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Alabama
AL SB 215, Occupational Therapy
Alabama has adopted SB 215, effective 8/1/13. The significant changes include, but are not limited to:
- Providing a new definition for the practice of occupational therapy which now includes
- Case management and transition functions; and
- Fitting and training of orthotics and prosthetic devices, assistive technology and adaptive devices.
- Adding licensed physician assistants, nurse practitioners, and licensed psychologists to those who can refer patients to an occupational therapist and those who can reevaluate patients involved in long-term occupational therapy
- Removing the supervised fieldwork experience requirement for licensure as an occupational therapist
Colorado
SB 285, IME and Bill Review (Recoupment)
Colorado has adopted SB 285, effective 7/1/13. The significant changes of this bill include an additional section regarding recoupment on a bill and when an employer/insurer may request an IME. The changes include:
- If a claimant has paid for medical treatment that is admitted or found to be compensable and that costs more than the amount specified in the fee schedule, the employer or the carrier, must reimburse the claimant for the full amount paid. The employer or carrier is entitled to reimbursement from the medical providers for the amount in excess of the amount specified in the fee schedule; and
- The bill also extends the amount of time from 18 to 24 months from the date of injury that must pass before an employer or insurer may request an IME if the treating physician has not determined that an injured worker has reached MMI. If the IME selected determines that the worker has reached MMI, the IME must also determine the worker's permanent medical impairment
CO SB 249, IME Reports
Colorado has adopted SB 249, effective 8/7/13. The significant changes included in this bill include, but are not limited to:
- Requiring the Department to review an IME report within 5 days after its receipt and notifying the provider and all parties that there are deficiencies in the report; and
- Requiring that the provider has 20 days to remedy the deficiencies and resubmit the report.
Florida
HB365: Rx: Bio similar Agents
- Introduced: 3/5/2013
- Effective: 7/1/2013
- Associated Bills: FL S 732
- Permits class II institutional pharmacy formulary to include biologics, biosimilars, & bio similar interchangeable
- Outlines requirements for a pharmacist when dispensing a substitute biological product that is determined to be bio similar to & interchangeable for prescribed biological product
- Provides notification requirements for pharmacist in a class II or modified class II institutional pharmacy
- Requires Board of Pharmacy to maintain current list of interchangeable bio similar products
- Replaces companion bill SB732
HB553: Work Comp System Administration
- Introduced: 1/28/2013
- Effective: 7/1/2013
- Amends many administrative provisions of the Work Comp system
- Highlights include:
- 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
- Eliminates the requirement that workers' compensation health care providers be certified by the Department of Financial Services (DFS)
- Increases timeframes for health care providers to file medical reimbursement disputes with the DFS, for carriers to respond to the petition, and for the DFS to issue a written determination
- FL Official Web Site: http://www.flsenate.gov/Session/Bill/2013/0553
SB662: Repackaged Med Reimbursement Cap
- Introduced: 2/7/2013
- Effective: 7/1/2013
- Associated Bills: HB605
- Amended substantially to set a price cap of 112.5% of the average wholesale price set by the original manufacturer, plus an $8 dispensing fee for repackaged medications
- All bills for repackaged drugs would be required to include the National Drug Code assigned by the original manufacturer
- The amendment also repeals a section of Florida Statute 440 that allowed carriers and employers to pay contracted amounts for repackaged drugs even if they had not contracted with the physician or pharmacy dispensing the drugs
- Previous version of bill provided 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, which may not be the manufacturer of the repackaged or relabeled drug, plus a $4.18 dispensing fee, unless the carrier has contracted for a lower amount. The repackaged or relabeled drug price may not exceed the amount otherwise payable had the drug not been repackaged or relabeled.
Indiana
HB 1320, Reimbursement
Indiana has recently adopted HB 1320 which becomes effective on 7/1/13. The bill, among other things, establishes the following:
- New definitions - including definitions for legend drug, pecuniary liability, medical service provider, "service or product," and medical service facility;
- Whenever a prescription is filled using a repackaged legend drug, the maximum reimbursement amount for the repackaged legend drug must be computed using the average wholesale price set by the original manufacturer for the legend drug.
- If the National Drug Code for a repackaged legend drug cannot be determined from the medical service provider's billing or statement, the maximum reimbursement amount for the repackaged legend drug is the lowest cost generic for that legend drug;
- Urges the legislative council to assign to the interim study committee on insurance the study of several fee and payment-related elements of the workers' compensation program and occupational diseases program;
- Beginning 7/1/14, there will be separate ways to determine pecuniary liability of employers or carriers for payment to medical service providers and for payment to medical service facilities;
- The payment to a medical service provider or medical service facility for an implant furnished to an employee may not exceed the invoice amount plus 25%; and
- After June 30, 2014, the amount payable to medical service facilities when an amount has not previously been negotiated, is 200% of the amount payable on the same date under the medical service facility's Medicare reimbursement rate for the same service or product.
Maine
SB 483 - Pharmacy Choice
Maine has enacted Senate Bill 483 which makes amendments to allow Pharmacy Choice and becomes effective September 19, 2013. This bill allows employees who have been prescribed drugs for a covered injury/disease the right to select the provider, pharmacy or pharmacist for dispensing and filling the prescription drug.
Minnesota
S.B. 1234 - QRC; Prevailing Charges; LT Opioid Use
Minnesota S.B. 1234 adopts various Workers' Compensation Advisory Council recommendations and becomes effective at various times designated within each section of the summary. The bill includes, but is not limited to, the following key provisions:
- Revises definition of "personal injury" and "occupational disease" to include "mental impairment."
- Limits job development services provided by a qualified rehabilitation consultant (QRC) firm or a registered rehabilitation vendor to a specific number of weeks or hours per month.
- Prohibits an individual QRC from providing certain case management services unless those services are part of an approved rehabilitation plan.
- Requires prevailing charges calculation to be based on no more than two years of billing data immediately preceding the date of the service for treatment, articles, and supplies provided to an injured worker while an inpatient/outpatient at a small hospital.
- Provides for adoption of rules establishing criteria for long-term use of opioids or other scheduled medications, including use of written contracts between the injured worker and prescribing provider.
Montana
MT S.B. 323 - Query of Rx Drug Registry by Treating Physician for Schedule Drugs
Montana S.B. 323 pertains to a treating physician's query of the Prescription Drug Registry. This bill becomes effective July 1, 2013 and includes, but is not limited to, the following provisions:
- Permits a treating physician to query the Prescription Drug Registry prior to initially prescribing or refilling of a Schedule II or III drug for treatment of a workers' comp injury/occupational disease.
- Requires a treating physician to note each query conducted in the patient's medical file.
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