March Industry & Regulatory Update

 

Recently Adopted or Amended Rules

Arkansas

Arkansas HB 1185 became effective on March 1, 2013 and revises the definitions of "prescription" and "therapeutically equivalent" as well as adding the definition of "therapeutic class".  The significant changes to the revised definitions include:

  • A physician may authorize a pharmacist to substitute a therapeutically equivalent drug that is at a lower cost to the patient;
  • A pharmacist must discuss suggested substitution with the patient and notify the subscriber within 24 hours after the drug is dispensed to the patient; and
  • Therapeutically equivalent means drug products from the same therapeutic class (please see summary for complete definitions).

Louisiana

The Louisiana Dept of Labor, Office of Worker's Compensation Administration has adopted new rules within Chapter 3, Electronic Billing and became effective on February 20, 2013.  Section 306 will contain the Electronic Medical Billing and Payment Companion Guide where it outlines the following:

  • Allows health care providers and payers to use agents to accomplish requirements of the electronic billing
  • Requires the payer, or its authorized agent, to validate the EDI file per the guidelines contained within the companion guide
  • Advises that payors and health care providers are responsible for the acts and omissions of their agents in the performance of services for their client's payor
    • 

New York

New York Workers Comp Board adopted the amendments to the Medical Treatment Guidelines and related rules. These rules became effective March 1, 2013 and include but are not limited to the following:
  • New definition for denial
  • Adds Carpal Tunnel Syndrome Guidelines
  • Prior authorization is no longer required for Anterior Acromioplasty and Chondroplasty
  • Amends the Variance Process (i.e. timeframe to submit a request, requests can be partially granted, resubmission of variance requests, carriers may deny substantially similar requests from the same provider, etc.)
  • Amends the Informal Resolution process/timeframe

Access to the 2013 Medical Treatment Guidelines and the appropriate revised forms please refer to the following links:

Texas

The Texas Department of Insurance recently repealed and replaced Utilization Review rules, 28 TAC 19.2001 - 19.2017.  These rules became effective on February 20, 2013 and contain several significant changes, including but not limited to the following:

  • Define new terms, including "adverse determination," "concurrent review," and "reasonable opportunity;"
  • Provide new requirements for becoming a certified URA and explain becoming a registered URA;
  • Describe disqualifying associations for providers conducting UR;
  • Require that personnel conducting UR hold an unrestricted or administrative license in Texas or be otherwise authorized to provide health care services in Texas;
  • Require new provisions for notices of all adverse determinations;
  • Provide new requirements before issuing an adverse determination;
  • Explain that providers performing peer reviews or required medical exams regarding the review of the medical necessity or appropriateness of health care are performing UR and must generate a written report;
  • Provide requirements for independent reviews of medical necessity; and
  • Repeals and removes the criminal penalties for practicing UR without a license and for other violations of these rules.
Open Rule-Making / Bills in Progress

California  

  • SB146: Pharma Documentation Elimination; Removal of Pharmacies as "Service Providers"
    • Introduced: 1/31/2013
    • This bill would remove many of the requirements that a pharmacy is required to submit with its electronic request for payment to a PBM or other entity:
      • A copy of all reports showing the services performed
      • The prescription or referral from the primary treating physician if the services were performed by a person other than the primary treating physician
      • Any evidence of authorization for the services that may have been received
      • An itemization of services provided and the charge for each service - (this requirement was removed in committee on March 13, 2013).
      • The bill would prohibit a payor from requiring a pharmacy to provide a copy of the prescription (when the information was already supplied electronically) with a request for payment when submitted and would give any entity 90 days after Jan. 1, 2014 to resubmit
    • This bill has the support of many PBMs as it would eliminate requirements for submission of reports and other attachments that are already identified in the electronic submission.
    • Last Action: Read third time. Passed. (Ayes 32. Noes 0.) Ordered to the Assembly on 3/18/2013.
    • Official Bill Text: http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_0101-0150/sb_146_bill_20130131_introduced.html
  •  SB626: Reversal of Key SB863 Provision
    • Introduced: 2/22/201
    • The main provisions of this bill are to eliminate SB863 language that makes IMR determinations final and not subject to overturning by an ALJ or the WCAB. It also:
      • Removes the requirement that an IMR reviewer's identity be kept confidential
      • Requires physicians performing UR or IMR to be licensed in CA
      • Removes the SB863 provision that disallows psychiatric impairment from factoring into a permanent disability rating
      • Removes from the Labor Code language saying that a chiropractor cannot continue to serve as the primary physician after reaching the 24-visit cap on treatments
      • Provides that a physician may remain the employee's primary treating physician even if additional medical treatment, as specified in the Medical Treatment Utilization Schedule, has been denied as long as the physician complies with the reporting requirements set forth by the administrative director
      • Last Action: 3/11/2013, referred to Com. on L.&I.R. based on the heavy support from Governor Brown of SB863 it does not appear that this bill will pass
      • Official Bill Link: http://www.leginfo.ca.gov/cgibin/postquery?bill_number=sb_626&sess=1314&house=S

