Blog

Policy Matters

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

Policy Matters Brief - October 14, 2024

October 14, 2024 · Public Policy & Regulatory Affairs Team

California Workers’ Compensation DMEPOS Fee Schedule adjusted

The California Division of Workers’ Compensation (DWC) recently posted an order to adjust the Durable Medical Equipment, Prosthetics, Orthotics, Supplies (DMEPOS) portion of its Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system, as required by law. This OMFS adjustment order will pertains to services rendered on or after October 1, 2024, and covers the maximum reasonable fees for DMEPOS. The new drug list, which includes redline changes, can be found here.

California Workers’ Compensation MTUS Drug Formulary updated

The California Division of Workers’ Compensation (DWC) recently issued an order updating its MTUS Drug Formulary list. The updated drug list will take effect on November 1, 2024. California’s formulary drug list is based upon ACOEM guidelines, which the DWC combines with the drug formulary requirements and existing MTUS opioid guidelines. With these adopted changes, the MTUS Drug Formulary drug list will be version 12. The new drug list, which includes redline changes to specific treatments and medications, can be found here.

California Governor veto’s work comp UR bill

California Governor Gavin Newsome vetoed a bill which would have made significant changes to physicians who perform utilization review for workers’ compensation claim. Senate Bill 636 would have required that doctors performing utilization review on California claims to be licensed in California and licensed by the Medical Board of California. The bill spent roughly a year in the state legislature, moving from the Senate to the Assembly and finally passing both chambers on August 30, 2024.

Florida continues discussion on medical fee guidelines

The Florida Division of Workers’ Compensation (DWC) recently held a second stakeholder workshop’ meeting to discuss potential changes to its Workers’ Compensation Health Care Provider Reimbursement Manual for 2025. This would mark the second workshop meeting the Division held regarding proposed changes to the reimbursement manual which would – if approved through the formal rule-making process – take effect on July 1, 2025. At the most recent meeting, the Division listened to concerns from system stakeholders about the most recent draft of the manual and announced that upon review of secondary comments the Division intends to move forward with the formal rule-making process. Information on the reimbursement manual and the meeting can be found here.

Massachusetts to hold hearing on DMEPOS fee schedule

The Massachusetts Office of Health and Human Services (OHHS) issued a notice of a public hearing regarding reimbursement rates for DMEPOS and Respiratory Therapy Equipment along with other non-work comp healthcare processes. In Massachusetts, the reimbursement/fee schedule for workers’ compensation is tied to the state Medicaid rates published by the OHHS. The hearing is scheduled for Monday October 21, 2024 at 10:30 a.m. and the comment period for public comment closes on Monday October 28, 2024 at 5 p.m. Information regarding access to the hearing along with the proposed rule changes can be found here.

Minnesota Workers’ Compensation Medical Fee Schedule updated

The Minnesota Department of Labor and Industry (DLI) recently published notices of adoption of annual medical fee schedule updates to adjust conversion factors and various other rates, along with adopting updated facility fee schedule sources. These updates apply to services provided and discharge dates on or after October 1, 2024. Fee schedule resources/documents webpage.

New Mexico holding hearing on 2025 fee schedule

The New Mexico Workers’ Compensation Administration (WCA) will hold an in-person only hearing regarding proposed changes to its existing medical fee schedule for 2025. The hearing will take place on October 22, 2024 at 2 p.m. and all interested stakeholders are urged to attend and provide feedback. Any comments or questions regarding the proposed should be directed to the WCA no later than November 1, 2024 at WCA-generalcounselbureau@wca.nm.gov. Proposed changes for the 2025 fee schedule can be found 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.

Subscribe now