Calif Edition Banner March 2010
Vol 1, Issue 17

Find Solutions & Strategies                                 May 17, 2010

Prescription Drugs and Workers' Comp 
CMS Clarifies Guidance on Prescription Drugs and Medicare Workers' Comp Set-Aside Agreements
In This Issue
* FEATURED ARTICLE: CMS on prescription drugs
* PANEL DECISIONS: repackaged drugs, rule 30
* PANEL DECISIONS REPORTER: $159/yr. special offer
* BLOG ROUND UP: fraud, CCC's, utilization review, network physicians, QMEs

A Note From the Editor

Robin Kobayashi
Dear WC Professionals:
Please note that our raffle for the California e-Discovery book ends soon. See box below for more information on how to win this book.
Robin E. Kobayashi, J.D.
LexisNexis Editorial & Content Development

How to Enter Our Raffle for California E-Disovery Book

P1550 Calif. E-Discovery book cover
Purchase our 22-Year CD-ROM Archive of Workers' Comp Laws of Calif at *50% Off
and be eligible to win our new Calif. E-Discovery book
You must contact me first to obtain a promotional code for the CD-ROM archive at:
Offer expires June 1, 2010
*Discount price is $51.50 plus tax, shipping & handling
Web Poll Final Results
Should a worker who uses medical marijuana at home be fired by his employer for testing positive for drugs?
  • Yes - 27%
  • Depends on nature of work - 36%
  • No - 36%
Quick Links
WCJ Roster (updated 4/27/10)
EAMS Blogs Index (updated 4/30/2010)
Impairment Guides Resource Center (formerly AMA Guides Resource Center)
Popular Posts

FEATURED ARTICLE: prescription drugs

CMS Clarifies Guidance on Prescription Drugs and Medicare Workers' Comp Set-Aside Agreements. The Centers for Medicare & Medicaid Services issued a new memorandum dated May 14, 2010, to clarify guidance in CMS's April 3, 2009 and July 1, 2009 procedure memoranda regarding prescription drugs administered to Medicare beneficiaries for off-lable and/or unlabeled outpatient uses and whether these drugs are considered covered by Medicare Part D and, therefore, appropriately included in a Medicare Workers' Compensation Set-aside Agreement (WCMSA) proposal. The May 14, 2010 memorandum also changes the Rated Age (RA) language to be included in WCMSAs, as detailed in the August 25, 2008 procedure memorandum. Read the memo

recent panel decisions - sneak preview
Each week we report 2 to 3 recent panel decisions that we're considering for the LexisNexis® services:
NOTE:  If you have any problem accessing cases, please email me at

Liens; Repackaged Pharmaceuticals. WCAB rescinded WCJ's finding that lien claimant was entitled to partial reimbursement of its lien for repackaged drugs dispensed by treating physician, when WCAB found that lien claimant's claim for reimbursement was governed by 2003 OMFS as Medi-Cal system did not include repackaged pharmaceuticals, that to obtain reimbursement under 2003 OMFS, physician provider must prove his usual charge--i.e., amount paid for pharmaceuticals--and if charge is disputed, defendant must prove that formula set forth in OMFS provides for a lesser reimbursement than physician's usual charge, and that, here, there was no evidence presented as to what treating physician paid for pharmaceuticals dispensed to applicant; WCAB remanded matter for development of record. See Mendoza panel decision.


Medical-Legal Procedure; Panel Qualified Medical Evaluations. WCAB, granting removal on its own motion, rescinded WCJ's finding that defendant was not entitled to a panel QME under Labor Code §§ 4060 and 4062.2, and held Rule 30(d)(3) did not apply because it did not become effective until 2/17/2009, after defendant denied applicant's claim, and could not be applied retroactively to deprive defendant of panel QME, and even if defendant did not issue denial until 3/2009, defendant was entitled to a panel QME under Rule 30(d)(1) since defendant requested a QME panel on 2/13/2009; although WCAB expressed concern that Rule 30 may contravene LC 4060(a) and (c), allowing defendant to obtain medical determination on compensability at any time after claim form is filed, WCAB did not  reach that issue in this case. See Washington panel decision.

NPD reporter banner

NEW! Designed especially for Lexis subscribers, this new monthly reporter saves you research time so that you can quickly find recent panel decisions on key topics.

We do the legwork for you:
Our editorial consultants pour through hundreds of cases to find noteworthy decisions that you should know about.
What you get each month: Brief summaries of typically 40 to 65 cases, arranged by topic. Commentary articles written by guest contributors.
How you'll get it: (1) Web version*, which allows Lexis subscribers to link directly to the WCAB decisions on; and (2) Print version, which can be stored in a binder.
View sample web version: Click here
What it costs: Regular price - $199/yr. Special Limited Time Offer for eNewsletter subscribers - $159 for the first year's subscription. Offer expires 12/31/2010.
Pre-orders: Contact 
First issue begins in June 2010.
* Each web issue accessible for up to a year 
Fraud Sign
Workers' Comp  Fraud Blotter 5/13/2010 - recent arrests, charges, convictions, investigations. Read it
Cal Comp Cases
Cal. Comp. Cases May Advanced Postings 5/12/2010. Penalties. Medical Provider Networks. Permanent Disability. Injury AOE/COE. Read it
CWCICWCI Study Documents Ongoing Increases in Use of Network Physicians in California Workers' Comp. Read it
Cal Comp CasesCalifornia Workers' Compensation Cases Roundup 5/10/2010. The April issue of Cal. Comp. Cases is now available on Read it
Reid SteinfeldCurrent Law on Utilization Review in California, by Reid Steinfeld and Richard Boggan. Read it
JacobsmeyerQME Ex Parte Contact Issue Addressed by California Appellate Court, by Richard Jacobsmeyer. Read it
news headlines
> CA: CWCI Reports on Medical Network Provider Use in California
> CA: Senate Passes Extension on CIGA's Authority to Issue Revenue Bonds for Workers' Comp Claims
> CA: DWC Releases Latest Study on Access to Medical Care in California's Workers' Comp System
> CA: Prunedale Woman Ordered to Pay $40K Restitution for Insurance Fraud, Perjury, Elder Abuse
> CA: Senate Committee Chair Demands DWC Provide Timeline for New Permanent Disability Rating Schedule
> CA: DWC Issues Third Notice of Revisions to Medical Provider Network, Employee Information Rules
> Crawford & Company Announces 1Q 2010 Results
> National Workers' Compensation Defense Network Announces Free Semi-Annual Seminar In Los Angeles
> Controversial Franchisee Misclassification Case Set for Trial in U.S. District Court
> Test Case for Genetic Discrimination in the Workplace Filed With EEOC
> Zurich Adds Karen Rose to Underwriting Staff in Los Angeles Office
> A.M. Best Affirms Ratings for Zenith and Its Subsidiaries

california top cases
California Top Cases (updated 5/16/2010), powered by Cal. Comp. Cases
> Alvarez v. W.C.A.B.
P2548 CA WC HotDocs
Order the Forms
P1432 book cover
Order Today
Top 25 Blogs 2009
View the Honorees
80283 cover
Order Today
LexisNexis and the Knowledge Burst logo are registered trademarks of Reed Elsevier Properties Inc., used under license. Other products or services may be trademarks or registered trademarks of their respective companies.

Privacy & Security Copyright © 2010 LexisNexis, a division of Reed Elsevier Inc. All rights reserved.