Florida    

  • HB553: Workers' Compensation  System Administration
    • Introduced: 1/28/2013                     
    • Effective Date: 7/1/2013
    • Amends many administrative provisions of the work comp system
    • Revises provider reimbursement dispute procedures
    • Revises penalties for certain violations of overutilization of treatment
    • Deletes provisions providing for removal of physicians from lists of those authorized to render medical care under certain conditions
    • Revises health care provider requirements & responsibilities
    • Last Action:03/18/2013, on committee agenda-- Government Operations Appropriations subcommittee 03/20/13, 1:00 pm, Morris Hall
    • Official FL Web Site Link: http://www.flsenate.gov/Session/Bill/2013/0553                   
  • SB662: Repackaged Med Reimbursement Cap
    • Introduced: 2/7/2013 
    • Effective Date: 7/1/2013
    • Provides that if a drug has been repackaged or relabeled, the reimbursement amount shall be calculated by multiplying the number of units dispensed times the per-unit AWP set by the original manufacturer of the underlying drug plus a $4.18 dispensing fee less any contractual reductions
    • The underlying drug may not be the manufacturer of the repackaged or relabeled drug
    • The repackaged or relabeled drug price may not exceed the amount otherwise payable had the drug not been repackaged or relabeled
    • Last Action:03/15/2013, on committee agenda-- Banking and Insurance, 03/20/13, 3:00 pm, 110 Senate Office Building
    • Official FL Web Site Link: http://www.flsenate.gov/Session/Bill/2013/0662
  • HB605: Repackaged Medication Reimbursement Cap
    • Introduced: 2/5/2013
    • Effective Date: 7/1/2013
    • Provides that if a drug has been repackaged or relabeled, the reimbursement amount shall be calculated by multiplying the number of units dispensed times the per-unit AWP set by the original manufacturer of the underlying drug plus a 4.18 dispensing fee less any contractual reductions
    • The underlying drug may not be the manufacturer of the repackaged or relabeled drug, amount
    • The repackaged or relabeled drug price may not exceed the amount otherwise payable had the drug not been repackaged or relabeled
    • Last Action:03/15/2013 On Committee agenda-- Health Quality Subcommittee, 03/19/13, 9:00 am
    • Official FL Web Site Link: http://www.flsenate.gov/Session/Bill/2013/0605
  • HB483: Physician Dispensed Pharmaceuticals
    • Introduced:   1/22/2013
    • Effective Date: 7/1/2013
    • Prohibits a carrier/payor from refusing to authorize the services of a physician solely because the practitioner is a dispensing physician
    • Provides for authorized physician to dispense & fill prescriptions
    • Prevents carrier/payor from determining which pharmacy or dispensing physician to utilize for prescriptions
    • Prohibits physician or physician's assignee from holding an ownership interest in licensed pharmaceutical repackaging entity & from setting prices for repackaged pharmaceuticals
    • Related Bills: SB1662 (similar) introduced on 3/7/2013; HB605 (comparable) introduced on 3/15/2013; SB0662 (comparable) introduced on 2/5/2013
    • Last Action: Introduced to Health Quality Subcommittee; Insurance and Banking Subcommittee; Health and Human Services Committee -HJ 57 on 3/5/2013
    • Official FL Web Site Link: http://www.flsenate.gov/Session/Bill/2013/483

