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Arkansas
SB 498, Credentialing
Arkansas SB 498 became effective 4/10/13 and adds a new section of law to allow the Arkansas State Medical Board to provide information to credentialing organizations specifically for Physician Assistants, Radiology Assistants, Radiology Practitioner Assistants, Occupational Therapists, Occupational Therapy Assistants and Respiratory Care Practitioners. This new law includes but is not limited to the following:
- Definitions of "credentialing information" and "credentialing organization";
- Use of credentialing information;
- Fees for credentialing services;
- Disclosure of credentialing information.
Minnesota
MN S.B. 1016 - Nurse Practice Act
MN S.B. 1016 revises the MN Nurse Practice Act and becomes effective August 1, 2013. The bill includes, but is not limited to, the following provisions:
- adds definitions for "monitoring" and "patient"
- revises definitions for "practice of practical nursing" and "practice of professional nursing"
- replaces definition for "nursing assistant" with "unlicensed assistive person"
Mississippi
MS HB 777 Pharmacy Benefit Managers and Plans
Mississippi HB 777 becomes effective on July 1, 2013 and amends the definitions of Pharmacy Benefit Manager, Pharmacy Benefit Management Plan as well as the repeal of several sections from July 1, 2013 to July 1, 2016.
North Dakota
HB 1052, Notice of Preferred Provider
North Dakota House Bill 1052 becomes effective on August 1, 2013. This bill amends the section of the North Dakota Century Code relating to an employer's selection of a preferred provider. Changes include, but are not limited to:
- Requiring the employer to give written notice of the identity and the terms of the preferred provider program;
- Requiring the employer to give written notice to its employees at least annually after the initial notice;
- Requiring the employer to post written notice of the identity of the preferred provider and the terms of the preferred provider program at both fixed worksites and any mobile worksites; and
- Invalidating the employer's selection of a preferred provider if the employer fails to reasonably inform employees of the terms of the preferred provider program.
Oklahoma
SB 250, MRI Requirements
Effective August 29, 2013, Oklahoma adopted changes to workers' compensation law governing the medical fee schedule by altering requirements for entities that perform MRIs.
SB 1062, Workers' Compensation Reform
Oklahoma adopted SB 1062, effective February 1, 2014. Significant changes included in the bill include but are not limited to the following:
- Major reform bill in the State of Oklahoma, introduced by the Pres. Pro Tem of the Senate
- Strongly backed by the Chamber of Commerce; staunchly opposed by organized labor
- Switches the state's court-based workers' compensation system to an administrative system, similar to that in use in Arkansas - focus is on reduction of litigious nature of work comp in Oklahoma
- Requires 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; dubbed the "Oklahoma Injury Benefit Act"
- The "opt out" provision is similar to the measure introduced last legislative year, but does not require an employer to have a high experience modifier or a $50,000 one-year loss in order to qualify for the program, nor is there a provision specifying use of an ERISA (Employee Retirement Income Security Act) plan to provide benefits
- 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. The governor's appointees would serve six-year staggered terms and be subject to Senate confirmation
- Allows for appeal of an ALJ decision to the Workers' Compensation Commission on payment of a $175 filing fee, and provides rules for Commission review and/or reversal, as well as provisions for appeal to the Supreme Court
- 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
- Contains provisions, likely to be controversial, that eliminate benefits for injuries resulting from the use of a keyboard or video terminal (i.e., carpal tunnel syndrome); the limiting of mental health benefits to $6,500; and a section that would appear to allow employers to deduct payments paid on one claim from those resulting from a second injury
- The bill also would transfer responsibility for investigating workers compensation fraud from the Attorney General's Office to the Insurance department, reduce the statute of limitations for filing a claim from two years to one except in death cases, and attempt to eliminate double billing by medical care providers
South Dakota
SB133: Pharmacy Audit Integrity Program
- Introduced: 1/22/2013
- Effective: 3/8/2013
- Establishes a pharmacy audit integrity program to provide standards for an audit of pharmacy records carried out by a pharmacy benefits manager or any entity that represents the pharmacy benefits manager
Tennessee
SB 200 - Workers' Comp Reform
Tennessee Governor Haslam has signed into law significant workers' compensation reform legislation, SB 200 ("The Workers' Compensation Reform Act of 2013") and the law will become effective July 1, 2014. The new law includes the following key provisions:
- Creation of a new Court of Workers' Compensation Claims in the Division of Workers' Compensation to have original and exclusive jurisdiction over all contested claims for workers' compensation benefits with DOI on or after 07/01/2014. The state courts will no longer play a role under the new system.
- Creation of a Workers' Compensation Appeals Board to review orders entered by workers' compensation judges upon application of any party to a claim.
- Creation of a Medical Advisory Committee to assist in developing treatment guidelines and advise the administrator on issues relating to medical care in the workers' compensation system.
- Creation of a Medical Payment Committee to hear disputes on medical bill payments between providers and insurers and advise the administrator on issues relating to the medical fee schedule and medical care cost containment in the workers' compensation system.
- Revisions to determination of permanent partial disability (PPD) indemnity benefits.
- Changes to definition of "injury" to include addition of "primarily" standard to all injuries, meaning that the employment contributed more than 50% in causing the injury, considering all causes, as established by a preponderance of the evidence.
- Changes to process for employee to provide notice of injury to employer.
- Adoption of rules, on or after July 1, 2014, by the administrator regarding the electronic submission and processing of medical bills by health care providers to insurance carriers.
- Changes to employer provided panels of physicians in the event three or more providers are not available in the employee's community and specialist physician referrals.
- Replacement of remedial/liberal construction with statutory construction, meaning that the law will be applied impartially favoring neither the employee nor the employer.
- Creation of a workers' compensation mediation program and ombudsman program to assist injured/disabled employees, persons claiming death benefits, employers, and other persons in protecting their rights, resolving disputes, and obtaining information under workers' compensation law.
Utah
SB 78 Biosimilar Products
Utah SB 78 becomes effective 6/3/13 and includes the following:
- Defines biological product and biosimilar product
- Addresses and limits the substitution of biosimilar products for biological products
SB 147 Treatment Guidelines
Utah SB 147 becomes effective 7/1/13 and includes but is not limited to, the following:
- 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
- Adds advanced practice registered nurse to the definition of physician as part of managed health care and preferred provider programs
Washington
B32599: Anesthesia, Physical and Occupational Therapy - Increases in Conversion Factors
- Introduced: 12/18/2012
- Effective: 5/7/2013
- Changes the conversion factor used to calculate payment levels for services payable through the resource-based relative value scale (RBRVS) fee schedule
- Changes the conversion factor used to calculate payment for anesthesia services ($3.22 to $3.25)
- Increases the maximum daily payment for physical and occupational therapy ($119.01 to $119.96)
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