The State of the States

Regulatory Review

A round-up of nationwide regulatory changes affecting the workers' compensation industry.
By: | June 1, 2015


Medical Fee Schedule

The Division of Workers’ Compensation adjusted the official medical fee schedule to conform to changes in the Medicare payment system. The physician and nonphysician practitioner fee schedule update adopts the Centers for Medicare and Medicaid Systems national physician fee schedule relative value file and related files for services rendered on or after May 1.


Interpreter Fee Schedule

The Division of Workers’ Compensation proposed interpreter fee schedule regulations. The proposed regulations include a new fee structure based on factors, including whether the interpreter is certified, the language to be interpreted, and the forum where the interpreting occurs. The base rate for a certified Spanish interpreter is derived from the federal court rate. Higher rates are paid for certified interpreters of other languages, and lower rates are paid to provisional and noncertified interpreters. The rules are intended to establish objective, uniform rates resulting in faster bill payment without liens and protracted litigation. An independent bill review procedure will resolve residual disputes. The regulations require the use of certified interpreters in all forums whenever possible, with restrictions on the use of provisionally certified interpreters. The regulations also require interpreters to provide detailed billing information and set forth specific billing codes to be compensated. The billing information and codes require the interpreter to identify the event billed, the time charged, the language, and qualifications of the interpreter in addition to information specific to the particular situation. The proposed rules also clarify the selection of and arrangement for interpreters.



The Department of Financial Services, Division of Workers’ Compensation adopted amendments to rules regarding penalties. The amendment revises the penalty calculation worksheet to provide the premium credit for the initial payment of premium made to secure coverage against an assessed penalty and to adjust the penalty look back period and the penalty multiplier to conform to statutory changes. The amendment also changes the time frame to impute the employer’s payroll in the absence of business records from 20 to 28 days after receipt of the department’s request to produce records, and changes the factor to calculate employee payroll from 1.5 to two times state average weekly wage to conform to a Florida statute. Also, the time frame for the employer to provide additional records is revised to 20 business days after the service of the first amended order of penalty assessment. The new rules went into effect on April 12.


Electronic Data Interchange

The Industrial Commission revised its electronic data interchange claims release implementation guide.


The commission is developing a request for proposal process to contract for vendors to facilitate EDI claims filing for workers’ compensation carriers and self-insured employers and their claims administrators. EDI claims release 3.0 for first reports of injury and subsequent reports of injury will begin July 1, 2017. Those who need implementation assistance should send an email to [email protected]

New Hampshire

Compensation Appeals Advisory Board

The Department of Labor proposed amendments to rules regarding the purpose, definitions, procedures, and duties of the Compensation Appeals Advisory Board. The former rules expired in 2013 and are being adopted again. Changes in the expired rules include clarification that “board” refers to advisory board, the definition of “candidate,” and new questionnaire for the evaluation of compensation appeals board members. The department scheduled a public hearing at 11 a.m. on June 5 at 95 Pleasant Street in Concord. Comments should be submitted to [email protected] by June 12.

New York

Payor Compliance Project

The Workers’ Compensation Board announced that the first phase of the payor compliance project will be fully implemented by the fourth quarter of 2015. All payors, including carriers, third-party administrators, self-insured employers, self-insured trusts/groups, and governmental subdivisions will receive a quarterly report of their performance in the areas of: 1) timeliness of the first report of injury filing; 2) timeliness and reporting of initial payment of compensation; 3) timeliness of notice of controversy filing; and 4) percentage of claims controverted. Payors will be provided with a significant period of time to adapt to performance goals. Upon the passage of a sufficient amount of adjustment time, the board will notify payors of systemic violations of statutory and regulatory filing, paying, reporting, and controverting requirements. The board will establish and publish the administrative process for penalties in the future. The board will issue sample reports to all payors to evaluate performance for the second and third quarters of 2015.


Travel Expenses

The Department of Labor and Industries proposed amendments to a rule regarding travel expenses. The proposed amendment affects workers participating in a vocational retraining plan.


The existing rule excludes workers in vocational retraining from receiving reimbursement for the first 15 miles of an authorized one-way trip and the first and last 15 miles of an authorized round trip. The proposed amendment will allow workers who are actively participating in a vocational retraining plan to receive reimbursement for travel associated with the retraining without a reduction of mileage. The department scheduled a public hearing on June 2 at 1 p.m. at 7273 Linderson Way SW in Tumwater. The department plans to adopt the rule on June 30.

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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