Hawaii                  

  • HB152: Proposal to Increase from 110% to 130% of Medicare
    • Introduced: 1/18/2013 
    • Effective Date: 1/01/2014
    • Re-introduction of proposal to increase reimbursements from 110% to 130% of Medicare's Resource-Based Relative Value Scale (bill died last year)
    • Last Action: 3/12/2013 the committee on Judiciary and Labor recommends that the measured be passed with amendments.
    • Official State Link to Bill: http://capitol.hawaii.gov/measure_indiv.aspx?billtype=HB&billnumber=152
  •  SB876: New Dispute Resolution Process
    • Introduced: 1/18/2013  
    • New bill introduced to allow the director of the Department of Labor and Industrial Relations to resolve billing dispute
    • Would authorize an employer and a medical provider to ask the director to render an     administrative decision in a dispute over "a reasonable disagreement relating to specific medical service charges"
    • After petitioning the director for review, the parties would have to continue negotiations for 31 calendar day
    • If no resolution to their differences, the director could render a decision without holding a hearing
    • The decision would be final and non-appealable
    • Last Action 2/15/2013 report adopted; passed second reading as amended and referred to Ways and Means
    • Official Link: http://capitol.hawaii.gov/measure_indiv.aspx?billtype=SB&billnumber=876
  • HB1176: Dispute Resolution
    • Introduced: 1/24/2013
    • Authorizes the employer and provider of services to notify the director of labor and industrial relations in the event of a reasonable disagreement relating to specific medical service charges
    • Requires that the notice of dispute is done in writing and that the parties negotiate during the thirty-one calendar days following the date of the notice to the director; allows parties to request the director to render an administrative decision without a hearing in the event the parties fail to reach an agreement within the thirty-one day negotiation period; establishes that the administrative decision rendered by the director is final and non-appealable
    • Last Action: 2/21/2013 the committees on Finance recommends that the measure be deferred
    • Official State Bill Status: http://www.capitol.hawaii.gov/measure_indiv.aspx?billtype=HB&billnumber=1176
  • HB891: Prescription Drug Price Caps; Physician Dispensing (Companion bill SB1122)
    • Introduced: 1/24/2013                  
    • Effective Date: 7/1/2013       
    • Establishes price caps within the Hawaii workers' compensation insurance system for drugs
    • Authorizes a dispensing fee to physicians
    • Limits physicians' authority to directly dispense prescription medications
    • Last Action: 2/15/13 passed second reading as amended in HD1 and referred to committee on Finance with none voting aye with reservations; none voting no
  • SB1122: Drug Reimbursement; Dispensing Fees (Companion bill HB891)
    • Introduced: 1/24/2013                  
    • Effective Date: 7/1/2013
    • Establishes price caps for the Hawaii workers' compensation insurance system for drugs
    • Authorizes reimbursement of a dispensing fee to physicians who dispense prescription medications directly to patients
    • Sets the reimbursement amounts for drugs in accordance with the medical fee schedules adopted by the director pursuant to subsection (c) or a lower amount for which the carrier contracts
    • Provides for payment for prescription drugs at the average wholesale price as listed in the Red Book, plus no more than 40% of the AWP for drugs sold by a physician, hospital, pharmacy, or provider of service other than a physician, with certain exceptions
    • Sets the price for repackaged drugs at the standard prescription drug price + a pre-defined "repackaging premium"
    • For compound medications, reimbursement is based on the sum of the fee due for each medication ingredient having an assigned NDC that is used in the compounded medication
    • Provides that if information pertaining to the original labeler or manufacturer of the underlying drug product used in repackaged or compounded medications is not provided or is unknown, then reimbursement shall be based on the most reasonable and closely related AWP for the underlying drug product
    • Last Action: 1/24/2013 referred to Senate committees on Judiciary and Labor & Ways and Means
    • Official Bill Digest and Status: http://capitol.hawaii.gov/measure_indiv.aspx?billtype=SB&billnumber=1122&year=2013              
  • SB1302: Pharmacy - Repackaged/Compounded Drug Pricing Comparable to Retail Pharmacies
    • Introduced: 1/24/2013                  
    • Effective Date: 7/1/2013
    • Restricts reimbursement of repackaged prescription drugs and compound medications to amounts comparable to that of retail pharmacies under state law
    • Reimbursement for brand name prescription medication shall be the AWP as listed in Red Book plus 40% of AWP, except where the carrier and the specific provider seeking reimbursement have directly contracted between one another for a lower reimbursement amount
    • If the brand name medication has been repackaged or relabeled, reimbursement shall be calculated by multiplying the number of units dispensed by the AWP set by the original manufacturer of the underlying   medication, plus 40%
    • Reimbursement for generic prescription medication shall be the AWP as listed in Red Book plus 60% of AWP, except where the carrier and the specific provider seeking reimbursement have directly contracted between one another for a lower reimbursement amount
    • If the generic medication has been repackaged or relabeled, reimbursement shall be calculated by multiplying the number of units dispensed by the AWP set by the original manufacturer of the underlying medication, plus 60%
    • Compounded medications shall be reimbursed based on the sum of the average wholesale prices due for each medication ingredient having an assigned national drug code that is used in the compounded medication, plus 40%
    • If information pertaining to the original labeler or manufacturer of the underlying medication product used in repackaged or compounded medications is not provided or is unknown, then reimbursement shall be based on the most reasonable and closely related AWP for the underlying medication product
    • Last Action: 1/28/2013 referred to Senate committees on Judiciary and Labor/Commerce and Consumer Protection, Ways and Means
    • Official Bill Link: http://capitol.hawaii.gov/measure_indiv.aspx?billtype=SB&billnumber=1302&year=2013

