VolumeEighteenNumberTwo February2017

Volume Eighteen Number TwoFebruary 2017Published by Mitchell International, Inc.

FEATURED IN THIS ISSUE:

Illinois Proposes Workers’ CompensationReformOn January 11, 2017, Senate Bill (SB) 12 was introduced into the Illinois 100th General Assembly. This bill containsseveral proposed changes for various sections of Title 50.

continued on page 3

Fee Schedule &Legislative News

a newsletter byMitchell Compliance Solutions

Mitchell International, Inc., founded in 1946 and headquartered in San Diego, California, is a leadingprovider of information and workflow solutions to the Property&CasualtyClaimsand Automotive Col-lision Repair industries. The company’s comprehensive solution portfolio streamlines the entire auto phys-ical damage, bodily injury and workers’ compensation claimsprocesses. Mitchell enablesmillionsofelectronic transactionsbetweenmore than 30,000 businesspartners eachmonth to enhance partnerproductivity, profitability, and customer satisfaction. For more information onMitchell International,please visit our website atwww.mitchell.com.

Fee Schedule &Legislative NewsTable of Contents

Volume Eighteen Number TwoFebruary 2017Published by Mitchell International, Inc.

a newsletter byMitchell Compliance Solutions

Illinois Proposes Workers’ CompensationReform (cont.) 3eBilling, EDI, and Reporting News 3MCO and UR News 4Other Industry News 5CMS, FR, and OIG Announcements 7Calendar of Events 8State Legislative Changes 10Fee Schedule Updates 18Acronym Glossary 51

The Fee Schedule & Legislative News is published by Mitchell

International, Inc. It is collaboratively produced by Mitchell’s Workers’

Compensation Solutions (WCS) and Auto Casualty Solutions (ACS)

divisions.

Questions or comments about the Fee Schedule & Legislative

News (including distribution and circulation questions or

requests for back issues) may be directed to

[email protected].

The information contained in this newsletter was obtained

from sources deemed reliable; however, Mitchell

International, Inc. cannot guarantee the accuracy or

completeness of the information provided. ©2015 Mitchell

International, Inc. All rights reserved. All referenced Internet

links, which are provided as a courtesy to our readers, are

not under the control of Mitchell International Inc. and thus

Mitchell is not responsible for the contents of any linked site,

any subsequent link contained in a linked site, or any

changes or updates made to such sites. Editor’s note:

Throughout this newsletter, quoted text (italicized) is

presented verbatim according to the original publication.

However, due to the size and layout limitations of this

newsletter, formatting liberties have been taken to improve

readability.

Fee Schedule & Legislative News 2

mailto:[email protected]

Acronyms in the Fee Schedule & Legislative News

Acronyms are frequently used throughout the Fee Schedule & Legislative News. For your convenience, full definitions of theseacronyms are provided in ourAcronym Glossary at the end of the newsletter.

Illinois Proposes Workers’ CompensationReform (cont.)Some of the changes proposed in the bill are, but not limited to, the following:

n Adopt rules for electronic billing by March 1, 2017 and require employers and insurers to accept electronic claims on orbefore September 1, 2017.

n On or after June 1, 2017, change the maximum allowable payment for ASTC, ASTF, Outpatient Radiology, OutpatientPathology and Laboratory, and Professional Services Radiology to 85% of the fee schedule amount.

n On or after June 1, 2017, change the maximum allowable payment for Hospital Outpatient Surgical Facility andProfessional Services Surgery to 90% of the fee schedule amount.

n Under utilization review, limit the number of visits to 24 per claim for chiropractic, occupational therapy, and physicaltherapy, beginning January 1, 2018. However, on January 25, 2017, the bill was amended and the 24 visit cap provisionwas removed from the proposed bill.

To view the bill in its entirety, use the link provided.

http://ilga.gov/legislation/100/SB/10000SB0012.htm

http://ilga.gov/legislation/BillStatus.asp?DocNum=12&GAID=14&DocTypeID=SB&LegId=98855&SessionID=91&GA=100

Since the bill's introduction, it has had two amendments and is currently with the Assignments committee. The MitchellRegulatory Affairs team will continue to monitor this bill for movement and adoption and provide updates in futurecommunications.

Note Statements and opinions expressed in this article are solely those of the author and should not be taken as legal adviceand/or legal opinion.

eBilling, EDI, and Reporting NewsThis section provides information from state and national entities regarding their eBilling, EDI, and reporting initiatives.

eBillingIllinois

On January 11, 2017, the state introduced SB 12, this bill contains provisions for electronic billing. If adopted, rules for electronicbilling will be adopted on or before March 1, 2017 and shall require that all employers and insurers accept electronic claims onor before September 1, 2017.






Claim ReportingIdaho

On January 25, 2017, the state announced that the new EDI website is now available, as well as all the documentation andrequirements for the EDI Claims Release 3.0. The links to the states website and announcement are provided below.

https://iic.idaho.gov/EDI/edi.html

https://iic.idaho.gov/EDI/ISO_website_announcement_012517.pdf

Oklahoma

On December 29, 2016, the Oklahoma Workers' Compensation Commission announced that beginning January 1, 2018,electronic filing of First Report of Injury (FROI) and Subsequent Report of Injury (SROI) will become mandatory. Electronicreporting will be through an EDI transmission using the Claims 3.0 reporting standards adopted by the InternationalAssociation of Industrial Accident Boards and Commissions (IAIABC). For additional information, the link is provided below.

https://okwccedi.info/documents/OK%20WCC%20EDI%20Implementation%20Announcement%20(12.29.2016).pdf

Medical ReportingNevada

On January 11, 2017, the state posted the notification and instructions for the FY 2016 Annual Claims Activity reporting. Thereport is due to the state by February 28, 2017. All the information regarding the requirements can be accessed on the state’swebpage.

http://dir.nv.gov/WCS/Insurer-TPA_Reporting/

National EDIs/ReportingFederal Reporting

On January 4, 2017, the Centers for Medicare andMedicaid Services (CMS) posted an update to the Section of the Medicare,Medicaid and SCHIP Extension Act of 2007 (MMSEA) of the No-Fault Insurance andWorkers’ Compensation User Guide(NGHP User Guide). This update can be found on the NGHP User Guide section of the CMS website.

https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/NGHP-User-Guide/NGHP-User-Guide.html

MCO and UR NewsThis section provides information about events, legislation, and other issues that affect MCOs and UR.

Florida Workers' CompensationOn January 11, 2017, the state sent out a communication regarding a public hearing that will take place on February 7, 2017for the proposed changes to Rule 69L-30. The notification and proposed rule changes are published in the FloridaAdministrative Weekly.

https://www.flrules.org/gateway/ruleNo.asp?id=69L-30.002

IllinoisOn January 11, 2017, SB 12 was introduced into the Illinois 100th General Assembly. This bill contains provisions for utilizationreview beginning January 1, 2018.



https://iic.idaho.gov/EDI/edi.html

https://iic.idaho.gov/EDI/ISO_website_announcement_012517.pdf

https://okwccedi.info/documents/OK WCC EDI Implementation Announcement (12.29.2016).pdf

http://dir.nv.gov/WCS/Insurer-TPA_Reporting/



https://www.flrules.org/gateway/ruleNo.asp?id=69L-30.002


TennesseeOn December 30, 2016, the state amended Chapter 0800-02-06 General Rules of the Utilization Review Program. Theamended rules will take effect on January 29, 2017. For additional information, the link is provided below.

http://share.tn.gov/sos/rules_filings/10-25-16.pdf

Utah Workers' CompensationOn December 22, 2016, the state added section R612-300-14, Advance Practice Register Nurse, to the Administrative Code.The new section is as follows:

(Excerpt from the Administrative Code Rule R612-300-14)

R612-300-14. Advance Practice Registered Nurse.

A. Authority. This rule is enacted under the authority of 34A-1-104 and 58-31b-803.

B. Requirement. An advanced practice registered nurse who treats an injured worker and prescribes Schedule II

controlled substances for chronic pain is subject to the provisions of the "Model Policy on the Use of Opioid Analgesics

in the Treatment of Chronic Pain," July 2013, adopted by the Federation of State Medical Boards, which is incorporated

by reference.

The entire Administrative Code can be accessed from the link below.

http://www.rules.utah.gov/publicat/code/r612/r612-300.htm#T14

WashingtonOn January 4, 2017, the state adopted rule WAC 296-23-245 that allows the elimination of the existing differential paymentfor Advanced Registered Nurse Practitioners (ARNPs), effective November 15, 2016. Services performed by an ARNP must bebilled using the appropriate procedure code listed in the fee schedules, preceded by a Type of Service Code "N." For additionalinformation, the link is provided below.

http://apps.leg.wa.gov/wac/default.aspx?cite=296-23-245

Other Industry NewsThis section contains additional information related to the workers’ compensation industry.

New YorkOn January 23, 2017, the state posted the temporary suspension notice for Dr. Robert Karpman with regards to himperforming IMEs, effective January 20, 2017.

http://www.wcb.ny.gov/content/main/SubjectNos/sn046_917.jsp

On January 19, 2017, the state posted the following subject numbers regarding health care providers who are authorized ornot authorized to treat workers under the New YorkWorkers’ Compensation system:

n Changes to the List of Health Care Providers Authorized


n Newly Authorized Health Care Providers Approved List


n Temporary Suspension of Dr. Thomas Vincent Savino




http://www.rules.utah.gov/publicat/code/r612/r612-300.htm#T14






n Voluntary Resignation of Dr. Ahmed Adel Elsoury


On January 13, 2017, the state posted Subject Number 046-0912, regarding the voluntary resignation of Dr. Glenn JorstadJakobsen.


On January 6, 2017, the state posted Subject No. 046-911, regarding the temporary suspension of Dr. Sheikh Qadeer to treatinjured workers, effective January 6, 2017.


On January 4, 2017, the state posted Subject No. 046-909, regarding the submission of forms to the WCB.


On January 3, 2017, the state posted Subject No.046-910, regarding the voluntary resignation of Dr. Emmanuel Lambrakisfrom treating injured workers, effective December 22, 2016. The notice can be viewed from the link provided below.


On December 22, 2016, the state posted Subject No. 046-908, regarding the temporary suspension of Dr.Leeland Jones totreat injured workers, effective December 19, 2016. The notice can be accessed from the link provided below.


OklahomaOn January 18th, 2017, the state posted proposed rule amendments to Chapter 15 Title 810 to modify procedures andstandards for IndependentMedical Examiners and Advanced Practice Registered Nurses. For additional information, use thelink provided below.

https://www.ok.gov/wcc/documents/85A%20Ch.%2015%20Proposed%20Permanent%20Rules%20submitted%2012.22.16.pdf

OregonOn January 4, 2017, the state posted the food, lodging, and mileage updates for 2017. These rates can be accessed from thelink provided below.

http://wcd.oregon.gov/Bulletins/bul_112.pdf

WashingtonThe Department of Labor and Industries adopted rule WSR 16-22-065. This adoption repeals all the Lumbar Fusion - StructuredIntensive Multidisciplinary Program (SIMP) rules for Chronic Noncancer Pain. The procedure is no longer covered. For additionalinformation, use the link provided below.

http://www.lni.wa.gov/rules/AO16/15/1615CR103.pdf








https://www.ok.gov/wcc/documents/85A Ch. 15 Proposed Permanent Rules submitted 12.22.16.pdf

https://www.ok.gov/wcc/documents/85A Ch. 15 Proposed Permanent Rules submitted 12.22.16.pdf


http://www.lni.wa.gov/rules/AO16/15/1615CR103.pdf

CMS, FR, and OIG AnnouncementsThis section highlights some of the publications posted by the Centers for Medicare andMedicaid Services (CMS), the FederalRegister (FR), and the Office of the Inspector General (OIG) throughout the month. Since these entities publish continually, notall documents are included here.

Centers for Medicare and Medicaid ServicesJanuary 13, 2017

n Medicare andMedicaid Program: Conditions of Participation for Home Health Agencies, effective July 13, 2017.

https://www.federalregister.gov/documents/2017/01/13/2017-00283/medicare-and-medicaid-program-conditions-of-participation-for-home-health-agencies

January 5, 2017

n 2017 Durable Medical Equipment Prosthetics, Orthotics, and Supplies Healthcare Common Procedure Coding System(HCPCS) code jurisdictional list, effective January 1, 2017.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9903.pdf

December 29, 2016

n FY 2017 Annual Update for the Clinical laboratory Fee Schedule and Laboratory Services subject to reasonable chargepayment, effective January 1, 2017.


December 22, 2016

n January 2017 Update of the Ambulatory Surgical Center (ASC) Payment System, effective January 1, 2017.


n January 2017 Update of the Hospital Outpatient Prospective Payment System (OPPS), effective January 1, 2017.


Federal RegisterJanuary 3, 2017

n Rule Update

Medicare Program:

Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality ReportingPrograms.

https://www.gpo.gov/fdsys/pkg/FR-2017-01-03/pdf/2016-31774.pdf

December 29, 2016

n Rule Update

Medicare Program:

Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2017.















Calendar of EventsThis section provides dates, times, and locations of upcoming events, meetings, or training sessions that may be of interest.The events within this section have been arranged chronologically. For this reason, recurring events are relisted for each dateof occurrence.

Mitchell's Upcoming Training Courses: Capstone Intermediate andAdvancedn Dates: 02/07/2017 - 09/15/2017

Course Description: Geared toward experienced Capstone users looking to increase bill processing automation anddecrease processing time. In addition, learn how other SmartAdvisor users are taking advantage of Capstone and whatissues they are encountering. These are hands-on courses containing real-world scenarios. Participants are welcome tobring their laptops, or they can use the Mitchell Training Room workstations.

Location: Irvine, CA or Coppell, TX, depending on the course and date (see details below).

Instructor: Scott R. Smith

Materials provided: Training guides.

Lunch: Provided daily.

Sign-up: Contact your account manager for pricing.

Intermediate Training Capstone Training (2 days)

n Course Objectives:

- Understanding and using Capstone best practices which reduces users wait time for bills

- Creating Functional and Query calculations allowing for easier testing and problem solving

- Rule precedence and workflow discussion focused on eliminating rule conflicts

- Using UDFs and Lookup Tables to reduce rule complexity and enable end user configuration of rules

n Location:

- Irvine, CA (02/07/2017 - 02/09/2017 and 09/12/2017 - 09/13/2017)

- Coppell, TX (05/11/2017 - 05/12/2017)

Advanced Training Capstone Training (2 days)

n Course Objectives:

- Parameter calculations to enable creation of template calculations

- Implementing Action Options to reduce user processing time

n Location:

- Irvine, CA (02/09/2017 - 02/10/2017 and 09/14/2017- 09/15/2017)

- Coppell, TX (0 9/14/2017- 09/15/2017)

February 2017 and Beyondn February 2 – 3, 2017

7th Annual Louisiana Workers’ Compensation Educational Conference

Renaissance Baton Rouge Hotel


Baton Rouge, Louisiana

http://www.iwcf.us/images/Brochure_LA17FF.pdf

n February 12 – 15, 2017

43rd Annual Risk Management Conference PARMA – Public Agency Risk Management Association

Disneyland Hotel

Anaheim, California

http://parma.com/2017-annual-conference

n February 23 – 24, 2017

24th Annual DWC Educational Conference

LAX Marriott

Los Angeles, California

http://www.dir.ca.gov/DWC/educonf24/DWC_EducationalConference.html


http://www.iwcf.us/images/Brochure_LA17FF.pdf

http://parma.com/2017-annual-conference

http://www.dir.ca.gov/DWC/educonf24/DWC_EducationalConference.html

State Legislative ChangesThis section provides information about changes being made to states’ legislation. The table contains the jurisdiction, bill/rulenumber, status of the bill/rule (see Bill/Rule Status Abbreviation Legend for status codes and descriptions), and a briefsummary of the bill/rule. Please provide comments on this format by sending an email to [email protected].

