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April Compliance Updates
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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.
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State Updates in This Email
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The following states had significant recent updates:
- California
- Florida
- Michigan
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More Insights in This Email
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- Additional Auto Updates
- Additional WC Updates
- Additional Pharmacy Updates
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New York
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Drug Formulary and OnBoard Portal WC
The New York State Workers' Compensation Board is moving forward with plans to fully implement the WC drug formulary for all prescriptions effective June 7, 2021. Notice of the change should be provided by May 1, 2021 to any NY claimants who are currently taking non-formulary medications. In conjunction with this change, the Board will also be launching its new OnBoard portal for prior authorizations and other communications. Learn More →
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State-Run MPN (AB1465) WC
UPDATED: This bill was completely amended on 4/26/21 to establish a funding mechanism for a comprehensive study of a state-run Medical Provider Network at the direction of CHSWC. The study will examine:
- Time to initial treatment for MPN vs. non-MPN bills
- Frequency/cause of any delays for MPN vs. non-MPN treatment
- Travel distance for injured workers for MPN vs. non-MPN providers
Creation of a state-run MPN will not be moving forward at this time.
Learn More →
MPN/UR/IBR Changes (AB399) WC
UPDATED: This comprehensive MPN/UR bill has been amended to a 2-year bill, and will not be moving forward in the legislative process in the current session, but may be picked up again next year. Key stakeholders agreed to discuss a potential regulatory fix with the DIR during the interim session. Learn More →
Med/Legal Adoption WC
On March 30, 2021, the California Office of Administrative Law (OAL) sent the final approved version of the Medical Legal Fee Schedule to the Secretary of State. The update includes: declaration of physician accounting for records review of evaluation procedure descriptions/definitions. All changes to this fee schedule are effective April 1, 2021. The state is aware of the fact that there may not be time to implement these changes to evaluations that are currently in process. Learn More →
California Court Interpreter Rates 2021 WC
Effective July 1, 2021, interpreter fees will increase for court proceedings in the state Superior Court system. Learn More →
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Health Care Provider Reimbursement Manual Hearing WC
FL has scheduled a hearing (5/6/21, 9:30 EST) to review the proposed revisions of the Health Care Reimbursement Manual Rules. Mitchell will be in attendance at the hearing. Read the proposal here →
Utilization & Reimbursement Dispute Rules WC
FL has postponed its hearing on proposed administrative rules related to Utilization & Reimbursement Disputes until September 2021. In the meantime, the Division is working with the litigants in the dispute resolution litigation to try and devise an amicable compromise ahead of the revised date. For details, see Case# 21-0714 →
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 main purpose of this bill is to repeal personal injury protection (PIP) coverage and replace it with mandatory BI coverage. As of 4/28/21, the Florida Senate is considering whether or not to adopt the amendments put forward by the House. There is a time limitation on the current session, which is coming to a close on 4/30/21. Learn More →
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Minnesota
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MinnesotaCare Provider Taxes Auto
Provider tax rate is now 2% of the gross revenues derived from patient services which include most services provided to patients, such as diagnostic and therapeutic services, bed, and board. This rate applies to health care providers (physicians, psychologists, physical therapists, chiropractors, ambulance services, wholesale drug distributors, etc). It does NOT apply to residential care facilities, home health agencies as well as exams for insurance, employment, litigation, and so forth. For more details, read the updates here. Learn More →
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Additional Workers' Comp Updates
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Georgia
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Fee Schedules WC
Effective April 1, 2021, Georgia has new medical and dental fee schedules (see FairHealth for purchase). Of note:
- CPT & CDT codes updates are in line with the AMA and ADA; HCPCS codes were updated to match CMS
- CPT and CDT maximum allowable reimbursements (MAR) have been recalculated
- Certain services can now be provided via telemedicine with the same MAR
- Pharmaceutical: Both brand name and generic drugs will be reimbursed at Medi-Span AWP rate with dispensing fees of $4.51/brand and $6.76/ generic
Learn More →
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Texas
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Proposed HCN Changes (Informal Admin. Rule Making)WC
On March 11, 2021, the Texas Department of Insurance posted an informal draft of proposed regulations to update rules related to Health Care Networks (HCN). The proposal would make a number of changes to the HCN operational framework, including:
- Updated definitions
- 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
- New rules for identifying telehealth providers within an HCN provider listing and plan modifications addressing telehealth
- Requirements to notify the state in the event of a change of ownership fo the HCN
- A requirement that a network may provider health care services to employees only through a written contract with an insurance carrier except for specified circumstances
- New rules governing provider credentialing
- New rules governing the provision of Utilization Review (UR)
- Revamped rules for the list of criteria needed for an "appropriate independent review"
- New rules governing disputes
- An update to the official TDI address
Written comments were due to the state by 5:00pm CST on April 12, 2021. Learn more →
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Additional Pharmacy Updates
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Montana
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Physician Dispensing (SB 374) WC
The Montana legislature is considering a bill to allow physicians to dispense medications, but was amended to prohibit physicians from dispensing medications to injured workers. Learn more →
Formulary Update Goes Live WC
The Montana Department of Labor and Industry announced that the COVID-19 temporary suspension of implementation of the drug formulary for legacy claims has been lifted. The drug formulary will now apply to all medications effective April 14, 2021. Learn More →
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North Dakota
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Opioid Legislation (HB 1139) WC
Limits opioid reimbursement to a maximum of 90 MME per day or a 7-day supply during the initial 30 days of opioid use. Benzodiazepine reimbursement is limited to a cumulative duration of 4 weeks, unless approved for anxiety. Reimbursement is prohibited for concurrent prescriptions of opioids and benzodiazepines. Effective date is July 1, 2022. Learn more →
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Additional Compliance Updates
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Getting OnBoard With NY's Regulatory Changes
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Over the last few years, New York has implemented new reforms to increase the speed and efficiency of its claims process. Dr. Lisa O'Connor tells us about one of them, OnBoard, New York’s new online web portal for processing claims.
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Watch Now →
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