Iowa        

  • HB274: State's Workers' Compensation Laws
    • Introduced: 2/26/2013                  
    • Modifies alternate care procedures for medical treatment, creating registries of physicians who treat and evaluate work-related injuries
    • Provides for the retention of a medical director, creates a state Workplace Injury Care Providers Registry Fund
    • Establishes a Workers' Compensation Advisory Council
    • Provides for and appropriates fees, and effective dates, concerns the provision of medical services
    • Last Action: 2/27/2013 to House Committee on Labor
    • Link to Legislation: http://coolice.legis.iowa.gov/Cool-ICE/default.asp?Category=BillInfo&Service=DspHistory&var=HF&key=0309C&ga=85  

Indiana                   

  • HB1320: Bill Introduced to Cap Inpatient Hospital Fees + Remove "Savings" Model of Compensation for BR Companies
    • Introduced: 1/17/2013                 
    • Proposal to introduce Medicare-based hospital fee schedule for treating injured workers, with an original cap of 175% of Medicare charges for workers' compensation services; amended to 225%
    • This bill would also increase the maximum weekly benefit for injured workers from $650 to $750
    • The bill had a provision that would remove the ability for a bill review service to be paid based on the amount by which claims are reduced, this provision was removed
    • Defines "medical service facility", "services and/or product", and "medical service provider" for purposes of the worker's compensation law
    • Provides for workers' compensation insurance policy periods as permitted in certain rules
    • Specifies clean claim payment requirements related to worker's compensation claims
    • Specifies that all data collected by the worker's compensation rating bureau is considered to be confidential
    • Last Action: 2/25/2013 in committee - second house
    • Official IN Legislative Information: http://www.in.gov/apps/lsa/session/billwatch/billinfo?year=2013&session=1&request=getBill&docno=1320 - latest_info

