The State of the States

Regulatory Review

Significant workers' comp regulatory developments from around the nation.
By: | March 14, 2014


Filing requirement: The Board of Workers’ Compensation amended a rule regarding changes in the filing requirement for the form that provides notice to a worker of a medical release to return to work with restrictions or limitations. The rule provides that the form must be filed with the board at the same time it is serves on the worker and worker’s attorney. The form must be filed within 60 days of the authorized treating physician’s release of the worker to return to work with restrictions. Form WC-104 can be found here.


Take-out credit program: The Compensation Rating Bureau issued a circular regarding the take-out credit program for the 2013 calendar year.

To receive credits, carriers must have enrolled with the National Council on Compensation Insurance by Feb. 21. Carriers already enrolled in the NCCI system or that received a take-out credit for the 2012 calendar year are not required to enroll in the 2013 take-out credit program. During the week of March 24, NCCI will send an email announcing the availability of the take-out credit report. Carriers in agreement with the report must indicate acceptance of credits by April 11. More information can be found here.


Medical fee schedule: The Department of Workers’ Claims proposed amendments to the medical fee schedule for physicians. The current procedural terminology codes were updated to 2013 standards. New relative values were created for codes added to the schedule using Fair Health, Inc. benchmark values. Dental procedure codes were added to the fee schedule. Conversion factors increased to $60.88 for evaluation and management, surgery, radiology, pathology/lab, general medicine, and physical medicine. The conversion factor for anesthesia changed to $77 and health care common procedure coding system changed to $64.22. There is an addition of 38 temporary codes in the surgery section and descriptions include treatment for disc arthroplasty, injections, and implants. Clarification was included to address repackaging of medications and drug screening in a physician’s office. The fee schedule also provides values appropriate for new, used, and rented durable medical equipment. The department scheduled a public hearing on Feb. 25 at 10:30 a.m. in Frankfort. Written comments will be accepted until Feb. 28. More information is available here.


Hospital outpatient services: The Bureau of Workers’ Compensation proposed amendments to rules regarding payment of hospital outpatient services and ambulatory surgical center services. The rules adopt the Medicare ambulatory surgical center rates. The rules maintain a 110 percent payment adjustment factor for designated pain management procedures, a 104 percent adjustment factor for designated orthopedic procedures, and a 100 percent adjustment factor for all other procedures. The rules also increase coverage to include lumbar microdiscectomies and laminectomies in the ambulatory surgical center setting when the treating physician has admitting privileges as a hospital within 30 miles of the ambulatory surgical center or otherwise closest hospital. For more information, visit the bureau’s website.


Procedural rules: The Workers’ Compensation Division proposed changes to rules regarding procedural rules, rulemaking, hearings, and attorney’s fees. The rules clarify the authority and limitations applicable to agency representatives at certain types of hearings. The administrative law judge must not allow an agency representative to present legal argument. “Legal argument” is defined to include arguments on the jurisdiction of the agency to hear the contested case, the constitutionality of a statute or rule, and the application of court precedent to the facts of a particular contested case proceeding.

Legal argument does not include presentation of motions, evidence, examination of witnesses, or presentation of arguments on the application of statutes or rules to the facts in the contested case, comparison of prior actions of the agency in handling similar situations, the literal meaning of statutes or rules, the admissibility of evidence, or the correctness of procedures being followed. The division scheduled a public hearing on Feb. 24. Comments will be accepted at [email protected] until Feb. 27. For more information, check the division’s website.

Medical fee and payment: The Workers’ Compensation Division proposed changes to rules regarding medical fee and payment and medical services. The rules adopt updated fee schedules and resources for the payment of health care providers. The rules also adopt the National Council for Prescription Drug Programs universal claim form for workers’ compensation and the implementation guide. The rules provide consistent requirements for payment of “no-show” appointments. The rules describe how a worker can request advance payment for transportation and lodging necessary to attend a medical appointment. The rules also establish a process for a health care provider to request an insurer’s preauthorization for diagnosis studies, as well as a time frame for the insurer to respond. The division scheduled a public hearing on Feb. 24. Comments will be accepted at [email protected] until Feb. 27. More information can be found here.


Utilization review: The Division of Workers’ Compensation amended rules regarding utilization review, case management, medical cost containment, and the fee schedule. Upon receipt of an appeal request by a worker or authorized treating physician, the division or its contractor must conduct the utilization review appeal. Unresolved disputed between a carrier and provider concerning bills due to conflicting interpretation of the rules can be resented to the medical payment committee on or after July 1. A request for committee review can be submitted within one year of the date of service. The rules also create a procedure for committee review of fee schedule disputes. The rules go into effect on March 26. More information 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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