The State of the States

Regulatory Review

Key workers' comp regulatory developments from across the country.
By: | February 16, 2014 • 4 min read

California

Medical provider networks: The Division of Workers’ Compensation modified its proposed medical provider networks regulations. The proposed modifications include penalty changes to align notice violations with the entity responsible for giving actual notice, and penalty changes to limit multiple violations for an MPN applicant and reduction of penalties. The modifications clarify alternative access standard requirements, out-of-network policies, and required physician appointment time frames. MPNs approved on or before Jan 1, 2011 will be deemed approved until Dec. 31, 2014. The rules also clarify the MPN medical access assistant responsibilities. The rules clarify the application plan requirements, including for taking electronic signatures, ancillary services, and qualify of care. The rules eliminate the modification filing requirements for a 10 percent provider listing change and for a 25 percent change in covered employees. The rules change the mitigation requirements to specify a time frame and to allow for first time violations to be considered as a factor. Find more information here.

Independent bill review. The Division of Workers’ Compensation modified its proposed rules regarding standardized paper billing and payment, electronic billing and payment, independent medical review. The proposed modifications include revised forms for providers to request a second bill review and independent bill review. The rules provide that the 90-day time limit for requesting a second review can be extended by mutual written agreement between the provider and the claims administrator. A revision limits the number of separate IBR requests that can be consolidated for a single IBR determination to a maximum of 20. The instructions of the application for independent medical review were revised to clarify the consequence of a decision to not participate in the IMR process. The rules also clarify that an IMR determination cannot be issued based solely on information provided by a utilization review determination. More information can be found here.

Nevada

Telemedicine: The Division of Industrial Relations, Department of Business and Industry proposed regulations authorizing providing medical benefits by telemedicine to injured workers. An insurer or third part administrator must pay for telemedicine service if the services were authorized in writing by the insurer or third part administrator at least five business days before the date of the appointment, approved in writing by the injured worker at least five business days before the date of the appointment, and the injured worker was present throughout the appointment. A separate reimbursable item will be added to the medical fee schedule. The proposed addition to the medical fee schedule is a telemedicine origination site fee. Diagnostic or other procedures performed in conjunction with a telemedicine visit are separately reimbursable if authorized separately. The physician or consultant at the distant site is reimbursed using the appropriately billed code. A public hearing was scheduled on Jan. 14. Click here for further information.

Texas

Medical fee guideline conversion factors: The Department of Insurance issued a bulletin informing workers’ compensation system participants of the annual change to the medical fee guideline conversion factors. For services provided in the 2014 calendar year, a conversion factor of $55.75 applies to service categories of evaluation and management, general medicine, physical medicine and rehabilitation, radiology, pathology, anesthesia, and surgery when performed in an office setting. The conversion factor of $69.98 applies to surgery when performed in a facility setting. A copy of the bulletin can be found here.

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Mode of payment: The Division of Workers’ Compensation proposed informal amendments to rules regarding mode of payment by insurance carriers and a new rule regarding payments made through an access card. The new rule clarifies that the requirements for issuing electronic payments through access cards ensure that injured workers receive benefits in an appropriate, timely, and cost-effective manner. The division accepted informal comments until Jan. 20. Formal comments will be accepted once the rules are formally proposed. For more information, click here.

Virginia

Premium level adjustments: The State Corporation Commission set the workers’ compensation premium level adjustments. The approved changes decrease the overall premium levels for the federal classifications in both the voluntary market and assigned risk plan and industrial and surface and underground coal mines in the assigned risk plan. The changes increase the overall premium level for the industrial and surface and underground coal mine classifications in the voluntary market. The changes go into effect on April 1 for new and renewal workers’ compensation policies. Click here to read more.

Washington

Elevator program: The Department of Labor and Industries adopted rules regarding the elevator program. The rules adopt the current national conveyance safety standards for elevators and escalators, platform lifts and chair lifts, belt man lifts, and personnel hoists. The rules contain exceptions to the national safety conveyance standards to ensure public, worker, and building safety. The rules include language to clarify statutory requirements for conveyance owners, mechanics, and contractors. The rules adopt proposals requested by stakeholders, such as requiring withdraw notices to be submitted to the department if a mechanic leaves to work in another state and plans to return to work in Washington state. The rules also provide clarification for existing conveyance safety standards. The rules provide clarification for existing conveyance safety standards. The rules went into effect on Jan. 1. Those with questions should email [email protected] Further information can be found here.

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]