Kansas    

  • SB73: Kansas Workers' Compensation Reform
    • Introduced: 2/18/2013                  
    • Bill moves administrative duties from the Department of Administration to the Department of Health and Environment
    • Actions the use of AMA impairment guidelines from the 4th edition to the 6th edition effective 2015
    • Adds legal citizenship status requirements for compensation
    • Last Action: 2/20/2013 Passed as amended Yea 32, Nay 8; 3/15/2013 Hearing: Tuesday, March 19, 2013, 1:30 PM Room 346-S
    • Official KS Legislative Information: http://www.kslegislature.org/li/b2013_14/measures/sb73/

Kentucky                            

  • SB113: Amends several provisions of the Workers' Compensation Act in KRS Chapter 342
    • Introduced: 2/7/2013    
    • Amends existing KY WC Act mostly with changes to rules affecting disability ratings and benefits
    • Much of this bill has to do with claims adjudication issues, but there is a paragraph that defines the penalty for denial of services that is eventually overturned: (13)(a)
    • Part of the justification for a medical fee schedule in workers' compensation is the guarantee and speed of payment; therefore, notwithstanding subsection (4) of this section, if an employer, its insurance carrier, or any other entity on behalf of the employer files a challenge to a medical bill or service and it is determined that the bill or service is appropriately payable pursuant to this section, the fee to be paid, whether by fee schedule, administrative regulation, or in some other manner, shall be increased twenty percent (20%)
    • Last Action: referred to Judiciary committee 2/11/13
    • Bill Status: http://www.lrc.ky.gov/record/13RS/SB113.htm

Maryland              

Michigan                            

Minnesota            

Nebraska              

  • LB291: Timely payment and penalties
    • Introduced: 1/16/2013
    • Changes medical payment provisions of the Nebraska Workers' Compensation Act, providing time limits and penalties for late payment of medical payments
    • All medical payments payable under the Nebraska Workers' Compensation Act shall be payable within thirty days after notice has been given or within thirty days after the entry of a final order, award, or judgment of the compensation court
    • If a medical payment is delinquent by thirty days or more, fifty percent shall be added to the amount payable and shall be paid to the employee
    • Last Action: 1/18 notice of hearing for 1/28/13 
    • Official Link to Bill: http://nebraskalegislature.gov/FloorDocs/Current/PDF/Intro/LB291.pdf
    • Bill History: http://nebraskalegislature.gov/bills/view_bill.php?DocumentID=18193
      • 

New Hampshire                              

  • SB095: An injured employee shall have the right to select his or her own pharmacy or pharmacist
    • Introduced: 1/3/2013
    • Effective: 1/1/2014
    • An injured employee has the right to select his or her own pharmacy or pharmacist for dispensing and filling prescriptions for medicines
    • The insurance carrier shall reimburse the health care provider or pharmacy processing agent for prescription drug
    • The fee established by the following formulas based on the average wholesale price (AWP) as reported by a nationally recognized pharmaceutical price guide or other publication of pharmaceutical pricing data in effect on the day the prescription is dispense
    • Generic drugs: (AWP per unit) x (number of units) x (1.25) + $4.00 dispensing fee=reimbursement amount
      • Brand name drugs: (AWP per unit) x (number of units) x (1.09) + $4.00 dispensing fee=reimbursement amount
    • Last Action:  3/14/2013   Committee Report: should pass with amendment #2013-0867s, 3/21/13; vote 5-0; CC; SC12
    • NH Bill Status: http://www.gencourt.state.nh.us/bill_status/bill_docket.aspx?lsr=887&sy=2013&sortoption=&txtsessionyear=2013&txtbillnumber=sb95&q=1
  • HB255: Workers' compensation physician selection, generic drugs, and preferred provider network pilot program
    • Introduction: 1/3/2013
    • This bill makes certain changes in the law relative to workers' compensation including:
      • Allowing an employer or the employer's insurance carrier or self-insurer to select a health care provider during the first 10 days of an employee's injury
      • Requiring pharmacies to substitute generic drugs unless the prescribing physician indicates that the brand name drug is medically necessary
      • Establishing a 3-year pilot program in certain counties for a 90-day preferred provider network
      • Allowing an employer or employer's insurance carrier or self-insurer to provide a pharmacy benefits management program
    • Additional points

