Legislative Updates

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StateWatch: Bill Review October 2017

Posted by Genex on October 20, 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 (CMS) has posted updates to several fee schedules and files that come into effect Oct. 1.



Addendum 3 memorandum and revisions for Ambulatory Surgery Centers (ASC) and hospital rates have been posted by the state Department of Labor. The rules are effective as of Oct. 1.


The data files and guidelines for the Physician and Pharmaceutical Fee Schedule have been updated and posted by the Industrial Commission and went into effect. Oct. 1.


The Physician Fee Schedule and the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Fee Schedule have been updated by the Department of Industrial Resources to comply to the Medicare payment system. The schedules went into effect Oct. 1.

Also, Outpatient and Ambulatory Surgical Centers (ASC) quarterly updates were recently posted by the Division of Workers’ Compensation. The adjustments to the fee schedule is effective Oct. 1.

Fraud Watch

California recently suspended eight additional providers   treating patients in the workers’ compensation system due to fraud. 


The Workers’ Compensation Board has updated its Medical and Inpatient Facility fee schedules. The schedules became effective for discharges on or after Oct. 1.


Updated rates for the 101 CMR 206.00 Standard Payments to Nursing Facilities have been posted by the state’s Health and Human Services and are effective as of Oct. 1. The state also has also proposed changes for the 101 CMR 204.00 Rates of Payments to Residential Care Facilities and the 101 CMR 304.00 for Community Health Centers.


The Department of Labor and Industry has updated fee schedule conversion factors along with IME fee adjustments for hospital DRG payments are effective for discharge dates of Oct. 1 and after.

WATCHLIST: Senate Filing 1293 has been introduced. It proposes changes to how inpatient hospital services will be repriced.


The Department of Labor and Industry has updated its domiciliary care rates for 24-hour patient home health services. The rates went into effect Oct. 1. Also, lodging rates to reimburse injured workers for travel expenses has been updated and is effective Oct. 1.


The Workers’ Compensation Board has issued the following notices regarding health care providers authorized or approved for treating injured workers:

  • Subject No.046-988 Newly Authorized Health Care Providers Approved to Render Services to Injured Workers Under the Workers' Compensation Law.
  • Subject No. 046-989 Changes to the List of Health Care Providers Authorized to Render Services to Injured Workers Under the Workers' Compensation Law.


Rule 04 NCAC 10J .0103 regarding fees for institutional services has been approved for permanent adoption.


Data files for Ambulatory Surgery Centers (ASC), Medical Provider Fee Schedule, Outpatient Hospital and Physician Drugs were updated and became effective Oct. 1.


The Workers Compensation Division has posted permanent rules for OAR 436-010 Medical Services, OAR 436-030 Claims Closure and Reconsideration and OAR 436-035 Disability Rating Standards. The changes went into effect Oct. 8.


The Department of Labor and Industry’s quarterly update for Part A (Tables A-J) and Part B Medical Providers has been released with an effective date of Oct. 1. 


The Department of Labor and Industries has announced that effective Oct. 1 Negative Pressure Wound Therapy (NPWT) for home use is covered only for treatment of a condition accepted on or related to a claim.


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