use when crafting their own legislation to implement a workers’ compensation drug formulary.

NCOIL is principally comprised 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.

California bill would accommodate workers’ comp medical treatment during work hours

A bill related to scheduling of medical treatment in workers’ comp that was previously passed by the California Senate is currently pending in the state Assembly. Senate Bill 1205 states that although injured workers should make a reasonable effort to schedule treatment outside of their regular work hours, a reasonable effort should not require them to consequentially delay treatment. The amended bill goes on to state that if the treatment occurs during working hours and if the timing of the treatment is foreseeable, injured workers are to provide reasonable, advance notification to their employer. If the timing of the treatment is unforeseeable, they must provide notice of the treatment as soon as practicable. The bill also states that leave taken pursuant to this law shall run concurrently with leave taken pursuant to the federal Family and Medical Leave Act as well as the California Family Rights Act if the worker was eligible at the time it was taken.

If the employer denies an injured worker’s request to attend scheduled treatment during regular work hours, the employer's conduct would constitute a violation under the law and may be subject to monetary penalties.

A prior version of the bill passed by the Senate would have made an injured worker who returns to work entitled to receive all reasonable expenses of transportation, meals, and lodging related to receiving treatment, in addition to one day of temporary disability indemnity, or a percentage of one day of temporary disability indemnity equivalent to the percentage of the wages lost receiving treatment. The bill was amended in the Assembly in late June and is up for third reading.

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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