VolumeSeventeenNumberThree March2016 ... · VolumeSeventeenNumberThree March2016...

Volume Seventeen Number ThreeMarch 2016Published by Mitchell International, Inc.

FEATURED IN THIS ISSUE:

Florida Adopts Revision FOn February 3, 2016, the state posted the final versions of several rules under Chapter 69L-7, effective February 18,2016. This update includes changes to the following rules:

n 69L-7-710 Definitions

n 69L-7-720 Forms

n 69L-7-730 Health Care Provider Medical Billing and Reporting Responsibilities

n 69L-7-740 Insurer Authorization and Medical Bill Review Responsibilities

n 69L-7-750 Insurer Electronic Medical Reporting Filing to the Division

https://www.flrules.org/gateway/ChapterHome.asp?Chapter=69L-7

continued on page 3

Fee Schedule &Legislative News

a newsletter by Mitchell Compliance Solutions


Mitchell International, Inc., founded in 1946 and headquartered in San Diego, California, is a leadingprovider of information and workflow solutions to the Property&CasualtyClaimsand Automotive Col-lision Repair industries. The company’s comprehensive solution portfolio streamlines the entire auto phys-ical damage, bodily injury and workers’ compensation claimsprocesses. Mitchell enablesmillionsofelectronic transactionsbetweenmore than 30,000 businesspartners eachmonth to enhance partnerproductivity, profitability, and customer satisfaction. For more information onMitchell International,please visit our web site atwww.mitchell.com.

Fee Schedule &Legislative NewsTable of Contents

Volume Seventeen Number ThreeMarch 2016Published by Mitchell International, Inc.

a newsletter by Mitchell Compliance Solutions

Florida Adopts Revision F 3Meet the Regulatory Compliance Team 5eBilling, EDI, and Reporting News 6Auto Industry News 7MCO and UR News 7Other Industry News 7CMS, FR, and OIG Announcements 9HIPAA 5010 News and Announcements 10Calendar of Events 11ICD-10 News and Announcements 12State Legislative Changes 26Fee Schedule Updates 36Fee Schedule Status at a Glance 73Acronym Glossary 76

The Fee Schedule & Legislative News is published by Mitchell

International, Inc. It is collaboratively produced by Mitchell’s

Workers’ Compensation Solutions (WCS) and Auto Casualty

Solutions (ACS) divisions.

Questions or comments about the Fee Schedule & Legislative

News (including distribution and circulation questions or

requests for back issues) may be directed to

[email protected].

The information contained in this newsletter was obtained

from sources deemed reliable; however, Mitchell

International, Inc. cannot guarantee the accuracy or

completeness of the information provided. ©2015 Mitchell

International, Inc. All rights reserved. All referenced Internet

links, which are provided as a courtesy to our readers, are

not under the control of Mitchell International Inc. and thus

Mitchell is not responsible for the contents of any linked site,

any subsequent link contained in a linked site, or any

changes or updates made to such sites. Editor’s note:

Throughout this newsletter, quoted text (italicized) is

presented verbatim according to the original publication.

However, due to the size and layout limitations of this

newsletter, formatting liberties have been taken to improve

readability.

Fee Schedule & Legislative News 2

mailto:[email protected]

Acronyms in the Fee Schedule & Legislative News

Acronyms are frequently used throughout the Fee Schedule & Legislative News. For your convenience, full definitions of theseacronyms are provided in our Acronym Glossary at the end of the newsletter.

Florida Adopts Revision FRule 69L-7-750 indicates the time when submitters need to test the newly-implemented changes with the state. The first tierof submitters will need to test 150 days after the effective date (on or before July 17, 2016) and complete testing by August31, 2016.

Additionally, on February 12, 2016, the state sent out the following email communication to all Medical EDI Submitters:

Florida Medical EDI Submitters:

Revisions to the Florida Workers’ Compensation Medical Services Billing, Filing and Reporting Rule (69L-7 F.A.C. and

69L-8 F.A.C. Billing Rule Series), were adopted and will become effective on February 18, 2016. This rule incorporates

the 2015 Florida Medical Implementation Guide (MEIG) and the conversion to Revision F. The testing process for

Revision F will be similar to the testing process used for the conversion to Revision E, with some exceptions. Please

note the following:

Submitters have been broken into three test groups based on the date of conversion to Revision E, per guidelines

contained in the Medical Services Billing, Filing, and Reporting Rule, 69L-7.750, F.A.C. Timeframes for the three test

groups are as follows:

n Group 1: July 17, 2016 – August 31, 2016

n Group 2: September 1, 2016 – October 15, 2016

n Group 3: October 16, 2016 – November 29, 2016

- For new batch submitters, electronic files containing fifteen test bills for all form types being tested will need to betransmitted to the Division. For established batch submitters, electronic files containing five test bills for each of theother form types being tested will need to be transmitted to the Division. Before placing test files in the“Incoming” SSH FTP (SFTP) directory, please ensure that the test/production indicator in the file names andtransmission header records is set to “T”.

- There are several scenarios that need to be included in the test bills. A spreadsheet containing the details of thesescenarios has been attached to this e-mail.

- If needed, pre-filled “dummy” forms may be obtained from the Division.

- Paper copies corresponding to these electronic bills will also need to be supplied. These may be faxed to thedivision at the following number: (850) 413-1986.

- Testing is not considered complete until all bills have been accepted by the Medical Data Management System andpassed visual comparison to paper bills and all scenario tests have been successfully completed.

Submitters will be notified via e-mail upon completion of testing. We will be updating our website with information

pertaining to Revision F, including the 2015 MEIG, in the near future so additional information will be forthcoming. If

you have questions pertaining this email, please send them to: [email protected].

Michelle Carter, MPA

Sr. Mgmt Analyst Supervisor

Division of Workers' Compensation

Bureau of Data Quality & Collection

Email: [email protected]




Mitchell falls within the first group of submitters for testing. Additionally, Mitchell has reached out to the state regarding thesubmitter testing process; the state has indicated that Mitchell can conduct Revision F testing on behalf of its clients, so therewill be no need for clients to test individually.Mitchell’s Regulatory Affair’s team will continue to provide information in futurenewsletters and communications as information is obtained from the state.

Mitchell’s compliance/development teams are currently reviewing the Rev F changes and will be publishing a clientcommunication once this initial review is complete. If you have any questions or concerns regarding Rev F, please [email protected] or your account manager.

Note Statements and opinions expressed in this article are solely those of the author and should not be taken as legal adviceand/or legal opinion.



Meet the Regulatory Compliance TeamMitchell’s Compliance Team contains a diverse group of talented individuals. This section will feature information about a different team member each month.

NamePamela Martinez

TitleData Analyst II

Time with Mitchell8 years

EducationCertified Profession Coder – CPC; ICD-10 Certified - 2015

Organization MembershipsAmerican Academy of Professional Coders (AAPC)

Pamela has worked in the healthcare industry for over 14 years, including working with the Health Information Services (HIS)department at Alvarado Hospital where she began as a volunteer and was subsequently hired while getting her education inmedical coding. Once certified, she found her first medical coding position within a surgical pathology group in San Diego.Because of her previous background in the Workers’ Compensation Insurance field, she was a fit for Mitchell International. Shewas hired by Mitchell to perform bill review and enjoyed 5+ years in the Auto Casualty Solutions (ACS) Customer Service unitassisting with 3rd party second level reviews.

Currently, she works on bill review data, endnote compliance, and ICD-10 mappings within the ACS Health InformationManagement (HIM) unit. She has also been involved with CPT/HCPCS code review projects for the workers’ compensationunit. This transition has given her the opportunity to explore many facets of the Auto Casualty and Worker’s Compensationarea and apply new knowledge daily to data analysis and compliance.

Pamela’s passion is research. She loves to take a subject apart and get to bottom of it in an effort to find the what, when,where, why, and how. I guess you could say she loves to “get to the heart of the matter.”


eBilling, EDI, and Reporting NewsThis section provides information from state and national entities regarding their eBilling, EDI, and reporting initiatives.

eBillingThere is nothing to report at this time.

Claim ReportingThere is nothing to report at this time.

Medical ReportingCalifornia

On February 12, 2016, the state posted the DWC Newsline 2016-21, regarding the proposed amendments to the WCISRegulations and EDI Implementations Guides. The state will conduct a public hearing on March 28, 2016. Comments on theamendments will be accepted until 5:00 p.m. on the day of the hearing. To access the Newsline and the proposed regulations,see the links below.

http://www.dir.ca.gov/DIRNews/2016/2016-21.pdf

http://www.dir.ca.gov/dwc/DWCPropRegs/WCIS-Regulations/WCIS_Regulations.htm

http://www.dir.ca.gov/dwc/DWCPropRegs/WCIS-Regulations/Notice.pdf

http://www.dir.ca.gov/dwc/DWCPropRegs/WCIS-Regulations/ISOR.pdf

http://www.dir.ca.gov/dwc/DWCPropRegs/WCIS-Regulations/Regulations.pdf

Florida

On February 3, 2016, the state posted the final versions of several rules under Chapter 69L-7, effective February 18, 2016. Itincludes changes to the following rules:

n 69L-7-710 Definitions

n 69L-7-720 Forms

n 69L-7-730 Health Care Provider Medical Billing and Reporting Responsibilities

n 69L-7-740 Insurer Authorization and Medical Bill Review Responsibilities

n 69L-7-750 Insurer Electronic Medical Reporting Filing to the Division


Please see the feature article for additional details.

National EDIs/ReportingThere is nothing to report at this time.



http://www.dir.ca.gov/dwc/DWCPropRegs/WCIS-Regulations/WCIS_Regulations.htm

http://www.dir.ca.gov/dwc/DWCPropRegs/WCIS-Regulations/Notice.pdf

http://www.dir.ca.gov/dwc/DWCPropRegs/WCIS-Regulations/ISOR.pdf

http://www.dir.ca.gov/dwc/DWCPropRegs/WCIS-Regulations/Regulations.pdf


Auto Industry NewsThis section contains information related to jurisdictional changes in the auto industry.

New YorkIn January 2015, bill S02370 was introduced to the Senate and Assembly, regarding the adoption of the medical treatmentguidelines in the No-Fault System. On January 22, 2015, the bill was referred to the Committee on Insurance. This bill wascarried over to the 2016 legislative session and still resides with the Committee on Insurance as of January 6, 2016. Currently,there is no further movement on this bill.

http://assembly.state.ny.us/leg/?default_fld=&bn=S02370&term=2015&Summary=Y&Text=Y

MCO and UR NewsThis section provides information about events, legislation, and other issues that affect MCOs and UR.

CaliforniaOn February 5, 2016, the state posted a DWC Forum to propose an update to the Mental Illness & Stress Guideline. Thischange includes the adoption of the ODG Mental Illness & Stress Guidelines, dated March 25, 2015. The state would removethe reference to the American College of Occupational and Environmental Medicine (ACOEM) Practice Guidelines from thecurrent rule. The proposed rules can be found on the state’s web site under “Forums.”

http://www.dir.ca.gov/dwc/ForumDocs/MTUS-Mental-Illness-Stress/MTUS-Mental-Illness-Stress.htm

ColoradoOn February 8, 2016, the state posted adopted Rule 17 – Exhibit 6: Lower Extremity Guidelines and Rule 17: MedicalTreatment Guidelines, effective March 16, 2016. To access these rules, use the link provided below.

https://www.colorado.gov/pacific/cdle/workers-compensation-proposed-and-adopted-rules

ConnecticutOn February 15, 2016, the WCC Medical Protocols for Psychological Pain Assessment and Treatment became effective. Theseprotocols can be accessed from the link below.

http://wcc.state.ct.us/download/acrobat/protocols.pdf

Other Industry NewsThis section contains additional information related to the workers’ compensation industry.

