The State of the States

Regulatory Review

Key workers' comp regulatory developments from around the country.
By: | April 21, 2014


Fee Schedule. The Industrial Commission scheduled a hearing regarding the physicians’ and pharmaceutical fee schedule on April 17 at 1 p.m. at 800 West Washington Street in Phoenix. In addition to public comments, the commission will consider a report prepared by commission staff. The methodology committee recommended that the commission explore the possibility of conducting an annual review of all codes rather than every four years. The commission also welcomes public comment on whether it should adopt a different methodology to determine reimbursement values that is an “Arizona based product” as recommended by the methodology committee.


The committee also recommended that the commission update to the most recent current procedural terminology, review “follow up” or “after care” days associated with the “global period,” and adopt the health care common procedure coding system as published by the Centers for Medicare and Medicaid Services. Written comments will be accepted until 10 days after the hearing. Click here for more information.


Medical Provider Networks. The Division of Workers’ Compensation modified its proposed medical provider networks regulations. The proposed modifications include a further description of the requirements for physician acknowledgements obtained through a website listing. The rules also clarify the occurrences and dates when physician acknowledgements are required. The rules clarify that the geocoding results will be used by the division in reviewing MPN plans to give an approximation of MPN compliance with the access standards. The modifications clarify the definition of MPN medical access assistant and the requirements where the same individual performs both the duties of a MPN medical access assistant and a claims adjuster. The MPN website listing of all treating physicians in the MPN must indicate those not currently taking new workers’ compensation patients and designate “by referral only” those secondary treating physicians who may only be seen with an approved referral.

The modifications also set a requirement that MPNs that were approved before Jan. 1 that are not in compliance with current MPN regulations must file a modification and update to comply no later than Jan. 1, 2018. Penalties for a violation of MPN access standards may be assessed if the MPN applicant fails to permit an injured covered employee to obtain medical treatment from an out-of-network physician when the MPN medical access assistant fails to meet the required timelines. Click here for more information.

North Carolina

Industrial Commission Rules. The Industrial Commission adopted proposed rules. The rules state that copies of the commission’s rules and forms may be obtained by contacting the commission. The adopted rules amend the procedure for claims administration. The rules set the procedure for a worker’s request to reinstate compensation. The rules state the requirements for an employer’s safety rules or regulations to be considered approved by the commission. Upon the request of an employer to take a written or recorded statement, the employer must notify the worker that the statement may be used to determine whether the claim will be paid or denied. The rules state that medical motions must be submitted electronically. The rules also clarify that physical therapists, occupational therapists, speech therapists, and other direct care providers are not rehabilitation professionals. The rules set compensation for mediators. The amended rules went into effect on April 1.


Administrative Practice and Procedure. The Department of Labor and Industry, Workers’ Compensation Appeal Board, and Office of Adjudication proposed amendments to rules of administrative practice and procedure before the board and workers’ compensation judges. The rules clarify filing dates if filing by mail, common carrier, electronically, or by hand-delivery. The rules add definitions of “board,” claim petition,” and “UEGF claim petition.” The definition of “writing” is clarified to include electronic communications.The proposed rules require a worker’s attorney to submit a copy of the fee agreement or any other statement or claim for disbursements, costs, and expenses and to obtain approval from the judge or board before the agreement, statement, or claim will be valid. The proposed rulemaking does not require the creation of forms. The rules authorize a judge to compel the attendance of the parties at medication. Comments should be submitted to Elizabeth Crum at 1010 North Seventh Street, Harrisburg, PA 17102.


Utilization Review. The Department of Labor and Workforce Development approved amendments  regarding utilization review, case management, medical cost containment, the medical fee schedule, the inpatient hospital fee schedule, and the medical impairment rating registry program.


The rules state that the Workers’ Compensation Division will charge fees for each utilization review appeal that it completes. Unresolved disputes between a carrier and a provider concerning bills due to conflicting interpretation of the rules may be presented to the medical payment committee on or after July 1. The rules set the procedure for committee review. The rules delete references to the commissioner of the department and replace such with “administrator.” The changes went into effect on March 26. Click here for more information.


Medical Quality Review. The Division of Workers’ Compensation proposed changes to an internal revised medical quality review process document. The changes would require arbiter meeting to be held at least twice per year. Nurse investigators must present all complaint recommendations through the quality assurance committee. The changes also require informal settlement conferences authorized to be conducted with at least one qualified arbiter. A second arbiter or the associate medical advisor may be assigned if available. Those with questions should contact [email protected]

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]