Legislative Updates

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StateWatch: Bill Review July 2017

Posted by Genex on July 24, 2017

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 announced file updates to the following billing areas. The updates went into effect July 1.



The state Department of Labor has posted an Addendum 2 update for the Hospital and Ambulatory Surgery Center Fee Schedules. The update went into effect July 1.

WATCHLIST: DIR is also currently reviewing feedback on medical treatment utilization schedule (MTUS) drug formulary regulations from a public hearing it held May 1.


The Department of Industrial Resources (DIR) has posted its California Official Medical Fee Schedule update for Physician and Non-Physician Practitioner services. The new fee schedule changes, which became effective July 1, were updated to comply with Medicare demands.

WATCHLIST: Implementation of California’s proposed drug formulary update has been delayed several months to allow stakeholders more time to react and prepare for program changes. DIR officials expect the updates to now be effective Jan. 1, 2018, instead of the original July 1, 2017, start date.


The Workers’ Compensation Commission has published its Practitioner Fee Schedule update. The new rules took effect July 15.


The Executive Office of Health and Human Services (EOHHS) has adopted rates for its Certain Substance-related and Addictive Disorders programs. The new rates went into effect July 1.

EOHHS also posted payment rate changes to the 101 CMR 350.00 Home Health Services and 101 CMR 206.00 Nursing Facility Services. These rates became effective July 14.


The Department of Labor and Industry has updated its facility fee schedules for Inpatient, Outpatient, Ambulatory Surgery Center, Ambulance, Dental, and Professional Services. These changes became effective July 1.


The New Mexico Gross Receipts Tax (NMGRT) rates have been updated, effective for dates of service from July 1- Dec. 31.


Updates have been made to the ND Fee Schedule for Clinical Laboratory, Medical Provider and Physician Drug by the Workforce Safety & Insurance (WSI) division. The new fees took effect July 1.

In addition, WSI has implemented the use of the 3m Ambulatory Payment Classification (APC) grouper. This will enable the division to incorporate additional Medicare APC methodologies into outpatient reimbursements. Also, the Outpatient Hospital Fee Schedule Guidelines will be updated with the new conversion factor, new status indicators, and payment parameters.

North Dakota has updated the following guidelines, effective July 1:

  • Ambulance
  • Anesthesia
  • Ambulatory Surgery Center
  • Clinical laboratory
  • Dental
  • Durable Medical Equipment
  • Evaluation and Management
  • Guidelines and Medical Services,
  • Home Health
  • Inpatient Hospital
  • Medicine
  • Outpatient Hospital
  • Pathology
  • Physician-administered Drugs
  • Physical and Occupational Therapy
  • Radiology
  • Surgery


The Workers’ Compensation Services division has updated its data files for Part A (tables A – J) and Part B Medical Providers.


The National Council on Compensation Insurance (NCCI) will be adding Texas as a reporting state. Mandatory reporting begins third quarter of 2018.


The Department of Labor and Industries has updated its Medical Aid Rules and Payment Rates for Professional, Pharmacogenetic Testing, Ambulatory Surgery Center, and Hospital services. The changes took effect July 1.


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