ArizonaOn January 28, 2016, the state posted a notification on its web site regarding the revised form, 104 for Notice of Claims Status.This notice replaces the previous notice from August 17, 2015 and can be accessed from the link below.

http://www.ica.state.az.us/Claims/Claims_About_New_Form_104.aspx


http://assembly.state.ny.us/leg?default_fld=&bn=S02370&term=2015&Summary=Y&Text=Y

http://www.dir.ca.gov/dwc/ForumDocs/MTUS-Mental-Illness-Stress/MTUS-Mental-Illness-Stress.htm


http://wcc.state.ct.us/download/acrobat/protocols.pdf

http://www.ica.state.az.us/Claims/Claims_About_New_Form_104.aspx

NevadaOn January 28, 2016, the state sent out an email communication indicating that it will conduct training for the new feeschedule that became effective February 1, 2016. Classes were held on February 17th. For more information, contact theDivision at 1.702.486.9000.

New YorkOn February 22, 2016, the state posted Subject No. 046-841, which indicates the “newly authorized health care providersapproved to render services to injured workers under the worker’s compensation law." This notice can be accessed from thelink below.

http://www.wcb.ny.gov/content/main/SubjectNos/sn046_841.jsp

Additionally, on February 22, 2016, the state posted Subject No. 046-842, which indicates the “changes to the list of healthcare providers authorized to render services to injured works under the workers’ compensation law." This notice can beaccessed from the link below.


On February 4, 2016, the state posted Subject Numbers 046-838 and 046-839, regarding the temporary suspension of twophysicians. For more details, please use the links provided below.



Additionally, on February 12, 2016, the state posted Subject Number 046-840, regarding the temporary suspension for Dr.Ilora Imam Rafique to treat injured workers, effective February 8, 2016. This notice can be accessed from the link below.


OhioOn February 4, 2016, the final rule 4123-17-24 was filed with an effective date of February 14, 2016. This rule nowimplements provisions for optional coverage for Ohio employers to cover Ohio employees that work out of state. An employerwould need to obtain an “other states coverage policy” (OSCP) to offer this coverage. For more details regarding this revisedrule, please see the link below.

http://www.registerofohio.state.oh.us/pdfs/4123/0/17/4123-17-24_PH_FF_N_RU_20160204_0939.pdf







http://www.registerofohio.state.oh.us/pdfs/4123/0/17/4123-17-24_PH_FF_N_RU_20160204_0939.pdf

CMS, FR, and OIG AnnouncementsThis section highlights some of the publications posted by the Centers for Medicare and Medicaid Services (CMS), the FederalRegister (FR), and the Office of the Inspector General (OIG) throughout the month. Since these entities publish continually, notall documents are included here.

Centers for Medicare and Medicaid ServicesFebruary 19, 2016

n Healthcare Provider Taxonomy Codes (HPTCs) April 2016 Code Set Update, effective April 1, 2016

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9461.pdf

n Reclassification of Certain Durable Medical Equipment HCPCS Codes Included in Competitive Bidding Programs (CBP) fromthe Inexpensive and Routinely Purchased Payment Category to the Capped Rental Payment Category, effective July 1,2016


February 4, 2016

n Off-Cycle Update to the Inpatient Prospective Payment System (IPPS) Fiscal Year (FY) 2016 Pricer, effective January 1,2016


n April 2016 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly PricingFiles, effective April 1, 2016


Federal RegisterJanuary 15, 2016

n Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical LaboratoryImprovement Amendments (CLIA) Edits


Office of the Inspector GeneralThere is nothing to report at this time.












HIPAA 5010 News and AnnouncementsThis section contains information on what is happening on a national level with the implementation of the Health InsurancePortability and Accountability Act version 5010 (HIPAA 5010). This includes updates, resources, national timelines, and eventinformation.

General OverviewHIPAA was first adopted in 1996 to establish standards for electronic transactions to protect privacy and security. The HIPAAversion 4010A1 standards were the first to be implemented. The federal government made revisions to the HIPAA standardsand implemented a new version, HIPAA 5010, for use in electronic transactions for all HIPAA-covered entities, effectiveJanuary 1, 2012.

Mitchell Implementation OverviewMitchell supports the HIPAA 5010 transactions for those states that currently adopted 5010 standards. For information onimplementation for specific products (e.g. SmartAdvisor), please contact your Mitchell Account Manager.

Resources and Useful Web SitesOrganization Web Site

ADA http://www.ada.org/

ANSI http://www.ansi.org/

ASCX12 http://www.x12.org/

CMS http://www.cms.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asp

DISA http://www.disa.org/

EHNAC http://www.ehnac.org/

Federal Register http://edocket.access.gpo.gov/2009/pdf/E9-740.pdf

IAIABC http://www.iaiabc.org/iaiabc/default.asp

ISO http://www.iso.org/iso/home.html

NCPDP http://www.ncpdp.org/

PHDSC http://www.phdsc.org/standards/x12/gapassist.asp

WEDI http://wedi.org/

EventsThis section contains information about upcoming events related to the HIPAA 5010 implementation which may be ofinterest. These events include audiocasts, conferences, meetings, seminars, training sessions, and webinars.

Organization Event/Topic

Dates/Times/Locations

Members Only (MO)/Available to Public(ATP)

Web Site

WEDI 5010 837SubWorkgroupCall

2nd and 4thThursday of themonthTeleconferencespacerspacerspace

MOspacerspacerspacerspace

http://www.wedi.org/forms/MeetingCalendar/


http://www.ada.org/

http://www.ansi.org/

http://www.x12.org/

http://www.cms.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asp

http://www.disa.org/

http://www.ehnac.org/

http://edocket.access.gpo.gov/2009/pdf/E9-740.pdf

http://www.iaiabc.org/iaiabc/default.asp

http://www.iso.org/iso/home.html

http://www.ncpdp.org/

http://www.phdsc.org/standards/x12/gapassist.asp

http://wedi.org/

http://www.wedi.org/forms/MeetingCalendar/

Calendar of EventsThis section provides dates, times, and locations of upcoming events, meetings, or training sessions that may be of interest.The events within this section have been arranged chronologically. For this reason, recurring events are relisted for each dateof occurrence.

March 2016 and Beyondn February 29 – March 4, 2016

HIMSS16 Annual Conference & Exhibition

Sands Expo Convention Center

Las Vegas, NV

http://www.wedi.org/forms/meeting/MeetingFormPublic/view?id=65CE700000056

n March 10 – 11, 2016

2016 WCRI Annual Issues & Research Conference

West Copley Place

Boston, MA

http://www.wcrinet.org/conference.html

n April 10 – 13, 2016

RIMS 2016 Annual Conference and Exhibition

San Diego Convention Center

San Diego, CA

https://www.rims.org/RIMS16/Pages/Home.aspx

n April 12 – 15, 2016

Mitchell Capstone Intermediate and Advanced 4-Day Training

Mitchell Office

Coppell, Texas

Contact your account manager for details and registration information

n April 18 – 21, 2016

IAIABC 102nd Convention

Santa Fe, New Mexico

http://www.iaiabc.org/iaiabc/EducationHQ.asp

n May 23 – 26, 2016

WEDI 25th Annual National Conference

The Grand Hotel

Salt Lake City, UT

http://www.wedi.org/forms/meeting/MeetingFormPublic/view?id=6D07B000000CE


http://www.wedi.org/forms/meeting/MeetingFormPublic/view?id=65CE700000056

http://www.wcrinet.org/conference.html

https://www.rims.org/RIMS16/Pages/Home.aspx

http://www.iaiabc.org/iaiabc/EducationHQ.asp

http://www.wedi.org/forms/meeting/MeetingFormPublic/view?id=6D07B000000CE

ICD-10 News and AnnouncementsThis section contains information on what is happening on a national level with the implementation of the InternationalClassification of Diseases, 10th edition (ICD-10). This includes updates, resources, national timelines, and event information.

NewsColorado

The state recently posted an article titled “ICD-9 vs ICD-10” on its web site under the “What’s New” section. The entire articlecan be accessed from the link provided below.

https://www.colorado.gov/pacific/cdle/dwc

California

On September 22, 2015, the DWC posted Newsline No. 2015-86 regarding the final regulations that have been posted formoving to ICD-10. The state indicated that ICD-10 must be used for services rendered and inpatient discharges on or afterOctober 1, 2015, and that ICD-9 codes will not be allowed on or after October 1, 2015. However, the state will allow a “graceperiod” regarding the use of the forms 5021, PR-2, PR-3, and PR-4. Providers will be allowed to use both the old and revisedforms from October 1, 2015 – December 31, 2015; however, for services rendered on or after October 1, 2015, the ICD-10codes must be used regardless of what form is used. After January 1, 2016, only the new forms can be used. To read theNewsline in its entirety, use the link below.


CMS

On August 13, 2015, CMS posted the current edition of the MLN Connects Provider eNews. This edition contains the followinginformation:

n Countdown to ICD-10

n National Provider Calls and Events

n Announcements

n Educational Products

To view this in its entirety, please use the link provided below.

https://www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Provider-Partnership-Email-Archive-Items/2015-08-13-eNews.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending&imagelink=y

On July 27, 2015, CMS posted clarifying questions and answers related to the July 6, 2015 CMS/AMA Joint Announcement. Toview this recent communication, please see the link below.

http://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/ICD10

On July 24, 2015, CMS posted the most current MLN Provider eNews, it contains various information regarding the transition tothe ICD-10 as well as questions and answers. To access the information, use the link below.

http://www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Downloads/2015-07-23-eNews.pdf

On July 7, 2015, CMS sent out the following communication to the medical provider community. This letter reminds providersof the approaching effective date of October 1, 2015, for the use of ICD-10 codes and what resources are available forassisting providers in this transition. The entire letter can be accessed from the link below.

http://www.cms.gov/Medicare/Coding/ICD10/Downloads/MedicareProviderICD-10.pdf


https://www.colorado.gov/pacific/cdle/dwc




http://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/ICD10

http://www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Downloads/2015-07-23-eNews.pdf

http://www.cms.gov/Medicare/Coding/ICD10/Downloads/MedicareProviderICD-10.pdf

On July 6, 2015, CMS and the AMA released a joint communication indicating that they are both working to assist providerswith the conversion from ICD-9 to ICD-10, since there are only a few months left until the official effective date of October 1,2015. To view this joint communication, please see the link below.

http://www.cms.gov/Medicare/Coding/ICD10/Downloads/AMA-CMS-press-release-letterhead-07-05-15.pdf

Delaware

The state announced in an e-mail to stakeholders that it will adopt the ICD-10 guidelines, effective January 1, 2016. The ICD-9guidelines should be used until that time.