Oklahoma             

  • HB1546: Workers' Compensation Administrative Reform
    • Introduced: 2/4/2013    
    • Creates the Workers' Compensation Commission
    • Provides for composition, appointment and confirmation
    • Provides term of office, prohibits outside employment, as well as required qualifications and other administrative guidelines
    • Last Action: on 2/18/2013 referred to the Rules Committee
    • Link to Status of HB1546: http://www.oklegislature.gov/BillInfo.aspx?Bill=HB1546
  • SB250: Workers' Compensation Provider Reimbursement
    • Introduced: 2/4/2013    
    • This bill calls for a new fee schedule to be created with the express purpose of reducing the cost of workers' compensation medical care by 5%
    • The new fee schedule will be reviewed and revised every two years
    • The Director of the Oklahoma State Employees Group Insurance board shall provide the Administrator such information as may be relevant in the development of the Fee Schedule
    • Making adjustments to the Fee schedule the administrator shall use the reimbursement rate for each CPT code provided in the CMS for use in the Oklahoma Medicare fee schedule
    • MRI will not be allowed unless by an accredited entity
    • DME suppliers must be accredited by a CMS approved accreditation organization.
    • Last Action: Passed on 3/6/2013 in the Senate - Referred to house first reading scheduled 3/7/2013 - Second Reading referred to Judiciary on 3/14/2013
    • Link to Status: http://www.oklegislature.gov/Billinfo.aspx?Bill=SB250
  • SB485: Workers' Compensation Act
    • Introduced: 2/4/2013
    • Relates to workers' compensation, creates the Workers' Compensation Law, defines terms, provides scope of Workers' Compensation Law
    • Provides for tolling of time limitations in certain circumstance, provides for exclusive remedies, provides exception to exclusive remedies
    • Provides penalty for certain conduct
    • Provides for Workers' Compensation Fraud Investigation Unit, provides for director, provides for compensation of director, provides duties of unit, provides for certain personnel
    • Last Action: 2/5/2013 Second Reading referred to Judiciary Committee then to Appropriations Committee   Currently in Appropriations Committee
    • Link to Status: http://www.oklegislature.gov/BillInfo.aspx?Bill=SB485&Session=1300
  • HB2100: Pharmacy Benefit Management
    • Introduced: 1/17/2013
    • Requires PBM to be license
    • Requires the State Board of Pharmacy to adopt licensure procedure
    • Give State Board of Pharmacy the authority to a subpoena witnesses and take certain action against a license for certain reason
    • Requires PBM to report specific information
    • Requires contract between PBM and provider to include specific information; including requirements of a drug product; providing for codification and providing an effective date
    • Last Action: 3/13/2013 third reading measure passed house; first reading in Senate scheduled 3/14/2013
    • Link to Bill: http://www.oklegislature.gov/BillInfo.aspx?Bill=HB2100
  • HB1362: Workers' Compensation Administrative Changes
    • Introduction: 2/4/2013
    • Relates to workers' compensation, creates an administrative system for the Workers' Compensation Code
    • Designates the Insurance Department as the state agency designated to oversee the workers' compensation system
    • Creates the Division of Workers' Compensation within the Department
    • Provides duties and authority of the Division
    • Provides authority of the Insurance Commissioner and the Commissioner of Workers' Compensation
    • Provides for investigations, provides duties of the Insurance Department
    • Last Action: 2/5/2013 referred to the judiciary committee
    • Link to Bill: http://www.oklegislature.gov/BillInfo.aspx?Bill=HB1362
  • SB1062: Workers' Compensation Reform
    • Introduction: 2/4/2013
    • Major reform bill in the State of Oklahoma, introduced by the President Pro Tem of the Senate
    • Switches the state's court-based workers' compensation system to an administrative system, similar to that in use in Arkansas
    • Would require the state to maintain both the old system and the new one for at least three years
    • Allows employers to offer alternative benefit plans for injured employees (the so-called "opt out" provision), modeled after Texas' non-subscriber alternative but with stipulated benefit provisions
    • Reduces some benefits by capping temporary total disability awards at 70% of the employee's average weekly wage, instead of 100%
    • Requires the governor to appoint three members to a commission to be charged with naming administrative law judges who would hear all workers' compensation claims
    • Adopts ODG guidelines for determining the frequency and extent of services presumed to be medically necessary and appropriate for compensable injuries
    • Requires physicians to prescribe drugs "as clinically appropriate and as recommended" by ODG
    • Last Action: Measure passed in Senate 2/27/2013; Second reading referred to Judiciary 3/14/2013
    • Link to Bill: http://www.oklegislature.gov/BillInfo.aspx?Bill=SB%201062

