Updated July 2014
Keep current with new legislation and its potential effect on your organization. This regulatory update is for informational purposes only, and provides some key highlights on state initiatives that may impact the services GENEX provides.
CMS: On May 29, 2014, the Centers for Medicare and Medicaid Services (CMS) amended the recently released Workers’ Compensation Reference Guide published in February 2014. The changes affect medical review, treating physician reports, pharmacy records, and Merit Orders, among others. Click here to view.
CDC: The CDC analyzed 2012 prescribing data collected from retail pharmacies in the United States by a commercial vendor. CDC calculated prescribing rates by state for various types of opioid painkillers.
Key findings include:
- Southern states – Alabama, Tennessee, and West Virginia in particular – had the most painkiller prescriptions per person.
- The Northeast, especially Maine and New Hampshire, had the most prescriptions per person for long-acting/extended-release painkillers and for high-dose painkillers.
- State variation was the greatest for oxymorphone (a specific type of painkiller), among all prescription painkillers. Nearly 22 times as many prescriptions were written for oxymorphone in Tennessee as were written in Minnesota. Click here to view.
ALASKA In an effort to relieve some of the burden on small employers, the governor recently signed HB 141 dealing with workers’ compensation. By defining the rates for out-of-state services, HB 141 eliminates the potential for workers’ compensation claims provided in another state to be billed at Alaska’s higher rates for the same service. Alaska has some of the highest premiums in the nation. The bill helps small employers by creating more stability and predictability when dealing with workers’ compensation claims. Click here to view.
ARIZONA New prescription drug-monitoring program rules necessitated by a missed deadline that left the previous rules unenforceable will take effect August 2, 2014, according to an Arizona Board of Pharmacy item in the state’s Administrative Register. Click here to view.
HB 2046 - This bill makes revisions related to the Arizona health care cost containment system. Click here to view.
COLORADO HB 1383 takes effect April 1, 2015. Colorado employers will have to double the number of physicians their employees can choose from for treatment of workplace injuries. HB 1383 requires most businesses to offer a list of four physicians who can treat work injuries, twice the number of providers that must be offered under existing law. Employers in rural areas would be exempt from the requirement to offer four physicians, and will be allowed to continue providing workers a list of two providers. The proposed reforms would have also prohibited employers from reducing settlements by 50% for safety violations or requiring a worker resign as a condition of a settlement. Click here to view.
ILLINOIS SB 3287 was signed into law. This bill excludes safety consultants from exclusive remedy provisions of Illinois' workers’ comp law. The bill removes protection from "service organization(s)" that are "retained" by employers or insurers to provide safety advice or service, but does not affect safety services provided by brokers or insurers. Click here to view.
SB 2187 was signed into law. Illinois is the third state in the nation, joining New Mexico and Louisiana, that authorizes psychologists to write prescriptions used to treat mental illnesses. The bill requires licensed clinical psychologists to complete advanced education and training in psychopharmacology, as well as supervised clinical training in settings, such as hospitals, outpatient clinics, mental health clinics, and correctional facilities. Limitations on psychologists prescribing in SB 2187 will allow these providers to write scripts for antidepressants, but not for stimulants. Additionally, they can’t prescribe for children, adolescents, adults 66 or older, pregnant women, or individuals with developmental disabilities. Click here to view.
LOUISIANA The Office of Workers' Compensation posted the adoption of rules related to Medical Treatment Guidelines for Chapter 20- 23 of Title 40, effective June 20, 2014. The utilization review amendments alter the existing medical treatment schedule authorization and dispute resolution rules. The amendments also add provisions addressing approval of a defined number of evaluation and management office visits in an otherwise compensable claim. The amended rules can be viewed in the June 20, 2014 edition of the Louisiana Register. Click here to view.
MINNESOTA Chapter 311, SF 2470 signed into law. This bill creates a patient registry under the Department of Health relating to the therapeutic use of medical cannabis. It authorizes the use of medical cannabis in limited forms for certain qualifying medical conditions and regulates the distribution and manufacture of medical cannabis. It also creates a task force to conduct an impact assessment on medical cannabis therapeutic research and provides for certain criminal and civil protections for parties involved in the registry program. Click here to view.
