Subscribe today to receive notice of our latest thought leadership, articles, and updates.
Recent updates
Policy Matters
The latest legislative and regulatory activity that impacts you and the services we provide
Policy Matters Brief - May 28, 2025
May 28, 2025 · Public Policy & Regulatory Affairs Team
California Legislative committee passes presumption and QME bills
The California Assembly Appropriations Committee recently passed two bills impacting the state’s workers’ compensation policy.
The first bill, Assembly Bill 1125, would extend a presumption for heart trouble incurred on or off the job for all peace officers working for the Department of State Hospitals. This presumption, which is currently restricted to peace offers at Atascadero State Hospital, would expand and codify this coverage for all state hospitals in California. The bill now goes to the full Assembly for consideration.
More information can be found: here.
The second bill, Assembly Bill 1293, would require the Division of Workers’ Compensation to develop a template for a Qualified Medical Evaluator (QME) Report Form as well as a form for parties to use when communicating with QME’s before an evaluation. The bill would also require the Division to publish an annual report summarizing results of its review of these reports as well as reports rejected by a workers’ compensation law judge or the Division.
More information can be found: here.
Colorado Workers' Compensation expands physician choice and modifies medical disputes
As of August 6, 2025, the Colorado Division of Workers' Compensation (DOWC) will allow injured workers to choose any Level I and Level II accredited physician listed by the DOWC. This update will also shift the burden of proof to the employer or insurer if they dispute a medical treatment recommended by the treating physician. In such cases, the employer or insurer must now prove that the recommended treatment is not reasonable, necessary, or related. Effective date August 6, 2025.
More information can be found here.
Colorado updates its Workers' Compensation accreditation program
The Colorado Division of Workers' Compensation (DOWC), in order to ensure continued access to qualified medical care for injured workers, has expanded eligibility to allow for all regulated health care professionals who treat workers' compensation patients and is regulated by DORA to obtain Level I accreditation. Effective date August 6, 2025.
More information can be found here.
Colorado regulates Medical Nutrition Therapy
The Colorado House and Senate passed House Bill 122, which proposes a licensing framework for dietitians and nutritionists so that only qualified professionals are authorized to provide medial nutrition therapy. Starting September 1, 2026, individuals must be licensed to provide medical nutrition in the state.
More information can be found here.
Louisiana House passes workers’ compensation fee schedule bill
The Louisiana House of Representatives passed bill(s) that would require medical fee schedules to be based on rates charged in neighboring states. The bill now resides in the State Senate.
House Bill 117 modifies the requirements for creation and utilization of fee schedules by setting reimbursement rates for medical services, drugs and supplies. HB 117 would also replace the requirement that rates be the mean of usual and customary charges for services with the requirement that rates be reasonable when compared to the workers’ compensation reimbursement schedule and have similar characteristics to surrounding states.
More information can be found here: here.
Michigan provides updated payment/billing guidance for auto no-fault insurers
The Michigan Department of Insurance and Financial Services (DIFS) recently issued Bulletin 2025-11-INS, which supersedes Bulletin 2024-06-INS and incorporates recent court opinions. Although the bulletin clarifies the fee schedule in MCL 500.3157, it does not apply to treatment costs for motor vehicle accidents occurring before June 11, 2019. The bulletin further states that providers desiring additional reimbursement should contact insurers for claims reprocessing and timely payment of PIP benefits that are considered overdue if not paid within 30 days after the insurer receives reasonable proof of loss.
More information can be found here.
Minnesota updates the workers' compensation system
Minnesota has adopted several significant updates to its workers' compensation system based on recommendations from the Workers' Compensation Advisory Council. Key provision of the updates include: expanded definition of "employee“, household nursing services, extended time limits for claims, increased exemption from seizure and reduction of some employer penalties; and reporting requirements. This bill has various effective dates dependent on the articles of law.
More information can be found here.
Montana revises workers' compensation laws relating to travel and reimbursement
Montana House Bill 367 revises the Montana workers' compensation laws applying to travel-related injuries, substance abuse, and claim substantiation for workers' compensation benefits on or after October 1, 2025.
More information can be found here.
Oklahoma modifies the Administrative Workers' Compensation Act
The Oklahoma Senate passed Bill 95, which modifies existing law to exclude individuals participating in temporary work arrangements, where they observe a work environment and gain experience without financial compensation, from being considered employees under the Administrative Workers' Compensation Act. Effective Date November 1, 2025.
More information can be found here.
Oklahoma updates the Patient's Right to Pharmacy Choice Act
The Oklahoma Department of Insurance (OID) recently updated its Patient's Right to Pharmacy Choice Act to exclude the administration or management of pharmacy discount cards or programs from the category of Pharmacy Benefit Managers. The OID also extended the state Attorney General’s oversight to all PBMs, insurers. auditors, vendors, or any other individuals or entities acting on behalf of or in collaboration with a PBM.
More information can be found here.
Oregon Workers' Compensation Division increases attorney fees
Effective July 1, 2025, the Oregon Workers' Compensation Division will raise the following attorney fees:
- Medical and Vocational Disputes: the maximum attorney fee that may be awarded will increase from $4,000 to $6,358.
- Reclassification Claims: the director will determine a reasonable hourly rate of no less than $319 per hour and no more than $465 per hour.
- Temporary Disability Compensation Benefits: total fee payable may not exceed $6,124 increased from the prior amount of $5,600.
More information can be found here.
Tennessee expands cancer presumptions for Firefighters
Tennessee Senate Bill 288, signed into law and effective July 1, 2025, adds prostate, breast, and pancreatic cancers to the list of illnesses presumed to be caused by a firefighter's employment. To qualify for the presumption, firefighters must undergo a medical examination after July 1, 2025, including cancer screening that show no evidence of the listed cancers at the time of the exam. Death benefits are also increased if a firefighter dies from one of the covered cancer's and is presumed to be job-related.
More information can be found here.
Vermont Legislature proposing legislation related to extreme temperature conditions
The Vermont State Senate recently introduced Senate Bill 153, which would establish safety requirements for employers with workers exposed to extreme temperatures.
The bill would require employers to have written plans, updated annually, on how they manage extreme temperatures and require provision of safety measures such as water breaks, acclimation and air conditioning, and heat under certain conditions.
The bill defines extreme temperatures as anything above 80 degrees or below 60 degrees and would not apply to workers exposed to extreme temperatures for short periods of time, such as 15 minutes or fewer per hour.
More information can be found here: here.
West Virginia Department of Revenue implements exempting purchases by a Health Provider
As part of its update to the 2002 West Virginia Expenditure Study–Consumers Sales and Service Tax and Use Tax Expenditures, the West Virginia State Tax Division adopted a rule that explains and clarifies the exemption from consumers sales tax provided in W. Va. Code §11-15-9i as added by Com. Sub. for House Bill No. 2380 (2007) and House Bill No. 2515 (2019) The rule specifically exempts purchases by a health provider of certain drugs, durable medical goods, mobility enhancing equipment and prosthetic devices from the state consumers sales and service tax. In addition, the rule supersedes the rules for per se exemption from consumer sales tax for the lease or sale of motor vehicles. Effective Date May 13,2025.
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. |
