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

Policy Matters Brief - February 6, 2025

February 6, 2025 · Public Policy & Regulatory Affairs Team

California Bill Expands Cancer Exemption for Fire Fighters

The California State Senate is considering legislation that would explicitly include airport firefighters in the state's cancer presumption. In addition to expanding the list of workers covered by the presumption in Labor Code Section 3212.1, SB 230 would add coverage for active firefighting members of a fire department at a commercial airport who have specialized training.

To qualify for the presumption, firefighters would have to be "trained and certified by the state fire marshal as meeting the standards of Fire Control 5 and Section 139.319 of Title 14 of the Federal Code of Regulation.”

Fire Control 5 refers to training on techniques necessary for crash-related fire rescue services. The federal code outlines operational requirements for aircraft rescue and firefighting.

Colorado Workers’ Compensation updates Rule 11- Division Independent Medical Examination Process

The Colorado Workers’ Compensation Board enacted an updated/amended version of Rule 11- Division Independent Medical Examiners (DIME) on January 14, 2025. Physician qualifications, DIME physician compliance protocols and the DIME process (including payments/fee updates) all were revised.

For more information on the notice is available here.

Colorado Medical Fee Schedule Correction Notice

The Colorado Division of Workers Compensation has posted an update to its Medical Fee Schedule File. The file’s spreadsheet contains 17 tabs, the second of which includes the Medical Fee Schedule for 2025 as well as corrected facility and non-facility relative values units and rates for CPT 98941.

The corrected Medical Fee Schedule file is located here.

The prior memo dated October 15, 2024 is located here.

Florida Bill to Address Heart Disease Presumption

Florida lawmakers introduced bills that appear to answer the state fire marshal's call to revise the definition of heart disease to presume that certain conditions are compensable for first responders.

SB 366 and identical companion measure HB 269 would define heart disease in Section 112.18 to mean "any organic, mechanical or functional abnormality of the heart, its structures or the coronary arteries." Currently, Section 112.18 declares that conditions including heart disease, hypertension and tuberculosis are presumed to arise out of employment for firefighters, law enforcement officers and correctional workers.

Illinois Bills to Expand Presumptions

Illinois lawmakers introduced several bills that to bolster first responder presumptions, require the state to meet the same deadlines as private employers, and disallow deducting the value of workers' compensation benefits from survivor benefits paid to police and firefighters.

HB 1309 would address the rebuttable presumption of compensability for bloodborne pathogens, staph infections, lung and respiratory diseases and conditions, heart and vascular diseases and conditions, hypertension, tuberculosis, cancer, hernias, and hearing loss for firefighters, emergency medical technicians, and paramedics.

The bill would also declare that the presumption relating to hearing loss cannot be overcome with evidence showing that an injured worker was not exposed to noises at a volume and duration that exceed statutory thresholds.

Lawmakers also introduced HB 1820, which would prohibit reducing state disability or survivor benefits paid to firefighters or police officers who are also receiving workers' compensation or occupational disease benefits, and SB 1344, which would extend existing deadlines for private employers to also apply to the state.

New Mexico amends its Workers Compensation Administrative Rules 11.4.3 NMAC, Sections 8 and 11

The New Mexico Workers Compensation Administration posted an order amending the following sections of its Workers Compensation Administrative Rules:

Payment of Claims (11.4.3.8) – an employer shall, upon request of the worker provide a written statement of the basis of a claim denial within 30 days of receiving a request.
Mileage Benefit (11.4.3.11) – increases in mileage, transportation, meal and commercial lodging expenses for travel to HCPs

The amendments were enacted on January 1, 2025. For more information on these amendments (which are now in effect), please refer to the September 12, 2024 Policy Matters Brief, as well as the New Mexico register website here.

New York Workers’ Compensation Board eBilling Project

The New York Workers’ Compensation Board (WCB) recently released a bulletin reminding stakeholders that the WCB will require health care providers to contract with an electronic submission partner to submit the CMS-1500 universal medical billing form electronically on their behalf beginning August 1, 2025.

In an initial notification dated August 1, 2024, the Board stated that although stakeholders should continue to use the paper CMS-1500 form prior to August 1, 2025, providers are encouraged to transition to electronic submission well in advance of that date to reduce the likelihood of submissions being “lost” in the transition.

More information on the WCB CMS-1500 project can be found here.

New York Legislation Requires Hearing for all Claims

The New York State Senate is considering legislation to provide injured workers with an initial hearing in every case so they can appear before a referee to understand their rights and obligations under the state's workers' compensation laws.

SB 2344 would create a new statute requiring the WCB to index workers' compensation claims immediately upon receiving a medical report along with either a claim filed by an injured worker or an employer's report of injury.

The WCB would be required to hold an initial hearing within 60 days of a claim being indexed if it includes allegations of lost wages or lost time due to injury. After the initial hearing, the WCB would be required to schedule another hearing before a referee within 45 days of either party requesting it.

Ohio Workers’ Compensation Hospital Service Fee Schedule Updated

The Ohio Bureau of Workers’ Compensation (BWC) recently adopted updates to its rule governing payment of hospital impatient service and the associated fee schedule appendix, for discharge date of February 1, 2025.

The updates were made to reflect changes to the Medicare Inpatient Prospective Payment System (IPPS) related to inflation and performance adjustments, the adoption of the 2025 IPPS rule updates, and the increase in the BWC payment adjustment factor from 118.1% to 121.0% of Medicare rate.

For more information regarding the updates may be viewed online here: Rule Details

Oklahoma Workers’ Compensation Commission increases mileage reimbursement

The Oklahoma Workers’ Compensation Commission announced an increase in the mileage reimbursement from $.67 to $.70 cents per mile. Effective date of January 1, 2025.

More information can be found here.

Oregon Workers’ Compensation Division increases mileage reimbursement

The Oregon Workers’ Compensation Division issued an updated bulletin to provide an increase in the private vehicle mileage rate to $.70 cents per mile, effective January 1, 2025

More information can be found here.

Virginia Workers’ Compensation Commission mileage reimbursement rate increase.

The Virginia Workers’ Compensation commission issued an update to its mileage reimbursement rate from $.67 to $.70 cents per mile, effective January 1, 2025.

More information 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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