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Arkansas
SB 965-Amended Definition of Prescription
Arkansas SB 965 became effective on 3/28/13 and revises the definition of "prescription". The significant changes include that:
- A substitution of a therapeutically equivalent drug must occur only after the prescriber grants such authorization for each prescription; and
- The statement above does not apply to specific acts of drug therapy management or disease state management delegated to a pharmacist based upon a written protocol or patient care plan approved by a physician.
Minnesota
H.F. 582, Facility Licensing, Advanced Diagnostic Imaging Services
H.F. 582 was enacted on March 18, 2013 and becomes effective August 1, 2013. This law provides an additional option for facilities conducting and processing advanced diagnostic imaging services to be licensed according to Minnesota Health Code. Previously, MN law only allowed for accreditation of such facilities by August 1, 2013.
North Dakota
SB 2190 - Biosimilar Biological Products
North Dakota Senate Bill 2190 adds a new section to Chapter 19-02.1, the North Dakota Food, Drug, and Cosmetic Act, of the North Dakota Century Code. The bill specifies when a pharmacy may substitute a prescription biosimilar product for a prescribed product. The new law becomes effective on August 1, 2013.
Ohio
Amended Rule 4123-6-21.3: Outpatient Medication Formulary
The Ohio Bureau of Workers' Compensation ("BWC") has amended Rule 4123-6-21.3, the Outpatient Medication Formulary for the BWC's pharmacy benefit program, effective 4/1/13 , for the outpatient medication formulary for the BWC's pharmacy benefit program. The formulary is required for use for state fund claims. Self-insuring employers may utilize the formulary, but are not required to do so. The rule became effective on 4/1/13.
Oregon
Adopted OR Medical Fee and Services Rules
Oregon Division of Workers' Compensation's revised the Medical Fee and Payment Rules and Medical Services Rules. The revised rules include the following:
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Introduced: 2/1/2013
- Adopts currents version of CPT, HCPCS, etc.
- For outpatient imaging services assigned a code under the CPT® and identified by the revenue codes 0320 through 0359, 0400 through 0409, or 0610 through 0619, pay the lesser of: (A) The amount assigned to the CPT® code in the Non-Facility Maximum column of Appendix B; or (B) the amount charged
- Several sections language changed from "shall" to "must" in sections governing reimbursement to claimant for expenses incurred
- Provides that billings not submitted according to OAR 436-009-0010(2) in the proper form must be returned to the medical provider within 20 days of receipt of the bill with a written explanation describing why the bill was not paid or what needs to be corrected (reference to OAR section newly-added)
- Adds new requirements for time-based CPT codes (page 26)
- Increases record review max hours to 6 from 4 (page 28/29)
- Copies of requested medical records must be paid under OSC R0001 or R0002 (latter newly-added) (page 25, reimbursement for R0002 on page 33)
- Increases rate of reimbursement for P0003 from $147.56 to $290.36 for Director single medical review/report
- Adds compensability for reimbursement for translators for "reasonable" time spent waiting at the location for the medical provider to examine or treat the patient as well as reasonable time spent on necessary paperwork for the provider's office. (page 39)
- Includes new requirements for interpreters' invoices (page 40)
- Adds provision that states Appendix D does not apply when an ASC's cost for an implant is more than $100 (page 50)
- Last Action: 3/21/2013, Rule Adoption
- Text of New Rules: http://www.cbs.state.or.us/wcd/policy/rules/docconv_25797/9_13051ub.pdf
South Dakota
S.B. 75, AMA Guides to the Evaluation of Permanent Impairment, Revised Edition
South Dakota has enacted S.B. 75. This bill was signed by Governor Daugaard on March 14, 2013, and becomes effective July 1, 2013. The bill is of interest to CIME, Case Management, and Utilization Review.
The bill replaces the AMA Guides to the Evaluation of Permanent Impairment, 4th edition, June 1993, with the 6th edition, July 2009 reprint.
Tennessee
New Rules: TN TAC 0800-02-01-.02, FROI; TAC 0800-02-06-.12, UR Pain Management
The Tennessee Department of Labor and Workforce Development, Division of Workers' Compensation, has adopted new rules. The new rules revise Chapter 0800-02-01, Definitions and First Report of Injury (FROI), and add Chapter 0800-02-06, Appeals for Pain Management Services. These rules include, but are not limited to, the following:
- Revises the definition of "filing".
- Revises the filing requirements for Form C-20, Employer's First Report of Work Injury or Illness.
- Provides for penalties for non-compliance with filing requirements.
- Provides for a fee to be charged by the Division of Workers' Compensation to the employer for utilization review appeals.
- Become effective June 23, 2013.
Utah
SB 147, Treatment Guidelines
Utah adopted SB 147 on 3/22/13 with changes effective 7/1/13. The bill modifies the Workers' Compensation Act and the Occupational Disease Act to include provisions for the creation of treatment protocols that include determinations of medical necessity and medical treatment guidelines. Additionally, advanced practice registered nurse has been added to the definition of physician as part of provider network requirements.
Virginia
H.B. 1655, Auto - Assignment of Medical Benefits
Virginia has enacted HB 1655, signed by Governor McDonnell March 5, 2013 and becomes effective July 1, 2013. The bill provides new definitions, procedures and requirements for assignment of medical expense benefits by an insured to a health care provider under a motor vehicle insurance policy.
S.B. 1285, Dispensing Interchangeable Biosimilar Biological Products
Virginia has enacted S.B. 1285, signed by Governor McDonnell March 18, 2013 and becomes effective July 1, 2013. The bill includes, but is not limited to, the following provisions:
- New definitions to include Biological Product, Biosimilar, and Interchangeable; and
- Pharmacy requirements for dispensing interchangeable biosimilars in place of prescribed biological products.
Washington
Adopted rules for IME, WAC 296-23-302, 317 and 337
The Washington Department of Labor and Industries adopted rules effective 2/25/13
for IMEs and approved independent medical examiners. The new rules:
- Require a licensed provider to submit an IME provider application to the Department to become an approved IME provider.
- Require an IME firm to have a medical director who has a Washington state medical license.
- Update IME examiner qualifications.
- Establish new educational requirements for IME examiners in the state that examiners must comply with by 3/1/14.
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