Jurisdiction Bill/Rule

Status Summary/Impact

Arizonaspacerspacerspacerspacerspacer

HB2334spacerspace

ICSpacerspacerspa

This bill was filed with the legislature and currently is being held in the InsuranceCommittee for review. If this bill is passed, it will set workers' compensationpenalty provisions for bad faith indemnity and medical claims. The bill can beviewed on the state's legislative website.http://www.azleg.gov/DocumentsForBill.asp?Bill_Number=HB2334&Session_ID=114

California AB 44 I The bill would remove the requirement for utilization review and the medicalreview process for incidents of a terrorist act or workplace violence. Additionally,this bill would add physical or psychological injury from a terrorist attack orworkplace violence to the list of injuries for aggregate disability payments.http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB44

AB1124

A On or before July 1, 2017, the medical treatment utilization schedule adopted bythe administrative director shall include a drug formulary using evidence-basedmedicine. The drug formulary shall include a phased implementation for workersinjured prior to July 1, 2017 to ensure injured workers safely transition tomedications pursuant to the formulary. Once established, no less than quarterlyupdates will be made to the drug formulary to allow for the provision of allappropriate medications, including those new to the market. The drug formularyshall not apply to care provided in an emergency department or inpatient setting.http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB1124

SB1160

A On September 30, 2016, this bill was signed and approved by the Governor. Thebill can be accessed from the link provided below.https://leginfo.legislature.ca.gov/faces/billCompareClient.xhtml?bill_id=201520160SB1160



http://www.azleg.gov/DocumentsForBill.asp?Bill_Number=HB2334&Session_ID=114

http://www.azleg.gov/DocumentsForBill.asp?Bill_Number=HB2334&Session_ID=114

http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB44




https://leginfo.legislature.ca.gov/faces/billCompareClient.xhtml?bill_id=201520160SB1160

https://leginfo.legislature.ca.gov/faces/billCompareClient.xhtml?bill_id=201520160SB1160



AB1244

A This bill requires the administrative director to promptly suspend any physicianpractitioner or provider from participating in the workers’ compensation system ifas a physician, practitioner, or provider the individual or entity meets specifiedcriteria, including if that individual has been convicted of any felony ormisdemeanor involving fraud or abuse of the Medi-Cal program, Medicareprogram, or workers’ compensation system, if that individual’s license, certificate,or approval to provide health care has been surrendered or revoked, or if thatindividual or entity has been suspended, due to fraud or abuse, from participationin the Medicare or Medicaid programs.The bill enacts special lien proceedings for the adjudication of any liens of aphysician, practitioner, or provider who has been suspended pursuant to theseprovisions because he or she has been convicted of a felony or misdemeanor thatmeets specified criteria. The bill was signed and approved by the Governor onSeptember 30, 2016.This bill can be viewed in its entirety from the link below.http://www.leginfo.ca.gov/cgi-bin/postquery?bill_number=ab_1244&sess=CUR&house=B&author=gray_<gray>

SB1175

A “This bill would require, effective for services on or after January 1, 2017, thatrequests for payment with an itemization of services provided and the charge foreach service be submitted to the employer within 12 months of the date of serviceor within 12 months of the date of discharge for inpatient facility services. The billwould also require, effective for services provided on or after January 1, 2017, thatall bills for medical-legal evaluation or medical-legal expense be submitted to theemployer within 12 months of the date of service in the manner prescribed by theadministrative director. The bill would provide that requests for payment and billsfor medical-legal charges are barred unless timely submitted. The bill would requirethe administrative director to adopt rules to implement the 12-month limitationperiod, as specified.”http://www.leginfo.ca.gov/pub/15-16/bill/sen/sb_1151-1200/sb_1175_bill_20160826_chaptered.pdf

Connecticut SB 27 I This bill would add job-related mental or emotional impairments from witnessingdeath or aftermath of death in the workplace caused by another person under thepersonal injury definition in order to collect workers’ compensation benefits.https://www.cga.ct.gov/asp/CGABillStatus/CGAbillstatus.asp?which_year=2017&selBillType=Bill&bill_num=SB27

Florida Auto SB 156 I This bill would makes several changes to the Personal Injury Protection (PIP) rulesthat include revising the term clinic, deleting a provision for reporting, and deletinga provision for no-fault regarding clinic reimbursement. If adopted, this bill wouldbe effective January 1, 2020.http://www.flsenate.gov/Session/Bill/2017/0156/BillText/Filed/PDF


http://www.leginfo.ca.gov/cgi-bin/postquery?bill_number=ab_1244&sess=CUR&house=B&author=gray_<gray>

http://www.leginfo.ca.gov/cgi-bin/postquery?bill_number=ab_1244&sess=CUR&house=B&author=gray_<gray>

http://www.leginfo.ca.gov/pub/15-16/bill/sen/sb_1151-1200/sb_1175_bill_20160826_chaptered.pdf

http://www.leginfo.ca.gov/pub/15-16/bill/sen/sb_1151-1200/sb_1175_bill_20160826_chaptered.pdf

https://www.cga.ct.gov/asp/CGABillStatus/CGAbillstatus.asp?which_year=2017&selBillType=Bill&bill_num=SB27

https://www.cga.ct.gov/asp/CGABillStatus/CGAbillstatus.asp?which_year=2017&selBillType=Bill&bill_num=SB27

http://www.flsenate.gov/Session/Bill/2017/0156/BillText/Filed/PDF



Hawaii HB2715

A Originally this bill would have made the state a monopolistic, requiring employersto obtain workers' compensation coverage from the state or be self-insured. Thefinal bill, adopted and signed by the governor, requires a study to be done by anactuarial firm regarding closed claims. This shall be completed by November 2017.The bill can be viewed on the state's legislative website at the following link.http://www.capitol.hawaii.gov/measure_indiv.aspx?billtype=HB&billnumber=2715&year=2016

SB1178

R If adopted, this bill would amend the PIP statutes to remove the $75 cap onacupuncture.

http://www.capitol.hawaii.gov/session2016/bills/sb1178_.htm

SB2376

R If adopted, this bill would add provisions for “retail community pharmacies; outsideof retail network; geographic exemption.” Further, “if a beneficiary utilizes a non-network retail community pharmacy pursuant to subsection (a), the non-networkretail community pharmacy shall be reimbursed a $12.50 dispensing fee plus theproduct cost at the higher rate of reimbursement.” The bill can be accessed fromthe link provided below.http://www.capitol.hawaii.gov/session2016/bills/sb2376_.htm

Idaho HB435

R In early February, HB435 was introduced in the 2016 legislative session. This bill ifadopted would adopt statutes that would not require the employer or surety topay for medical services in amounts that exceed the fee schedule.http://www.legislature.idaho.gov/legislation/2016/H0435.htm

Illinois HB5751

R If adopted, this bill would amend existing laws to provide that neither an employernor a surety shall be required to pay medical fees in excess of those provided bythe Industrial Commission.http://ilga.gov/legislation/BillStatus.asp?DocNum=5751&GAID=13&DocTypeID=HB&LegId=95214&SessionID=88&GA=99

SB 12 R On January 11, 2017, SB 12 was introduced into the Illinois 100th GeneralAssembly. This bill contains some workers’ compensation reform changes . Someof the proposed changes are changes to the maximum allowable payment,electronic billing, utilization review, fraud parameters, etc. The bill has variouseffective dates for the proposed changes.http://ilga.gov/legislation/100/SB/10000SB0012.htm


http://www.capitol.hawaii.gov/measure_indiv.aspx?billtype=HB&billnumber=2715&year=2016

http://www.capitol.hawaii.gov/measure_indiv.aspx?billtype=HB&billnumber=2715&year=2016



http://www.legislature.idaho.gov/legislation/2016/H0435.htm

http://ilga.gov/legislation/BillStatus.asp?DocNum=5751&GAID=13&DocTypeID=HB&LegId=95214&SessionID=88&GA=99

http://ilga.gov/legislation/BillStatus.asp?DocNum=5751&GAID=13&DocTypeID=HB&LegId=95214&SessionID=88&GA=99




SB2515

R This bill, if adopted, would do the following:“Amends the Illinois Insurance Code. Provides a process to register with theDepartment of Insurance as a pharmacy benefits manager and what informationmust be included. Provides that the Director of Insurance may revoke, suspend,deny, or restrict a certificate of registration for violation of the Code or on othergrounds as determined necessary or appropriate by the Director. Provides thatthe Department shall regulate the drug pricing process used by pharmacybenefits managers, and specifies the appeals process for such pricing. Providesthat pharmacy benefits managers shall not mandate that a covered individual usea specific pharmacy or provide incentives to encourage the use of a specificpharmacy under specified circumstances. Provides criteria for entities to use inperforming on-site audits of pharmacy records. Provides that health plans mustpermit their enrollees to receive benefits, which may include a 90-day supply ofcovered prescription drugs, at any of its network community pharmacies.Contains provisions concerning medication synchronization. Provides thatdispensing fees shall be determined exclusively on the total number ofprescriptions dispensed. Regulates how pharmacy benefits managers may utilizepersonally identifiable data. Provides that the Department can regulate otherspecified activities of pharmacy benefits managers. Makes other changes.Effective January 1, 2017.”

As of January 10, 2017, the bill had the status of "session sine die".http://ilga.gov/legislation/BillStatus.asp?DocNum=2515&GAID=13&DocTypeID=SB&LegId=95015&SessionID=88&GA=99

Louisiana HB725

R OnMarch 4, 2016, HB 725 was introduced in the legislative session and if adoptedwould create a closed pharmacy formulary adopting the most recent ODG and theuse of Appendix A. If adopted this bill would be effective July 1, 2017.

http://www.legis.la.gov/legis/BillInfo.aspx?s=16RS&b=HB725&sbi=y

Maryland SB 194 I This bill would require employers/insurers to pay medical bills within 45 days ofreceipt. If adopted, this bill would become effective October 1, 2017.http://mgaleg.maryland.gov/2017RS/bills/sb/sb0194f.pdf

Missouri SB 700 A On August 28, 2016, SB 700 passed and became effective. This bill modifies thefollowing section of Chapter 287 of the Missouri Workers’ Compensation Act:n §287.090.1(4) Veterans’ Organizations Exemption

n §287.245 Workers’ Compensation Grants—Volunteer Firefighters

n §287.957 Workers’ Compensation Premium Rates –Spilt Point.

n §287.975 Contractor Classification Premium Adjustment ProgramThe law can be viewed from the link provided below.http://labor.mo.gov/sites/default/files/Changes-Chapter-287-per-SB-700_Eff-8-28-2016.pdf




http://www.legis.la.gov/legis/BillInfo.aspx?s=16RS&b=HB725&sbi=y

http://mgaleg.maryland.gov/2017RS/bills/sb/sb0194f.pdf

http://labor.mo.gov/sites/default/files/Changes-Chapter-287-per-SB-700_Eff-8-28-2016.pdf

http://labor.mo.gov/sites/default/files/Changes-Chapter-287-per-SB-700_Eff-8-28-2016.pdf



Nebraska LB 429 I This bill was originally introduced in the 2015 Nebraska legislative session onJanuary 16, 2015. This bill was carried over to the 2016 legislative session. Ifadopted, this bill would revise the statutes to incorporate utilization andmedicaltreatment guidelines. As of March 9, 2016, this bill has been indefinitelypostponed.http://www.nebraskalegislature.gov/FloorDocs/Current/PDF/Intro/LB429.pdf

LB 743 I This bill was introduced on January 6, 2016 in the 2016 Nebraska legislativesession. If adopted, this bill would change how the reimbursements of shoulderinjuries are handled. The bill can be accessed from the link below. As of March 9,2016, this bill has been indefinitely postponed.http://www.nebraskalegislature.gov/FloorDocs/Current/PDF/Intro/LB743.pdf

LB1001

I On January 15, 2016, LB 1001 was introduced into the 2016 Nebraska legislativesession. A public hearing was held on February 8, 2016 to discuss the proposedchanges. If adopted, this bill would revise the disability compensation schedules.This bill can be viewed in its entirety from the link below. As of March 9, 2016, thisbill has been indefinitely postponed.http://www.nebraskalegislature.gov/FloorDocs/Current/PDF/Intro/LB1001.pdf

LB1005

I On January 15, 2016, LB 1005 was introduced into the 2016 Nebraska LegislativeSession. A public hearing was held on February 8, 2016 to discuss the proposedchanges. If adopted, it would revise the Nebraska statues to provide instructions forevidence-based drug formulary and become effective for services on or afterJanuary 1, 2017. As of March 9, 2016, this bill has been indefinitely postponed.http://www.nebraskalegislature.gov/FloorDocs/Current/PDF/Intro/LB1005.pdf

New Hampshire SB 3 IC If adopted, this bill would require the insurance department to set rates for thepayment of medical services rendered in the treatment of workers' compensationinjuries. The bill was referred to interim study January 2016. The link is providedbelow.

http://www.gencourt.state.nh.us/bill_status/billText.aspx?id=174&txtFormat=pdf&v=current

New Jersey A3401

P This bill requires workers’ compensation medical bills to be sent and received in anelectronic format and would require that bills be paid within 15 working days afterthe receipt of the electronic billing. On September 15, 2016, the bill passed boththe House and the Senate with no opposition. The bill became law without thegovernor's signature.http://www.njleg.state.nj.us/2016/Bills/A3500/3401_I1.PDF


http://www.nebraskalegislature.gov/FloorDocs/Current/PDF/Intro/LB429.pdf






http://www.njleg.state.nj.us/2016/Bills/A3500/3401_I1.PDF



AB4302

R If adopted, this bill would restrict medical expense coverage for opioid drugs unlessthe prescribing healthcare professionals adhere to certain guidelines. This billwould also allow health plans to disqualify healthcare professionals from theirnetwork if they do not comply with the guidelines. For additional information, seethe link provided below.http://www.njleg.state.nj.us/2016/Bills/A4500/4302_I1.PDF

