At the 2015 IAIABC Annual Convention, jurisdictional representatives provided highlights of administrative initiatives and policy issues impacting their states. The highlights included:
Kansas – Legislation was proposed to role back from using the AMA 6th edition guidelines for impairment to the 4th edition which was the prior standard. The State Attorney General proposed this bill due to concerns the new AMA guides could result in a constitutional challenge to their worker’ compensation system. The bill never made it out of committee.
Virginia – Medical costs continue to be the concern in their workers’ compensation system. There is currently no fee schedule in the state and there has been much opposition to this concept. The Legislature asked the Commission to set up a working group to study a possible fee schedule in the future
Wisconsin – Legislation passed to change the adjudication function to the Department of Hearings and Appeals rather than having an adjudication process dedicated exclusively to workers’ compensation. This change was part of cost-cutting reforms pushed by the Governor.
Nebraska – The state is considering a pharmacy formulary, and hospital outpatient fee schedule. There is also talk about eliminating or reducing the vocational rehabilitation program in the next session.
Maine – State passed a rebuttable presumption for firefighters. They are also looking at a potential pharmacy formulary.
North Dakota – The tremendous economic growth in the state has put a strain on DWC operations. They cannot increase staffing without legislative approval. One big issue has been workers injured in North Dakota who return to their home state for treatment. There are challenges in the medical fees for such cases.
Louisiana – State is looking to update their 25-year old fee schedule which is based on usual and customary charges. They are looking at developing a Medicare-based fee schedule.
Minnesota – State is moving to a DRG hospital fee schedule based on Medicare charges.
Idaho – The state is looking to develop a hospital and pharmacy fee schedule.
Tennessee – State is mid-way into implementation of treatment guidelines, case management certification and a closed formulary. These changes were all required by legislation passed in 2014. They are also looking at a fee schedule for hospitals. Opt-out legislation was proposed but did not move forward. This is expected to be revisited in 2016.
South Carolina – Three diferent opt-out bills have been proposed. They expect one of these will get some traction in the legislature.
Rhode Island – They are looking at updating their fee schedules from usual & customary to one tied to Medicare.
Nevada – Attempts to change to the 6th edition of the AMA guidelines for impairment evaluation failed in the legislature. Firefighters now have lifetime reopening rights on heart/lung presumption claims.
New Mexico – The Court of Appeals ruled that excluding farm and ranch workers from workers’ compensaiton was unconstitutional. The state is looking at implementation of a formulary for medical marijuana based on court decisions requiring this to be paid under workers’ compensation.
North Carolina – A Medicare based fee schedule is being implemented.