Compliance Updates

Welcome to the refreshed Mitchell | Genex | Coventry legislative, compliance and regulatory email. Get access to an expanded suite of compliance insights, from key state updates to hot topics.

State & Federal Updates in This Email

The following states had key updates recently or in the past month. Detailed insight into each state regulatory or legislative change follows below.

• Federal Marijuana Legislation
• Florida PIP Updates ^Auto
• Michigan Updates ^Auto
• New York Updates ^WC/Auto
• Utah Opioid Legislation/eScripts Legislation ^WC

Hot Topics in This Email

The topics below have spurred legislation and regulation in multiple states.

• COVID-19 Updates
• Fee Schedule Updates ^WC/Auto
• Formulary Updates ^WC
• Networks ^WC
• Physician Dispensing ^WC

State & Federal Updates

Federal

HR 365 - "Marijuana 1-to-3 Act"

Proposes to reschedule marijuana from a schedule I controlled substance to a schedule III controlled substance under the Controlled Substances Act. Referred to Subcommittee on Crime, Terrorism, and Homeland Security on March 5, 2021. Learn more.

Florida

SB 54 ^Auto

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. Learn more.

New Jersey

SB 3375 ^WC

If adopted, this bill would increase transparency of any communications with the treating physician to the patient or their legal representative as soon as it is practicable. That no medical provider shall withhold any communication from an employer or its insurance carrier, or third-party administrator to a treating physician, from an injured worker or legal representative of an injured worker upon request, without documented therapeutic medical reason for withholding that record. The bill also mandates non-interference with medical treatment and amends existing law to provide compensation for expert witnesses in hearings and to allow the hearings to be heard via telephone or video conferencing. If passed this will take effect immediately. Learn more.

New York

Updated CMS-1500 Timeline ^WC

On March 10, 2021, the New York WC Board posted an updated timeline for payers regarding the CMS-1500 initiative. Payers must comply with the mandate to accept medical bills electronically from clearinghouses by October 1, 2021, extended from the original date of July 1, 2021. Electronic Explanation of Benefits and providers submission mandate of the CMS-1500 has moved to the first quarter of 2022. The state will be providing more information as it becomes available. Learn more.

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ASC Emergency Rule March 2021 ^WC

On March 15, 2021, the New York WC Board posted an emergency adoption of rule section 329-2.1 of the 12 NYCRR that increases ASC fees for certain procedures. The emergency rule and proposed permanent adoption will be published in the March 31, 2021 state register. Learn more.

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Emergency Rule 2021 ^Auto

Emergency adoption of ASC procedures, effective March 2021. Learn more.

Utah

Opioids: HB 15 ^WC

Removes the exception to the 7-day limit on prescriptions for certain controlled substances after surgery. This rule goes into effect May 5, 2021. Learn more.

COVID-19 Updates

Several states recently extended their emergency rulings related to COVID-19. Click on the links below to access each state's executive order.

• Indiana
• Louisiana
• Oklahoma
• Rhode Island
• Vermont

Fee Schedule Updates

Michigan

No-Fault Fee Schedule ^Auto

Regulatory Impact Statement was received by the Administrative Rules Division for the Department of Insurance and Financial Services - Insurance. A hearing was held on 3/26/2021; the Mitchell regulatory team submitted questions and attended the hearing. There will be a comment period following the hearing. Read more.

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Auto Fee Schedule CPI Adjustment Bulletin ^Auto

Supersedes Bulletin 2021-10-INS to clarify that CPI adjustments apply to all amounts payable under MCL 500.3157(7) and MCL 500.3157(8) that were in effect on January 1, 2019. Public Acts 21 and 22 of 2019 amended Section 3157 of the Insurance Code, MCL 500.3157, to add a medical provider fee schedule. The fee schedule requires the Director to adjust the amounts payable that are to be applied under MCL 500.3157(7) or MCL 500.3157(8) on an annual basis by the percentage change in the medical component of the Consumer Price Index for the year preceding the adjustment. See MCL 500.3157(9). This bulletin informs interested parties that any amount payable under MCL 500.3157(7) or MCL 500.3157(8), that was in effect on January 1, 2019, shall be increased by 4.11% for dates of service July 2, 2021 through July 1, 2022. Read more.

Mississippi ^WC

Re-adopted emergency amendments for workers' comp fee schedule and telemedicine. Allows for larger range of providers to offer services and receive reimbursement. Updates the definition of telemedicine to state that it is the "practice of medicine using electronic communication, information technology, or other means between a physician, physician assistant, nurse practitioner, physical therapist, occupational therapist, speech therapist, psychiatrist, clinical psychologist, or dietitian in one location and a patient in another location with or without intervening health care provider."

