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

Policy Matters Brief - December 11, 2024

December 11, 2024 · Public Policy & Regulatory Affairs Team

Colorado workers’ compensation shoulder injury medical treatment guidelines updated

The Colorado Department of Labor and Employment/Division of Workers’ Compensation (DWC) recently adopted updates to Rule 17, Exhibit 4 of its Medical Treatment Guidelines, which specifically deals with shoulder injuries. The effective date is January 1, 2025.

Additional documentation can be viewed online here.

Ohio workers’ compensation updates employer’s reports, expenses, medical proof required

The Ohio Bureau of Workers’ Compensation also updated OAC 4123-5 -11, -13, -18, -20, and -21 relating to employer's reports, expenses related to the death of an injured worker, medical proof required for payment of compensation, payment of compensation, and abatement of claims.

The updates were effective December 1, 2024 and can be viewed online here.

Ohio Workers’ Compensation updates Office Locations, Forms, Employer’s Reports of Injuries

Ohio Bureau of Workers’ Compensation has updated OAC 4123-3-01 thru -38 non seq. The updates relate to office hours, forms, employers' reports of injuries and occupational diseases, applications for death benefits, preparation and filing of applications for compensation and/or benefits, procedures in the processing of applications for benefits, and awards.

The updates were effective December 1, 2024 and can be viewed online here.

New Mexico appoints Heather Jordan as new workers’ compensation director

Gov. Michelle Lujan Grisham has appointed Heather Jordan to serve as the director for the Workers’ Compensation Administration effective November 13, 2024. Ms. Jordan replaces Robert Doucette. More information can be located here.

Vermont updates workers’ compensation and occupational disease rules

The Vermont Department of Labor updated its workers’ compensation and occupational disease rules to include a new section that limits authorizing or ordering proposed medical treatment or diagnostic procedures to 9 months or if a change in the injured worker’s medical condition requires reevaluation of the request.

In addition, the Vermont Department of Health is now mandating that a medical provider who prescribes opioid medications must comply with the rule governing the prescribing of opioids to include acute pain.

These updates are effective January 1, 2025 and may be viewed here.

Washington workers’ compensation outpatient drug formulary updated

The Washington State Department of Labor & Industries announced changes to its outpatient drug formulary effective January 1, 2025. The updates include the addition of new drug classes. The updated formulary can be viewed online here.

New York to hold education webinar on CMS-1500 and eBilling changes

The New York Workers’ Compensation Board (WCB) issued a notice to all subscribers of their intent to provide two educational webinars on eBilling development. Under the evolving CMS-1500 project, the WCB is moving from its old billing forms to the CMS-1500 form for medical services and initiating several stages of developing eBilling. As of August 1, 2025, health care providers will be required to contract with an electronic submission partner to electronically submit their CMS-1500 forms electronically beginning.

The webinars will take place on January 8, 2025 and January 15, 2025. Interested parties can Register here.

New York Governor vetoes bill impacting workers’ compensation medical services prior approval

New York Governor Kathy Hocul recently vetoed Senate Bill 6929, which would have raised the preauthorization limit for medical treatment provided without prior approval to $1,500. Under existing law, the current level is set at $1,000. The bill would also have mandated that procedures cannot be summarily denied because they are not addressed in the medical treatment guidelines. The Senate passed the bill 58-1 and the Assembly passed the bill 136-5.

Nevada adopts new heat illness rules

The Nevada Division of Industrial Relations recently adopted a new heat illness regulation that will require businesses to conduct an analysis of working conditions that could cause heat related illnesses. This analysis is limited to job classifications that expose workers to heat illness for more than 30 minutes within a 60-minute period. To support this rule, employers must provide additional monitoring and agree to take action to prevent heat related illness. The adopted rule can be found here.

Texas proposes change to MMI exam requirements

Under a recently proposed Texas Division of Workers’ Compensation rule, treating doctors would be allowed to perform some Maximum Medical Improvement (MMI) examinations via telemedicine. The rule proposes to allow doctors to perform an MMI exam via telemedicine or telehealth services under certain circumstances. To perform such an exam:

The injured worker must have been examined by the treating doctor for the condition in question at least once before.
The injured worker must consent to the remote exam.
The condition must qualify as a minor injury, require no additional treatment, and cause no impairment.

The proposed rule 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.

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