Georgia

The state of Georgia posted information on its web site regarding the implementation of ICD-10. Although CMS will beadopting the use of ICD-10 effective October 1, 2015, the state of Georgia decided to allow a grace period through November1, 2015. The entire notification regarding Georgia’s implementation is available from the link below.

https://sbwc.georgia.gov/sites/sbwc.georgia.gov/files/medical_fee_schedule/ImplementationNotificationICD_10.pdf

Maryland

The state posted a reminder on its web site on September 22, 2015, regarding the use of ICD-10 codes on or after October 1,2015. The reminder states the following:

Excerpt from: State’s web site

"REMINDER

For services provided on or after October 1, 2015, Medicare requires that healthcare providers must use valid ICD-10 Codes.The transition to ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA).Please note, the change to ICD-10 does not affect CPT coding for outpatient procedures and physician services. TheCommission encourages healthcare providers and payers to engage in a dialogue as to implementation timeframes. Foradditional details and assistance, please visit: https://www.cms.gov/Medicare/Coding/ICD10."

http://www.wcc.state.md.us/MFG/Medical_Fee_Schedule.html

Minnesota

On September 14, 2015, the Minnesota Department of Health sent out an email communication that stated the following:

Excerpt from: Minnesota Department of Health email communication

"Minnesota Department of Health

Protecting, Maintaining, and improving the health of all Minnesotans

Interested parties –

Please see the information below regarding use of the ICD-10 code set in compliance with Minnesota Statutes, section62J.536 and related rules.

Background

Minnesota Statutes, section 62J.536 requires the standard, electronic exchange of health care business transactions. Thestatute is administered by the Minnesota Department of Health (MDH). Rules describing technical specifications for therequired electronic transactions are known as Minnesota Uniform Companion Guides (MUCGs).

As noted in a June 2015 MDH announcement, ICD-10 coding must be used for health care dates of services on or afterOctober 1, 2015 as required by 45 CFR §162.1002. The requirement to use ICD-10 applies to all entities subject to M.S.§62J.536, including entities not subject to federal HIPAA administrative simplification regulations. In addition, the MUCGsalso state specifically that they must be “used in conjunction with all applicable Minnesota and federal regulations, including… requirements for use of ICD-10.”

References to use of ICD-9 codes that will no longer be valid as of October 1, 2015 have been superseded by requirementsto use ICD-10


http://www.cms.gov/Medicare/Coding/ICD10/Downloads/AMA-CMS-press-release-letterhead-07-05-15.pdf

https://sbwc.georgia.gov/sites/sbwc.georgia.gov/files/medical_fee_schedule/ImplementationNotificationICD_10.pdf

https://www.cms.gov/Medicare/Coding/ICD10


It has been brought to our attention that minor references to the use of ICD-9 codes, which will no longer be appropriate onor after October 1, 2015, were inadvertently not updated as planned and appear in current versions of the MUCGs. MDH isreviewing the MUCGs for any updates or changes that may be needed.

The requirements for the correct, appropriate use of ICD-10 codes described above supersede any MUCG statementsregarding use of ICD-9 codes that may be out of date as of October 1, 2015."

http://www.health.state.mn.us/asa/updt10.pdf

On July 1, 2015, the Minnesota Department of Health posted a bulletin "Use ICD-10 for health care dates of service on or after10/1/2015" indicating that on or after October 1, 2015, ICD-10 will be required for use. The bulletin can be accessed from thelink below.


New Jersey Auto

The state recently posted information regarding the transition to ICD-10 codes and how it relates to PIP. These FAQs can beaccessed from the link below.

http://www.state.nj.us/dobi/pipinfo/icd10conversionfaq.html

North Carolina

On August 21, 2015, the state released an email communication with a bulletin regarding ICD-9 and ICD-10 requirementschanges, effective October 1, 2015. At the time of publishing this newsletter, the bulletin was not yet posted on the state'sweb site. The bulletin content is provided below.

Excerpt from: North Carolina Industrial Commission (NCIC) Bulletin

“Medical ICD-9 and ICD-10 Requirements Changes

Effective October 1, 2015

Based on the ICD-10 compliance date of October 1, 2015, NCIC is preparing to enable reporting of ICD-9 and ICD-10diagnosis and procedure codes effective October 1, 2015. NCIC will accept both ICD-9 and ICD-10 diagnosis/procedurecodes in the following data elements: DN0520 Outpatient Reason for Visit Code, DN0521 Principal Diagnosis Code,DN0522 ICD-9 CM Diagnosis Code, DN0525 ICD-9 CM Principal Procedure Code, DN0535 Admitting Diagnosis Code, andDN0736 ICD-9 CM Procedure Code.

NCIC edits are as follows:

a. For claims with a DN0509 SERVICE BILL DATE(S) RANGE on or after October 1, 2015, NCIC will only accept ICD-10 codes.

b. For claims with a DN0509 SERVICE BILL DATE(S) RANGE before October 1, 2015, NCIC will accept only ICD-9 codes.

c. The determination on the value (ICD-9 or ICD-10) sent on the bill will be based on the applicable X12 CODE LISTQUALIFIER CODE.

d. Reporting of ICD-9 and ICD-10 on the same bill will result in rejection of the bill.

For more information, please contact the NCIC EDI Support Team at [email protected] or visit www.ncicedi.info.

Thank you,

North Carolina Industrial Commission EDI Support Team

[email protected]

[email protected]”

Ohio WC

On July 15, 2015, the state posted a notice of public hearing for proposed rule 4123-3-36, to rescind Appendix A of this rulethat contains ICD-9 codes and replace it with a new Appendix A containing ICD-10 codes. The public hearing was held on







August 21, 2015. The update to Appendix A was adopted on September 21, 2015, and is effective October 1, 2015. Theadopted rules can be found on the state's web site using the link provided below.

http://www.registerofohio.state.oh.us/jsps/publicdisplayrules/processPublicDisplayRules.jsp?entered_rule_no=4123-3-36&doWhat=GETBYRULENUM&raID=0

South Carolina

On August 27, 2015, the state sent out a communication indicating that it will be adopting ICD-10, effective October 1, 2015,to align with Medicare’s effective date. To view the communication in full, please use the link provided.

http://www.wcc.sc.gov/Documents/What%27s%20New/Medical%20Services%20Notices/2015%2008%2025%20ICD%2010%20effective%20Oct%201.pdf

Mitchell Implementation OverviewMitchell created our products to be versatile and to easily adjust to any new ICD-10 date. As ICD-10 becomes the standard formany states, Mitchell continues to monitor and address state-specific information. This means deploying our planned releasesof updated features/functionality. It is our commitment that clients currently performing ICD-10 testing or planning ICD-10testing this year will have our full support. We have support members in place to ensure timely responses to your questions forboth testing and production bills/claims using ICD-10 with Mitchell products.

Finally, we encourage clients to remain committed to testing ICD-10 this year, while our resources are fully engaged ininteroperability testing with you and our partners.

If you have any further questions, please contact your Mitchell Account Manager.

Resources and Useful Web SitesOrganization Web Site

AAPC http://www.aapc.com/ICD-10/faq.aspx

AHIMA http://www.ahima.org/education/onlineed/Programs/ICD10

CDC http://www.cdc.gov/nchs/icd/icd10cm.htm

CMS Main: http://www.cms.gov/ICD10CM: http://www.cms.gov/ICD10/11b1_2011_ICD10CM_and_GEMs.asp#TopOfPagePCS: http://www.cms.gov/ICD10/11b15_2012_ICD10PCS.asp#TopOfPage

Federal Register http://edocket.access.gpo.gov/2009/pdf/E9-743.pdf

HRSA http://www.hrsa.gov/healthit/icd10/

ICD-10 Hub http://www.icd10hub.com/

ICD10 Watch http://www.icd10watch.com/

NCHS http://www.cdc.gov/nchs/index.htm

NCVHS http://www.ncvhs.hhs.gov/

WEDI http://wedi.org/

WHO Main: http://www.who.int/en/ICD: http://www.who.int/classifications/icd/en/

ICD-10 Monitor http://www.icd10monitor.com/




http://www.wcc.sc.gov/Documents/What's New/Medical Services Notices/2015 08 25 ICD 10 effective Oct 1.pdf

http://www.wcc.sc.gov/Documents/What's New/Medical Services Notices/2015 08 25 ICD 10 effective Oct 1.pdf

http://www.aapc.com/ICD-10/faq.aspx

http://www.ahima.org/education/onlineed/Programs/ICD10

http://www.cdc.gov/nchs/icd/icd10cm.htm

http://www.cms.gov/ICD10

http://www.cms.gov/ICD10/11b1_2011_ICD10CM_and_GEMs.asp#TopOfPage

http://www.cms.gov/ICD10/11b15_2012_ICD10PCS.asp#TopOfPage

http://edocket.access.gpo.gov/2009/pdf/E9-743.pdf

http://www.hrsa.gov/healthit/icd10/

http://www.icd10hub.com/

http://www.icd10watch.com/

http://www.cdc.gov/nchs/index.htm

http://www.ncvhs.hhs.gov/

http://wedi.org/

http://www.who.int/en/

http://www.who.int/classifications/icd/en/

http://www.icd10monitor.com/

EventsThis section contains information about upcoming events related to ICD-10 implementation which may be of interest. Theseevents include audiocasts, conferences, meetings, seminars, training sessions, and webinars.

Organization Event/ Topic Dates, Times,and Locations

Members Only(MO)/Available toPublic (ATP)

Web Site

AAPCspacerspacerspacerspacer

ICD-10 Training On-site training ATP http://www.aapc.com/ICD-10/On-Site-Training.aspx

eLearningCenter

ICD-10 MedicalCoding

Onlinespacerspacerspacerspacerspa

ATP http://www.theelearningcenter.com/dspCourseDetail. cfm?detailid=5505

WEDI ICD-10 WGspacerspacerspacerspacerspa

2nd Tuesday ofthe month, 2:00p.m. EST -Teleconference

MOspacerspacerspacerspacer

http://www.wedi.org/forms/meeting/MeetingFormPublic/view?id=CD200000061A

WEDI Crosswalks 2nd and 4thWednesday ofthe month, 1:00p.m. EST -Teleconference

MO http://www.wedi.org/forms/meeting/MeetingFormPublic/view?id=CD5900000111

WEDI ImpactAssessment

2nd and 4thThursday of themonth, 12:00p.m. EST -Teleconference


WEDI Implementation 3rd Tuesday ofthe month, 2:00p.m. EST -Teleconference

MO http://www.wedi.org/forms/meeting/MeetingFormPublic/view?id=CD22000007CB

WEDI Timeline 1st and 3rdWednesday ofthe month, 2:00p.m. EST -Teleconference



http://www.aapc.com/ICD-10/On-Site-Training.aspx

http://www.theelearningcenter.com/dspCourseDetail.cfm?detailid=5505

http://www.theelearningcenter.com/dspCourseDetail.cfm?detailid=5505



http://www.wedi.org/forms/meeting/MeetingFormPublic/view?id=CD5900000111




http://www.wedi.org/forms/meeting/MeetingFormPublic/view?id=CD22000007CB

http://www.wedi.org/forms/meeting/MeetingFormPublic/view?id=CD22000007CB



Mitchell's State-by-state ICD-10 Readiness OutreachThe following grid provides information from a recent outreach Mitchell conducted on each state's ICD-10 readiness. For adetailed description of the Product Options, see the Product Option Legend.

Note This grid was last revised on September 21, 2015. The latest copy of the grid, which is frequently updated, is availableusing the following link: ICD State Readiness Grid.

State Coverage AdoptionStatus

State Comments onAdoption

Product Options Comments

Alabama Workers'Comp.

Yes spacerspacerspacerspacerspacerspacerspacerspacerspacerspacerspacerspacerspacerspacerspacerspacerspacerspace

SmartAdvisor - 2 http://www.labor.alabama.gov/docs/law/wc_480-5-5-.02.pdf

Auto CustomerDiscretion

Not addressed by state. DecisionPoint - 3SmartAdvisor - 3

Alaskaspacerspacerspacerspacerspacerspacerspacerspacerspacerspacerspacer

Workers'Comp.spacerspacerspacerspacerspacerspacerspacerspace

Yesspacerspacerspacerspacerspacerspacerspacerspace

At the March 16, 2015,Medical Services ReviewCommittee meeting, themembers voted to adopt"a rule requiring providersto comply with CMS prescribed ICD codes."