New Jersey Auto A3402

R OnMarch 3, 2016, Assembly Bill No. 3402 was introduced into the State of NewJersey 217th Legislative session. This bill, if adopted, would implementrequirements for eBilling of medical services. It would require that bills be paidwithin 15 days after the receipt of the electronic billing. This bill has currently beenreferred to the Assembly Financial Institutions and Insurance Committee. To viewthis bill in its entirety, use the link provided below.http://www.njleg.state.nj.us/2016/Bills/A3500/3402_U1.PDF

New Mexico HM78 A This bill puts provisions in place for the Workers’ Compensation division and otheragencies to study the costs and impacts of air ambulance services and the ADA of1978. The report was presented to the legislative finance committee by October 1,2016.https://www.nmlegis.gov/Sessions/16%20Regular/memorials/house/HM078.pdf

New York A2462

R This bill, if adopted, would allow injured workers to be treated by a licensed orcertified acupuncturists under the workers’ compensation program. This bill, ifadopted, would become effective 180 days after it becomes law. This bill wastabled as of September 23, 2016.http://assembly.state.ny.us/leg/?default_fld=&bn=A02462&term=2015&Summary=Y&Text=Y

A2541

R Same as A2462.http://assembly.state.ny.us/leg/?default_fld=%0D%0A&bn=A02541&term=2015&Summary=Y&Actions=Y&Text=Y#jump_to_Text

A4087

R This bill, if adopted, would put provisions in place to recognize massage therapistsas valid providers under the statutes as well as establish fees. If adopted, it wouldbecome effective immediately.http://assembly.state.ny.us/leg/?default_fld=%0D%0A&bn=A04087&term=2015&Summary=Y&Actions=Y&Text=Y

A5724

R This bill, if adopted, would establish fees for social worker services under theworkers compensation statutes. These provisions would become effective 180 daysafter becoming law.http://assembly.state.ny.us/leg/?default_fld=%0D%0A&bn=A5724&term=2015&Summary=Y&Actions=Y&Text=Y


http://www.njleg.state.nj.us/2016/Bills/A4500/4302_I1.PDF

http://www.njleg.state.nj.us/2016/Bills/A3500/3402_U1.PDF

https://www.nmlegis.gov/Sessions/16 Regular/memorials/house/HM078.pdf

http://assembly.state.ny.us/leg?default_fld=&bn=A02462&term=2015&Summary=Y&Text=Y

http://assembly.state.ny.us/leg?default_fld=&bn=A02462&term=2015&Summary=Y&Text=Y

http://assembly.state.ny.us/leg?default_fld=%0D%0A&bn=A02541&term=2015&Summary=Y&Actions=Y&Text=Y#jump_to_Text



http://assembly.state.ny.us/leg?default_fld=%0D%0A&bn=A04087&term=2015&Summary=Y&Actions=Y&Text=Y






A6692

R This bill was introduced in the 2015 legislative session and then carried over in2016. This bill would allow injured workers to seek medical treatment outside theirPPO after their first visit. Currently, this bill was referred to the Committee on Laborand, if adopted, will become effective 90 days after it has become law.http://www.nysenate.gov/legislation/bills/2015/A6992

AB 15 R On January 4, 2017, AB15 was pre-filed with the 2017 New York Legislative Ses-sion. This bill, if adopted, would implement changes regarding payment for phar-macy services. The bill currently has been referred to the Committee on Labor.http://assembly.state.ny.us/leg/?default_fld=&leg_video=&bn=A00015&term=2017&Summary=Y&Actions=Y&Text=Y

S 1490 R Companion bill to A2541, reads the same as A2462.

S 2370 R This bill was introduced in the Senate and Assembly regarding the adoption of themedical treatment guidelines in the No-Fault System. On January 22, 2015, the billwas referred to the Committee on Insurance. This bill was carried over to the 2016legislative session and still resides with the Committee on Insurance as of January6, 2016. Currently, there was no further movement on this bill.http://assembly.state.ny.us/leg/?default_fld=&bn=S02370&term=2015&Summary=Y&Text=Y

Texas HB499

I This bill is related to unfair settlement practices in workers' compensation claims. Ifadopted, it would be effective September 1, 2017.http://www.capitol.state.tx.us/Search/DocViewer.aspx?ID=85RHB004991B&QueryText=%22workers+compensation%22&DocType=B

Washington S5519

R This is the Marijuana Reform Act bill. This bill was referred to committee in the2015 regular session. Recently, the bill was reintroduced and retained in presentstatus under the 2016 1st special session. There has been no further activity on thisbill.http://app.leg.wa.gov/billinfo/summary.aspx?bill=5519&year=2015

West Virginia SB 60 R If adopted this bill would put provisions in place for payment of medical services atreasonable and necessary.http://www.legis.state.wv.us/Bill_Status/bills_history.cfm?INPUT=60&year=2016&sessiontype=RS

Bill/Rule Status Abbreviation LegendThe following list contains descriptions for the Status codes used in the State Legislative Changes table:

Code Definition: DescriptionA Adopted: Rule adopted and made effective on a specific date.

AR Administrative Review: Review by a subcommittee on specific amended rule changes.


http://www.nysenate.gov/legislation/bills/2015/A6992

http://assembly.state.ny.us/leg/?default_fld=&leg_video=&bn=A00015&term=2017&Summary=Y&Actions=Y&Text=Y

http://assembly.state.ny.us/leg/?default_fld=&leg_video=&bn=A00015&term=2017&Summary=Y&Actions=Y&Text=Y

http://assembly.state.ny.us/leg?default_fld=&bn=S02370&term=2015&Summary=Y&Text=Y

http://assembly.state.ny.us/leg?default_fld=&bn=S02370&term=2015&Summary=Y&Text=Y

http://www.capitol.state.tx.us/Search/DocViewer.aspx?ID=85RHB004991B&QueryText=%22workers+compensation%22&DocType=B

http://www.capitol.state.tx.us/Search/DocViewer.aspx?ID=85RHB004991B&QueryText=%22workers+compensation%22&DocType=B

http://app.leg.wa.gov/billinfo/summary.aspx?bill=5519&year=2015

http://www.legis.state.wv.us/Bill_Status/bills_history.cfm?INPUT=60&year=2016&sessiontype=RS

http://www.legis.state.wv.us/Bill_Status/bills_history.cfm?INPUT=60&year=2016&sessiontype=RS

Code Definition: DescriptionC On the Calendar: The bill was placed on the calendar for vote.

D Defeated: Bill was defeated and no further action has taken place.

E Enacted: Bill passed and made into law.

ER Emergency Rules: Rules put into effect for an emergency period.

FP Failed Passage: Bill did not pass.

I Introduced: Bill introduced in the legislative session.

IC In Committee: Bill is with a particular committee for review.

IH In the House: Bill is in the House and moving through the process.

IP Indefinitely Postponed: Bill has been postponed until further notice.

IS In the Senate: Bill is in the Senate and moving through the process.

P Passed: Bill was passed in the Senate, House, or both.

PC Public Comments: Proposed bill or rule is available for public comment.

PH Public Hearing: Proposed bill or rule is slated for public hearing.

PR Proposed: Proposed rules were posted for review and comment.

R Referred: Bill referred to another committee for further action.

RF Refiled: Bill will be refiled at a later date.

V Vetoed: Bill was vetoed by the appropriate authority (i.e. the governor or the president).

W Withdrawn: Bill has been withdrawn.


Fee Schedule UpdatesThis section contains researched information obtained from state resources regarding jurisdictional changes that have takenplace in the last six months and those anticipated to take place in the future. Unless otherwise indicated, these changes applyto workers’ compensation only. Note that the “New Adoptions!” headings only appear when a new adoption has taken place.Send comments or suggestions to [email protected].

AlabamaNew Adoptions!

n On December 20, 2016, the state posted the 2017mileage reimbursement rate of $0.535 per mile. This is a decrease fromthe 2016 rate of $0.54 per mile.

https://www.labor.alabama.gov/docs/guides/wc_mileage_rate.pdf

Future Plans/Proposals

n The state posts revisions to hospital and ASC rates each quarter for 2017.

Previous Updates

n On December 15, 2016, the state posted the adopted files to update the Medical, Hospital and ASC fee schedules,effective January 1, 2017. The files can be accessed on the state’s website.

https://www.labor.alabama.gov/wc/2017FeeSchedules.aspx

n On October 11, 2016, the state posted Revision 3 for the Ambulatory Surgery Centers and Hospital Fee Schedule updates,effective October 1, 2016. The updated fee schedule can be accessed from the links provided below.

https://labor.alabama.gov/wc/FeeSchedules/Addendum%203%20Memo.pdf

https://labor.alabama.gov/wc/FeeSchedules/2016%20Ambulatory%20Surgery%20Center%20Fee%20Schedule(revision%203).pdf

https://labor.alabama.gov/wc/FeeSchedules/2016%20Hospital%20Fee%20Schedule(revision%203).pdf

AlaskaFuture Plans/Proposals

n On December 8, 2016, the state posted a notice regarding the proposed changes to the Medical Fee Schedule. A publichearing took place on January 12, 2017, where additional comments can be made in person. The effective date isexpected to be April 1, 2017. The public hearing and proposed fee schedule can be accessed on the state’s website.

https://aws.state.ak.us/OnlinePublicNotices/Notices/View.aspx?id=183803

n The state conducted a meeting on July 15, 2016 of the Workers’ Compensation Medical Services Review Committee(MSRC). The notice can be viewed from the link provided below.


Previous Updates

n On December 1, 2016, the state posted a notice regarding the adoption of the International Classification of Diseases,2017 edition. It is effective October 1, 2016. The notice can be viewed from the link below.

http://labor.alaska.gov/wc/notices/2016-11-public-notice-of-amended-materials.pdf

n On September 26, 2016, the state’s vendor Optum posted updates to the fee schedule. The updates incorporate the Drugsand Biological files changes made by CMS. These changes are effective October 1, 2016.



https://www.labor.alabama.gov/docs/guides/wc_mileage_rate.pdf

https://www.labor.alabama.gov/wc/2017FeeSchedules.aspx

https://labor.alabama.gov/wc/FeeSchedules/Addendum 3 Memo.pdf

https://labor.alabama.gov/wc/FeeSchedules/2016 Ambulatory Surgery Center Fee Schedule(revision 3).pdf

https://labor.alabama.gov/wc/FeeSchedules/2016 Ambulatory Surgery Center Fee Schedule(revision 3).pdf

https://labor.alabama.gov/wc/FeeSchedules/2016 Hospital Fee Schedule(revision 3).pdf



http://labor.alaska.gov/wc/notices/2016-11-public-notice-of-amended-materials.pdf

ArizonaFuture Plans/Proposals

n The state historically updates the fee schedule every October.

Previous Updates

n On September 6, 2016, the state posted the adopted fee schedule changes, effective October 1, 2016. The data files andguidelines can be accessed from the link below.

http://www.ica.state.az.us/Director/DIR_FSList2016.aspx

n The state recently updated its Fee Schedule FAQs (2015) Edition. This updated document can be accessed from the linkprovided below.

http://www.ica.state.az.us/Director/DIR_FSFAQs.aspx

ArkansasFuture Plans/Proposals

n CPT1 codes and the Medicare RBRVS are adopted by the state automatically, applicable on its effective date (January 1) asrequired each year in accordance with Rule 30.

Previous Updates

n There are no updates from the last six months to report at this time.

CaliforniaNew Adoptions!

n On January 25, 2017, the state posted an update to the Physician’s Fee Schedule to conform to the Medicare paymentmethodology, effective March 1, 2017.

http://www.dir.ca.gov/dwc/OMFS9904.htm#7

n On December 28, 2016, the state posted the updates for the Pathology and Clinical Laboratory sections of the feeschedule, effective January 1, 2017.

http://www.dir.ca.gov/dwc/FeeSchedules/PathologyLaboratory_FeeSchedule/January2017/Order.pdf


n On September 9, 2016, the state posted amendments to the draft Home Health Care Fee Schedule. The followingsections are included in the amendments:

- Adopt Section 9789.90 Home Health Care – Definitions

- Adopt Section 9789.91 Home Health Care – Eligibility for Services & Payment.

- Adopt Section 9789.92 Home Health Care – PaymentMethodology & Billing Rules.

- Adopt Section 9789.93 – Table A

The comment period for these changes was opened till September 26, 2016. The text of the proposed regulations can befound on the state’s website.

http://www.dir.ca.gov/dwc/DWCPropRegs/HomeHealthCareFeeSchedule/HomeHealthCareFeeSchedule.htm

1CPT® is a registered trademark of the AmericanMedical Association.


http://www.ica.state.az.us/Director/DIR_FSList2016.aspx

http://www.ica.state.az.us/Director/DIR_FSFAQs.aspx


http://www.dir.ca.gov/dwc/FeeSchedules/PathologyLaboratory_FeeSchedule/January2017/Order.pdf


n On August 26, 2016, the state posted Department of Industrial Relations (DIR) News Release No. 2016-83, regarding theposting of the draft drug formulary regulations on the Division ofWorkers’ Compensation (DWC) online forum. AssemblyBill 1124 requires the DWC to have a drug formulary by July 1, 2017. The state is well on the way to completing theserequirements. The online forum can viewed from the link provided below.

http://www.dir.ca.gov/dwc/ForumDocs/Implementing-AB-1124-Drug-Formularyand-update-of-MTUS-Guideline/Implementing-AB-1124-Drug-Formularyand-update-of-MTUS-Guidelines.htm

n OnMay 24, 2016, the state posted modifications to the proposed Home Health Care Fee Schedule. The state acceptedcomments until June 8, 2016. The modified proposal can be found on the state's website.


n On February 11, 2016, the state posted DWC Newsline 2016-20. The state participated in a public hearing on February 17,2016 to discuss the proposed workers' compensation drug formulary. The entire Newsline can be accessed from the linkbelow.

http://www.dir.ca.gov/DIRNews/2016/2016-20.pdf

Previous Updates

n On December 16, 2016, the state adopted major changes to the Hospital Outpatient Departments and AmbulatorySurgery Center sections of the fee schedule. The update will make all hospital outpatient services payable as it is in theMedicare Hospital outpatient Departments Prospective Payment System (HOPPS). The update is effective December 15,2016. The notice can be accessed from the link provided below.


n On December 15, 2016, the state posted a notice for the update of the Durable Medical Equipment, Prosthetics, Orthoticsand Supplies (DMEPOS), effective January 1, 2017. The changes conform to the Medicare update of the DMEPOS fees.The notice can be found on the state website.


n On December 14, 2016, the state posted a notice regarding the update of the Medical andMedical-Legal TravelExpenses, effective January 1, 2017. The mileage rate decreased to $0.53. The notice can be found on the state’s website.


n On December 1, 2016, the state posted a notice for the update to the Inpatient Fee Schedule, effective January 1, 2017.The changes conform to the Medicare update for the Acute Inpatient Fees. The updated rules and fees can be accessedfrom the link provided below.

http://www.dir.ca.gov/DWC/OMFS9904.htm#4

n On September 8, 2016, the state posted the changes for the Durable Medical Equipment, Prosthetics, Orthotics andSupplies (DMEPOS) section of the Official Medical Fee Schedule (OMFS).

