These rules originally became effective 1/1/13 for 180 days pursuant to an emergency rule filed 12/21/2012. The emergency rules have been readopted without changes and are effective 7/1/13 until 10/1/13.

The emergency regulations specify what communications are allowed with the AME and QME.

After 7/1/13, all medical treatment disputes must go through the IMR process regardless of the date of injury. However, AMEs and QMEs will continue to provide opinions over disputes regarding the need for future medical care.

This summary is for informational purposes only and no new compliance activities are associated with these readopted emergency rules.

BR and IBR, California readoption

The California Division of Workers' Compensation readopted emergency regulations related to bill review and Independent Bill Review (IBR).

These rules originally became effective 1/1/13 for 180 days pursuant to an emergency rule filed 12/21/2012. The emergency rules have been readopted without changes and are effective 7/1/13 until 10/1/13.

The emergency regulations:

The California Division of Workers' Compensation readopted emergency regulations that are related to Utilization Review and Independent Medical Review (IMR).

These rules originally became effective 1/1/13 for 180 days pursuant to an emergency rule filed 12/21/2012. The emergency rules have been readopted without changes and are effective 7/1/13 until 10/1/13.

Effective 1/1/13, the new regulations:

Note: Prior to 7/1/13, requirements established by the changes in regulations were dependent on whether the date of injury was before or after 1/1/13. After 7/1/13, requirements are the same regardless of the date of injury.

Electronic Filing of Liens, California 8 CCR § 10205

CA's Emergency Rules pertain to the Electronic Filing of Liens, adopted in response to SB 863.

These rules originally became effective 1/1/13 for 180 days pursuant to an emergency rule filed 12/21/2012. The emergency rules have been readopted without changes and are effective 7/1/13 until 9/25/13.

The significant changes to the law as established in the original rule adoption, and re-established in the 7/1/13 adoption include but are not limited to the following:

• New definitions (Cost, Electronic Filing, Initial Lien, Section 4903(b) Lien, etc.);
• Excludes medical treatment disputes that are subject to IMR and IBR from the lien process;
• Establishes requirements and forms for the electronic filing of liens;
• Incorporates medical treatment related transportation expenses and interpreter fees as services subject to the lien process; and,
• Creates an initial lien fee of $150 for liens filed on or after January 1, 2013. (The fee is payment for the filing of the lien and must be submitted prior to or at the filing of the initial lien.)
• Creates a lien activation fee of $100 for liens filed prior to January 1, 2013. (The fee is payment for activation of a lien and must be filed prior to filing a Declaration of Readiness to Proceed for a lien conference, prior to appearing at a lien conference, or prior to January 1, 2014, whichever occurs first.)

 HB175: Workers' Compensation

Professional Fees

• Pathology, laboratory, radiological services and durable medical equipment fee schedule allowable fees will be reduced 15%. Payment calculation will be 85% of 90% of the 75th percentile of the actual charges.
• Medical codes currently itemized within the fee schedule as being paid at POC85 will now be populated with fee schedule rates which will be based on Relative Value Units wherever possible.
• Non-authorized drug screening and per-procedure reimbursements for drug testing will be limited.
• A formulary and fee methodology for pharmacy services, prescription drugs and other pharmaceuticals that discount AWP will be developed
• A ban on repackaging pharmacy fees and adoption of preferred drug list will be the responsibility of the Health Care Advisory Panel (HCAP).
• The HCAP will be required to implement a cap on Anesthesia fees; and
• Adopt and recommend regulations for the Health Care Payment System
• The "Medical" inflationary adjustment which is based on the CPI-U, City Average will be removed allowing hospitals to have the same inflation adjustment rate as other providers
• The HCAP will develop a maximum allowable fee schedule for ASC's that will results in stable charges and cost neutral with respect to medical costs.

Please note: Inflationary adjustments mentioned in any of the above sections will be frozen to two (2) years and will not be recouped when the adjustments resume. Barring any further changes to statutes, the freeze will end with the January 31, 2016 fee schedule update.