SmartAdvisor - 2spacerspacerspacerspacerspacerspacerspacerspacerspacerspacerspacerspacerspace

http://labor.alaska.gov/wc/med-serv-comm/2015-03-16-MSRC_Meeting_Minutes.pdf



Arizona Workers'Comp.

CustomerDiscretion

No state regulationaddressing use of ICD-10.State highly recommendsadopting ICD-10.

SmartAdvisor - 3



Arkansas Workers'Comp.

CustomerDiscretion

No state regulationaddressing use of ICD-10. State highly recommends adopting ICD-10.

SmartAdvisor - 3



California Workers'Comp.

Yes *For state reporting: State has advised dates ofservice on orafter 10/01/2015 willbypass edits with adjustment code 146 - "Diagnosis was invalid for thedate(s) of service reported."

SmartAdvisor - 2StateReporting - 2

Medical Billing and Payment GuideVersion 1.2.1 indicates 10/01/2015for the transition from ICD-9 to ICD-10.http://www.dir.ca.gov/dwc/DWCPropRegs/ICD10/FinalRegulations/MedicalBillingandPaymentGuide.pdf




https://na26.salesforce.com/sfc/p#300000000cy9/a/3200000098If/fxkSaYSV1J1meWPH6iz96Vsu7RLkj9IMDaUMJAwWbTU

http://www.labor.alabama.gov/docs/law/wc_480-5-5-.02.pdf

http://www.labor.alabama.gov/docs/law/wc_480-5-5-.02.pdf




http://www.dir.ca.gov/dwc/DWCPropRegs/ICD10/FinalRegulations/MedicalBillingandPaymentGuide.pdf







Colorado Workers'Comp.

Yes The state confirmed thatICD-10 will replace ICD-9when adopted by Medicare

SmartAdvisor - 2 Fee Schedule language: The International Classification of Diseases,Tenth Revision Clinical Modification(ICD-10-CM) will replace the ICD-9-CM as the official codes for reporting diagnoses when adopted bythe Centers for Medicare and Medicaid Services (CMS).



Connecticut Workers'Comp.

Yes The state adopted theICD-10 guidelines, effective 01/01/2016.

SmartAdvisor - 2



Delaware Workers'Comp.

CustomerDiscretion

Pending confirmation bythe state.

SmartAdvisor - 3



Florida Workers'Comp.

Yes FAC Rule 59-69L-7.020 -Florida Healthcare Reimbursement manual effective August 9, 2015.*For state reporting: State has indicated datesof service after10/01/2015 with ICD-9codes will be rejected.


https://www.flrules.org/Gateway/View_notice.asp?id=15979603


Per the Florida Office ofInsurance Regulation, thechange in the reference ins.627.736(5)(d), FloridaStatutes, from "ICD-9" to"ICD-10" will require theLegislative to pass a billrequiring such change.

DecisionPoint - 3SmartAdvisor - 3

Georgia Workers'Comp.

Yes The State Board of Workers' Compensation willadopt ICD-10-CM/PCSalong with CMS' implementation date of October 1, 2015, with a graceperiod through November1, 2015.

SmartAdvisor - 2



Hawaii Workers'Comp.

CustomerDiscretion

No state regulationaddressing use of ICD-10.

SmartAdvisor - 3









Idaho Workers'Comp.

Yes Effective October 1, 2015,all covered entities underthe Health Insurance Portability Accountability Act(HIPAA) are required tobill with the ICD 10 diagnostic coding set.

SmartAdvisor - 2 http://www.iic.idaho.gov/medical/medical.html



Illinois Workers'Comp.

Yes Update to the ICD for Inpatient Rehabilitation Hospitals will be posted inSeptember 2015.

SmartAdvisor - 2 http://www.iwcc.il.gov/faqmed.htm



Indiana Workers'Comp.

Yes State highly recommendsalignment with ICD-10.

SmartAdvisor - 2 http://www.in.gov/wcb/files/Procedural_Guidance.pdf



Iowa Workers'Comp.

CustomerDiscretion

No state regulationaddressing use of ICD-10.

SmartAdvisor - 3 No rules regarding provider billingin the state.



Kansas Workers'Comp.

CustomerDiscretion


SmartAdvisor - 3 http://www.dol.ks.gov/Files/PDF/WorkCompConnection2015-08.pdf



Kentucky Workers'Comp.

CustomerDiscretion


SmartAdvisor - 3 The Department of Workers' Claimsdoes not regulate ICD codes.



Long Shore(OWCP)

Workers'Comp.

Yes SmartAdvisor - 2

Louisiana Workers'Comp.

Yes SmartAdvisor - 2 The state made changes to parts ofRule 40 to include ICD-10 languagewhich include sections: 2519, 2701,2705, 5101 and 5113.




http://www.iic.idaho.gov/medical/medical.html

http://www.iic.idaho.gov/medical/medical.html

http://www.iwcc.il.gov/faqmed.htm

http://www.iwcc.il.gov/faqmed.htm

http://www.in.gov/wcb/files/Procedural_Guidance.pdf

http://www.in.gov/wcb/files/Procedural_Guidance.pdf

http://www.dol.ks.gov/Files/PDF/WorkCompConnection2015-08.pdf

http://www.dol.ks.gov/Files/PDF/WorkCompConnection2015-08.pdf




Maine Workers'Comp.

Yes - Inpatient Only

The Board has not takenan official position onwhich version of ICD touse, so health care providers will have the optionof using ICD-9 or ICD-10(except for inpatient facility bills, which will need tocontain ICD-10 codes todetermine the correctmaximum allowable payment per the fee schedule).

SmartAdvisor - 2



Maryland Workers'Comp.

Yes SmartAdvisor - 2 http://www.wcc.state.md.us/adjud_claims/notices_and_announcements/Year_2013/Oct_2013_Notices.html



Massachusetts Workers'Comp.




Michigan Workers'Comp.

Yes Rule 418.10922 SmartAdvisor - 2 http://www.michigan.gov/documents/wca/14_rules_477175_7.pdf



Minnesota Workers'Comp.

Yes Any reference to ICD-9 inthe statute is replacedwith ICD-10.

SmartAdvisor - 2 http://www.health.state.mn.us/asa/updt10.pdf



Mississippi Workers'Comp.

CustomerDiscretion


SmartAdvisor - 3



Missouri Workers'Comp.

CustomerDiscretion


SmartAdvisor - 3




http://www.wcc.state.md.us/adjud_claims/notices_and_announcements/Year_2013/Oct_2013_Notices.html




http://www.michigan.gov/documents/wca/14_rules_477175_7.pdf

http://www.michigan.gov/documents/wca/14_rules_477175_7.pdf






Montana Workers'Comp.

CustomerDiscretion


SmartAdvisor - 3



Nebraska Workers'Comp.

Yes -TraumaSurgeon

Rule 26 (dated11/26/2014): For inpatient hospital traumaadmission after10/01/2015, claim mustcontain an ICD-10 code.

SmartAdvisor - 2



Nevada Workers'Comp.




New Hampshire

Workers'Comp.

CustomerDiscretion


SmartAdvisor - 3



New Jersey Workers'Comp.

CustomerDiscretion


SmartAdvisor - 3

Auto Yes State will accept both ICD-9 and ICD-10. Denial forICD-9 after 10/01/2015 isnot acceptable per FAQpublished 09/11/2015.



New Mexico Workers'Comp.

Yes SmartAdvisor - 2 http://www.workerscomp.state.nm.us/research/docs/BillingInstructions2013.pdf



New York Workers'Comp.

Yes State advises no denialbased on ICD-9 after10/01/12015 or ICD-10prior to 10/01/15.

SmartAdvisor - 2 http://www.wcb.ny.gov/content/main/SubjectNos/sn046_746.jsp

Auto Yes DecisionPoint - 3SmartAdvisor - 3




http://www.workerscomp.state.nm.us/research/docs/BillingInstructions2013.pdf








North Carolina Workers'Comp.

Yes ICD-10 Diagnosis CodesRequired as of October 1,2015. Beginning October1, 2015, pursuant to N.C.Gen. Stat. § 97-26(g1)and in alignment with federal regulations, theapplicable administrativestandard for diagnosiscode sets for medicalbilling and reporting inNorth Carolina workers’compensation cases willtransition to the International Classification ofDiseases, 10th Edition,Clinical Modification andProcedure Coding System(ICD-10), from the 9th Edition (ICD-9).


http://www.ic.nc.gov/news.html#hot



North Dakota Workers'Comp.

Yes 92-01-02-40 (effective04/01/2014) implementsICD-10.

SmartAdvisor - 2



Ohio Workers'Comp.

Yes 3901-8-03: ICD-9 codesare scheduled to be displaced by ICD-10. Uponadoption, all references toICD-9 switch to ICD-10.

SmartAdvisor - 2 https://www.bwc.ohio.gov/provider//brochureware/icd/details.asp



Oklahoma Workers'Comp.

CustomerDiscretion

365:10-1-32 (2012): Payer may not requirepractitioner to use anycoding system other thanHCPCS, CPT, ICD-10.

SmartAdvisor - 2



Oregon Workers'Comp.

Yes Updated in Rule 436-009. SmartAdvisor - 2StateReporting - 2

http://www.cbs.state.or.us/wcd/policy/rules/docconv_21365/9_15058.pdf






https://www.bwc.ohio.gov/provider//brochureware/icd/details.asp

https://www.bwc.ohio.gov/provider//brochureware/icd/details.asp







Pennsylvania Workers'Comp.

CustomerDiscretion

Pending confirmation bythe state. Note: State uses old DRGgrouper version whichmay be impacted by ICD-10.

SmartAdvisor - 3



Rhode Island Workers'Comp.

CustomerDiscretion


SmartAdvisor - 3 No response from the state.



South Carolina Workers'Comp.

Yes - Inpatient Only

The change to ICD-10does not affect CPT codingfor outpatient proceduresand physician services. Atthis time, the Commissionwill make no changes tothe CPT code set withinthe current 2010 MedicalServices Provider Manual.

SmartAdvisor - 3 http://www.wcc.sc.gov/Documents/What's%20New/Medical%20Services%20Notices/Updated%20HCFA%201500%20Form%202014%2003%2019.pdf



South Dakota Workers'Comp.




Tennessee Workers'Comp.

Yes The Bureau will acceptboth ICD-9 and ICD-10codes on the 10/01/2015effective date. The state iscurrently looking at rulemaking to use the ICD-10exclusively, but the effective date for such rulemaking is unknown at thistime.

SmartAdvisor - 2 http://www.tn.gov/workforce/topic/wc-assistance-for-medical-providers



Texas Workers'Comp.

Yes SmartAdvisor - 2StateReporting - 3

http://www.tdi.texas.gov/wc/hcprovider/documents/icd10remind0315.pdf




http://www.wcc.sc.gov/Documents/What's New/Medical Services Notices/Updated HCFA 1500 Form 2014 03 19.pdf





http://www.tn.gov/workforce/topic/wc-assistance-for-medical-providers









Utah Workers'Comp.

CustomerDiscretion

State recommends thatproviders use ICD-10 forcontinuity, but is not mandating the use.

SmartAdvisor - 3 http://www.laborcommission.utah.gov/media/pdfs/industrialaccidents/pubs/Bull2015-1ICD-10.pdf



Vermont Workers'Comp.