These changes are effective October 1, 2016 and can be accessed from the link provided below.


n On September 7, 2016, the state posted the adjustments to the OMFS (Physician Services/Non-Physician PractitionerServices), effective October 1, 2016. The order adopting these changes can be accessed from the link below.


CMS/Federal RegisterNew Adoptions!

n On January 11, 2017, CMS posted an update to the Provider Specific Files (PSF) for the following provider types:

- Inpatient









http://www.dir.ca.gov/DWC/OMFS9904.htm#4



- Skilled Nursing Facility

- Home Health Agency

- Inpatient Rehab

- Long Term Care

- Inpatient Psychiatric Facility

The update is effective on January 1, 2017.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/psf_text.html

n On January 3, 2017, CMS posted correction notices to correct technical errors for the Ambulatory Surgery Center andHospital Outpatient Prospective System (OPPS) Fee Schedules.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/index.html

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html

n On December 23, 2016, CMS posted the Clinical Laboratory Fee Schedule, effective January 1, 2017.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/index.html


n No future plans are proposed at this time.

Previous Updates

n On December 14, 2016, CMS posted a correction to the HCPCS data file.

https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS-Items/2017-Corrections-to-Alpha-Numeric-HCPCS-File.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending

n On December 9, 2016, CMS posted the Home Health Code Weight Table update, effective January 1, 2017.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/coding_billing.html

n On December 8, 2016, CMS posted the ASP Price file, NOC Pricing file and the ASP NDC-HCPCS Crosswalk, effectiveJanuary 1, 2017.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/2017ASPFiles.html

n On December 8, 2016, CMS posted the Durable Medical Equipment Prosthetics/Orthotics and Supplies Fee Schedule,effective January 1, 2017.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/DMEPOS-Fee-Schedule-Items/DME17-A.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending

n Recently, CMS published a revised set of POS codes to be used for the billing of professional services, effective January 1,2017. A new Place of Service code, 02, was added for Telemedicine:

02 Telehealth The location where health services and health related services are provided or received, through atelecommunication system. (Effective January 1, 2017)

Previously, this place of service was unassigned. For additional information, please see the link below.

https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set.html

n On November 15, 2016, the CMS posted an update to the Anesthesia Conversion Factors, effective January 1, 2017.

https://www.cms.gov/Center/Provider-Type/Anesthesiologists-Center.html



https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/index.html

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/index.html








https://www.cms.gov/Center/Provider-Type/Anesthesiologists-Center.html

n On November 11, 2016, CMS posted an update to the Place of Service (POS) codes, effective January 1, 2017.


n On November 8, 2016, CMS posted the Health Professional Shortage Area (HPSA) Bonus Payments for primary care andmental health professionals, effective January 1, 2017.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HPSAPSAPhysicianBonuses/index.html?redirect=/hpsapsaphysicianbonuses/

n On November 7, 2016, CMS posted an update to the Ambulatory Surgical Center (ASC) Payment final rule, effectiveJanuary 1, 2017.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/ASC-Regulations-and-Notices-Items/CMS-1656-FC.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending

n On November 7, 2016, CMS posted the annual update to the Healthcare Common Procedure Coding System (HCPCS) file,effective January 1, 2017. Additionally, on November 17, 2016, CMS reposted the files for HCPCS with revisions.

https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS.html?DLSort=0&DLEntries=10&DLPage=1&DLSortDir=descending

n On November 7, 2016, CMS posted an update to the Hospital Outpatient PPS final rule, effective January 1, 2017.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1656-FC.html

n On November 4, 2016, CMS posted the final rule for the Physician Fee schedule annual update. Then on November 11,2016, CMS posted the Relative Value Units (RVU) file for the Physician Fee Schedule. These updates are effective January1, 2017. The updates can be accessed from the links provided below.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files-Items/RVU17A.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending

n On November 3, 2016, CMS posted an annual update of the Home Health PPS, effective January 1, 2017.

https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-26290.pdf

n On November 1, 2016, CMS posted Hospital Value-Based Purchasing (VBP) Tables 16A and 16B, effective October 1, 2016for FY 2017.


n On October 21, 2016, CMS posted the HCPCS data files for the “G” codes updated October 21, 2016. The new update canbe accessed from the link below.

https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update.html

n On October 12, 2016, the Centers for Medicare andMedicaid Services (CMS) posted the quarterly Provider Specific Files(PSF) for Inpatient, Skilled Nursing Facility, Home Health, Hospice, Inpatient Rehabilitation, Long Term Care and InpatientPsychiatric Facility, effective October 1, 2016.


n On September 13, 2016, the Centers for Medicare andMedicaid Services (CMS) posted the transmittal for the update tothe Health Professional Shortage Area (HPSA) Bonus Pay program, effective January 1, 2017. CMS has not yet posted thedata files that will be used for this update. The transmittal can be viewed from the link below.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2016-Transmittals-Items/R3610CP.html?DLPage=1&DLEntries=10&DLSort=6&DLSortDir=descending














https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-26290.pdf







n On September 12, 2016, CMS posted the ASP Drug Files, effective October 1, 2016. The updated files can be accessedfrom the link provided below.


n On September 2, 2016, CMS posted the updated tables for Medically Unlikely Edits (MUEs) for Practitioner Services, FacilityOutpatient Services, and Durable Medical Equipment Supplier Services, effective October 1, 2016. The updated tables canbe accessed from the link below.

https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html

n On August 26th, 2016, CMS posted the newly added “G-codes" update, effective October 1, 2016. These codes can beaccessed from the link below.


n On August 26, 2016, CMS posted the data files related to the October 1, 2016 quarterly update for the Physician FeeSchedule. These files can be viewed at the link provided below.


Additionally, CMS posted the data files for the October 1, 2016 quarterly update for the Durable Medical Equipment,Prosthetic, Orthotics and Supplies. These files can be viewed at the link provided below.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/DMEPOS-Fee-Schedule.html

n On August 4, 2016, the Centers for Medicare andMedicaid (CMS) posted the final rules and data for the Acute InpatientPPS FY2017, effective October 1, 2016. The rules and data files can be accessed on the CMS website.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2017-IPPS-Final-Rule-Home-Page.html

n On August 1, 2016, CMS posted the final rules and data for Inpatient Rehabilitation Facility PPS FY2017, effective October1, 2016. On August 4, 2016, CMS posted additional data files for this update. The rules and data can be found on the CMSwebsite.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientRehabFacPPS/Data-Files.html

n On July 11, 2016, CMS posted the quarterly update to the Provider Specific Files (PSF) for Inpatient, Skilled Nursing Facility,Home Health, Hospice, Inpatient Rehab, Long Term Care and Inpatient Psychiatric Facility, effective July 1, 2016. The filescan be accessed on the CMS website.


n On July 7, 2016, CMS posted the Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) pricerupdate, effective October 1, 2016.


ColoradoNew Adoptions!

n On January 19, 2017, the state posted the 3rd revision to the data file for the fee schedule, effective January 1, 2017. Therevision can be found on the state's website with the extension of 01192017 in the naming convention of the file.

https://www.colorado.gov/pacific/cdle/directors-interpretive-bulletins-regarding-medical-fee-schedule














n On January 11, 2017, the state posted a second corrected version of the Medical Fee Schedule, effective January 1, 2017.A couple of the significant corrections are listed below:

- Values for education supplies

- New Advance Diagnostic Imaging (ADI) Fee Schedule for technical and professional components



n The state has posted public hearing notifications, effective July 18, 2016, for the following proposed rules:

Notices of Rule Hearings

- Rule 1: General Definitions and General Provisions

- Rule 5: Claims Adjusting Requirements

- Rule 6: Modification, Termination or Suspension of Temporary Disability Benefits

- Rule 7: Closure of Claims, Approval of Settlement Agreements and Petitions to Reopen

- Rule 8: Authorized Treating Physician

- Rule 9: Division ofWorkers’ Compensation Dispute Resolution

The proposed rule language can be accessed from link below:

https://www.colorado.gov/pacific/sites/default/files/Proposed_Rules_1_5_6_7_8_9.pdf

Previous Updates

n On November 15, 2016, the state posted the adopted Resource Based Relative Value Scale professional Fee Schedule,effective 01/01/2017. For additional information, see the link provided below.

https://www.colorado.gov/pacific/cdle/workers-compensation-proposed-and-adopted-rules

n On September 28, 2016, the state posted adopted Rule 16: Utilization Standards and Rule 18: Medical Fee Schedule,along with the 2017 exhibits to the Medical Fee Schedule. The rules are effective January 1, 2017. The adopted rules canbe accessed from the link provided below.


Colorado (Auto)Future Plans/Proposals


Previous Updates


ConnecticutFuture Plans/Proposals

n Historically, the state adopts the Practitioner Fee Schedule in July of each year.

Previous Updates




https://www.colorado.gov/pacific/sites/default/files/Proposed_Rules_1_5_6_7_8_9.pdf



DelawareFuture Plans/Proposals

n Historically, the state adopts the fee schedule annually every January.

Previous Updates

n The state posted a “Final Order” updating subsections 3.2, 4.18, and 4.22 of the 19 DE Administrative Code. This ordermakes corrections to technical errors in the regulations. The entire order can be accessed from the link provided below.

http://regulations.delaware.gov/register/june2016/final/19%20DE%20Reg%201102%2006-01-16.pdf

District of ColumbiaFuture Plans/Proposals

n Data file updates from CMS for anesthesia, clinical lab, DMEPOS, HCPCS, inpatient hospital, outpatient hospital, andphysician services are made either annually (based on calendar or fiscal year) or quarterly (January 1, April 1, July 1 andOctober 1 of each year) with an addedmarkup, where applicable, as defined in the district's statute.

Previous Updates









FloridaFuture Plans/Proposals

n On December 21, 2016, the state posted a notification of a public meeting that took place on January 4, 2017, regardingthe following:

- The Three-member Panel 2017 Biennial Report

- The Division’s Annual Report on the resolution of health care provider medical reimbursement disputes and activities(2016) conducted pursuant to 440.13(8)(a), F.S.

The meeting packet and notice to the public meeting are provided below.

http://www.myfloridacfo.com/Division/WC/pdf/Three-Member-Panel-Meeting-Packet-Jan-4-2017.pdf

http://www.myfloridacfo.com/Division/WC/noticesRules.htm

n The state held a public hearing on October 24, 2016, regarding the proposed changes for the Florida Workers’Compensation ReimbursementManuals for Hospitals, ASC's and HealthCare Providers. The following is an excerpt takenfrom the Florida rules notification, regarding the proposed changes:


http://regulations.delaware.gov/register/june2016/final/19 DE Reg 1102 06-01-16.pdf







http://www.myfloridacfo.com/Division/WC/pdf/Three-Member-Panel-Meeting-Packet-Jan-4-2017.pdf


69L-7.501: The proposed rule is amended to adopt the 2016 Edition of the Florida Workers’ Compensation

Reimbursement Manual for Hospitals (“Manual”), as approved by the Three-Member Panel during a scheduled

meeting held on April 20, 2016, pursuant to paragraph 440.13(12)(a), F.S. The 2016 Edition of the Manual increases

the per diem reimbursement rates for surgical and non-surgical hospital inpatient services and the threshold dollar

amount triggering Stop-Loss reimbursement above reimbursement allowances specified in the 2014 Edition of the

Manual, as adopted by the existing rule. The 2016 Edition of the Manual also provides an updated fee schedule for

various categories of hospital outpatient services based on the Current Procedural Terminology (“CPT”) line level charge

data, with an adjustment of the Maximum Reimbursement Allowance (“MRA”) based on the geographic location of the

service provider.

69L-7.100: The proposed rule amendment incorporates and adopts for use the 2016 Edition of the Florida Workers’

Compensation Reimbursement Manual for Ambulatory Surgical Centers (“ASC Reimbursement Manual”), as approved

by the Three-Member Panel on April 20, 2016, pursuant to paragraph 440.13(12)(a), F.S. The 2016 Edition of the ASC

Reimbursement Manual contains an updated list of the Maximum Reimbursement Allowances (“MRAs”) for various

medical services provided to Florida’s injured workers.

69L-7.020: The proposed rule amends the existing rule to adopt and incorporate by reference the 2016 Edition of the

Florida Workers’ Compensation Health Care Provider Reimbursement Manual, as approved by the Three-Member

panel on April 20, 2016, pursuant to paragraph 440.13(12)(a), F.S. The aforementioned manual is updated to

incorporate the 2016 Medicare Conversion Factor and Resource Based Relative Value Scale (“RBRVS”) geographic-

specific reimbursement levels used to determine Maximum Reimbursement Allowances (“MRAs”) for physician’s

services and non-surgical hospital outpatient services provided to Florida’s injured workers.

Notices for the proposed rules can be viewed in the links provided below.

https://www.flrules.org/Gateway/View_notice.asp?id=18083436



n The state conducted a rule development workshop on July 28, 2016 on the proposed rule changes for the following:

- 69L-7.501 2016 Florida Workers’ Compensation ReimbursementManual for Hospitals on July 28, 2016 at 9:00am.

- 69L-7.100 Florida Workers’ Compensation ReimbursementManual for Ambulatory Surgical Centers on July 28, 2016at 10:30am.

- 69L-7.020 Florida Workers’ Compensation Health Care Provider ReimbursementManual on July 28, 2016 at 1:00pm

The proposed changes can be accessed from the links provided below.


Draft 69L-7.501 Workshop 2016HRM 07_15_2016

Draft 69L-7.100 Workshop 2016ASCRM 07_15_2016

Draft 69L-7.020 Workshop 2016HCPRM 07_19_2016

Previous Updates


Florida (Auto)Future Plans/Proposals

n Data file updates from CMS for anesthesia, ASC, ASP Drug, clinical lab, DMEPOS, HCPCS, home health PPS, inpatienthospital, outpatient hospital, physician services, and rehabilitation PPS are made annually March 1 (based on calendar orfiscal year) with an addedmarkup, where applicable, as defined in the state's statute.






Previous Updates


GeorgiaFuture Plans/Proposals

n Updates to the ASC, DME, home health, hospital, IME, medical records, pharmaceutical, physician, and transportationrates are historically updated April 1 of each year.

Previous Updates

n On December 13, 2016, the state posted an amendment to the outpatient and ASC fee schedule retroactive to April 13,2016. The amendment can be accessed from the link provided below.

http://sbwc.georgia.gov/sites/sbwc.georgia.gov/files/medical_fee_schedule/OutpatientReimbursement12_13_16.pdf

HawaiiNew Adoptions!

n On December 30, 2016, the state posted a notification that the Workers’ Compensation Exhibit A Fee Schedule, effectiveJanuary 1, 2017 is deferred until further notice. The current Exhibit A Fee Schedule, dated January 1, 2014, shouldcontinue to be used.

https://labor.hawaii.gov/dcd/files/2012/11/mfs-2017.pdf


n Historically, Hawaii adopts the Medicare Fee Schedule when it is updated January 1 of each year.

n The state posted proposed changes to the Workers' Compensation Medical Fee Schedule in Title 12 Chapter 15 andExhibit A, to be effective January 1, 2017.

