Alaska
In the wake of testimony provided by Optum, the Alaska Workers’ Compensation Board approved a draft 2027 Medical Fee Schedule on August 28, 2026. The draft introduces new reimbursement and billing requirements for physician-dispensed, repackaged, compounded, topical, and OTC medications.
Among other changes, physician dispensed and repackaged drugs will be reimbursed using the original manufacturer NDC and existing AWP-based methodology, while new reimbursement caps will apply to topical medications and compounded topical preparations. The draft also imposes additional medical necessity, prescribing and billing requirements for compounded and topical products.
The draft will now move through the formal rulemaking process, with an anticipated effective date of January 1, 2027.
It is worth noting that the previously approved 2026 Fee Schedule was rejected, causing a delay in implementation. However, the Board indicated that they do not anticipate a similar occurrence in 2027.
A copy of the draft 2027 Medical Fee Schedule is available in the Public Meeting Packet for the August 28 meeting here.
Illinois
Illinois Governor JB Pritzker recently signed legislation (House Bill 5228) containing several workers’ compensation reforms governing Utilization Review (UR) and Medical Examinations.
House Bill 5228 amends existing law to require that adverse UR determinations be made by a physician when the recommended services are prescribed or provided by a physician. The reviewing physician must have a valid, unrestricted U.S. license and be currently certified by a recognized, relevant American medical specialty board.
Additionally, the reviewing physician must have experience treating and managing patients with the condition for which the service is being requested. The same qualification standards will apply to health care professionals responsible for resolving appeals of adverse UR determinations.
The legislation also establishes that an UR certification remains valid for three months after it is received by the injured worker and health care provider, or for the duration of treatment prescribed by the treating provider. For surgical procedures, the certification must include coverage for three months of postoperative health care services.
House Bill 5228 took effect on August 7, 2026, and can be accessed here.
New York
Following stakeholder feedback on its January 2026 proposal, the New York Workers' Compensation Board (WCB) published a revised proposal to update its Medical, Acupuncture, PT/OT, Behavioral Health, Podiatry and Chiropractic Fee Schedules. Key revisions include: correcting CPT code 95999 to 0 RVUs (Relative Value Units), adding provider-specific clarifications, revising deposition-related provisions and retaining the current Behavioral Health Fee Schedule structure and 2018 CPT code set.
The revised proposal was published in the September 2, 2026 State Register and is available through the WCB website here: Proposed Amendments to Sections 329-1.3, 329-4.2, 333.2, 343.2, and 348.2 of Title 12 of the NYCRR (Medical Fee Schedules Update, Revised Proposal). Public comments will be accepted for 45 days following publication.
Oregon
The Oregon Workers’ Compensation Division adopted permanent amendments to its medical fee, medical services, managed care, claim closure, disability rating and claims administration rules effective October 1, 2026. The amendments primarily make permanent a set of temporary rules that took effect April 8, 2026, implementing expanded authority for nurse practitioners and physician associates.
A comparison of the temporary and permanent rules identified no new material changes affecting pharmacy benefits, reimbursement, billing or claims-processing changes. As a result, the October 1 amendments largely formalize policies already in effect rather than introduce significant new administrative or reimbursement requirements.
The amended rules, along with the prior versions, are available on the Division’s website: Oregon Workers' Compensation Division : New rules : Laws and rules : State of Oregon.