Tennessee           

  • HB194: Comprehensive Workers' Compensation Reform
    • Introduction: 1/28/2013
    • Create an independent state agency run by a governor-appointed administrator to oversee the system
    • Remove disputes from the courts and move them into a purely administrative process, and create an ombudsman program
    • See amendment for more detail
    • Note: Labor and consumer advocates are marshaling opposition to Gov. Bill Haslam's proposed workers' compensation reform package
    • Last Action: Committee for Government Operations recommended passage and referred to Finance/Ways and Means on 3/19/13
    • Amendments: http://tn.gov/governor/pdf/S42BW-213021315480.pdf
    • Bill Status and Text: http://wapp.capitol.tn.gov/apps/BillInfo/Default.aspx?BillNumber=HB0194
  • HB573: Excludes diseases of the heart or brain as an injury, personal injury or occupational disease under workers' compensation
  • HB327: Removes certain medical conditions from the definitions of injury, personal injury and occupational diseases (cross-filed with SB 616)
  • SB616: Removes certain medical conditions from the definitions of injury, personal injury and occupational diseases (cross-filed with HB 327)

Virginia                   

  • HB2206: Payment of charges for medical services; duties of insurance carriers; unfair claim settlement practices; fees
    • Introduced: 1/10/2013
    • Provides for reimbursement based on contracted rates, or if no contract, based on prevailing rates in the community (restatement of existing law)
    • Removes authority for a bill review "audit" to change billed procedure codes
    • After July 1, 2013, ties increases in provider fees to the medical services component of the CPI
    • Adds provisions restricting provider contract modifications
    • Last Action: 2/5/2013 Left in commerce and Labor
    • Bill Status and Text: http://lis.virginia.gov/cgi-bin/legp604.exe?ses=131&typ=bil&val=HB2206&submit=GO
  • HB1612: New Fee Schedules Proposed
    • Introduced: 1/6/2013
    • Proposed Effective date: 10/1/2013
    • Proposed legislation that would enable the VA Workers' Compensation Commission to promulgate comprehensive medical care fee schedule regulations
    • The regulations would be based on Medicare, where applicable, utilize Medicare coding and reimbursement rules, and address fees of physicians/surgeons, hospitals, ancillary services provided by other health care facilities/providers, pharmacy/pharmaceutical services, and UR issues/procedures
    • Last Action:2/5/2013 Left in Commerce and Labor
    • Bill Status and Text:http://lis.virginia.gov/cgi-bin/legp604.exe?ses=131&typ=bil&val=HB1612
  

Note: This information is neither intended to be all-inclusive for the industry, nor for public redistribution. Please feel free to send your questions, comments, suggestions, and requests for further information to Coventry at Regulatory@cvty.com 

  

 

© 2013 Coventry Health Care Workers Compensation, Inc. All rights reserved. The information which is provided herein and links to other related web sites are offered as a courtesy to our clients. All material is intended for information, communication and educational purposes only and is in no manner an endorsement, recommendation or approval of any information. Coventry Workers' Comp Services accepts no liability for the consequences of any actions taken on the basis of the information provided.

 
Copyright © 2013 Coventry Health Care Workers Compensation, Inc. All Rights Reserved.