A public hearing was held on November 17, 2016. The notice and proposed changes can be viewed at the link providedbelow.

https://labor.hawaii.gov/dcd/files/2016/10/PublicHrgWC2016.pdf

Previous Updates

n Noridian posted its Medicare Physician Fee Schedules (MPFS) for 2017, which was used for Hawaii workers’ compensationand auto medical bill repricing. The files can be found on the Noridian website.

https://med.noridianmedicare.com/web/jeb/fees-news/fee-schedules/mpfs

Hawaii (Auto)New Adoptions!

n On December 30, 2016, the state posted a notification that the Workers’ Compensation Exhibit A Fee Schedule, effectiveJanuary 1, 2017 is deferred until further notice. The current Exhibit A Fee Schedule, dated January 1, 2014, shouldcontinue to be used.



n Historically, Hawaii adopts the Medicare Fee Schedule when it is updated on January 1 each year.

n The state posted proposed changes to the Workers' Compensation Medical Fee Schedule in Title 12 Chapter 15 andExhibit A, to be effective January 1, 2017. A public hearing was held on November 17, 2016. The notice and proposedchanges can be viewed at the link provided below.



http://sbwc.georgia.gov/sites/sbwc.georgia.gov/files/medical_fee_schedule/OutpatientReimbursement12_13_16.pdf






Previous Updates

n Noridian posted its Medicare Physician Fee Schedules (MPFS) for 2017, which was used for Hawaii workers’ compensationand auto medical bill repricing. The files can be found on the Noridian website.


IdahoFuture Plans/Proposals


Previous Updates


IllinoisNew Adoptions!

n On January 3, 2017, the state posted multiple files for the update to the fee schedules and guidelines, effective January 1,2017.

https://iwcc.ingenix.com/download.asp


n On January 11, 2017, the state introduced SB 12. This bill contains various provisions for workers’ compensation reform. Ifadopted, the bill would change the following:

(Excerpt from SB 12)

(a-2.5) For procedures, treatments, services, or supplies covered under this Act and rendered or to be rendered on or

after June 1, 2017, the maximum allowable payment for the following service categories set forth in Title 50, Section

7110.90 of the Illinois Administrative Codes shall be 85% of the fee schedule amounts in effect of May 31, 2017,

which shall be adjusted yearly by the Consumer Price Index-U, as described in subsection (a) of this Section:

(1) Section 1: Ambulatory Surgical Treatment Center (ASTC) and Accredited Ambulatory Surgical Treatment Facility(ASTF).

(2) Section 7 ( C): Hospital Outpatient – Radiology

(3) Section 7 (D): Hospital Outpatient – Pathology and Laboratory.

(4) Section 8 (F): Professional Services – Pathology and Laboratory.

(5) Section 8 (G): Professional Services – Radiology.

(a-2-6) For procedures, treatments, services, or supplies covered under this Act and rendered or to be rendered on or

after June 1, 2017, the maximum allowable payment for the following service categories set forth in Title 50,

Section7110.90 of the Illinois Administrative Code shall be 90% of the fee schedule amounts in effect on May 31,

2017, which shall be adjusted yearly by the Consumer Price Index-U, as described in subsection (a) of this Section:

(1) Section 7(F): Hospital Outpatient Surgical Facility.

(2) Section 8 (D): Professional Services – Surgery.

(a-4) The Commission, in consultation with the Workers’ Compensation Medical Fee Advisory Board, shall promulgate

by rule an evidence-based drug formulary and any rules necessary for its administration. Prescriptions prescribed for

workers’ compensation cases shall be limited to those prescription drugs and does on the closed formulary. A request

for a prescription that is not on the closed formulary shall be reviewed pursuant to section 8.7 of this Act.




https://iwcc.ingenix.com/download.asp


n Anesthesia, ASC, HCPCS, Hospital, and Physician Fee Schedules are updated January 1 of each year.

Previous Updates


IndianaFuture Plans/Proposals


Previous Updates


IowaFuture Plans/Proposals


Previous Updates


KansasFuture Plans/Proposals

n On October 20, 2016, the state posted the proposed 2017 Kansas Medical Fee Schedule online for review. The stateconducted a public hearing on November 18, 2016. The following was proposed:

- Increase fees by 3% for most physician services.

- Changes to the outpatient and ambulatory surgical reimbursement to a Prospective Payment System (PPS)methodology from billed charges.

- Revise fees for IMEs, depositions, testimony, and trauma activation levels.

To view the proposed fee schedule, use the link provided below.

http://www.kssos.org/Pubs/register/2016/Vol_35_No_36_September_8_2016_pages_777-792.pdf

http://www.dol.ks.gov/Files/PDF/med_fees_2016.pdf

n On September 8, 2016, the state posted notification in the Kansas State Register of a public hearing that was held onNovember 18, 2016 regarding proposed changes to the Kansas Schedule of Medical Fees forWorkers’ Compensation. Thestate proposes the following:

- Increase fees by 3% for most physician services.

- Changes to the outpatient and ambulatory surgical reimbursement to a Prospective Payment System (PPS)methodology from billed charges.

- Revise fees for IMEs, depositions, testimony, and trauma activation levels.

The notification can be viewed in its entirety from the link provided below.



n The state will adopt a new fee schedule effective in 2017. The state indicated the 2015 fee schedule will remain in effectfor 2016 and until the new fee schedule is released.






Previous Updates

n On December 6, 2016, the recently updated fee schedule became available on the state’s website. The fee schedule iseffective January 1, 2017 and can be accessed from the link provided below.


KentuckyFuture Plans/Proposals


Previous Updates

n On October 6, 2016, the Kentucky Workers’ Compensation Medical Fee Schedule for Physicians was received from thestate’s vendor. The fee schedule is effective on October 7, 2016.

The new fee schedule makes updates to the following:

- Charges for physicians

- Time value for anesthesia

- Use of G-codes for drug screening

- Dental codes

- J codes

- Air and ground transportation

The fee schedule is available for order from the state’s vendor using the link provided below.

https://secure.kentucky.gov/formservices/WorkersComp/Physicians

LouisianaFuture Plans/Proposals


Previous Updates

n On October 19, 2016, the state posted amendments in the Louisiana State Register for updates to the medical guidelinesand reimbursement values for portions of the fee schedule, effective October 20, 2016. These changes can be viewedfrom the link provided below.

http://www.doa.la.gov/osr/REG/1610/1610.pdf

MaineFuture Plans/Proposals


Previous Updates

n On December 6, 2016, the state posted its updated fee schedule appendices. The fee schedule is effective January 1,2017.

http://www.maine.gov/wcb/

n On September 15, 2016, the state posted the updated data files for the Inpatient Hospital Fee Schedule, effective October1, 2016. The files can be accessed from the link below.




https://secure.kentucky.gov/formservices/WorkersComp/Physicians

http://www.doa.la.gov/osr/REG/1610/1610.pdf



MarylandNew Adoptions!

n On December 29, 2016, the state posted revised data files for the rates effective, January 1, 2017.

http://www.wcc.state.md.us/MFG/Medical_Fee_Schedule.html


n The next Medical Fee Schedule update is planned for January 1, 2017.

Previous Updates

n On December 7, 2016, the state posted all sections of the Medical and Fee Guidelines which includes:

- Maryland Specific Conversion Factor (MSCF)/Percentage Multiplier

- Reimbursement Rates file

- Ambulatory Surgery Centers

- Anesthesiology

- Orthopedic/Neurological Surgical CPT Codes

- CPT Codes Not Valued by CMS

- Miscellaneous Information

On December 12, 2016, the state reposted the Reimbursement Rate files.

The entire fee schedule can be viewed from the link provided below.


n On November 10, 2016, the state posted the annual state-specific conversion factors, effective January 1, 2017.


MassachusettsNew Adoptions!

n On January 19, 2017, the state posted the updated rates of payments for hospitals , effective January 1, 2017.Additionally, the state posted an update to the Health Safety Net Uniform Assessment percentage, effective October 1,2016.

Rates of Payments for Hospitals (PAFs)

http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/adminbull-2017/ab-17-01.pdf

Health Safety Net Uniform Assessment Percentage


n On December 30, 2016, the state posted an emergency adoption for the changes to 101 CMR 350.00 Home HealthServices.

http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/101-cmr-350-emergency-adoption.pdf

n On December 28, 2016, the state posted the final notice for the adoption of changes to 101 CMR 206.00 Nursing Facilities.The changes are effective December 30, 2016.

http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/nf-fy17-9c-notice-of-final-agency-action.pdf







http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/101-cmr-350-emergency-adoption.pdf

http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/nf-fy17-9c-notice-of-final-agency-action.pdf


n On December 28, 2016, the state posted the proposed changes for 101 CMR 323.00 Hearing Aid Services. The state willbe conducting a public hearing on January 23, 2017, regarding these changes. If adopted, the changes will becomeeffective April 1, 2017.

http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/101-cmr-323-public-hearing-notice.pdf

http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/101-cmr-323-redline.pdf

n The state conducted a public hearing on December 23, 2016, regarding the proposed changes for 101 CMR 346.00 Ratesfor Certain Substance and Addictive Disorder Programs. If the changes are adopted, they will become effective January 1,2017. The proposed changes can be viewed from the link provided.


n On November 2, 2016, the state posted information that it conducted a public hearing on the proposed changes for 101CMR 345.00 Temporary Nursing Services and 101 CMR 204.00 Rates of Payments to Resident Care Facilities on November30, 2016. The proposed changes as well as the hearing notice can be accessed from the link below.



http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/combined-notice-public-hearing.pdf

n OnMarch 29, 2016, the state posted the public hearing notice for 101 CMR 346.00: Rates for Certain Substance Relatedand Addictive Disorders (SRAD) Programs. The public hearing was held on April 29, 2016. The notification and proposedrules can be accessed from the links provided below.

http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/101-cmr-346-public-hearing.pdf


n On February 25, 2016, the state posted notification for the public hearing that was held onMarch 21, 2016 to discuss andreview the proposed regulation for 101 CMR 310.00: Adult Day Health Services. To view the notification as well as theproposed regulations use the links provided below.


http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/101-cmr-310-redlined.pdf

Previous Updates

n On October 14, 2016, the state posted the final adoption for 101 CMR 343 Hospice Services with an update date ofOctober 21, 2016. The changes can be found in the link below.

http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/101-cmr-343-hospice.pdf

n October 4, 2016, the state posted an updated code andmodifier, T1023-TU for the Personal Care Attendant Program, 101CMR 309.00. The new code, modifier, and rate can be accessed from the link below.


n On October 3, 2016, the state posted updated rates for Nursing Facilities 101 CMR 206.00, effective October 1, 2016. Therates can be accessed from the link below.

http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/certified-nursing-facility-rates.pdf

n On August 10, 2016, the state posted the final adoption of rule 101 CMS 331.00 Prescription Drugs, effective July 1, 2016.



http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/101-cmr-323-public-hearing-notice.pdf





http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/combined-notice-public-hearing.pdf




http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/101-cmr-310-redlined.pdf

http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/101-cmr-343-hospice.pdf


http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/certified-nursing-facility-rates.pdf


MichiganNew Adoptions!

n On January 16, 2017, the state posted the fee schedule data and rules on its website, effective January 13, 2017.

http://www.michigan.gov/wca/0,1607,7-191-26922_27470_28076-86583--,00.html



Previous Updates

n On August 2, 2016, the state posted the Hospital Cost-to-Charge Ratios, effective August 1, 2016. These new rates can beaccessed from the link provided below.

http://www.michigan.gov/wca/0,4682,7-191-26922-335659--,00.html

n The state adopted some new rules for Certified Anesthesiology Assistants and made clarifications on the OpioidReimbursement rule effective dates. For now the conversion factors and RVU remain the same. The new rules can befound on the LARA Workers’ Compensation website at the link provided below.

http://www.michigan.gov/wca/0,4682,7-191--367064--,00.html

Michigan (Auto)Future Plans/Proposals


Previous Updates


MinnesotaFuture Plans/Proposals

n On January 5, 2017, the state conducted a rehabilitation panel meeting on the proposed changes to the rehabilitationrules 5220.0100 - 5220.1900 and 5220.2510 - 5220.2870.

http://www.dli.mn.gov/Pdf/docket/5220rule.pdf

n On December 22, 2016, the state is anticipating an amendment under statute § 14.388 to update the rules for theindependent medical examination, relative value, and the pharmacy fee schedules. Possible amendments are listedbelow:

- Statute §§ 176.135 and 62J, requiring all Minnesota providers and payers to utilize electronic medical billing andpayment.

- Changes related to billing and payment of workers’ compensation medical and hospital bills, which would includewording, formatting, and renumbering changes recommended by the revisor.

For additional information, see the link provided below.

http://www.dli.mn.gov/PDF/docket/5219_5221_1216_docket.pdf

n On October 3, 2016, the state posted a notification in the Minnesota State Register to consider amendments to all of therehabilitation rules. The possible amendments are for Rules 5220.0100 to 5220.1900 along with penalties under Rules5220.2510 to 5220.2870. The state is accepting written comments until further notice. The state indicated it will notpublish a notice of intent to adopt the rules until after December 3, 2016. Additional information can be found from thelink below.

http://www.comm.media.state.mn.us/bookstore/stateregister/41_14.pdf


http://www.michigan.gov/wca/0,1607,7-191-26922_27470_28076-86583--,00.html

http://www.michigan.gov/wca/0,4682,7-191-26922-335659--,00.html

http://www.michigan.gov/wca/0,4682,7-191--367064--,00.html

http://www.dli.mn.gov/Pdf/docket/5220rule.pdf

http://www.dli.mn.gov/PDF/docket/5219_5221_1216_docket.pdf

http://www.comm.media.state.mn.us/bookstore/stateregister/41_14.pdf

n OnMarch 12, 2015, the state released an email communication advising that the Minnesota Department of Labor andIndustry is proposing rule changes for Minnesota Rules, Parts 5221.6040, 5221.6105, and 5221.6110. The rules wouldmake changes to the long term treatment of injured employees on opioid medications. The proposed rules can beaccessed from the link below.

http://www.dli.mn.gov/PDF/docket/5221Draft2.pdf

n Medical Fee Schedules are typically adopted on an annual basis on October 1.