CustomerDiscretion

The state DIR is not adopting ICD-10 as it is notapplicable to fee scheduleor rules. The Departmentof Health highly encourages providers to followthe CMS Mandate. NOSTATUTE REFERENCES forworkers compensation.

SmartAdvisor - 3



Virginia Workers'Comp.

CustomerDiscretion

Not addressed by state. SmartAdvisor - 3 http://www.vwc.state.va.us/



Washington Workers'Comp.

Yes SmartAdvisor - 2 L&I Readiness for ICD-10 & 5010



West Virginia Workers'Comp.


Auto Yes DecisionPoint - 3SmartAdvisor - 3

Wisconsin Workers'Comp.

CustomerDiscretion


SmartAdvisor - 3



Wyoming Workers'Comp.

CustomerDiscretion


SmartAdvisor - 3




http://www.laborcommission.utah.gov/media/pdfs/industrialaccidents/pubs/Bull2015-1ICD-10.pdf



http://www.vwc.state.va.us/

http://www.lni.wa.gov/ClaimsIns/Providers/Billing/BillLNI/Electronic/ICD10.asp

Product Option Legend

Option # Status onAdoption

Description

DecisionPoint - 1 No Use configurable settings to deny/warn/do nothing when ICD-10 codes are submitted.

DecisionPoint - 2 Yes Use configurable option to accept ICD-9 post-implementation date.

DecisionPoint - 3 CustomerDiscretion

Use both option 1 and 2 to accept both ICD versions post-implementation date.

SmartAdvisor - 1spacerspacerspacer

NoReservedfor futureuse

The state has not adopted ICD-10 and current rule regulations adopt ICD-9 into its guidelines.SmartAdvisor is not configured to accept ICD-10 by default. If your business prefers to acceptICD-10 bills as of 10/01/2015, the Allow ICD-10 prior to compliance date Client UDF shouldbe set to "Y" (Note: When this UDF option is enabled, there is no date validation for ICD versioning). To date, SmartAdvisor has all states set to a 10/01/2015 ICD-10 date. As of thedate of this publication, no states have mandated to remain using ICD-9 in lieu of ICD-10.

SmartAdvisor - 2 Yes The state has officially adopted or confirmed the preferred use of ICD-10. The jurisdictiontable that stores the ICD-10 effective dates for each state is set based on a date of service onor after 10/01/2015. No action is needed to allow ICD-10 into the system. The Allow ICD-9after compliance date Client UDF can be set to "N" or left blank, or "Y" if your business has apreference to continue allowing bills containing ICD-9 codes for dates of service after the

effective date.*Exception: New York, New Jersey Auto, and Colorado should have the Allow ICD-9 aftercompliance date set to "Y" based on regulatory feedback specified in the grid. Georgiaimplemented a grace period for ICD-9 continuation only through 11/01/2015.

SmartAdvisor - 3 CustomerDiscretion

The state has officially adopted or confirmed the preferred use of ICD-10. The jurisdictiontable that stores the ICD-10 effective dates for each state is set based on a date of service onor after 10/01/2015. No action is needed to allow ICD-10 into the system. The Allow ICD-9after compliance date Client UDF can be set to "N" or left blank, or "Y" if your business has apreference to continue allowing bills containing ICD-9 codes for dates of service after the

effective date.*Exception: New York, New Jersey Auto, and Colorado should have the Allow ICD-9 aftercompliance date set to "Y" based on regulatory feedback specified in the grid. Georgiaimplemented grace period for ICD-9 continuation only through 11/01/2015.

StateReporting - 1 At this time, the state will reject all bills--including denials--reported with an ICD code notapplicable for the effective date. Mitchell is currently working with the state to see if they arewilling to accept ICD-9 denials after the ICD-10 date.

StateReporting - 2 The state will accept bills with ICD codes not applicable for its effective date ONLY if it is adenial with adjustment code 146 - Diagnosis was invalid for the date(s) of servicereported. SmartAdvisor Message code XDU is crosswalked to CARC 146 and can be used forthese denials.

StateReporting - 3 The state will be able to accept bills with either ICD-9 or ICD-10 after the compliance effective date. The state indicated it does not have any edits in place enforcing the complianceeffective date.


State Legislative ChangesThis section provides information about changes being made to states’ legislation. The table contains the jurisdiction, bill/rulenumber, status of the bill/rule (see Bill/Rule Status Abbreviation Legend for status codes and descriptions), and a briefsummary of the bill/rule. Please provide comments on this format by sending an email to [email protected].

Jurisdiction Bill/Rule

Status Summary/Impact

Alabama 480-5-5

PR On December 31, 2015, published in the Alabama Administrative Monthly wereproposed rule changes for the Department of Labor. The proposed amended rulesaffect the following sections:n 480-5-5-.02 Definitions

n 480-5-5-.04 Statement of Services

n 480-5-5-.05 Entity Qualified to Perform Bill Screening

n 480-5-5-.09 Procedure to Pre-Certification

n 480-5-5-.15 Bill ScreeningThe proposed changes to the above sections are to update the rule language from ICD-9 to ICD-10. The state accepted comments on these changes till February 8, 2016. Toview the changes in its entirety, you can access the December 31, 2015 edition of theAlabama Administrative Monthly at the link provided below.http://alabamaadministrativecode.state.al.us/UpdatedMonthly/AAM-DEC-15/AAM-DEC-15.htm

Arizonaspacerspacerspacerspacerspacer

HB2334spacerspace

ICSpacerspacerspa

This bill was filed with the legislature and currently is being held in the InsuranceCommittee for review. If this bill is passed, it will set workers' compensation penaltyprovisions for bad faith indemnity and medical claims. The bill can be viewed on thestate's legislative web site.http://www.azleg.gov/DocumentsForBill.asp?Bill_Number=HB2334&Session_ID=114

California AB1124

A On or before July 1, 2017, the medical treatment utilization schedule adopted by theadministrative director shall include a drug formulary using evidence-based medicine.The drug formulary shall include a phased implementation for workers injured prior toJuly 1, 2017 to ensure injured workers safely transition to medications pursuant to theformulary. Once established, no less than quarterly updates will be made to the drugformulary to allow for the provision of all appropriate medications, including those newto the market. The drug formulary shall not apply to care provided in an emergencydepartment or inpatient setting.http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB1124



http://alabamaadministrativecode.state.al.us/UpdatedMonthly/AAM-DEC-15/AAM-DEC-15.htm

http://alabamaadministrativecode.state.al.us/UpdatedMonthly/AAM-DEC-15/AAM-DEC-15.htm

http://www.azleg.gov/DocumentsForBill.asp?Bill_Number=HB2334&Session_ID=114

http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB1124



Delaware HB166

A On July 27, 2015, the Governor signed HB 166 into law. This bill puts the following inplace:

Excerpt from: Excerpt from HB 166

“This bill removes the certification requirement for health care providers who

are not licensed in Delaware, but licensed in another state; changes the

allowable payment for these non-certified, out-of-state providers to the lesser

of the usual and customary, the other state's maximum reimbursement,

Delaware's maximum reimbursement, or a negotiated contract; and adds

utilization review as a payer recourse for non-certified, out-of-state providers.

This bill also allows the Workers' Compensation Oversight Panel to realize the

2016 and 2017 mandated medical cost savings in the Delaware workers'

compensation system through any component of the health care payment

system and not just the fee schedule. This bill also allows the Workers'

Compensation Oversight Panel to create regulations pertaining to the use of

electronic billing in the workers' compensation healthcare payment system.”

The bill can be accessed in its entirety from the link below.https://legiscan.com/DE/bill/HB166/2015

Federal HR2247

R On May 12, 2015, HR 2247 was introduced in the House and since then was referredto the Subcommittee on Health. This bill would "require the Secretary of Health andHuman Services to provide transparent testing to assess the transition under theMedicare fee-for-services claims processing system from the ICD-9 to the ICD-10standard, and for the other purposes."https://www.congress.gov/bill/114th-congress/house-bill/2247/all-info

HR2126

R On April 30, 2015, HR 2126 "Cutting Costly Codes Act of 2015" was introduced in theHouse and referred to the Subcommittee on Health. If adopted, this bill would"prohibit the Secretary of Health and Human Services from replacing ICD-9 with ICD-10in implementing the HIPAA code set standards.”https://www.congress.gov/bill/114th-congress/house-bill/2126/text

Florida HB7073

IC “Ratification of Rules/Florida Workers' Compensation Health Care ProviderReimbursement Manual/DFS: Ratifies specified rules relating to Florida Workers'Compensation Health Care Provider Reimbursement Manual, for sole & exclusivepurpose of satisfying any condition on effectiveness pursuant to s. 120.541(3), F.S.”http://www.myfloridahouse.gov/Sections/Bills/billsdetail.aspx?BillId=56498&

S1402

I “Ratification of Department of Financial Services Rules: Ratifying a specified rulerelating to the Florida Workers’ Compensation Health Care Provider ReimbursementManual for the sole and exclusive purpose of satisfying any condition on effectivenesspursuant to s.120.541(3), F.S., which requires ratification of any rule exceeding thespecified thresholds for likely adverse impact of increase in regulatory costs; providingapplicability, etc. “http://www.myfloridahouse.gov/Sections/Bills/billsdetail.aspx?BillId=56498&


https://legiscan.com/DE/bill/HB166/2015

https://www.congress.gov/bill/114th-congress/house-bill/2247/all-info

https://www.congress.gov/bill/114th-congress/house-bill/2126/text

http://www.myfloridahouse.gov/Sections/Bills/billsdetail.aspx?BillId=56498&

http://www.myfloridahouse.gov/Sections/Bills/billsdetail.aspx?BillId=56498&



SB0852

R This bill was introduced on January 12, 2016, regarding the medical use of marijuanaand the creation of the Florida Medical Marijuana Act as well as many other provisions.If adopted, this bill would become effective July 1, 2016.https://legiscan.com/FL/text/S0852/id/1274183

Florida Auto SB1112

I The state introduced Senate Bill 1112 Motor Vehicle Insurance. If adopted, this billwould delete certain requirements for specific fee schedule or payment limitations. Thespecific language would be changed to read:

“A payment for medical services made by an insurer pursuant to the schedule

of maximum charges set forth in subparagraph 1. is deemed to be payment of

a reasonable amount for such services pursuant to paragraph (1)(a). Such

payments may include the application of Medicare coding policies and

payment methodologies of the federal Centers for Medicare and Medicaid

Services, including applicable modifiers, if the coding policy or payment

methodology does not constitute a utilization limit.”

Then entire text of the proposed legislation can be accessed at the link provided below.http://www.flsenate.gov/Session/Bill/2016/1112/BillText/__/PDF

Hawaii HB1974HD2/SB2923

IH Requires DLIR to update the workers' compensation medical fee schedule annually.Authorizes DLIR to establish a workers' compensation medical fee ceiling that exceeds110% of the fees prescribed in the Medicare Resource Based Relative Value Scale forHawaii. Makes appropriations. Sunsets June 30, 2019. Effective July 1, 2050 (SD1).http://www.capitol.hawaii.gov/measure_indiv.aspx?billtype=HB&billnumber=1974&year=2014

HB2715

R On January 27, 2016, HB 2715 was introduced in the 2016 legislative session andpassed its first reading. This bill had some movement on February 9, 2016. The bill wasreferred to the committee on Labor and Finance. If adopted, this bill would makeHawaii a monopolistic state and put the following provisions in place:

1. “Repealing the Hawaii employers’ mutual insurance company;

2. Establishing the state workers’ compensation insurance company, as a public

body corporate attached to the department of labor and industrial relations, to

provide workers’ compensation insurance;

3. Requiring employers to either obtain workers’ compensation coverage only

from the state workers’ compensation insurance company or be self-insured.”

