ARIZONA 

• Due to budgetary constraints, the Work Comp Division in the state is not recommending any new legislation  
• The Commission has been asked to consider the development of a dedicated dispute resolution team for medical-related issues (such as reasonableness/necessity of a particular treatment regimen)
• The State Fund has asked the Commission to formulate a task force to consider the medical dispute resolution issue, as well as to examine how these types of issues are handled in other states 

CALIFORNIA
The state continues to move forward aggressively with rule-making activities in the wake of SB863, which has many provisions that take effect on 1/1/2013.  Changes and updates are occurring on a daily basis a few important things to be aware of:

• The DWC had been accepting comments on several different topics through December 7th (IMR/UR, IBR, Electronic Document Filings/Lien Filing Fee, Translator Certification, and QME's)
• Coventry sent extensive feedback to the state regarding the proposed rules for both Independent Bill Review and Utilization Review/Independent Medical Review
• After reviewing comments for only 3 days, the Division of Workers' Compensation (DWC) issued its Notice of Emergency Regulatory Action late Wednesday  (12/12/2012) on all 5 topics
• The emergency regulations will be filed with the state's Office of Administrative Law (OAL) on Dec. 20, 2012. The regulations to be filed with OAL can be found on the DWC website (DWC website) 
• OAL has up to 10 days to consider the rules, but may approve them before the 10 days have elapsed. Upon OAL approval and filing with the Secretary of State, the regulations are effective for 180 days while the Division initiates formal rule-making procedures to adopt permanent regulations
• Opportunity is given by the state to comment on emergency regulations, as well as to participate in the formal rule-making process thereafter for the permanent regulations
• Coventry is reviewing the revised regulations on an expedited basis to compare with the original versions the state had posted last week for public commentary and has begun operational planning  in parallel with the rule-making activities, in anticipation of the upcoming workflow changes
• Coventry will continue to pass along information to clients as it becomes available    

COLORADO 

• Colorado recently adopted changes to Rules 16 (Utilization Standards) and 18 (Medical Fee Schedule)
• Coventry had previously provided feedback to the state when the rules were proposed
• The last interactive meeting with the state was 12/5/2012, and Coventry was in attendance 
• Coventry continues its active participation with the state, and has developed a strong partnership relationship
• The Colorado Department of Labor and Employment/Division of Workers' Compensation has adopted revisions to Rule 17, Exhibit 10
• This rule was adopted on 11/26/12 and becomes effective on 1/1/13  

GEORGIA 

• Ebill  1/1/2012 Statute/Rules Enactment Phase
• Legislation that includes electronic billing was adopted 1/1/2012
• The go live date for electronic billing implementation has not yet been published
• The state will draft electronic billing clean claim guidelines
• The state has indicated that it intends to submit the draft guidelines to the IAIABC ProPay Sub-Committee for review prior to publishing  

ILLINOIS 

• Repackaged prescriptions:
  • New rules affecting the medical fee schedule took effect 11/5/ 2012
  • Rules affecting physician-dispensed medication were reviewed the week of 11/12/12 by the Joint Committee on Administrative Rules (JCAR)
  • They will announce developments on these rules, including their effective date and publication in the Illinois Register, as they occur
  • The  new language as published in the Illinois Register: "If a prescription has been repackaged, the Average Wholesale Price used to determine the maximum reimbursement shall be the Average Wholesale Price for the underlying drug product, as identified by its National Drug Code from the original labeler."
  • This rule went in effect on11/20/2012 and Coventry will have implementation  in Bill Review on 12/14/2012  
• Ebill
• 1/1/2012 Statute/Rules Enactment Phase, 6/30/2012 Go Live
• Illinois passed statutes authorizing the promulgation of electronic billing rules and guidelines
• No draft or final clean claim guidelines have been published
• Insurers and employers were required to be able to accept medical bills electronically as of 6/30/2012 
• Coventry has been accepting ebills for IL providers actively for some time
• New Rule - 50 Illinois Adm. Code 7110.90, Medical Fee Schedule
•  Illinois has recently adopted revisions to Rule 50 Ill. Adm. Code 7110.90, titled "Illinois Workers Compensation Commission Medical Fee Schedule." 
• Coventry received notification of the 11/16/12 adoption of these changes on 11/19/12 and they have a retroactive effective date of 11/5/12
• The rule changes implement the fee schedule portion of IL House Bill 1698, which went into effect last summer
• This rule establishes:
• New guidelines for reimbursement that is not covered by the fee schedule;
• New guidelines for procedure codes and implants relating to out of state treatment;
• New standards for implants and cost outliers for the "Hospital Inpatient: Standard and Trauma" service category of the fee schedule;
• New standards for implants and cost outliers for the "Hospital Outpatient" service category of the fee schedule;
• Addition of standards for Accredited Surgical Treatment Facility; and
• New reimbursement standards for Dental and Emergency Room service categories.    

