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The State of the States
Regulatory Review
California
Recordkeeping
The California Department of Industrial Relations, Division of Occupational Safety and Health proposed amendments to rules regarding recordkeeping.
A reference to “a public and private employer” was changed to “an employer” because the rule covers all employers. The partially exempt industries list was updated to mirror the list of partially exempt industries under the federal Occupational Safety and Health Administration’s standard, with the exception of motion picture and video industries. The state will continue to require employers of establishments in motion picture and video industries to maintain such records.
Qualified Medical Evaluators
The California Department of Industrial Relations, Division of Workers’ Compensation proposed amendments to rules regarding qualified medical evaluators. The changes amend the procedures for obtaining qualified medical evaluator medical-legal evaluations that are used to resolve disputes in the workers’ compensation system. The proposed amendments implement an online system that will replace an existing paper system for requesting and generating a panel of randomly selected QMEs in represented cases. The proposed regulations also make changes to clarify and make uniform the specialty code listings on the QME application and request forms. The proposed regulations also simplify the form and process for requesting a QME panel in unrepresented cases.
Connecticut
Fee Schedule
The Connecticut Workers’ Compensation Commission announced changes to the official fee schedule for hospitals and ambulatory surgical centers.The new fee schedule includes instructions for computation of inpatient reimbursement. For outpatient hospital and ambulatory surgical center reimbursement, the fee schedule includes facilities’ wage index groups and corresponding fees. The changes are effective for medical services rendered on or after April 1, regardless of the date of injury, which are payable to health care facilities authorized or permitted to render care under the state’s workers’ compensation law.
Delaware
Reimbursement
The Delaware Office of Workers’ Compensation amended a rule regarding the reimbursement percentages for non-covered medical codes. Medical codes for treatment in an ambulatory surgery center and not covered in the schedule are reimbursed at 64.02 percent for geozip 197 and 66.5 percent for geozip 199. Hospital outpatient non-covered medical codes are paid at 60 percent of charge for both geozips, per the fee schedule.
Hospital Outpatient and Ambulatory Surgical Treatment Methodology
The Delaware Office of Workers’ Compensation corrected a rule regarding health care payment rates. The rule states that reimbursement shall be made at the lesser of the maximum allowable or billed charges notwithstanding the contract provision in the statute. Rules regulating the payment of hospital outpatient and ambulatory surgical center fees are primarily from the outpatient prospective payment system. Reimbursement for hospital outpatient and ASCs shall be in compliance to federal regulations. Outpatient prospective payment system reimbursement incorporates ambulatory payment classification groups. Procedure codes (HCPCS Level I and II) are assigned an ambulatory payment classification group based on clinical characteristics and cost similarities. The Centers for Medicare and Medicaid Services assigns relative weights to the APC groups. Current procedural terminology category II and III codes may fall in an APC, but they are not recognized in the health care payment system.
Florida
Expert Medical Advisors
The Florida Division of Workers’ Compensation proposed amendments to rules regarding expert medical advisors. The proposed rule clarifies and streamlines the process by which a physician becomes certified as an expert medical advisor. The rule also introduces online certification and certificate issuance that includes an EMA tutorial. The rule also adds an online list of certified EMAs through which each physician is responsible for updating their profile to reflect any changes to the physician’s current information.
Michigan
Health Care Services
The Michigan Department of Licensing and Regulatory Affairs, Workers’ Compensation Agency proposed amendments to the health care services rules and fee schedule.
The health care services rules were revised to update the health care fee schedules for reimbursement to providers for treatment of injured workers and to guide providers and payers on the scope of reimbursement. The proposed rules maintain consistency with the Centers for Medicare and Medicaid Services guidelines. The rules also update billing and reimbursement language to include the services of certified anesthesiologist assistants, clarify the application timetable for opioid treatment reimbursement rules, and enhance efficiency with respect to a carrier’s professional health care review certification renewal. Reimbursement for opioid treatment goes into effect for injury dates on or after June 26 and on Dec. 26 for all other injury dates.