If adopted, this bill would require that a transition plan be put into place by 2017 forthe establishment of the state insurance company. . This bill can be viewed in itsentirety from the link below.http://www.capitol.hawaii.gov/session2016/bills/HB2715_.htm

Kansas SB167

I If adopted, this bill would revert the use of the AMA Guides to the Evaluation ofPermanent Impairment Guidelines back to the 4th Edition.http://www.kslegislature.org/li/b2015_16/measures/sb167/


https://legiscan.com/FL/text/S0852/id/1274183

http://www.flsenate.gov/Session/Bill/2016/1112/BillText/__/PDF

http://www.capitol.hawaii.gov/measure_indiv.aspx?billtype=HB&billnumber=1974&year=2014

http://www.capitol.hawaii.gov/measure_indiv.aspx?billtype=HB&billnumber=1974&year=2014

http://www.capitol.hawaii.gov/session2016/bills/HB2715_.htm

http://www.kslegislature.org/li/b2015_16/measures/sb167/



Louisiana SB256

I On April 3, 2015, SB 256 was introduced in the 2015 Regular Legislative Session. Ifadopted, this bill would provide for a prescription drug closed pharmacy formulary,implement an oversight panel, and adopt opioid drug and compound drug guidelines.It was reviewed for consideration by the Senate Health and Welfare committee onMay 6, 2015, but the session ended without a vote. It may be picked up in the nextlegislative session. The bill can be viewed from the link provided below.http://www.legis.la.gov/Legis/BillInfo.aspx?s=15RS&b=SB256&sbi=y

Michigan SB248

IC On March 26, 2015, SB 248 was introduced in the 2015 Michigan Legislative Session.On April 16, the bill passed the Senate and was sent to the House Committee onInsurance. Some of the changes being proposed are as follows:No cap on No-Fault medical benefits.No fee schedule being created for providers who treat auto injuries.Increased MCCA assessments.The bill can be viewed from the link below.http://www.legislature.mi.gov/documents/2015-2016/billintroduced/Senate/pdf/2015-SIB-0248.pdf

Minnesota HF2193

A On May 26, 2015, the legislature adopted House File 2193. The bill includes changes tothe reimbursement methodology for Inpatient Hospital. Effective January 1, 2016,workers' compensation inpatient bills are reimbursed using the Medicare MS-DRG. Thehighlights of the new methodology include:200% of the amount calculated for each hospital under the IPPSCatastrophic High Cost Injuries threshold of $175,000 annually adjustedCritical Access Hospitals reimbursed at usual and customary charge.

Additionally, this legislation included changes to the use of the ASC X12N 275 e-billingrequirements for attachments. It will now be mandatory for all workers' compensationmedical bills that require attachments to use the ASC X12N 275. The use of the 275will be effective July 1, 2016.

Effective September 1, 2015, this legislation also requires that payers provide thepatient name and control number on all payments made by check or electronictransfer, including bulk payment. Bulk payments are now be required to specify theamount paid for each patient.

The link below provides access to the adopted bill.http://wdoc.house.leg.state.mn.us/leg/LS89/HF2193.1.pdf

SF1822/HF1976

IC If adopted, this bill makes changes to the workers' compensation electronictransactions. One of the major points of this bill will be the required use of the ASCX12N 275 for attachments. The bill is currently in committee and is being monitored bythe industry very closely. The bill can be viewed on the legislative web site.https://www.revisor.mn.gov/bills/text.php?number=SF1822&version=1&session=ls89&session_year=2015&session_number=0


http://www.legis.la.gov/Legis/BillInfo.aspx?s=15RS&b=SB256&sbi=y

http://www.legislature.mi.gov/documents/2015-2016/billintroduced/Senate/pdf/2015-SIB-0248.pdf

http://www.legislature.mi.gov/documents/2015-2016/billintroduced/Senate/pdf/2015-SIB-0248.pdf

http://wdoc.house.leg.state.mn.us/leg/LS89/HF2193.1.pdf

https://www.revisor.mn.gov/bills/text.php?number=SF1822&version=1&session=ls89&session_year=2015&session_number=0

https://www.revisor.mn.gov/bills/text.php?number=SF1822&version=1&session=ls89&session_year=2015&session_number=0



Montana HB 90 E The bill makes changes to the rules for workers' compensation. It simplifies updatingfee schedule information each year. This bill is effective July 1, 2015.http://laws.leg.mt.gov/legprd/LAW0210W$BSIV.ActionQuery?P_BILL_NO1=90&P_BLTP_BILL_TYP_CD=HB&Z_ACTION=Find&P_SESS=20151

Nebraska LB429

I This bill was originally introduced in the 2015 Nebraska legislative session on January16, 2015. This bill was carried over to the 2016 legislative session. If adopted, this billwould revise the statutes to incorporate utilization and medical treatment guidelines.http://www.nebraskalegislature.gov/FloorDocs/Current/PDF/Intro/LB429.pdf

LB743

I This bill was introduced on January 6, 2016 in the 2016 Nebraska legislative session. Ifadopted, this bill would change how the reimbursements of shoulder injuries arehandled. The bill can be accessed from the link below.http://www.nebraskalegislature.gov/FloorDocs/Current/PDF/Intro/LB743.pdf

LB1001

I On January 15, 2016, LB 1005 was introduced into the 2016 Nebraska LegislativeSession. A public hearing was held on February 8, 2016 to discuss the proposedchanges. If adopted, it would revise the Nebraska statues to provide instructions forevidence-based drug formulary and become effective for services on or after January 1,2017.http://www.nebraskalegislature.gov/FloorDocs/Current/PDF/Intro/LB1001.pdf

LB1005

I On January 15, 2016, LB 1001 was introduced into the 2016 Nebraska legislativesession. A public hearing was held on February 8, 2016 to discuss the proposedchanges. If adopted, this bill would revise the disability compensation schedules. Thisbill can viewed in its entirety from the link below.http://www.nebraskalegislature.gov/FloorDocs/Current/PDF/Intro/LB1005.pdf

New Hampshire SB 45 I Introduced in 2015, SB45 was amended in January 2016 and has a new title,“establishing a committee to study opioid use in workers' compensation cases.” Ifadopted, this bill shall become effective upon passage. The committee shall report itsfindings and any recommendations for proposed legislation to the speaker of theHouse of Representatives, the president of the Senate, the House clerk, the Senateclerk, the governor, and the state library on or before November 1, 2016. For moreinformation, see the link below.http://www.gencourt.state.nh.us/bill_status/bill_docket.aspx?lsr=867&sy=2016&sortoption=&txtsessionyear=2016&txttitle=opioid&q=1


http://laws.leg.mt.gov/legprd/LAW0210W$BSIV.ActionQuery?P_BILL_NO1=90&P_BLTP_BILL_TYP_CD=HB&Z_ACTION=Find&P_SESS=20151

http://laws.leg.mt.gov/legprd/LAW0210W$BSIV.ActionQuery?P_BILL_NO1=90&P_BLTP_BILL_TYP_CD=HB&Z_ACTION=Find&P_SESS=20151

http://www.nebraskalegislature.gov/FloorDocs/Current/PDF/Intro/LB429.pdf




http://www.gencourt.state.nh.us/bill_status/bill_docket.aspx?lsr=867&sy=2016&sortoption=&txtsessionyear=2016&txttitle=opioid&q=1

http://www.gencourt.state.nh.us/bill_status/bill_docket.aspx?lsr=867&sy=2016&sortoption=&txtsessionyear=2016&txttitle=opioid&q=1



SB133

A At the beginning of 2015, SB 133 was introduced into the New Hampshire 2015Legislative Session. This bill adopted rules that requires the insurance commissioner tocreate a report on the best way to include workers' compensation medical claims datainto the New Hampshire health system data. It also clarifies how payments should bemade under the workers' compensation system. This report would be made availableto the public upon request.This bill was adopted and became effective September 4, 2015. The link to the bill isprovided below.http://www.gencourt.state.nh.us/legislation/2015/SB0133.pdf

HB477

IC This bill was introduced in the beginning of 2015; if adopted, it would require the laborcommissioner to establish a medical payment schedule. There has been no movementon this bill since February 2015. The link is provided below.https://legiscan.com/NH/bill/HB477/2015

SB 3 IC If adopted, this bill would require the insurance department to set rates for thepayment of medical services rendered in the treatment of workers' compensationinjuries. There has been no movement on this bill since March 2015. The link isprovided below.https://legiscan.com/NH/bill/SB3/2015

SB45 I In early January, Senate Bill 45 was introduced; if adopted, this bill would requireinjured workers to enter into an agreement regarding opioid treatment with theirhealth care provider. If adopted, this bill would become effective 30 days afterpassage.

New York A2462

R This bill, if adopted, would allow injured workers to be treated by a licensed or certifiedacupuncturists under the workers’ compensation program. This bill, if adopted, wouldbecome effective 180 days after it becomes law.http://assembly.state.ny.us/leg/?default_fld=&bn=A02462&term=2015&Summary=Y&Text=Y

A2541

R Same as A2462.http://assembly.state.ny.us/leg/?default_fld=%0D%0A&bn=A02541&term=2015&Summary=Y&Actions=Y&Text=Y#jump_to_Text

A4087

R This bill, if adopted, would put provisions in place to recognize massage therapists asvalid providers under the statutes as well as establish fees. If adopted, it wouldbecome effective immediately.http://assembly.state.ny.us/leg/?default_fld=%0D%0A&bn=A04087&term=2015&Summary=Y&Actions=Y&Text=Y


http://www.gencourt.state.nh.us/legislation/2015/SB0133.pdf

https://legiscan.com/NH/bill/HB477/2015

https://legiscan.com/NH/bill/SB3/2015

http://assembly.state.ny.us/leg?default_fld=&bn=A02462&term=2015&Summary=Y&Text=Y

http://assembly.state.ny.us/leg?default_fld=&bn=A02462&term=2015&Summary=Y&Text=Y

http://assembly.state.ny.us/leg?default_fld=%0D%0A&bn=A02541&term=2015&Summary=Y&Actions=Y&Text=Y#jump_to_Text



http://assembly.state.ny.us/leg?default_fld=%0D%0A&bn=A04087&term=2015&Summary=Y&Actions=Y&Text=Y




A5724

R This bill, if adopted, would establish fees for social worker services under the workerscompensation statutes. These provisionss would become effective 180 days afterbecoming law.http://assembly.state.ny.us/leg/?default_fld=%0D%0A&bn=A5724&term=2015&Summary=Y&Actions=Y&Text=Y

A6692

R This bill was introduced in the 2015 legislative session and then carried over in 2016.This bill would allow injured workers to see medical treatment outside their PPO aftertheir first visit. Currently, this bill was referred to the Committee on Labor and, ifadopted, will become effective 90 days after it has become law.http://www.nysenate.gov/legislation/bills/2015/A6992

S1490

R Companion bill to A2541, reads the same as A2462.