Previous Updates

n On December 13, 2016, the state posted updates for the Inpatient Hospital Fee schedule in the state register. The updateis effective January 1, 2017. Additional information is available in the link provided below.

http://mn.gov/admin/assets/SR41_24%20-%20Accessible_tcm36-266142.pdf

n On August 31, 2016, the state posted the Compact which contained the new conversion factors for 2017. This can beaccessed from the link below.

http://www.dli.mn.gov/WC/Compact.asp

n On August 4, 2016, the state posted instructions for Converting 2016 Medicare Relative Value Tables for Minnesotaworkers’ compensation use (from October 1, 2016 to September 30, 2017). The instructions can be viewed from the linkprovided below.

http://www.dli.mn.gov/WC/Pdf/steps2accessMedicareRVUtables_2016.pdf

Minnesota (Auto)Future Plans/Proposals


Previous Updates


MississippiFuture Plans/Proposals

n The state typically updates the Inpatient and Outpatient Hospital Fee Schedules annually on October 1.

Previous Updates

n On December 19, 2016, the state posted the DRG Weights, Inpatient Annual Amounts, and Cost-to-Charge Ratios,effective October 1, 2016.

http://www.mwcc.state.ms.us/#/medicalFeeSchedule

n The state adopted a new fee schedule, effective November 12, 2016. The fee schedule can be obtained from Optum, thestate's vendor.

n The state posted the following files to the Fee Schedule Update page:

- 2016 Annual Amounts

- 2016 DRG Relative Weights

- 2016 Cost to Charge Ratio

- 2016 Cost to Charge Ratio for MS LTAC

The change can be found on the state's webpage at the link provided below.



http://www.dli.mn.gov/PDF/docket/5221Draft2.pdf

http://mn.gov/admin/assets/SR41_24 - Accessible_tcm36-266142.pdf

http://www.dli.mn.gov/WC/Compact.asp

http://www.dli.mn.gov/WC/Pdf/steps2accessMedicareRVUtables_2016.pdf



MissouriFuture Plans/Proposals


Previous Updates


MontanaNew Adoptions!

n On January 9, 2017, the state posted the updated mileage rate for 2017. The new rate is $0.535 per mile.

http://erd.dli.mt.gov/work-comp-claims/medical-regulations/meals-lodging-mileage


n The state is expected to update its Professional and Facility Fee Schedules in July 2017.

Previous Updates


NebraskaNew Adoptions!

n On December 28, 2016, the state posted amendments to the Rules of Procedure along with the values for medical,surgical, and hospital Diagnosis-Related Groups (DRGs).

http://www.wcc.ne.gov/publications/rules.pdf

http://www.wcc.ne.gov/publications/recently_adopted_rule_amendments_non-adj.pdf

https://www.wcc.ne.gov/apps/IPUBA0008Jfrm.aspx



Previous Updates


NevadaFuture Plans/Proposals

n On July 27, 2016 the state conducted a workshop on the proposed changes for R071-16, R072-16 and R075-16. Theserules can be accessed from the link below.

http://doi.nv.gov/uploadedFiles/doinvgov/_public-documents/News-Notices/Regulations/2016.06.30 DOIWeb R071-16.pdf

Previous Updates

n On January 28, 2016, the state posted the updated fee schedule, effective February 1, 2016 – January 31, 2017.Additionally, the state also posted the revised Ambulatory Surgery Group and Outpatient Group List. The fee scheduleand the ASC listing can be accessed from the link below.

http://dir.nv.gov/WCS/Medical_Providers/


http://erd.dli.mt.gov/work-comp-claims/medical-regulations/meals-lodging-mileage

http://www.wcc.ne.gov/publications/rules.pdf

http://www.wcc.ne.gov/publications/recently_adopted_rule_amendments_non-adj.pdf

https://www.wcc.ne.gov/apps/IPUBA0008Jfrm.aspx

http://doi.nv.gov/uploadedFiles/doinvgov/_public-documents/News-Notices/Regulations/2016.06.30 DOI Web R071-16.pdf

http://doi.nv.gov/uploadedFiles/doinvgov/_public-documents/News-Notices/Regulations/2016.06.30 DOI Web R071-16.pdf

http://dir.nv.gov/WCS/Medical_Providers/

New HampshireFuture Plans/Proposals


Previous Updates


New Jersey (Auto)Future Plans/Proposals


Previous Updates

n On October 21, 2016, the state posted the adopted amendments to the Medical Protocol rules, effective October 17,2016. The new rules and exhibits can be accessed from the link below.

http://www.state.nj.us/dobi/pipinfo/aicrapg.htm

New MexicoNew Adoptions!

n On December 27, 2016, the state posted the New Mexico Gross Receipts Tax Rate Schedule, effective January - June2017.

http://www.tax.newmexico.gov/gross-receipts-tax-historic-rates.aspx


n Hospital ratios, the Physician Fee Schedule, and Part 7 of the rules are updated annually.

Previous Updates

n On December 5, 2016, the state posted the adopted Fee Schedule & Billing Instructions with the Assigned Hospital Ratiostable and the Director’s Fee Schedule Order, which indicates how the reimbursement amounts have been derived. Theadopted fee schedule is effective January 1, 2017. The fee schedule can be viewed at the link provided below.

http://www.workerscomp.state.nm.us/pdf/NewMexicoPFS2017.pdf

New YorkNew Adoptions!

n On January 3, 2017, the state made available the Durable Medical Equipment (DME) updates, effective January 1, 2017.

http://www.wcb.ny.gov/content/main/hcpp/MedFeeSchedules/20161227_DME_Revision.pdf



n On October 7, 2016, the state posted Subject No. 046-856, indicating that a new workers’ compensation pharmacy benefitplan is in the planning stages. The state will accept comments from stakeholders on the pharmacy benefit plan discussiondocument until November 14, 2016.

The pharmacy benefit plan discussion document recommends:

- All carriers/self-insured employers provide PBM services

- The establishment of a prescription drug formulary

- Limitations on the prescribing of compoundedmedications


http://www.state.nj.us/dobi/pipinfo/aicrapg.htm

http://www.tax.newmexico.gov/gross-receipts-tax-historic-rates.aspx

http://www.workerscomp.state.nm.us/pdf/NewMexicoPFS2017.pdf



- Compliance with medical treatment guidelines on all prescription drug recommendations both in and outside of NYS

- Implementation of the Board-defined reimbursement strategy for brand and generic products

The entire notice and the proposed changes can be viewed at the link provided below.


n On July 11, 2014, the state posted a "proposed medical fee schedule discussion document."

One of the key factors of the proposed changes is to move the current methodology for repricing to a RBRVS (Medicare)based fee schedule in 2015. The New YorkWorkers' Compensation board plans to publish another document similar tothis one in early 2015 for public discussion and comment. However, in the interim, the WCAB is accepting comments andquestions regarding the proposed changes. Since the New York Insurance Department typically adopts the Worker'sCompensation Fee Schedule, these changes will most likely be applicable to auto claims as well.

Previous Updates

n On November 21, 2016, an updated data file for the DME fee schedule was posted. The new fee schedule is effective fordates of service on or after February 15, 2017. The new schedule can be accessed from the link below:


n On October 28, 2016, the state posted an update to the DMEPOS fee schedule, effective December 1, 2016. The newly-updated file can be accessed from the link below.


n On September 8, 2016, the state posted an update to the Podiatry Fee Schedule. The fee schedule is retroactive toFebruary 17, 2014. Subject No. 046-875 and the changes to the fee schedule have been published on the state’s website.These publications can be accessed from the links below.


http://www.wcb.ny.gov/content/main/hcpp/podiatry-fee-schedule-documents.jsp

New York (Auto)Future Plans/Proposals

n On October 7, 2016, the state posted Subject No. 046-856, indicating that a new workers’ compensation pharmacy benefitplan is in the planning stages. The state accepted comments from stakeholders on the pharmacy benefit plan discussiondocument until November 14, 2016.

The pharmacy benefit plan discussion document recommends:

- All carriers/self-insured employers provide PBM services

- The establishment of a prescription drug formulary

- Limitations on the prescribing of compoundedmedications

- Compliance with medical treatment guidelines on all prescription drug recommendations both in and outside of NYS

- Implementation of the Board-defined reimbursement strategy for brand and generic products

The entire notice and the proposed changes can be viewed at the link provided below.


n On September 28, 2016, in the New York State Register, proposed rules were posted for New York No-Fault Regulation83. The state accepted public comments for 45 days from the date of this publication. To view the proposed changes, usethe link provided below.

http://docs.dos.ny.gov/info/register/2016/sept28/pdf/rulemaking.pdf








http://docs.dos.ny.gov/info/register/2016/sept28/pdf/rulemaking.pdf

n On July 11, 2014, the state posted a "proposed medical fee schedule discussion document." This document can be viewedin its entirety from the link provided below.

http://www.wcb.ny.gov/content/main/hcpp/MedFeeSchedules/MedicalFeeScheduleDiscussionDocument.pdf

One of the key factors of the proposed changes is to move the current methodology for repricing to a RBRVS (Medicare)based fee schedule in 2015. The New YorkWorkers' Compensation board plans to publish another document similar tothis one in early 2015 for public discussion and comment. However, in the interim, the WCAB is accepting comments andquestions regarding the proposed changes. Since the New York Insurance Department typically adopts the Worker'sCompensation Fee Schedule, these changes will most likely be applicable to auto claims as well.

Previous Updates

n The Department of Insurance is proposing changes to Regulations 68-C (11 NYCRR 65-3) regarding changing the addressfor the Department of Financial Services. This will also affect the address contained in the NF-10 form. Public commentswere accepted until January 9, 2017. The state is not expecting any opposition to these proposed changes. It will beeffective on the day it is published in the State Register. The proposed changes can be viewed at the following link.

http://www.dfs.ny.gov/insurance/r_prop/rp68ctext.pdf

n On November 21, 2016, an updated data file for the DME fee schedule was posted. The new fee schedule is effective fordates of service on or after February 15, 2017. The new schedule can be accessed from the link below:


n On September 8, 2016, the state posted an update to the Podiatry Fee Schedule. The fee schedule is retroactive toFebruary 17, 2014. Subject No. 046-875 and the changes to the fee schedule have been published on the state’s website.

These publications can be accessed from the links below.



North CarolinaNew Adoptions!

n On January 6, 2017, the state posted an announcement that the mileage rate for 2017 is $0.535 per mile.

http://www.ic.nc.gov/news.html#hot


n The state approved a temporary rule that took effect on January 1, 2017. The temporary rule currently has a legalchallenge being reviewed by the Wake County Superior Court. The state will provide updated information when it isreleased. The notice from the state can be viewed from the link provided below.


Previous Updates

n On December 5, 2016, the Commission met to discuss the adoption of the temporary rule regarding hospitalreimbursement. On December 6, 2016, the Commission approved the temporary rule, effective January 1, 2017. Thetemporary rule can be viewed on the state’s website.

http://www.ic.nc.gov/10J0103AdoptedTempRule.pdf


http://www.wcb.ny.gov/content/main/hcpp/MedFeeSchedules/MedicalFeeScheduleDiscussionDocument.pdf

http://www.dfs.ny.gov/insurance/r_prop/rp68ctext.pdf






http://www.ic.nc.gov/10J0103AdoptedTempRule.pdf

North DakotaFuture Plans/Proposals

n On January 12, 2017, the state posted a news update that reflects several changes to the Medical Fee Schedule that willbe effective January 1, 2017. The data file has not yet been posted.

http://www.workforcesafety.com/news/news-item/updated-fee-schedule-effective-january-1-2017

n Ambulance, Anesthesia, ASC, Clinical Laboratory, Dental, DME, E/M, Guidelines andMedical Services, Home Health,Inpatient Hospital, Medicine, Outpatient Hospital, Pathology, Physician-administered Drugs, physical and OccupationalTherapy, Radiology, and Surgery Fee Schedules are made either annually (based on calendar or fiscal year) or quarterly(January 1, April 1, July 1, and October 1 of each year) as defined in the state's statute.

Previous Updates

n On October 24, 2016, the state posted the updated fee schedules for Ambulatory Surgical Center, Outpatient Hospital,Physician Drug andMedical Provider Fee Schedule, effective October 1, 2016. The new updated schedules can beaccessed from the link below.

https://www.workforcesafety.com/WSI/billingfeeschedule/FeeSchedule/FeeSchedule

OhioNew Adoptions!

n On December 27, 2016, the state posted the following updated rules:

- 4123-6-21 Payment for outpatient medication

- 4123-6-21.1 Payment for outpatient medication by self-insuring employer

- 4123-6-21.3 Outpatient medication formulary

http://www.registerofohio.state.oh.us/pdfs/4123/0/6/4123-6-21$7_PH_FF_N_RU_20160919_0829.pdf

n On December 23, 2016, the state posted the Bureau Fee Schedule. On January 16, 2017, the state reposted the files forthe Bureau Fee Schedule due to an emergency amendment that was released by the Register of Ohio on December 30,2016. The updated files posted to the website include:

- Preamble

- Fees

- Always Therapy Codes

- Base Units 4123-6-21 Payment for outpatient medication

https://www.bwc.ohio.gov/provider/services/FeeSchedules.asp


n On October 27, 2016, the state posted revised filings to amendments for the following rules:

- Payment for outpatient medication – 4123-6-21

- Payment for outpatient medication by self-insuring employer – 4123-6-21.1

- Outpatient medication formulary – 4123-6-21-3

- Payment of hospital inpatient services – 4123-6-37.1

To view the entire revised filings, see the link provided below.

http://www.registerofohio.state.oh.us/jsps/publicdisplayrules/processPublicDisplayRules.jsp?agencyNumberString=4123&actionType=all&doWhat=GETBYFILINGAGENCY&Submit=Search


http://www.workforcesafety.com/news/news-item/updated-fee-schedule-effective-january-1-2017

https://www.workforcesafety.com/WSI/billingfeeschedule/FeeSchedule/FeeSchedule

http://www.registerofohio.state.oh.us/pdfs/4123/0/6/4123-6-21$7_PH_FF_N_RU_20160919_0829.pdf




n The state has posted draft notices regarding the update of the hospital inpatient services, outpatient medication, andoutpatient formulary, to be effective in 2017. The draft rules can be viewed at the link provided below.

https://www.bwc.ohio.gov/basics/guidedtour/generalinfo/OACInReview.asp

n On August 8, 2016, the state posted the proposed Professional Provider Medical Service Fee Schedule to be effectiveJanuary 1, 2017. The proposal can be found on the state’s website.


n The state posted the proposed Hospital Inpatient Reimbursement Rule to be effective February 1, 2017. The proposedchanges include updates to the payment adjustment factor for MS-DRG rate and outlier. The entire proposal can be foundon the state’s website.

https://www.bwc.ohio.gov/downloads/blankpdf/HospInReimburseRule0217.pdf

Previous Updates


OklahomaFuture Plans/Proposals

n Recently the state stakeholders met to review the fee schedule changes. It was announced that there would be no majorchanges in the Medical Fee Schedule this year; however, rules may be added to address new or eliminated codes. Foradditional information, see the link provided below.

https://content.govdelivery.com/accounts/OKWCC/bulletins/16948c6

n The commission formed a group to review possible revisions to the Medical Fee Schedule. The stakeholders will have aproposal for the commissioners to review this fall. The link to review the bulletin is provided below.

https://content.govdelivery.com/accounts/OKWCC/bulletins/1530061

n The state conducted a public hearing on February 18, 2016 to discuss proposed changes to chapters 1, 20, 15, and 25. Thisincluded proposed changes for reimbursement for advance practice registered nurses, drug screen testing for chronic painmanagement, and a process for appealing previously denied decisions under the closed formulary rule.

https://ok.gov/wcc/documents/Proposed%20Permanent%20Rules%20Adopted%20on%203-23-16.pdf

Previous Updates

n Recently, the state adopted the changes for reimbursement for advanced practice registered nurses, drug screen testingfor chronic pain management, and appeal processes. These changes became effective September 12 , 2016.

https://www.ok.gov/wcc/documents/2016%20new%20Permanent%20Rules%20effective%209.12.16.pdf

OregonFuture Plans/Proposals

n The state usually updates its cost-to-charge ratio in April and October of each year.

n On January 17, 2017, the state released its proposed rules to update OAR 436-009, OregonMedical Fee and PaymentRules and OAR 436-010, Medical Services. A public hearing is scheduled for February 16, 2017. Public comments can besubmitted until February 17, 2017.

