The State of the States

Regulatory Review

A round-up of nationwide regulatory changes affecting the workers' compensation industry.
By: | November 7, 2014


Durable medical equipment

The Division of Workers’ Compensation ordered that the durable medical equipment, prosthetics, orthotics, and supplies portion of the official medical fee schedule is adjusted to conform to changes to the Medicare payment system that were adopted by the Centers for Medicare and Medicaid Services.

Effective for services rendered on or after Oct. 1, the maximum reasonable fees for durable medical equipment, prosthetics, orthotics, and supplies must not exceed 120 percent of the applicable fees set forth in the fee schedule.


Periodic Reports

The Division of Workers’ Compensation proposed changes to a rule regarding periodic reports and employer work sites. The division proposed to repeal a rule requiring employers who are issued stop-work orders, where the assessed penalty exceeds $50,000, to file quarterly compliance reports with the division. Proposed amendments to the rule regarding employer work sites increase the time within which an employer must produce requested business records or be subject to a stop-work order from five business days to 10 business days.

Reimbursement Manual for Hospitals

The Division of Workers’ Compensation proposed changes to the reimbursement manual for hospitals. The threshold number of bills required to establish a “base rate” was increased from 20 to 40. This resulted in a revised set of “base rates.” The division proposed an effective date of Jan. 1, 2015. Those with questions should contact [email protected].


Reimbursement of Travel Costs

The Workers’ Compensation Division issued a bulletin regarding the reimbursement of injured workers’ travel, food, and lodging costs. The standard lodging and meal rates and the private vehicle mileage rate remain the same. The division updated the lodging and meal rates that exceed the standard rate for certain counties. The bulletin noted that if a worker needs special transportation or lodging, reimbursement can exceed the published rates. Parking fees and toll charges are also reimbursable. The division also said that lodging rates do not include taxes. Room tax is reimbursable in addition to the lodging allowance. The lodging and meal rates are effective from Oct. 1 through Sept. 30, 2015. The private vehicle mileage rates went into effect Jan. 1. Those with questions should contact a benefit consultant at (503) 947-7585. For a copy of the bulletin, visit

Electronic Data Interchange

The Workers’ Compensation Division proposed changes to rules regarding electronic data interchange and proof of coverage. The rules more completely describe reporting requirements. The rules also adopt a new EDI transmission profile form for insurers that intend to report directly to the agency. The rules also set standards for accuracy and timeliness of reporting and describe consequences for failure to meet the standards, including possible sanctions or revocation of EDI transmission approval. The rules distinguish employer cancellations of coverage from insurer terminations of coverage and explain associated recordkeeping responsibilities for insurers.


Administrative Procedures

The Workers’ Compensation and Safety Division proposed amendments to the administrative procedure rules. The rules update the workers’ compensation program’s administrative citation and penalty provisions to address the debarment penalties added to the statutes and state Supreme Court decisions on penalty assessment and calculation. A person who willfully makes a false statement or representation for the purpose of obtaining any benefit or payment for himself or another person will be assessed an administrative penalty of no more than $20,000. A worker who willfully makes a false statement or representation of material fact for the purpose of obtaining a workers’ compensation benefit forfeits all or a portion of his right to benefits based on the workplace injury.

The commissioner will prohibit an employer who willfully makes a false statement or representation for the purpose of deriving any benefit, including a lower insurance premium, from contracting with the state or any of its subdivisions for up to three years. An employer that fails to comply with the requirements to maintain workers’ compensation insurance or self-insurance will be assessed a penalty of no more than $100 per day for the first seven days that the employer neglected to secure coverage and no more than $150 per day thereafter.



The Department of Labor and Industries proposed amendments to rules that will amend the tables of classification base premium rates, experience rating plan parameters, experience modification factor calculation limitations, and retrospective rating plan size groupings for the workers’ compensation insurance program for the 2015 calendar year. Classification base rates were amended for updates loss and payroll experience. The department proposed a 1.8 percent overall average premium rate increase. The rule proposal also repealed the farm internship program rates and the rate holiday dividend. The department also proposed to move tree care and pruning services not otherwise classified into a new classification. To partially fund the logger safety initiative, the supplemental pension fund will be increased from 2 mils to 47.2 mils per hour for each employer and worker for work reported in the forest products industry risk classifications.

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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