S2370

R This bill was introduced in the Senate and Assembly regarding the adoption of themedical treatment guidelines in the No-Fault System. On January 22, 2015, the bill wasreferred to the Committee on Insurance. This bill was carried over to the 2016legislative session and still resides with the Committee on Insurance as of January 6,2016. Currently, there was no further movement on this bill.http://assembly.state.ny.us/leg/?default_fld=&bn=S02370&term=2015&Summary=Y&Text=Y

Oregon HB2797

A On December 29, 2015, the state sent out a communication regarding the “timely firstpayment of time loss.” House Bill 2797 was adopted on June 5, 2015 and requires thatemployers make the first temporary disability payment in workers’ compensation caseswithin 14 days after the employer has been notified or has knowledge that there is aclaim. The state sent out the communication on December 29, 2015 to remindemployers of the timely first payment. To view the notification as well as HB 2797 in itsentirety, click on the links provided below.http://www.cbs.state.or.us/wcd/communications/industry_notices/12_29.pdfhttp://www.oregon.gov/DCBS/mlac/Documents/2015/3-6-15/HB2797.pdf

HB2211

E This bill authorizes the imposing of civil penalties for violations of workers'compensation claims processing by a service company. The rules are effective January1, 2016.https://olis.leg.state.or.us/liz/2015R1/Downloads/MeasureDocument/HB2211/Introduced

HB2032

I If adopted, this bill would prohibit the employer or insurer from requiring that theworker obtain non-emergency medical services from a specific provider.




http://www.nysenate.gov/legislation/bills/2015/A6992



http://www.cbs.state.or.us/wcd/communications/industry_notices/12_29.pdf

http://www.oregon.gov/DCBS/mlac/Documents/2015/3-6-15/HB2797.pdf

https://olis.leg.state.or.us/liz/2015R1/Downloads/MeasureDocument/HB2211/Introduced

https://olis.leg.state.or.us/liz/2015R1/Downloads/MeasureDocument/HB2211/Introduced



Pennsylvania HB1800

R On December 18, 2015, HB 1800 was introduced into the 2015 legislative sessionbefore it adjourned for the year. This bill, if adopted, would establish the use ofevidenced based medical treatment guidelines when performing utilization review. Ifadopted, this bill would become effective within 60 days of adoption. Currently, this billwas referred to the committee on Labor and Industry.http://www.legis.state.pa.us/CFDOCS/Legis/PN/Public/btCheck.cfm?txtType=PDF&sessYr=2015&sessInd=0&billBody=H&billTyp=B&billNbr=1800&pn=2681

HB467

R If adopted, this bill would amend the Workers' Compensation Act to include thefollowing language:"…an employer may also establish a list of one or more designated coordinated careorganizations for treatment of employees, and if such list is established, the employeeshall only treat with a provider or providers who are participants in the one of thoseorganizations for the duration of the injury; and further provided…"http://www.legis.state.pa.us/CFDOCS/Legis/PN/Public/btCheck.cfm?txtType=PDF&sessYr=2015&sessInd=0&billBody=H&billTyp=B&billNbr=0467&pn=0512

Tennessee HB1720

R On January 14, 2016, HB 1720 was introduced into the 2016 legislative session. Ifadopted, this bill puts penalties into place for the use of “silent PPOs” as well as foruntimely payments. If adopted, it would be effective July 1, 2016. Currently this billresides with the Consumer and Human Resources Subcommittee.https://legiscan.com/TN/text/HB1720/id/1297010

SB721/HB997

S On February 12, 2015, SB 721 was introduced in the Tennessee 2015 GeneralAssembly. SB 721 is the companion bill for HB 997, which was also introduced onFebruary 12 but has now been deferred in the Senate Finance, Ways and MeansCommittee. HB 997 was deferred in the Consumer and Human ResourcesSubcommittee to the 2016 legislative session and no further action will be taken thisyear.This bill, if adopted, would create an alternative to the workers' compensation system.To view the bill in its entirety, click on the link below.http://wapp.capitol.tn.gov/apps/BillInfo/Default.aspx?BillNumber=SB0721

Texas HB687

I This bill specifies that a reference to the carrier or covered employer includes theirattorneys, consultants, sureties, indemnitors, employees, TPAs and other agents andmakes communications with them confidential. Exceptions include: docs offered inevidence, public records, or those that violate Labor Code Sec 415.002(a)(6)(re-allowing an employer to dictate claims handling methods or procedures).http://www.capitol.state.tx.us/BillLookup/History.aspx?LegSess=84R&Bill=HB00687


http://www.legis.state.pa.us/CFDOCS/Legis/PN/Public/btCheck.cfm?txtType=PDF&sessYr=2015&sessInd=0&billBody=H&billTyp=B&billNbr=1800&pn=2681




https://legiscan.com/TN/text/HB1720/id/1297010

http://wapp.capitol.tn.gov/apps/BillInfo/Default.aspx?BillNumber=SB0721

http://www.capitol.state.tx.us/BillLookup/History.aspx?LegSess=84R&Bill=HB00687



HB690/SB263

I In cases of occupational disease, this bill requires non-subscribers to file a reportincluding the total cost of medical treatment paid, number of days the employee wasabsent, amount of wage replacement paid to employee, and amount of anysettlement paid to employee up to and including a year after the injury occurred ifemployer had knowledge of disease. Commissioner shall issue rules to specify adeadline for report submissions.http://www.capitol.state.tx.us/BillLookup/History.aspx?LegSess=84R&Bill=HB00690

SB262

I This bill requires non-subscribers to maintain life insurance coverage for eachemployee with a death benefit of not less than $200,000. The employer may not bethe beneficiary of such a policy. Accepting a death benefit does not impact rights of aperson to bring a civil action against the employer.http://www.capitol.state.tx.us/BillLookup/History.aspx?LegSess=84R&Bill=SB00262

Utah HB 37 A On March 31, 2015, the Governor signed HB 37, which became effective May 1, 2015.This bill puts the following provisions in place:n Provides a copy of each issue of the bulletin to the Administrative Rules Review

Committee

n Incorporates technical amendments into the Rules

n Reauthorizes all state agency ruleshttp://le.utah.gov/~2015/bills/static/HB0037.html

Virginia HB378

R If adopted, this bill would put regulations in place to have the workers’ compensationfee schedule effective on January 1, 2018. To view the bill in its entirety, click on thelink below.http://lis.virginia.gov/cgi-bin/legp604.exe?ses=161&typ=bil&val=hb378&submit=GO

HB2384

A This bill establishes a schedule for providers and carriers to process claims electronically.The state plans on using the following schedule:All payers and providers must be in compliance with the Virginia’s e-billingrequirements by December 31, 2018. E-billing in Virginia will be available on avoluntary basis for six months after the Rule becomes effective.http://lis.virginia.gov/cgi-bin/legp604.exe?ses=151&typ=bil&val=hb2384

SB631

On January 15, 2016, SB631 was introduced in the 2016 legislative session and, ifadopted, would implement a workers’ compensation fee schedule, effective January 1,2018. This bill can be reviewed in its entirety from the link below.http://lis.virginia.gov/cgi-bin/legp604.exe?ses=161&typ=bil&val=SB631&submit=GO

Washington WAC296-17

A The state posted proposed rules regarding "General reporting rules, classifications,audit and record-keeping, rates and rating system for Washington workers'compensation insurance."http://www.lni.wa.gov/ClaimsIns/Rules/New/Proposed/default.asp?RuleID=413


http://www.capitol.state.tx.us/BillLookup/History.aspx?LegSess=84R&Bill=HB00690

http://www.capitol.state.tx.us/BillLookup/History.aspx?LegSess=84R&Bill=SB00262

http://le.utah.gov/~2015/bills/static/HB0037.html

http://lis.virginia.gov/cgi-bin/legp604.exe?ses=161&typ=bil&val=hb378&submit=GO

http://lis.virginia.gov/cgi-bin/legp604.exe?ses=151&typ=bil&val=hb2384

http://lis.virginia.gov/cgi-bin/legp604.exe?ses=161&typ=bil&val=SB631&submit=GO

http://www.lni.wa.gov/ClaimsIns/Rules/New/Proposed/default.asp?RuleID=413



Wisconsin SB536

I This bill, if adopted, makes various changes to the workers’ compensation law, whichinclude but are not limited to the following:n Redbook is to be used to determine the AWP for prescription drugsThe proposed bill can be viewed from the link below.http://docs.legis.wisconsin.gov/2015/proposals/sb536

Bill/Rule Status Abbreviation LegendThe following list contains descriptions for the Status codes used in the State Legislative Changes table:

Code Definition: DescriptionA Adopted: Rule adopted and made effective on a specific date.

AR Administrative Review: Review by a subcommittee on specific amended rule changes.

C On the Calendar: The bill was placed on the calendar for vote.

D Defeated: Bill was defeated and no further action has taken place.

E Enacted: Bill passed and made into law.

ER Emergency Rules: Rules put into effect for an emergency period.

FP Failed Passage: Bill did not pass.

I Introduced: Bill introduced in the legislative session.

IC In Committee: Bill is with a particular committee for review.

IH In the House: Bill is in the House and moving through the process.

IP Indefinitely Postponed: Bill has been postponed until further notice.

IS In the Senate: Bill is in the Senate and moving through the process.

P Passed: Bill was passed in the Senate, House, or both.

PC Public Comments: Proposed bill or rule is available for public comment.

PH Public Hearing: Proposed bill or rule is slated for public hearing.

PR Proposed: Proposed rules were posted for review and comment.

R Referred: Bill referred to another committee for further action.

RF Refiled: Bill will be refiled at a later date.

V Vetoed: Bill was vetoed by the appropriate authority (i.e. the governor or the president).

W Withdrawn: Bill has been withdrawn.


http://docs.legis.wisconsin.gov/2015/proposals/sb536

Fee Schedule UpdatesThis section contains researched information obtained from state resources regarding jurisdictional changes that have takenplace in the last six months and those anticipated to take place in the future. Unless otherwise indicated, these changes applyto workers’ compensation only. Note that the “New Adoptions!” headings only appear when a new adoption has taken place.Send comments or suggestions to [email protected].

AlabamaFuture Plans/Proposals

n The state will be posting a full fee schedule update in January 2017.

n The state posts revisions to hospital and ASC rates each quarter for 2016.

Previous Updates

n On December 17, 2015, the state posted Ambulance, Ambulatory Surgery Center (ASC), Anesthesia, Chiropractic, ClinicalLab, Dental, Durable Medical Equipment (DME), Home Health, Hospital, In-Office Surgery, Optometrist, Pain Pump,Pharmaceuticals, Physician Disability Codes, Physicians’ Maximum Fee Schedule, and Physical Therapy Fee Schedules. Theschedules are effective January 1, 2016 and can be accessed from the link below.

https://labor.alabama.gov/wc/2016FeeSchedules.aspx

n On October 6, 2015, the state posted Revision 3 for the Hospital and Ambulatory Surgery Center (ASC) Reimbursementschedules. The updates contain multiple effective dates for each hospital and ASC. The updates can be viewed on thestate’s web site.

http://www.labor.alabama.gov/wc/2015FeeSchedules.aspx

AlaskaNew Adoptions!

n On January 29, 2016, the state’s vendor posted an update to the fee schedule that reflected the change to the CMS data,effective January 1, 2016. The update can only be obtained directly from Optum.