Changes to OAR 436-009 include the following:

- Update of Appendices

- Balance Billing rules

- Cost-to-charge ratios for hospitals will only be published by bulletin once a year


https://www.bwc.ohio.gov/basics/guidedtour/generalinfo/OACInReview.asp


https://www.bwc.ohio.gov/downloads/blankpdf/HospInReimburseRule0217.pdf

https://content.govdelivery.com/accounts/OKWCC/bulletins/16948c6

https://content.govdelivery.com/accounts/OKWCC/bulletins/1530061

https://ok.gov/wcc/documents/Proposed Permanent Rules Adopted on 3-23-16.pdf

https://www.ok.gov/wcc/documents/2016 new Permanent Rules effective 9.12.16.pdf

- Increase conversion factors

- Increase interpreter services

Changes to OAR 436-010 include the following:

- Clarify rules for chiropractic physicians, naturopathic physicians, and physician assistants

- Authorization of temporary disability benefits

The entire proposed rules can be found at the link provided below.

http://wcd.oregon.gov/laws/Documents/Proposed_rules_and_testimony/Div-009-010/9-10-17XXXp.pdf

Previous Updates

n On December 16, 2016, the state posted temporary rules OAR 436-009 to update the reference materials and new codes.The update is effective January 1, 2017. The rules can be accessed from the links provide below.

http://wcd.oregon.gov/laws/Pages/new-rules.aspx

http://wcd.oregon.gov/medical/Pages/payment-tables.aspx

n On September 19, 2016, the state posted a corrected bulletin for the Hospital Fee Schedule The revised bulletin replacesthe bulletin that was released on September 15. The revised adjusted cost-to-charge ratios can be accessed from the linkbelow.


n On September 12, 2016, the state posted updated Bulletin 290 Hospital Cost-to-Charge Ratios, effective October 1, 2016.The updated bulletin can be accessed at the link provided below.


n The state held an advisory committee meeting to discuss changes to the OAR 436-009-0110, “Interpreters,” in the OregonMedical Fee and Payment Rules on June 21, 2016 at 9:00 pt. To obtain additional information, contact Fred Bruyns [email protected] or call 503-947-7717.

Oregon (Auto)Future Plans/Proposals

n The state usually updates its cost-to-charge ratio in April and October of each year.

Previous Updates

n On December 16, 2016, the state posted temporary rules OAR 436-009 to update the reference materials and new codes.The update is effective January 1, 2017. The rules can be accessed from the links provide below.



n On September 19, 2016, the state posted a corrected bulletin for the Hospital Fee Schedule The revised bulletin replacesthe bulletin that was released on September 15. The revised adjusted cost-to-charge ratios can be accessed from the linkbelow.


n On September 12, 2016, the state posted updated Bulletin 290 Hospital Cost-to-Charge Ratios, effective October 1, 2016.

The updated bulletin can be accessed at the link provided below.



http://wcd.oregon.gov/laws/Documents/Proposed_rules_and_testimony/Div-009-010/9-10-17XXXp.pdf










n The state held an advisory committee meeting to discuss changes to the OAR 436-009-0110, “Interpreters,” in the OregonMedical Fee and Payment Rules on June 21, 2016 at 9:00 pt. To obtain additional information, contact Fred Bruyns [email protected] or call 503-947-7717.

OWCP (Longshore)Future Plans/Proposals

n The next Medical Fee Schedule is expected to be effective sometime in 2016.

Previous Updates

n On September 22, 2016, the OWCP posted an update to the Medical Fee Schedule data. The update included changes toCPT, HCPCS, ADA, and OWPC codes with RVUs and conversion factors. These changes are effective September 8, 2016and can be accessed from the link provided below.

https://www/dol.gov/owcp/regs/feeschedule/fee/fee15/fs15_code_rvu_cf.pdf

PennsylvaniaNew Adoptions!

n On January 13, 2017, the state’s vendor posted an update to the Fee Schedule data to include new and deleted HCPCScodes, effective January 1, 2017.

n The state’s vendor released a second update to the BWC Part B Medical Fee Schedule, effective January 1, 2017. Thenotification states that the previous update is superseded by this recent update.


n Chargemaster, Part A (Tables A-I), and physician updates are generally adopted quarterly in January, April, July, andOctober.

Previous Updates

n On December 19th, 2016, the data files for Part A (tables A-J) and Part B Medical Providers were received from the state'svendor. The files are effective January 1, 2016.

n On September 20, 2016, the data files for Part A (tables A-J) and Part B Medical Providers were received from the state’svendor. The files are effective October 1, 2016.

Pennsylvania (Auto)Future Plans/Proposals

n Data files from CMS for ambulance, anesthesia, ASC, ASP drug, clinical labs, drug, DMEPOS, HCPCS, home health,inpatient hospital, outpatient hospital, physician, rehabilitation, and skilled nursing services are updated periodically withan addedmarkup, when applicable, as defined in the state's statute. These updates are made either annually (based oncalendar or fiscal year) or quarterly (January 1, April 1, July 1, and October 1 of each year).

Previous Updates







https://www/dol.gov/owcp/regs/feeschedule/fee/fee15/fs15_code_rvu_cf.pdf
























Rhode IslandFuture Plans/Proposals
















Previous Updates

n On December 1, 2016, the state posted updates to the Fee Schedule Rules and Rates. The effective date is November 1,2016. Listed below are some of the updates.

- Massage Therapy Guidelines

- Pharmacy Guidelines

- Physical and Occupational Therapy

- Work Hardening and Functional Capacity

- 00000 - 09999 Anesthesia Rates

- 80000 - 89999 Laboratory Rates

- 90000 - 98999 Medical Rates

- 99000 - 99999 Evaluation andManagement Rates

- A0000 - V9999 HCPCS Rates

- X000 - XV999 Workers Compensation Specific Rates

The link to the updates is provided below.

https://www.risingms.com/services/data-fee-schedules/ri-workers-compensation-medical-fee-schedule/end-user-agreement-2016/fee-schedule-2016/

South CarolinaNew Adoptions!

n On December 28, 2016, the state indicated that the mileage rate for 2017 will decrease to $0.535 per mile for workersthat travel for medical treatment.

http://www.wcc.sc.gov/welcomeandoverview/compensationrates/pages/default.aspx


n Medicare ASP drug, inpatient PPS, outpatient PPS, and rehabilitation PPS updates occur in January, April, July, and Octoberof each year.

Previous Updates

n On December 22, 2016, the state posted its updated mileage reimbursement rate, effective January 1, 2017. The rate hasdecreased from $0.54 to $0.53.5.

n On September 1, 2016, the newly revised fee schedule became effective. Information on ordering the fee schedule fromthe vendor Optum Insights can be obtained on the state’s website.

http://www.wcc.sc.gov/MSPM/Pages/default.aspx

South DakotaFuture Plans/Proposals


Previous Updates

n On August 12, 2016, the vendor for South Dakota posted corrections to the fee schedule, retroactive to June 28, 2016.

n The state adopted fee schedule changes, effective June 28, 2016. The changes can be accessed from the link below.

http://sdlegislature.gov/rules/DisplayRule.aspx?Rule=47:03:05




http://www.wcc.sc.gov/welcomeandoverview/compensationrates/pages/default.aspx

http://www.wcc.sc.gov/MSPM/Pages/default.aspx

http://sdlegislature.gov/rules/DisplayRule.aspx?Rule=47:03:05

TennesseeFuture Plans/Proposals

n On July 19th, 2016, the state held a public meeting to discuss the following:

- Comments on the Medical Fee Schedules, 0800-02-17,0800-02-18

- Rules for Medical Payments, Medical Fee Schedule

- Inpatient Hospital Fee Schedule

- NCCI Report

- 0800-02-19

For more information regarding this meeting please see the link below.

https://www.tn.gov/assets/entities/labor/attachments/MPC_Public_Notice1.pdf

n Effective March 22, 2016, the state proposed to adopt new deposition fees under Chapter 0800-02-16 by adding thefollowing changes:

- "Licensed physicians may charge their usual and customary fee for providing testimony by deposition to be used in aworkers’ compensation claim, provided that such fee does not exceed seven hundred fifty dollars ($750) for the firsthour.

- Depositions requiring over one (1) hour in duration shall be pro-rated at the licensed physician’s usual and customaryfee as set forth above, not to exceed four hundred fifty dollars ($450) per hour for deposition time in excess of one (1)hour. Physicians shall not charge for the first quarter hour of preparation time in excess of one quarter hour shall beadded to and included in the deposition time and billed at the same rates as for the deposition.

- Physicians may require pre-payment of a maximum of $750.00 for the deposition or in-person appearance; provided,that the following completion, the physician may bill for other amounts appropriately due. The payer may recover anyamounts that were overpaid.

- An additional fee of up to two hundred fifty dollars ($250) may be charged for a video deposition.

- Physicians who are late for a deposition may only be reimbursed for the time in attendance and not from the time ofthe scheduled deposition.

The proposed rule filing can be accessed from the link below.


n The state filed a proposed rulemaking to adopt medical treatment guidelines forWorkers’ Compensation. The stateproposed using the Work Loss Data Institute Official Disability Guidelines (ODG). If adopted, the new guidelines would gointo effect on February 28, 2016. The rule filing form and proposed rules can be found at the links provided below.


http://tnsos.org/rules/PendingRules.php

Previous Updates


TexasFuture Plans/Proposals

n CMS ambulance and HCPCS data file updates are made annually based on calendar year or fiscal year. Clinical laboratory,DMEPOS, drug, inpatient hospital, outpatient hospital, and physician services data from CMS is updated quarterly. Thestate's statutes and rules apply added markups to applicable CMS data files.


https://www.tn.gov/assets/entities/labor/attachments/MPC_Public_Notice1.pdf



http://tnsos.org/rules/PendingRules.php

Previous Updates









n On December 6, 2016, the state posted Bulletin B-0024-16 that contains the update to the annual Medical Fee GuidelineConversion Factors, effective January 1, 2017. The bulletin can be found on the state’s website.

http://www.tdi.texas.gov/wc/news/advisories/index.html

n Recently, the state of Texas adopted non-substantive changes to rule §134, effective September 1, 2016. These changesrestructure the medical fee guidelines, add new sections, and update existing rule language for services provided on orafter September 1, 2016. The memo, the side-by-side comparison and the amended/repealed rule can be accessed fromthe links provided below.

Adoption Document

Comparison Document

Rules


















http://www.tdi.texas.gov/wc/news/advisories/index.html

http://www.tdi.texas.gov/wc/rules/adopted/documents/ao134m0616.pdf

http://www.tdi.texas.gov/wc/rules/adopted/documents/ao134cht0616.pdf

http://www.tdi.texas.gov/wc/rules/2016rules.html













UtahFuture Plans/Proposals


Previous Updates

n On December 1, 2016, the state’s vendor posted updates to the fee schedule conversion factors and resource materials.Then on December 2, 2016, the state posted its Medical Fee Standards 2017, effective December 1, 2016. The MedicalFee Standards, 2017 can be found on the state’s website.

https://laborcommission.utah.gov/media/pdfs/industrialaccidents/pubs/2017MedFeeStandards.pdf

Utah (Auto)Future Plans/Proposals


Previous Updates


VermontFuture Plans/Proposals

n OnMay 25, 2016, the state posted proposed rules regarding denying or discontinuing payment for opioid medications.The deadline for public comments was July 14, 2016. The summary of the proposed rules can be found on the state’swebsite.

https://secure.vermont.gov/SOS/rules/display.php?r=380

n The state posted proposed changes to Rule 40, which includes the workers' compensation fee schedule. The stateaccepted comments through September 30, 2011, regarding these proposed changes. Proposed amendments to Rule 40were filed with the Interagency Committee on Administrative Rules on August 30, 2012. Since that time, there has beenno move to adopt Rule 40 updates; however, the state indicated that it hopes that the new rules will be adopted possiblyin 2016.

Previous Updates







https://laborcommission.utah.gov/media/pdfs/industrialaccidents/pubs/2017MedFeeStandards.pdf

https://secure.vermont.gov/SOS/rules/display.php?r=380

VirginiaNew Adoptions!

n On January 24, 2017, the state posted the draft proposal of the Medical Fee Schedule. Comments are due by February 15,2017. The instructions and draft can be found on the state's website.

http://www.vwc.state.va.us/


n The state has posted the timeline for the medical fee schedule. It can be accessed from the link below.

http://www.vwc.state.va.us/content/medical-fee-schedule-project-timeline

Previous Updates

n OnMarch 7, 2016, the Governor signed HB 378 which now establishes the creation of a Medical Fee Schedule forreimbursement of medical services provided to injuries arising out of workers’ compensation. The fee schedule will beeffective January 1, 2018. To view the bill in its entirety use the link provided below.

http://leg1.state.va.us/cgi-bin/legp504.exe?ses=161&typ=bil&val=hb378

n The state adopted emergency regulations regarding rules 16VAC30-50 from the Virginia Workers’ CompensationCommission (amending 16VAC30-50-150). Changes to the regulation include but are not limited to the “definition ofcommunity” and the zip codes associated with the different communities. The regulation changes can be viewed in itsentirety at the link below.

http://register.dls.virginia.gov/details.aspx?id=5455

WashingtonNew Adoptions!

n The Department of Labor and Industries adopted a rule change to allow for the elimination of the existing differentialpayment for Advanced Registered Nurse Practitioners (ARNP), effective November 15, 2016. Additional information canbe found in the link provided below.



n On July 19, 2016, the state proposed changes toWAC section 296-23-245, which will delete the following language:

The rate of reimbursement for the services billed by advanced registered nurse practitioners will be ninety percent of thevalue listed in the fee schedules.