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Professionals may only practice telemedicine in Mississippi if they have a valid Mississippi license. Learn more.

New York ^WC

On March 3, 2021, the New York Register posted the adoption of Rule amendment 442.2 and the additions of sections 442.4 and 442.5 of the NYCRR which includes the new Durable Medical Equipment (DME) fee schedule. The effective date for the new rules is June 7, 2021. Learn more.

South Carolina ^WC

The Medical Services Provider Manual and proposed pharmacy-related changes to the fee schedule are scheduled to take effect April 1, 2021, and will be released by vendor FAIR Health. Learn more.

Utah ^WC

The Commission adopted amendments to rules related to workers' compensation and medical care. The amendments update R612-300-3, which is entitled "Required Reports." The amendments clarify that form 123 is the Physician's Initial Report of Work Injury or Occupational Disease, and update Forms 043 and 044. The amendments also remove reference to Form 110. Learn more.

Formulary Updates

Montana ^WC

Adopted amendments to the workers' comp drug formulary. For prescriptions written between 1/1/2020 through 12/31/2020, the October 2019 edition of the ODG Drug Formulary will be adopted. For prescriptions written on or after 1/1/2021, the October 2020 edition of the ODG Drug Formulary will be adopted. Learn more.

New York ^WC

The proposed changes include: New date for compliance on the refill and renewal rules and medical marijuana will need prior authorization. Extended the notification process for providers and injured workers from April 1 to May 1, 2021. Learn more.

Networks

California

AB 1465 (Introduced) - State-Run MPN ^WC

This bill would create a new statewide California Medical Provider Network (CAMPN), and would allow an injured worker to choose from either their employer’s MPN or the CAMPN. The bill would mandate that all physicians in the CAMPN be paid at the Official Medical Fee Schedule. The bill would also require that all currently-existing Employer MPN’s turn their provider lists over to the state to create the new CAMPN within 60 days of the effective date of the legislation. All CAMPN physicians would be subject to UR and the Medical Treatment Utilization Schedule (MTUS). If adopted, the bill would be effective January 1, 2022.  Learn more.

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SB 399 (Introduced) - MPN and IBR Changes ^WC

This bill would make a number of changes to MPNs in California by:

1. Prohibiting MPN contracts from paying less than the Official Medical Fee Schedule
2. Precluding an MPN from listing physicians as a group and instead mandates that names of providers be included
3. Requiring MPN providers to work at least 8 hours per week at a location in order for an MPN to include that location to meet access standards
4. Allowing a provider that has already been certified by the MPN at one location to practice at other locations
5. Creating a $50,000 penalty for failure by an MPN to meet access standards for a given specialty, if the MPN does not authorize treatment outside the MPN

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Additional provisions include providing for automatic authorization for prospective/concurrent treatment decisions that have not been properly communicated to the requesting physician within 5 days, creation of a “non-IBR dispute process” to resolve provider disputes that are not currently in the jurisdiction of IBR, imposition of a $1,000 penalty per month for IBR fees that are not paid within 30 days, and a requirement that providers be reimbursed using the same payment method used to pay for IBR fees in the event that the provider wins an IBR dispute. The bill would also require a payer to provide “documentation of original payment” when denying a bill as a duplicate. Learn more.

Texas

Informal Draft Proposed Regulations: TX, 28 TAC § 10.1 – 10.22, Workers’ Comp Health Care Networks (HCN) ^WC

This proposal would make a number of changes to the HCN operational framework, including:

1. Updated definitions
2. Updated network configuration and access standards, including new requirements that trigger a material modification filing and disclosure requirements in the event that an HCN cannot meet access standards in a specified area
3. New rules for identifying telehealth providers within an HCN provider listing and plan modifications addressing telehealth
4. Requirements to notify the state in the event of a change of ownership of the HCN
5. Requirement that a network may provide health care services to employees only through a written contract with an insurance carrier except for specified circumstances
6. New rules governing provider credentialing
7. New rules governing the provision of Utilization Review (UR)
8. Revamped rules for the list of criteria needed for an “appropriate independent review”
9. New rules governing disputes
10. An update to the official TDI address. Written comments are due to the state by 5:00pm CST on April 12, 2021

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Review the draft proposal.

Physician Dispensing

Montana

SB 374 ^WC/Auto

The bill proposes to revise laws to allow the dispensing of drugs by medical practitioners. Learn more.

Nevada

SB 214 ^WC/Auto

The bill proposes to eliminate certain requirements in existing law governing the prescription and dispensing of controlled substances for the treatment of pain. It also proposes to authorize and regulate practitioners who are authorized to prescribe controlled substances to also dispense for the treatment of pain. Learn more.

Additional Compliance Updates