Legislative Updates

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StateWatch: Bill Review April 2019

Posted by Genex on April 23, 2019

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 bill review services Genex provides.

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The Centers for Medicare and Medicaid Services has updated its Physician and DMEPOS fee schedules as well as its Hospital Outpatient PPS Quarterly Restated Payment Rates. The changes went into effect April 1.


The Department of Industrial Relations has adjusted the following fee schedules, which went into effect April 1:


The Workers’ Compensation Commission has updated its Official Fee Schedule for Hospitals and Ambulatory Surgery Centers. The changes went into effect April 1.


The Board of Workers’ Compensation has made updates to the following guidelines and fee schedules which went into effect April 1:


The Labor Cabinet has updated its Hospital Cost-to-Charge ratios, effective April 1.


The Department of Labor and Industry has adopted a drug formulary, which took effect April 1.


On Sept. 1, the state will mandate eBilling, requiring auto casualty payors to accept bills electronically.


The Workers’ Compensation Board has updated its Medical Fee Schedule. The changes became effective April 1.

The board has also posted a clarification of drug testing rules. Ground Rule 12 identifies low/moderate/high risk test results and behavior and provides guidance to how frequently urine drug testing may be performed.

On April 1, the New York Compensation Insurance Rating Board (NYCIRB) began collecting New York medical transactional directly from its member insurers. The board also announced it will no longer use the National Council on Compensation Insurance (NCCI) as its medical data collection vendor.


State officials have announced fee schedule adjustments for Ambulatory Payment Classification, Ambulatory Surgery Center, DME, Medical Provider and Outpatient Hospital services.

State officials have also announced that total knee arthroplasty procedures due to work injury will no longer need to be exclusively performed in an inpatient hospital setting. Approval can now be made in an outpatient hospital and ambulatory surgical center settings


The Workers’ Compensation Division (WCD) has posted changes to its Medical Fee Schedule for workers’ comp and auto. WCD has also updated its Hospital Cost-to-Charge Ratios. Both changes took effect April 1.


The Department of Labor and Industry has announced the Medical Fee Schedule Part A (Tables A-J) and Part B have been updated. The changes took effect April 1.


The Workers’ Compensation Commission has updated its Medical Service Provider Manual. The changes became effective April 1.


The Workers' Compensation Commission has adopted electronic billing with a mandatory implementation date of July 1.


The Department of Labor and Industries has announced the Outpatient Drug Formulary and Selected Preferred Drug List have been updated and became effective April 1.  


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