California SB 146, Payment of Pharmacy Services
California adopted SB 146 on 8/19/13 amending Labor Code 4603.2. We were notified of the adoption on 8/20/13 and the bill became effective 8/19/13.
The significant changes include, but are not limited to:
- No longer requiring a copy of the prescription when requesting reimbursement for pharmacy services unless the provider has entered into a written agreement that requires a copy of a prescription for a pharmacy service.
- Allowing entities that submitted pharmacy bills for payment on or after 1/1/13 to resubmit those bills until 3/31/14 if they were originally denied for not including a copy of the prescription.
CA Interpreter Certification and Services
California, in response to SB 863, adopted permanent changes to interpreter certification requirements. We were notified of the adoption on 8/15/13 and the rules became effective 8/13/13.
The significant changes include, but are not limited to:
- The creation of separate certification requirements for interpreters at hearings, depositions or arbitrations and for interpreters at medical treatment appointments or medical legal exams.
- The establishment of an online accessible directory of certified interpreters.
CA rules 8 CCR 9795.1, 9795.1.5, 9795.1.6 and 9795.5 establish new law
Colorado
Colorado 7 CCR 1101-3 Rule 16 Utilization Standards and Rule 18 Medical Fee Schedule
Colorado has adopted amendments to Rule 16, Utilization Standards and Rule 18, Medical Fee Schedule. Rule 16 becomes effective 1/1/14 and Rule 18 will apply to all services rendered on or after 1/1/14.
The significant changes include, but are not limited to:
- Medical Fee Schedule effective for all services rendered on or after 1/1/14;
- Universal claim form to be used for PBM and dispensing pharmacies;
- Additional requirement on EOB of the name and address of the bill reviewer and TPA;
- Durable Medical Equipment billing and reimbursement;
- Outpatient Hospital Facility fees and reimbursement;
- Outpatient Diagnostic Testing or Treatment facilities reimbursement; and
- Evaluation and Management billing.
Minnesota
MN Rule 5219.0500, IME Fees, Annual Adjustments to Fee Schedule
The Minnesota Department of Labor & Industry has revised Rule 5219.0500, Independent Medical Examination Fees, to reflect annual adjustments to the fee schedule. The amendments are effective for services provided on or after October 1, 2013.
Ohio
OH 4121-3-09 IME Attendance
Ohio has adopted changes to Rule 4121-3-09 with respect to who may be present at an IME. We were notified of the adoption on 8/14/13 and the rule became effective 8/19/13. The significant changes include:
- Representatives of the parties may not be present at the IME;
- Injured workers may have a relative present at an IME if they would like; and
- Requirements of second medical examinations.