Introduced: 6/4/2013

Last Action: 6/27/2013, signed by Governor

http://legis.delaware.gov/LIS/LIS147.nsf/vwLegislation/HB+175?Opendocument

Bill Text: http://legis.delaware.gov/LIS/LIS147.nsf/vwLegislation/

Florida

FL HB 553 Workers' Compensation Administration

Florida has adopted HB 553 which revises several sections within the WC Law.  Notification of the June 7th adoption was received on June 10, 2013.  The effective date of this bill is July 1.  The significant amendments of this new law include, but are not limited to:

• The removal of the requirement for providers to be certified by the Department of Financial Services in order to be reimbursed for WC services provided
• The definition of  "Certified Health Care Provider" has been removed and;
• The definition of "Health Care Provider" removes the requirement for physicians or doctors to be certified, however, they must be licensed by the appropriate licensing board to provide skilled services.
• Amends timeframes for dispute resolution of disallowance or adjustments of payments and DFS determination timeframe.
• Amends the assessment amount of administrative fines.
• Carrier reporting requirements for return to work determinations has been amended.
• Responsibility for monitoring carriers has been transferred to DFS.

Georgia

GA H.B. 154 - Compensation for Medical Care; RTW

Georgia enacted H.B. 154 regarding the number of weeks an injured employee is entitled to medical benefits for catastrophic and non-catastrophic injuries. RLA received notice on July 1, 2013 of the May 6, 2013 enactment. The bill became effective July 1, 2013.

The bill limits the number of weeks that an employer is required to furnish medical care, treatment, and supplies to an injured worker for injuries occurring on or after July 1, 2013 not designated as catastrophic to a maximum of 400 weeks from the date of injury.

Hawaii

HB152: Auditor Assignment to Assess Adequacy of Fee Schedule

Introduced: 1/17/2013

Effective: 7/1/2013

• Requires the auditor to assist DLIR in adjusting and periodically reviewing the adequacy of the medical fee schedule
• Previous provision to increase reimbursements from 110 to 130% of Medicare completely removed from bill

 Last Action: 6/18/2013, Signed by Governor. Gov. Msg. No. 1197

Official State Link to Bill: http://capitol.hawaii.gov/measure_indiv.aspx?billtype=HB&billnumber=152

LegiScan Bill Tracker: http://legiscan.com/HI/bill/HB152

Louisiana

HB728: Workers' compensation changes on several items including choice of physicians, payment of benefits, and disputes

Effective: 8/1/2013

• The bill would limit insurers' ability to initiate legal proceedings against injured workers, reduce payer liability for penalties and attorney fees and impose a new notice process. These provisions would undo some of the 2012 workers' compensation reforms, which allowed insurers to initiate legal action against claimants in informal proceedings.

Last Action: 6/17/2013, Signed by the Governor on 6/17/2013

Official Bill Text: http://www.legis.la.gov/legis/BillDocs.aspx?i=223220&t=text

Official Bill Status: http://www.legis.la.gov/legis/BillInfo.aspx?s=13RS&b=HB728&sbi=y

Montana

MT ARM 24.29.1401A, .1433, .1512, .1513, and .1515 - Designated Treating Physician; Required Forms

The Montana Department of Labor and Industry (DOLI) has adopted new rules and amended existing rules to reflect changes that occurred as a result of the adoption of HB 334 during the 2011 legislative session. Official notice of the rule amendment was received in StateNet on July 10, 2013, and the rules became effective July 12, 2013.  

The new/amended rules include the following key provisions:

• Adds a definition for "Designated Treating Physician" and amends the definition of "Facility" or "health care facility";
• Allows an injured worker to select a treating physician;
• Requires use of the Medical Status Form (MSF) and the CMS 1500 treatment bill by a treating physician, ER or similar urgent care facility when seeing a claimant for the first time (related to the claim) and furnishing same to the insurer within 7 business days of the visit; and,
• Requires that functional improvement status be sufficiently documented on the MSF and the Montana Utilization and Treatment Guidelines outline the standards for functional improvement.

New Hampshire

NH SB 95-Employee Choice of Pharmacy 

SB147: Rx: Use of Generics Required Unless "Medically Necessary"

Introduced: 1/3/2013

Effective: 1/1/2014

• Pharmacies, including mail-order pharmacies, shall substitute generically equivalent drug products for all legend and non-legend prescriptions unless the prescribing practitioner handwrites "medically necessary" on each paper prescription, uses electronic indications when transmitted electronically, or gives instructions when transmitted orally that the brand name drug product is medically necessary; provided that in cases where the legend drug is less expensive, the legend drug shall be used.
• Prescription refills shall not require the reissuance of the "medically necessary" indication.

