The State of the States

Regulatory Review

A round-up of nationwide regulatory changes affecting the workers' compensation industry.
By: | March 27, 2015

Mississippi

Benefits

The Mississippi Workers’ Compensation Commission announced that effective Jan. 1 the weekly maximum benefit rate is $463.59. The overall maximum rate is $208,615.50.

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Hearings

The Mississippi Workers’ Compensation Commission updated the Official Notice of Hearing on the Merits form to include a statement requiring the claims adjuster on a claim to be present at the hearing or available by telephone for the duration of the hearing.

Mileage

The Mississippi Workers’ Compensation Commission announced that effective Jan. 1 the mileage reimbursement rate is 57.5 cents per mile.

New Mexico

IME Providers

The New Mexico Workers’ Compensation Administration announced that it is accepting applications from health care providers to be approved as independent medical exam providers. Applications are being accepted through April 30. Written public comments on any health care provider being considered or any current IME provider will be accepted from May 1-31.

New York

Medical Treatment Guidelines

The New York State Workers’ Compensation Board announced that new Non-Acute Pain Medical Treatment Guidelines, as well as revisions to the existing Medical Treatment Guidelines, went into effect on Dec. 15, 2014. 12 NYCRR 324.2 was amended to incorporate the Non-Acute Pain MTG as well as revisions to the third editions of the mid and low back, neck, shoulder, and knee MTGs and the second edition of the carpal tunnel syndrome MTG. Additionally, Intrathecal drug delivery (pain pumps) have been added to the list of procedures requiring prior authorization. The board stated that the new Non-Acute Pain MTG presents a comprehensive approach to the management of patients with chronic pain, including best practice recommendations for the appropriate use of narcotics. E-learning training programs have been developed to facilitate compliance with both the new Non-Acute Pain MTG and revised MTGs recommendations. The training consists of medical courses that enable providers to earn CME credits, as well as courses for nonmedical professionals. These programs are free and are available on the board’s website. In addition, the Non-Acute Pain Medical Treatment Guidelines training is available on the Medical Society of the State of New York’s website.

North Carolina

Benefit Rates

The North Carolina Industrial Commission established the 2015 maximum weekly benefit pursuant to N.C. Gen. Stat. § 97-29. The maximum weekly benefit applicable to all injuries and claims arising on and after Jan. 1, 2015, is $920.

Medical Fee Schedule

The North Carolina Industrial Commission announced the approval of three administrative rules revising its medical fee schedule. The new rules were approved by the Rules Review Commission on Feb. 19. The changes to fees for institutional services are scheduled to take effect on April 1 while the revised rates for professional services will take effect starting on July 1. The new schedule was developed in response to legislation requiring the Industrial Commission to revise its medical fee schedule to use current Medicare reimbursement rates and payment methodologies. The commission stated that the changes reflect a compromise agreement between insurance carriers, hospitals, physicians, and other medical care providers. As a result, maximum fees for hospitals and other institutional providers are set to decrease while fees for physicians, nurses, and other professional providers will increase. An analysis by the National Council on Compensation Insurance projects that the new Medical Fee Schedule will result in approximately $27 million in annual savings to the North Carolina workers’ compensation system. This estimate is based upon 2013 written workers’ compensation insurance premiums and self-insured employer data.

Ohio

Medical Fees

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The Ohio Bureau of Workers’ Compensation scheduled a public hearing to consider amendments to: 1) Rule 4123-6-37.2 regarding payment of hospital outpatient services; 2) Rule 4123-6-37.3 regarding payment of ambulatory surgical center services; 3) Rule 4123-6-08 regarding the bureau fee schedule; and 4) Rule 4123-6-21.3 regarding the outpatient medication formulary.

The amendments are required to comply with R.C. 119 requiring agencies to review their rules every five years and to update fees paid by the bureau to medical care providers.

South Carolina

Forms

The South Carolina Workers’ Compensation Commission announced that it has adopted the International Association of Industrial Accidents Boards and Commissions Claims EDI Release 3.0 standard for the voluntary electronic transfer of Subsequent Report of Injury information in place of the SCWCC Form 18 Semi Annual Reporting as of March 2. The commission implemented the mandatory submission for First Report of Injury in place of the SCWCC Form 12A as of Jan. 1, 2014. The new SROI process will allow electronic submission and improve the claims adjudication process and maintain industry standards in data reporting. Informal Conference requests will not be accepted electronically by SROI. Requests for ICs must be submitted on a Form 18 by email, U.S. Postal Service, or delivered to the commission.

Christina Lumbreras is a Legal Editor for Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at [email protected]

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The R&I Editorial Team can be reached at [email protected]