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The latest legislative and regulatory activity that impacts you and the services we provide
Policy Matters Brief - January 16, 2025
January 16, 2025 · Public Policy & Regulatory Affairs Team
Alaska workers’ comp medical fee schedule coding and reimbursement source materials updated
The Alaska Workers’ Compensation Board posted a notice that the updated/amended version of coding and reimbursement source materials referenced for use with the Medical Fee Schedule has been adopted, effective January 1, 2025. These updated/amended reimbursement and coding source materials should be utilized in conjunction with the 2025 version Medical Fee Schedule adopted on November 27, 2024.
For more information on the notice is available here
California DWC adjusts DMEPOS Official Medical Fee Schedule
The California Division of Workers’ Compensation (DWC) recently posted an order adjusting the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) section of the Official Medical Fee Schedule (OMFS) to conform to the 2025 changes in the Medicare payment system. The OMFS adjustment order is effective for services rendered on or after January 1, 2025.
More information can be found on the DWC website here
California DWC adjusts Physician and Non-Physician Practitioner Services Fee Schedule
The California Division of Workers’ Compensation (DWC) recently posted an order adjusting the Physician and Non-Physician Practitioner Services section of its Official Medical Fee Schedule (OMFS) to conform to the relevant changes in the 2025 Medicare Physician Fee Schedule. This adjustment order is effective for services rendered on or after February 1, 2025.
More information can be found on the DWC website here
California DWC boosts workers’ comp mileage rate for medical and medical-legal travel
The DWC announced that it has increased the mileage rate for medical and medical-legal travel expenses by 3 cents to 70.0 cents per mile effective January 1, 2025. The updated mileage reimbursement form is posted on the DWC website.
Additional documentation can be viewed online here.
New York governor vetoes preapproval threshold increase bill
In December, New York Governor Kathy Hochul vetoed Senate Bill 6929, which would have raised the preauthorization limit for treatment that can be provided without prior approval from $1,000 to $1,500. The bill would also have prevented procedures to be summarily denied because they're not in the medical treatment guidelines.
New York governor signs mental stress bill
Also in December, Governor Hochul signed Senate Bill 6635/Assembly Bill 5745, which prohibits the State Workers' Compensation Board from disallowing mental injury claims on the grounds that workers were not exposed to stress greater than what is typical for a given work environment. The measures modify a statute from 2017 that allowed first responders to file claims for work-related stress incurred in a work-related emergency.
North Carolina raises health care facility emergency department drug dispensing limits
An update to the medication supply provided to a patient being discharged from an emergency room in the State of NC. The prior rule permitted an emergency department to dispense a 24-hour supply of drugs to patients being discharged from the emergency department, The new rule adopted on December 2, 2024, was effective November 1, 2024, and states that the emergency department staff may dispense no more than a seven-day supply or the smallest quantity prepackaged by the manufacturer for patient dispensing, whichever is greater.
Additional documentation can be view online here
Maine bill filed to modify existing PTSD presumption
A bill recently filed in Maine would look to make permanent the existing state PTSD presumption. In 2017, the state created a PTSD presumption for law enforcement, firefighters and emergency medical workers; and in 2021 lawmakers added 911 dispatchers and corrections offices as covered under the presumption law. However, these two pieces of legislation are set to sunset on October 1, 2025. House Bill 82 would repeal the sunset provision and make the presumption permanent.
Ohio BWC revises professional provider & medical fee schedule
The Ohio Bureau of Workers’ Compensation (BWC) adopted an emergency rule updating its professional provider & medical fee schedule. The most significant changes include revised procedure coding and rates for many medical and ancillary services. These updates become effective January 1, 2025.
Additional documentation can be viewed at the links below:
Texas Legislature considers PTSD Bill for first responders
A bill recently filed for the 2025 Texas legislative session would expand the number of police, firefighters, and emergency services personnel who qualify for a PTSD presumption as a compensable injury. In 2017, the Legislature created a PTSD presumption for emergency services personnel employed by the state. House Bill 1667 would expand this presumption coverage to include certain city and county first responders, as well as first responders working for institutions of higher education, in addition to state employees.
Texas DWC increases medical conversion factors
The Texas Division of Workers’ Compensation (DWC) announced its annual update on reimbursement conversion factors for medical services. Effective January 1, 2025, medical conversion factors will see a 3.5% increase over 2024. This conversion factor rises from $67.18 to $70.18 and applies to E&M, general medicine, physical medicine and rehabilitation, radiology, pathology, anesthesia, and surgery performed in an office setting. The conversion factor for surgery performed in a facility was raised from $85.12 to $88.10.
More information can be found on the TDWC website here: Medical fee guideline conversion factors
Washington State considering PTSD coverage for correctional workers
Washington State lawmakers introduced bills in both the House and Senate that would expand PTSD coverage to additional state and municipal employees. House Bill 1070 and Senate Bill 5043, would create a presumption that PTSD is a compensable occupational disease for correctional facility workers. The bills would apply to correctional workers who develop PTSD after working full-time for at least 90 consecutive days. The bills also would adopt the presumption for up to 5 years after leaving full-time employment and allow employers to rebut the presumption.
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. |