Last Action: signed by Governor on 6/25/2013

Official Bill Text and Link: http://www.gencourt.state.nh.us/legislation/2013/SB0147.html

LegiScan Bill Tracker: http://legiscan.com/NH/bill/SB147

Oklahoma

OK Updated Spine Treatment Guidelines, Effective 6/24/2013

Effective June 24, 2013, the Physician Advisory Committee of Oklahoma has adopted new Oklahoma Treatment Guidelines for spinal injuries.

The OTG-Spine replaces the Physician Advisory Committee's treatment guidelines for the spine adopted before August 26, 2011. The OTG-Spine are effective until superseded by applicable law.

Oregon

HB2902: Equal Pay for Nurse Practitioners and Physician Assistants

Introduced: 2/13/2013

Effective: 6/18/2013

• NEW AMENDMENT ADDED: Main provisions sunset effective Jan 2, 2018
• Urgency measure; effective upon passage
• Creates Task Force on Primary and Mental Health Care Reimbursement to study and make recommendations to 2014 and 2015 regular sessions of Legislative Assembly on payment structure for primary care and mental health care workforce
• Sunsets task force on convening of 2016 regular session of Legislative Assembly
• Requires insurers to reimburse physician assistants and nurse practitioners in independent practices at same rate as physicians for same services
• Does not cover NP's/PA's in certain group practice HMO's

Last Action: 6/25/2013, Signed by Governor 6/18/2013. Chaptered 430, (2013 Laws) on June 25, 2013

Official Bill Status and Text:

http://apps.leg.state.or.us/MeasureInfo/Measure/AtGlance?session=38&MeasureNumber=HB2902

LegiScan Bill Tracking Link: http://legiscan.com/OR/bill/HB2902

Texas

TX SB 1322 - Fee Contracts for DME 

SB 1322 adds a new section of law relating to use of an informal or voluntary network to contract for fees for durable medical equipment.  The new section includes, but is not limited to:

 Establishes definitions for DME, informal network, and voluntary network;

TX HB 3152 - Provider Reimbursement HCN Contracts 

This bill is of interest to Bill Review and Networks.  The bill adds new sections to the law governing provider reimbursement within a certified network.  There are several significant changes to the law, including, but not limited to, the following: 

• Requires that a contract between a provider and management contractor or third party delegate acting as the provider's agent, include:
• The network's contract rate for services, and,
•  The amount of reimbursement the provider will receive after the agent's fee;
• Requires a management contractor or third party delegate who is serving as an agent to a provider to disclose that relationship in any contract with the network;
• Requires that a provider will be reimbursed at the contract rate when the contract complies with the Insurance Code; and,
• Requires that a provider will be reimbursed at the network's contract rate when the contract fails to comply with the Insurance Code.

Notice of the June 14, 2013, adoption was received on June 18, 2013, and the bill becomes effective September 1, 2013.  TX HB 3152 establishes new law.  Pertinent language in the new law has been bolded in the attached summary.

SB644: Prescription Drug Benefits

Introduced: 2/19/2013

Effective: 9/1/2013

Associated Bills: TX H 1032 - Identical

• The commissioner by rule shall:
  • prescribe a single, standard form for requesting prior authorization of prescription drug benefits;
  • (2) require a health benefit plan issuer or the agent of the health benefit plan issuer that manages or administers prescription drug benefits to use the form for any prior authorization of prescription drug benefits required by the plan;

Last Action: Signed by Governor 6/14/2014

Text of the bill: http://www.capitol.state.tx.us/BillLookup/Text.aspx?LegSess=83R&Bill=SB644

History of the bill: http://www.capitol.state.tx.us/BillLookup/History.aspx?LegSess=83R&Bill=SB644

WA WAC 296-20 - Coverage and Payment for Prescription Drugs 

Washington has adopted rules related to the coverage and payment for prescription drugs, effective 7/1/13.  We were notified of the 5/28/13 adoption on 6/19/13. 

The significant changes include, but are not limited to:

•  Updating the method used by the Department of Labor and Industries to determine drug coverage.
• Increasing the drug dispensing limitation to a 90 day supply when the employee is on a pension.  The supply limitation remains at 30 days for all other cases.
• Changing the steps an insurer may take when there are concerns regarding the amount or appropriateness of drugs being requested.
• Creates rules devoted to opioid authorization and payment.
• Establishes definitions.
• o Limits length of coverage and supply.
• o Creates rules and requirements for authorization of payment related to various phases of treatment and therapy.
• o Limits payment for pain-related emergencies.
• o Establishes proper and necessary treatment guidelines.
• o Creates provider documentation and reporting requirements.

• Hawaii
• Maryland