KENTUCKY 

• House Bill 1, Prescription Drug Monitoring, was adopted 04/28/12  and became effective August 2012
• Clean-up to House Bill 1to be proposed January 2013
• Led by physicians in KY
• Removes reference to specific drug names (as opposed to class)
• Exempts facility dispensing 
• Relaxes urinalysis requirement & bans
• Amends the use of long-acting or controlled-release opioids except in limited post-surgical situations
• Officially the Workers' Compensation Division of Kentucky is monitoring the changes due to the bill and will be discussing rules to propose in addition to this bill  

LOUISIANA 

• Louisiana proposed pricing and CPT update
• Pricing update to Title 40, LABOR AND EMPLOYMENT, Part I.
  Workers' Compensation Administration, Subpart 2. Medical
  Guidelines, Chapter 31.  
• Vision Care Services, Reimbursement
  Schedule
• Coventry expects this to be published in the 12/20/2012 Louisiana Register and the effective date will follow
• Coventry will ask the Louisiana Department of Labor to provide clear direction on the edition of CPT and HCPCS to use as the proposal does not include that information
• Ebill
• 1/1/2012 Statute/Rules Enactment Phase, 7/1/13 go live
• Louisiana released promulgated rules for electronic billing effective 12/20/2011 and is working on drafting clean claim guidelines
• The jurisdiction has indicated that it will follow IAIABC guidelines as closely as possible
• Payors will be required to accept medical bills electronically as of 7/1/2013  

MICHIGAN 

• Proposed repackaged medication reimbursement language has been recommended by the state's Workers' Compensation Agency which would require billers to use the original manufacturer's NDC when billing a repackaged medication
• Coventry has actively engaged Michigan JCAR and other like-minded stakeholders to support the proposed rule against physician and repackager lobbying

NEW JERSEY 

• New Jersey Assembly Bill 2652 has been enacted and became effective 11/19/12
• This bill prohibits charging the employee for authorized medical services, gives the Division of Workers' Compensation sole jurisdiction over medical charge disputes, and provides that medical treatment or workers' compensation payments must not be delayed due to a claim by a medical provider  

NEW YORK 

• First "updated" pharmacy fee schedule since July of 2007 (does not include quarterly emergency updates which have regularly occurred since 2007)
• Effective 11/28/12
• Includes re-adoption of direction of pharmacy care terms, with some clarifications as to prerequisites for directing care
• Includes clarification of repackaged medication reimbursement instructions, allowing the payor to select the most appropriate original manufacturer NDC, if the original bill contains a repackaged NDC
• Includes new compounded medication pricing instructions, requiring line item detailing
• Rules provide more control over where claimants fill prescriptions
• Better pricing controls over repackaged and compounded drugs    

NORTH CAROLINA

• Proposed fee schedule and ebilling rules become effective 1/1/2013
• Adopted rules under review by the Rules Review Commission
• Electronic claims and medical bill reporting
• Electronic reporting for FROI/SROI will become available on January 2, 2013, and mandatory implementation is required for workers' compensation carriers and self-insured employers by January 2, 2014
• Claims EDI testing became available beginning October 1, 2012
• Electronic reporting for Medical Billing will become available on March 1, 2013, and mandatory implementation is required for workers' compensation carriers and self-insured employers by March 1, 2014  
• Medical billing EDI testing became available December 1, 2012  
• North Carolina Industrial Commission adopts a new medical provider fee dispute resolution procedure
• Effective immediately, the NCIC has adopted a new Medical Provider Fee Dispute Resolution Procedure,pursuant to N.C. Gen. Stat. §97-26(i)
• Employers/carriers have 20 days to respond to Form 26I Questionnaire as part of the information dispute resolution process  
• If informal dispute resolution process does not resolve the issue, the provider may escalate the issue through the Industrial Commission

OHIO

• A bill has been proposed that focuses on creating superior outcomes for injured workers
• This bill works to ensure that care sought in the first 45 days following an injury is paid for regardless of whether the claims is eventually allowed or denied.  
• This will encourage injured workers to seek care-and doctors to provide it-without concern over the bill. If the claim is later denied, BWC will seek reimbursement from third party payors such as the worker's insurance company 
• Requires managed care organizations to create provider networks focused on quality care and return-to-work and require injured workers to use a network provider after 45 days
• Encourages workers to follow treatment protocol and move through the treatment process in a timely manner by tying certain benefits to their compliance with the treatment plan
• Rewards high-performing providers by easing payment processes and offering bonuses    

OKLAHOMA 

• The State is ramping up to overhaul its workers' compensation program
•  Proposals under consideration include a potential shift to an administrative-based system (and away from the judicial-based system that the state has in use today), as well as the "opt-out" alternative which had previously been considered during the 2012 legislative session
• Oklahoma has been holding meetings state wide to gather information and prepare to propose changes
• Coventry will be in attendance at the next meeting  

OREGON 

• Ebill Oregon statute enactment phase
• Oregon has not set a specific go live date for workers' comp electronic billing as yet (other insurance lines are scheduled for 1/2013)
• The state has formed an Advisory Committee to solicit input from payors, providers, eBill agents and clearinghouses
• The Committee held its first meeting on 10/17/2011  
• The next meeting was scheduled for October 2012 and was cancelled
• In November there were discussions about the 835 adjustment codes
• The IAIABC is working with WEDI to standardize adjustment codes across jurisdictions
• Coventry is supporting this effort   

UTAH 

• The workers' compensation advisory council is proposing changes to the medical fee schedule because they feel the current schedule is outside of their area of authority
• They are looking to remove any networks or contracts that are not direct contracts between the payor and the provider  

WASHINGTON 

• Coventry is continuing its active partnership with the state in anticipation of the 1/1/2013 implementation date for the L&I Certified Provider Network
• Coventry recently attended a payor meeting with the state to stay abreast of recent regulatory changes related to the L&I network, as well as to provide feedback and get answers to key questions
• Coventry will continue its proactive approach to the state and will continue to work through 2013 as the new network is formally launched    

PHARMACY UPDATE 

• Florida/Hawaii/Others
• Renewed filing of legislation supporting reform in: 
• Repackaged medications
• Compounded medication
• Medical foods
•  Increased emphasis on:
• Narcotic/opioid management
• Prescription drug monitoring 
•  Treatment guidelines
• Cost-centric issues will continue to be the most contested
• Utilization management will become increasingly more detailed and more employer-friendly
• Coventry will be Implementing more utilization management tools over more bills
• Integrating cost and utilization management tools over more bills