The proposed can be found at the following link.

http://lawfilesext.leg.wa.gov/law/wsr/2016/12/16-12-078.htm

n Historically, the state updates the ASC, Hospital, and Physician Fee Schedules and rules on July 1 each year.

Previous Updates

n On December 19th, 2016, the state posted the following amendments:

- 2017 ASC Fee Schedule Updates and deleted ASC codes, effective December 31, 2016

- Deleted procedure codes, invalid after December 31, 2016

- New CPT and HCPCS, effective January 1, 2017

These changes can be accessed from the link provided below.

http://www.lni.wa.gov/ClaimsIns/Providers/Billing/FeeSched/2016/Updates2016.asp


http://www.vwc.state.va.us/

http://www.vwc.state.va.us/content/medical-fee-schedule-project-timeline

http://leg1.state.va.us/cgi-bin/legp504.exe?ses=161&typ=bil&val=hb378

http://register.dls.virginia.gov/details.aspx?id=5455


http://lawfilesext.leg.wa.gov/law/wsr/2016/12/16-12-078.htm


n On November 1, 2016, the state made corrections to HCPC code J3301 and J8700 for both non-facility fees and facilityfees. For additional information, use the link provided below.


n On August 1, 2016, the state posted an update to the Physical Medical Services section of the fee schedule to add code1098M (Supplemental Functional Capacity Evaluation) with the maximum reimbursement fee of $125.68. The update canbe found on the state’s website.


West VirginiaFuture Plans/Proposals

n The ASC, Clinical Lab, HCPCS, Hospital, Medical, and Pharmacy Fee Schedules will now be conforming to the updateschedule that Medicare adopts on a quarterly basis.

Previous Updates









WisconsinNew Adoptions!

n On January 13, 2017, the state's vendor posted the updated certified database files, effective January 1, 2017.


n The state usually updates its hospital radiology database in January and July of each year.

Previous Updates

n On August 18, 2016, the state posted the updated data file for the hospital radiology database, effective July 1, 2016. Thedatabase can be accessed from the link below.

http://dwd.wisconsin.gov/wc/insurance/radiology/radiology_data.htm

WyomingFuture Plans/Proposals

n The state is proposing changes to the following rules:

- Chapter 6, Section 2 (Contested Case Proceedings), increase reimbursement for members of the Medical Commission.

- Chapter 10, Section 6 (Blood-borne Pathogen Testing and Prophylactic Care), reducing redundancy in formatting.










http://dwd.wisconsin.gov/wc/insurance/radiology/radiology_data.htm

- Chapter 10, Section 16 (Miscellaneous Medical Protocols), clarify criteria permitting massage therapy provider uponorders from the treating health care provider.

- Chapter 10, Section 19 (Off-label use of Medical Services), changes from one (1) to two (2) positive prospective,randomized, placebo-controlled, double-blind trial.

- Chapter 10, Section 21 (Physical Medicine and Restorative Services), changes from adopting the most current editionsof the Rehabilitation Therapy Utilization Guidelines for the Care and Treatment of InjuredWorkers and theChiropractic Utilization Guidelines for the Care and Treatment of InjuredWorkers.

- Chapter 10, Section 25 (Miscellaneous Medical Protocols), clarifies the physicians dispensing pharmaceuticals fromtheir offices will be reimbursed the same amount as a pharmacy.

Public comments were accepted from June 1, 2016 - July 18, 2016.

The proposed rules can be viewed from the link provided below.

http://soswy.state.wy.us/Rules/default.aspx

Previous Updates

n On December 7, 2016, the state’s vendor posted an update to the fee schedule, effective December 1, 2016.

n On November 1, 2016, the state posted a provider bulletin stating that cervical traction devices will not be authorizedbecause it is deemed not medically necessary for treatment. Upon further clarification with the state, this applies to HCPCScodes E0855 and E0849. To view the bulletin, use the link provided below.

http://www.wyomingworkforce.org/_docs/providers/bulletins/2016-10-Cervical-Traction-Devices.pdf

n On October 21, 2016, the state posted a provider bulletin for adopted changes to the guidelines for TranscutaneousElectric Nerve Stimulators (TENS). Some of the adopted changes include:

- 2 Leads TENS units (single channel) is now E0720

- 4 Leads TENS units (dual channel) is now E0730

These changes are effective October 6, 2016 and can be accessed from the link below.

http://www.wyomingworkforce.org/_docs/providers/bulletins/2016-10-TENS.pdf


http://soswy.state.wy.us/Rules/default.aspx

http://www.wyomingworkforce.org/_docs/providers/bulletins/2016-10-Cervical-Traction-Devices.pdf

http://www.wyomingworkforce.org/_docs/providers/bulletins/2016-10-TENS.pdf

AAPC: American Academy of Professional Coders

AASCIF: American Association of State CompensationInsurance Funds

ACA: Affordable Care Act

ACD: Actual Charge Data

ACO: Accountable Care Organization

ACOEM: American College of Occupational andEnvironmental Medicine

ACORD: Association for Cooperative Operations Researchand Development

ADA: American Dental Association

AER: Annual Expenditure Report (New Mexico)

AHIMA: American Health Information ManagementAssociation

AI: At Invoice

AIA: American Insurance Association

ALFA: American Law Firm Association

AMA: American Medical Association

AME: AgreedMedical Evaluator

ANE: Allowance Not Established

ANSI: American National Standards Institute

AOE/COE: Arising Out of Employment/Occurring in theCourse of Employment

APC: Ambulatory Payment Classification

APR-DRG: All Patient Refined-Diagnosis Related Groups

ASA: American Society of Anesthesiologists

ASC: Ambulatory Surgery Center/Accredited StandardsCommittee

ASCX12: The Accredited Standards Committee X12

ASIS: American Society for Industrial Security

ASP: Average Sales Price/Application Service Provider

ASTC: Ambulatory Surgical Treatment Center

AUC: Administrative Uniformity Committee

AWP: Average Wholesale Pharmaceuticals/AverageWholesale Price

AWV: Annual Wellness Visit

BARC: Bill Adjustment Reason Code

BAV: Basic Anesthesia Value

BR: By Report

CAH: Critical Access Hospital

CARC: Claims Adjustment Reason Code

CCR: Cost-to-Charge Ratio

CCWC: California Coalition onWorkers’ Compensation

CDC: Centers for Disease Control and Prevention

CDT: Current Dental Terminology (code)

CFR: Code of Federal Regulations

CMR: Code of Massachusetts Regulations

CMS: Centers for Medicare andMedicaid Services

COHE: Centers of Occupational Health and Education

CPI: Consumer Price Index

CPT: Current Procedural Terminology (code)

CRNA: Certified Registered Nurse Anesthetist

CTOB: Client Type of Bill

CWCI: California Workers’ Compensation Institute

DAW: Dispense as Written

DCN: Document Control Number

DISA: Data Interchange Standards Association

DIR: Department of Industrial Relations (California)

DME: Durable Medical Equipment

DMEPOS: Durable Medical Equipment, Prosthetics,Orthotics, and Supplies

DMS: DocumentManagement System

DN: Data Number

Acronym Glossary

Fee Schedule & Legislative News51

DOH: Department of Health

DOI: Date of Injury

DOL: Date of Loss/Department of Labor

DOS: Date(s) of Service

DRG: Diagnosis Related Group

DSH: Disproportionate Share Hospital

DWC: Department ofWorkers’ Compensation or Division ofWorkers’ Compensation

EAMS: Electronic Adjudication Management System

EDI: Electronic Data Interchange (or Interface)

EFT: Electronic Funds Transfer

EHNAC: Electronic Healthcare Network AccreditationCommission

E/M or E&M: Evaluation andManagement

EOB: Explanation of Benefits

EOBR: Explanation of Bill Review

EOR: Explanation of Review

ER: Emergency Room

FAQ: Frequently Asked Question

FEIN: Federal Employer Identification Number

FFS: Fee For Service

FISS: Fiscal Intermediary Standard System

FOIA: Freedom of Information Act

FR: Federal Register

FROI: First Report of Injury

FTP: File Transfer Protocol

GEAP: Generic Equivalent Average Price

GEM: General Equivalence Mapping

GPCI: Geographic Practice Cost Indices

HCO: Health Care Organization

HCPCS: Healthcare Common Procedure Coding System

HHS: Department of Health and Human Services

HIPAA: Health Insurance Portability and Accountability Actof 1996

HIPPS: Health Insurance Prospective Payment System

HITECH: The Health Information Technology for Economicand Clinical Health

HOPPS: Hospital Outpatient Prospective Payment System

HPP: Health Partnership Program

HPSA: Health Professional Shortage Area

HRA: Health Risk Assessment

HRSA: Health Resources and Services Administration

IAIABC: International Association of Industrial AccidentBoards and Commissions

IC: Individual Consideration

ICD-9: International Classification of Diseases 9th Revision

ICD-10: International Classification of Diseases 10thRevision

ICD-10-CM: International Classification of Diseases 10thRevision Clinical Modification

ICD-10-PCS: International Classification of Diseases 10thRevision Procedure Classification System

IME: IndependentMedical Evaluation or Impartial MedicalExamination/Examiner

IPF: Inpatient Psychiatric Facility

IR: Impairment Rating

IRF: Inpatient Rehabilitation Facility

IWFC: International Workers’ Compensation Foundation

LOS: Length of Stay

LPM: Liter Per Minute

MAE: Office of Monitoring, Audit and Enforcement (Maine)

MAP: Maximum Allowable Payment

MAR: Maximum Allowable Reimbursement

MCCA: Michigan Catastrophic Claims Association

MCN: Manual Change Notification

MCO: Managed Care Organization

MedPAC: Medicare Payment Advisory Committee

MEEAC: Medical Evidence Evaluation Advisory Committee

MITS: Medicaid Information Technology System

MMA: Medicare Modernization and Improvement Act of2006


MMI: Maximum Medical Improvement

MMSEA: Medicare, Medicaid, and SCHIP Extension Act of2007

MPC: Medical Payments Coverage

MPFS: Medicare Physician Fee Schedule

MPN: Medical/Medicare Provider Network

MRA: Maximum Reimbursement Allowance

MRI: Magnetic Resonance Imaging

MSA: Metropolitan Statistical Area

MSCF: Maryland Specific Conversion Factor

MS-DRG: Medicare Severity Diagnosis Related Group

MT: Message Therapy

MTB: Maximum Therapeutic Benefit

MTC: Maintenance Type Code

MTG: Medical Treatment Guidelines

MTUS: Medical Treatment Utilization Schedule

MUE: Medically Unlikely Edit

NAIC: National Association of Insurance Commissioners

NAMIC: National Association of Mutual InsuranceCompanies

NC: Not Covered

NCCI: National Correct Coding Initiative/National Council onCompensation Insurance

NCHS: National Center for Health Statistics

NCOIL: National Conference of Insurance Legislators

NCPDP: National Council for Prescription Drug Programs

NCVHS: National Committee on Vital and Health Statistics

NDC: National Drug Code

NGD: Negotiated Discount

NGHP: Non-Group Health Plan

NHIN: Nationwide Health Information Network

NICB: National Insurance Crime Bureau

NJCRIB: New Jersey Compensation Rating and InspectionBureau

NPI: National Provider Identification (number)

NPPES: National Plan and Provider Enumeration System

NUBC: National Uniform Billing Committee

NUCC: National Uniform Claim Committee

OAL: Office of Administrative Law (California)

OAR: Oregon Administrative Rules

OCE: Outpatient Code Editor (system)

ODG: Official Disability Guidelines

ODS: Organized Delivery System

ODJFS: Ohio Department of Job & Family Services

OESS: Office of E-Health Standards and Services

OIG: Office of the Inspector General

OMFS: Official Medical Fee Schedule

OPPS: Outpatient Prospective Payment System

OSIP: Office of Self Insurance Plans (California)

OWCP: Office ofWorkers’ Compensation Programs

PAS: Product of Ambulatory Surgery

P&C: Property and Casualty

PBM: Pharmacy Benefit Management

PBN: Pharmacy Benefit Network

PC: Professional Component

PCIAA: Property Casualty Insurers Association of America

PD: Permanent Disability

PDL: Preferred Drug List

PEN: Parenteral and Enteral Nutrition

PEO: Professional Employer Organization

PHDSC: Public Health Data Standards Consortium

PHI: Protected Health Information

PIHP: Prepaid Inpatient Health Plan

PIP: Personal Injury Protection

POS: Place of Service

PPACA: Patient Protection and Affordable Care Act

PPD: Permanent Partial Disability

PPI: Permanent Partial Impairment

PPO: Preferred Provider Organization


PPP: Preferred Provider Program

PPS: Prospective Payment System

PQRS: Physician Quality Reporting System (CMS)

PSF: Provider Specific File (CMS)

PT: Physical Therapy

QIW: Qualified InjuredWorker

QME: Qualified Medical Evaluator

RARC: Remittance Advice Remark Code

RBRVS: Resource Based Relative Value Scale

RCC: Ratio of Cost-to-Charge

RCW: Revised Code ofWashington

RFA: Request For Authorization

RFP: Request for Proposal

RN: Registered Nurse

RNE: Relative Value Not Established

RUG: Resource Utilization Group

RVD: Relative Values for Dentists

RVP: Relative Values for Physicians

RVS: Relative Value Study (or Scale)

RVU: Relative Value Unit(s)

SERFF: System for Electronic Rate and Form Filing

SGR: Sustainable Growth Rate

SIC: Standard Industrial Classification (code)

SIF: Second Injury Fund

SNF: Skilled Nursing Facility

SOS: Site of Service

SPA: State Plan Amendment(s)

SROI: Subsequent Report of Injury

SSD: Social Security Disability

SSL: Secure Sockets Layer

TC: Technical Component

TD: Temporary Disability

TDI: Texas Department of Insurance

TIN: Tax Identification Number

TOS: Type of Service

TPA: Third Party Administrator

TR3: Technical Report Type 3

TXANS: Texas Association of Responsible Non-subscribers

UB: Uniform Bill Patient Summary

UC: Usual and Customary

UCR: Usual, Customary, and Reasonable

UDF: User-defined Field

UPL: Upper Payment Limits

UR: Utilization Review

URAC: Utilization Review Accreditation Commission

UV: Unit Value

VPN: Voluntary Provider Network

WC: Workers' Compensation

WAC: Wholesale Acquisition Cost

WCA: Workers’ Compensation Administration

WCAC: Workers’ Compensation Advisory Council

WCB: Workers’ Compensation Board

WCC: Workers’ Compensation Commission

WCIO: Workers’ Compensation Insurance Organizations

WCIRB: Workers’ Compensation Insurance Rating Bureau ofCalifornia

WEDI: The Workgroup for Electronic Data Interchange

WHO: World Health Organization

WLDI: Work Loss Data Institute

WSI: Workforce Safety & Insurance (North Dakota)

XML: Extensible Markup Language