WATCH LIST: New York: A9721 and S7634 are awaiting signature by the governor. These bills would authorize reimbursement for acupuncture treatments in workers’ compensation cases. Under the bill, the chairman of the Workers’ Compensation Board would set the rates and terms of reimbursement. Click here to view.
The state Workers’ Compensation Board (WCB) posted proposed rules in the New York State Register on July 9, 2014 that would adopt Non-Acute Pain Medical Treatment Guidelines, which are set to go into effect August 13, 2014. The guidelines emphasize best practices for prescribing narcotics for injured workers in light of the national epidemic of opioid abuse, but they also address non-pharmacological treatments ranging from chiropractic visits to cognitive behavioral therapy. The guidelines reflect the consensus for diagnosing and managing chronic pain of the dozen medical professionals on the WCB’s Medical Advisory Committee. Click here to view.
The governor signed a series of bills (S 7908/A 10157) this week designed to combat the state’s growing heroin and opioid epidemic. The bills include measures to strengthen penalties and put in place new tools for law enforcement to crack down on the distribution of illegal drugs. For example, S 7908/A 10157 creates the offense of prescription medical fraud and deceit to address doctor shopping. It criminalizes behavior by individuals who obtain a controlled substance or a prescription by misrepresenting themselves as a doctor or pharmacist, or by presenting a forged prescription. Click here to view.
Another measure, S 04588 and A 08285, promotes the proper use of naloxone, which can reverse the effects of a heroin overdose. The bill ensures that health care professionals can prescribe naloxone by non-patient specific prescription, making it more readily available to police officers and first responders. Last year there were 89,269 cases of heroin and prescription opiate treatment admissions in the State of New York, an increase from 63,793 in 2004. Click here to view.
On June 12, 2014, the New York State Workers' Compensation Board posted several Subject Number notifications (Subject Numbers 046-692, 046-693 and 046-694) regarding health care providers authorized to treat injured workers under workers' compensation. Click here to view.
OKLAHOMA The governor has approved the Oklahoma Insurance Department’s emergency rules for pharmacy benefit managers, effective immediately. The rules set an initial application fee of $1,000 for a PBM license, which is nonrefundable if the application is denied, withdrawn, cancelled, or refused. An issued license will be in effect for one year, and renewal will cost an applicant $500. Failure of timely application for renewal will result in automatic expiration of the license. The emergency rules are in effect until September 14, 2015, unless superseded by another rule or disapproved by the state Legislature. Click here to view.
OREGON The Workers’ Compensation Division has updated several of its disability calculators. These calculators now include the state average weekly wage applicable to benefits paid on or after July 1, 2014. Here are links to the calculators posted to the division’s website: Calculator main page and temporary partial/temporary total disability.
On June 9, 2014, the Oregon Workers’ Compensation Division adopted a temporary rule to postpone the scheduled July 1, 2014 effective date for adoption of new electronic medical-billing rules. The division planned to adopt the International Association of Industrial Accident Boards and Commissions Electronic Data Interchange Implementation Guide for Medical Bill Payment Records, Release 2.0. The division did not say when it plans to repeal the temporary rule. Click here to view a notice of the temporary rule.
TEXAS The results of a Workers’ Compensation Research Institute study suggest that a closed pharmacy formulary similar to the one implemented in Texas could reduce the prevalence and costs of prescription drugs in other states. The WCRI study cited 2013 numbers from the Texas Department of Insurance report, which showed that new claims with non-formulary drugs that required preauthorization decreased by 67% from 2010 to 2011. Prescriptions written for non-formulary drugs decreased by about 70% for those new claims, and non-formulary drugs’ share of the total prescription drug costs for new claims decreased by more than 80%. Prescriptions for drugs included in the formulary fell by 4%, and total opioid prescriptions fell by 10%. Click here to purchase the WCRI study.
The state held a public hearing on June 16, 2014 regarding Rule 152.3 and 152.4, Attorney's Fees. These rules include the following changes: 1) Approval or denial of fees by the commission , and 2) Guidelines for legal services provided to the claimants and carriers. Click here to view information regarding the proposed rule.
WEST VIRGINIA HB 4208 was effective June 6, 2014. This legislation moved hydrocodone from Schedule 111, controlled substance to Schedule 11, and tramadol from being unscheduled to Schedule 1V. According to the CDC, West Virginia has the nation’s highest third highest rate of painkiller prescriptions. Click here to view.