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May Compliance Updates
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May was a busy month across the country, as several states made fee schedule updates or pushed forward with marijuana legalization. Below are a few key insights you need to know.
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Updates in This Email
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The following states and hot topics are highlighted in this email:
- New York
- Michigan
- Fee Schedules
- Marijuana Reform
- Additional Workers' Comp Updates
- Additional Auto Updates
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Administrative Rules for the No-Fault Fee Schedule Auto
Current Status: Administrative rules are still in draft form with no planned date of finalization.
Designated Freestanding Rehabilitation Facilities Auto
This bulletin notifies interested parties of the Director of the Department of Insurance and Financial Services’ (DIFS) designation of two freestanding rehabilitation facilities pursuant to Section 3157(4)(b) of the Insurance Code of 1956 (Code), MCL 500.3157(4)(b). Learn more →
Michigan Clarifies Requirement for Limit on PIP Benefits Under No-Fault Law Auto
The bulletin clarifies requirements for an insured person to limit personal injury protection (PIP) benefits under the no-fault auto insurance law. The no-fault auto insurance law requires insurers to issue a policy with unlimited PIP benefits unless an applicant or named insured completes, signs, and returns to an insurer or agent a PIP Medical Coverage Selection Form, a procedure referred to as “effective selection”. The applicant or named insured must provide adequate proof of Qualified Health Coverage (QHC) in order to limit the policy’s PIP coverage. If an applicant or named insured has made an effective selection, but seeks an exclusion for any or all eligible household members and then fails to provide the requisite proof of QHC for any or all household members to qualify for the exclusion, the insurer must issue a policy with $250,000 in PIP medical benefits for any or all household members that fail to provide the requisite proof of QHC, and must provide the exclusion to any or all household members that provide proof of QHC. Learn more →
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California WC
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On April 28, 2021, the California Division of Workers' Compensation posted the recordings of the question and answer sessions regarding the Medical Legal Fee Schedule that took place on April 13 and April 20, 2021. These recordings contain questions and answers about the implementation of the new fee schedule that went into effect on April 1, 2021. The recording can be found here →
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Virginia WC
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On May 19, 2021, the Virginia Workers' Compensation Commission posted a notice regarding the comment period for the proposed 2022 Medical Fee Schedule. The proposed changes include:
- An increase for the maximum fees by 5.7%
- Update to CPT/HCPCS codes
- Increase for hospital services
- Updated DRG Version to 38
The state will take public comments on the proposed changes through June 21, 2021. The effective date for adopted changes will be January 1, 2022. Learn more →
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Alabama WC
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Alabama became the 36th state to legalize marijuana for medical use. Under the provisions in SB 46, insurers are not required to reimburse or provide coverage for costs associated with the use of medical marijuana. Learn more →
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Mississippi WC
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In November 2020, Mississippi voters approved a ballot initiative to establish a state medical marijuana program. On May 14, 2021, the Mississippi Supreme Court struck down the initiative. Learn more →
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Additional State Updates WC
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So far in 2021, legislatures in New Mexico, New York and Virginia passed bills to legalize the use of recreational marijuana for adults. Additionally, following voter-approved ballot initiatives in Arizona, Montana, New Jersey and South Dakota, regulators are working to implement various levels of marijuana reform in their states.
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Additional Workers' Comp Updates
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Arizona
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HB 2454 - Telehealth WC
Detailed telehealth bill, including providing for insurance coverage, establishing provider requirements, allowing for interstate practice, and creating the Telehealth Advisory Committee.
Current Status: Passed May 5, 2021; Effective upon passage. Learn more →
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Colorado
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SB 197 - Employee Choice of Physician WC
This bill would reverse employer-led direction-of-care in Colorado, and would:
- Allow an injured worker to choose from any Level 1 or 2 accredited physician from the state’s list
- Require the employer to notify an injured worker of their right to choose a physician, and provide a form for designation
- Provide a mechanism for a one-time change of physician, and require employers to keep track of change-of-physician requests
- Allow the employer to designate a Level 1 or 2 physician if the injured worker fails to designate within 7 business daysCurrent
Status: Passed Senate. Set for hearing in House Business Affairs & Labor Committee May 27, 2021. Learn more →
Level 1/2 Physician List can be found here →
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Kentucky
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Administrative Rule-Making Proposal/Hearing on Utilization Review WC
KY has proposed substantial changes to its UR rules for all reviews starting January 1, 2022, and minor changes to existing rules for reviews prior to January 1, 2022. These proposed changes include:
- Creates a new position of Medical Director in the state
- Creates a new UR/Medical Bill Audit Program for reviews as of January 1, 2022 that requires:
- UR on all claims with cumulative medical costs over $1,000 or lost work days over 15 days, or payor to waive right to UR
- Payor to send electronic copies of denials to the Medical Director
- Payor UR internal appeals eliminated; UR appeals to be submitted to the Medical Director within 30 days, who then rules on the appeal within 14 days
- Payors to pay a $400 UR Appeals fee, regardless of the eventual outcome of the appeal
- Retains payor reconsideration process for medical bills, but appeals would go then through the same process as UR appeals, with the mandatory $400 fee
Hearing was held on May 27, 2021, at 10:00am ET and public comment will be accepted through May 31, 2021. Learn more →
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Minnesota
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HB 2253 WC
On April 26, 2021, HB 2253 was signed into law. This bill revises the process for Inpatient Hospital and ASCs, as well as extends a presumption that COVID-19 is compensable for frontline workers until December 31, 2021. Learn more →
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Montana
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Medical Treatment Guidelines & Drug Formulary WC
On May 7, 2021, the Montana Department of Labor and Industry posted notification of a public hearing for the proposed rules for the medical utilization and treatment guidelines for workers' compensation. A public hearing via zoom will be held on the proposal on June 11, 2021, at 10:00 a.m. Written comments are being accepted until June 11, 2021, at 5:00 p.m.
A few of the proposed changes include:
- Utilization and Treatment Guidelines effective dates changed to July 1, 2021
- Medical services provided on or after July 1, 2021: Montana Utilization and Treatment Guidelines, 7th edition, 2021
- Prescriptions written on or after July 1, 2021 use the April 2021 edition of the ODG Drug Formulary
Learn more →
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New Jersey
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Workers' Comp Medical Data Reporting WC
On May 25, 2021, Circular Letter #2009 was posted regarding New Jersey Workers' Compensation Medical Data Call moving from NCCI to the Compensation Rating and Inspection Bureau (CRIB). In July 2021 the NJCRIB will be sending e-mails to member carriers with information on how to determine eligibility. The response will be due back to the CRIB by the end of July.
It is expected that all carriers will complete the testing by July 1, 2022 in the Compensation Data Exchange (CDX) and will submit second quarter data to the CRIB by the third quarter 2022, but that carriers will also continue to report medical data to NCCI until the end of the fourth quarter 2022 for third quarter 2022 data. Learn more →
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Texas
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Ambulance Fees WC
On April 26, 2021, the United States Supreme Court denied the petition to hear the case regarding air ambulance fees. This petition was to specifically address if the Federal Airline Deregulation Act (ADA) preempts the Texas workers' compensation fee schedule that indicates fees need to be fair and reasonable. At this juncture, the Texas Supreme Court ruling that the ADA rules do not preempt the state's workers' compensation right to set rates for air ambulance services will continue to stand. Learn more →
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Florida
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Motor Vehicle No-Fault Law (SB54) Auto
The Florida state legislature has made numerous changes to SB54. Mitchell is closely following this bill as it goes through these changes.
Florida is currently one of two states that do not require mandatory Bodily Injury (BI) coverage. The bill eliminates PIP coverage in favor of bodily injury liability coverage; $25,000 for crash related injury or death or up to $50,000 for injury or death in a crash involving two or more people. Effective January 1, 2022. The bill has passed the House and Senate; awaiting Governor's signature. Learn more →
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Oregon
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Auto PIP Hospital Bulletin Auto/WC
On April 19, 2021, the Oregon Workers' Compensation Division published the Hospital Fee Schedule Bulletin 290. The bulletin contains the adjusted Cost to Charge ratios for Oregon and out of state hospitals effective May 1, 2021. This is applicable to auto and workers' compensation. Learn more →
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Additional Compliance Updates
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