Additionally, on February 11, 2016, the state posted a notice about the update to reference materials referred to underRule 8 AA 45.083. The following reference materials are being updated to the January 1, 2016 editions:

- Current Procedural Terminology (CPT) Codes

- Healthcare Common Procedure Coding System (HCPCS)

- Relative Value Guide

- Current Dental Terminology (CDT)

- Resource Based Relative Value Scale (RBRVS)

- Ambulatory Payment Classifications (APC)

- Medicare Severity Diagnosis Related Group (MS-DRG)

This notice can be found on the state's web site at the link provided below.

https://aws.state.ak.us/OnlinePublicNotices/Notices/View.aspx?id=180168

Future Plans/Proposals

n On December 3, 2015, the state posted the “Supplemental Notice of Adoption of Emergency Regulations of the AlaskaDepartment of Labor and Workforce Development and the Alaska Workers’ Compensation Board on Fee Schedules forPayment of Medical Expenses of Injured Workers.”



https://labor.alabama.gov/wc/2016FeeSchedules.aspx

http://www.labor.alabama.gov/wc/2015FeeSchedules.aspx


This notice is to inform stakeholders that while the Medical Fee Schedule was adopted as an emergency rule, the publicwill still have time to comment on the Notice of Proposed Changes that was published on September 23, 2015.Comments may be made no later than January 4, 2016. The online public notice can be viewed on the Workers’Compensation web site.


Previous Updates

n On October 29, 2015, the state adopted rule changes to the Workers’ Compensation Medical Fee Schedule. The adoptionincludes moving to the Resource-based relative value scale (RBRVS) methodology for repricing of medical bills with thefollowing conversion factors (CF):

- Evaluation and Management CF 80.

- Medicine (excluding anesthesiology) CF 80.

- Surgery CF 205.

- Radiology CF 257.

- Pathology and Laboratory CF 142.

This update is effective December 1, 2015. The entire rule and its adopted changes can be viewed from the link providedbelow.

https://aws.state.ak.us/OnlinePublicNotices/Notices/Attachment.aspx?id=101380

ArizonaFuture Plans/Proposals

No future plans are proposed at this time.

Previous Updates

n The state recently updated its Fee Schedule FAQs (2015) Edition. This updated document can be accessed from the linkprovided below.

http://www.ica.state.az.us/Director/DIR_FSFAQs.aspx

n On August 28, 2015, the state posted the updated Physician’s Fee Schedule, effective October 1, 2015, throughSeptember 30, 2016. The fee schedule can be downloaded from the state’s web site at the link provided below.

http://www.ica.state.az.us/Director/DIR_FSList2015.aspx

ArkansasFuture Plans/Proposals

n CPT1 codes and the Medicare RBRVS are adopted by the state automatically, applicable on its effective date (January 1) asrequired each year in accordance with Rule 30.

Previous Updates

n There are no updates from the last six months to report at this time.

1CPT® is a registered trademark of the AmericanMedical Association.



https://aws.state.ak.us/OnlinePublicNotices/Notices/Attachment.aspx?id=101380

http://www.ica.state.az.us/Director/DIR_FSFAQs.aspx

http://www.ica.state.az.us/Director/DIR_FSList2015.aspx

CaliforniaFuture Plans/Proposals

n The state posted on February 11, 2016, DWC Newsline 2016-20 regarding the public hearing that was held on February17, 2016, which related to the adoption of a workers’ compensation drug formulary by July 1, 2017. The Newsline can beaccessed from the link below.


n On October 16, 2015, the state posted its proposed rules and fees for the Home Health Services fee schedule. A publichearing was held on November 30, 2015 in Oakland. This is a new fee schedule for the California DWC. The newproposed sections are as follows:

- Section 9789.90 Home Health Care - Definitions

- Adopt Section 9789.91 Home Health Care - Eligibility for Services & Payment.

- Adopt Section 9789.92 Home Health Care – Payment Methodology & Billing Rules.

- Adopt Section 9789.93 Table A

The proposed Home Health Services fee schedule can be viewed at the link provided below.

http://www.dir.ca.gov/dwc/DWCPropRegs/HomeHealthCareFeeSchedule/HomeHealthCareFeeSchedule.htm

n The state announced a public meeting to discuss an Evidence-Based Drug Formulary for workers' compensation. Thepublic meeting was held on September 8, 2015 in Oakland, California. The state indicated that it is following goals inadopting a drug formulary:

Excerpt from: DIR Newsline No. : 2015-78

- “Improve appropriate care through the dispensing of evidenced-based medicine

- Expedite pharmaceutical treatment for ill and injured workers

- Reduce delays, including the reducing the need for elevated utilization review and independent medical review

- Improve efficient delivery of medical benefits and reduce administrative costs.”

The entire Newsline post can be found on the state's web site.


n On May 19, 2015, the state posted DIR Newsline No. 2015-44 indicating that there would be a public hearing held onJune 17, 2015 to discuss revising the Hospital Outpatient Departments and Ambulatory Surgical Centers fee schedule.

Excerpt from: Newsline No. 2015-44

"The Division of Workers' Compensation (DWC) has issued a notice of public hearing to revise Title 8 CCR section 9789.32 ofthe hospital outpatient departments and ambulatory surgical centers (HOPD/ASC) fee schedule. The public hearing hasbeen scheduled for 10 a.m., June 17, in the Auditorium of the Elihu Harris Building, 1515 Clay Street, Oakland, CA 94612.Members of the public may also submit written comment on the regulation until 5 p.m. that day.

The proposed amendment to the HOPD/ASC fee schedule regulation provides guidance regarding which HCPCS code touse when Medicare changes its coding practices resulting in different HCPCS codes to describe comparable "Other Services"under CMS' Hospital Outpatient Departments Prospective Payment System and the OMFS physician fee schedule."

The proposed fee schedule can be viewed on the state's web site.

http://www.dir.ca.gov/dwc/DWCPropRegs/HospitalOutpatientAnbulatorySurgicalCenters/HospitalOutpatientAnbulatorySurgicalCenters.htm



http://www.dir.ca.gov/dwc/DWCPropRegs/HomeHealthCareFeeSchedule/HomeHealthCareFeeSchedule.htm




Previous Updates

n On January 20, 2016, the state posted Division of Workers' Compensation (DWC) Newsline No.: 2016-03 regarding theadjustments made to the Official Medical Fee Schedule (Physician Services/Non-Physician Practitioner Services), effectiveJanuary 1 and Medi-Cal rates for pharmacy, effective January 15, 2016. This newsline as well as the adopted changes canbe found at the links below.


http://www.dir.ca.gov/dwc/OMFS9904.htm#7

n On January 8, 2016, the state issued Newsline No. 2016-01 regarding the update to the Ambulance Fee Scheduleeffective for services on or after January 15, 2016.


n On December 18, 2015, the state posted the clinical laboratory and pathology update to conform to the Centers forMedicare and Medicaid (CMS) changes. The updated files can be found on the state’s web site at the link provided below.


n On December 17, 2015, the state posted an adjustment to the Official Medical Fee Schedule (OMFS) Physician Service toinclude the updated Medicare Practitioner PTP Edits and Medically Unlikely Edits. These edits are effective January 1,2016.


n On December 16, 2015, the state posted an update to the Durable Medical Equipment Prosthetics, Orthotics and Supplies(DMEPOS), effective January 1, 2016. The state indicated that the data files have a new structure.

Excerpt from DIR Newsline 2015-122:

“The public should take note that for calendar year 2016, the data files contain a new structure which includes

“California Non-Rural” and “California Rural” fee columns. For some codes, the fee for services in a rural area is

different from the fee in a non-rural area. The status of “non-rural” versus “rural” is determined using the injured

worker’s address and the Medicare ZIP code file included in the adopted DME16-A fee schedule.”

The entire DIR Newsline article can be view on the state’s web site at the link provided below.


n On November 20, 3015, the state adopted the changes for Physicians and Non-Physician Practitioner Services effective forservices on or after January 1, 2016. The order updates the following:

- Medicare’s National Physician Fee Schedule

- The conversion factors

- The 2016 National Correct Coding Edits (NCCI)

- California specific codes to reflect the inflation increase


http://www.dir.ca.gov/dwc/FeeSchedules/Physician/PhysicianFeeSchedule/PhysicianFeeSchedule2016/Orders/Order-January.pdf

n On October 21, 2015, the state updated the OMFS to conform to the Medicare payment system adopting the CMSPhysician Fee Schedule Relative Value File (RVU). The update is effective retroactively to October 1, 2015. The notice fromthe state can be found at the link provided below.


The state also updated its monthly Medi-Cal rates, effective October 15, 2015.












n On October 6, 2015, The Governor signed Assembly Bill 1124 (Chapter 525) that requires the Administrative Director (AD)of the Department of Workers’ Compensation (DWC) to create a drug formulary within the medical treatment utilizationschedule. The AD is required to publish no less than two interim reports regarding the creation of the formulary and postthem on the DWC web site starting July 1, 2016, and continuing until the formulary is completed. The formulary must beadopted on or before July 1, 2017. The bill can be found on the state’s legislative web site at the link provided below.


CMS/Federal RegisterNew Adoptions!

n Medicare posted the adoption of updated zip code files, effective April 1, 2016. These files can be viewed on the CMSweb site at the link provided below.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FeeScheduleGenInfo/index.html

n On January 26, 2016, Medicare posted updated rates for the ASC Approved HCPCS Codes, effective January 1, 2016.Theupdated rates can be accessed from the link below.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates.html

n On January 15, 2016, Medicare posted HCPCS codes that are subject to and/or excluded from the edits for ClinicalLaboratory improvement amendments, effective January 1, 2016. This update contains codes that were discontinued onDecember 1, 2015 as well as new HCPCS codes for 2016. These changes can be accessed from the link below.


Additionally, on January 15, 2016, Medicare posted a new list of Food and Drug Administration (FDA) approved waivedtests. The list contains codes for any waived test that needs or does not need the “QW” modifier for proper payment.These changes can be accessed from the link below.



n On September 25, 2015, Centers for Medicare and Medicaid (CMS) released a news communication about a newlyproposed Medicare Clinical Diagnostic Laboratory Tests Fee Schedule. These new rates became effective January 1, 2017.The proposed rule can be viewed at the link provided below.

https://www.federalregister.gov/public-inspection

n On November 19, the House Ways and Means Committee submitted a proposal to update short-stay hospital payments.This is being proposed under the Hospital Improvements for Payment (HIP) Act of 2014. For further information on theproposed changes see the link below.

http://waysandmeans.house.gov/uploadedfiles/hip_sec-by-sec_.pdf

Previous Updates

n On December 23, 2015, CMS posted updated ASP Pricing files, effective January 1, 2016.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/2016ASPFiles.html

n On December 11, 2015, CMS posted the quarterly additions, deletions and revisions to the MUEs for practitioners,outpatient hospital, and durable medical equipment (DME) supplier services, effective January 1, 2016.

https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Version_Update_Changes.html




https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates.html





https://www.federalregister.gov/public-inspection

http://waysandmeans.house.gov/uploadedfiles/hip_sec-by-sec_.pdf

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/2016ASPFiles.htm


n On December 11, 2015, CMS posted the National Correct Coding Initiative (NCCI) quarterly additions, deletions, andmodifier indicator changes, effective January 1, 2016.


n On December 9, 2015, CMS reposted the Average Sales Price (ASP) Pricing and ASP NDC_HCPCS Crosswalk files,retroactive to January 1, 2015.


n On December 9, 2015, CMS reposted the ASP Pricing, NOC Pricing, and ASP NDC_HCPCS files, retroactive to October 1,2015.


n On December 9, 2015, CMS posted the ASP Pricing, NOC Pricing, and ASP NDC_HCPCS files, effective January 1, 2016.


n CMS posted the 2016 Final Rule for Ambulance and Ambulance Inflation Factor for CY 2016 and Productivity Adjustmentunder Transmittal number 3380.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AmbulanceFeeSchedule/index.html

n CMS posted the following files for the 2016 ZIP Code:

- Carrier Locality Files

- +4 Extension

- End of the Year Zip Code File

- Changes to the Zip Code File.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FeeScheduleGenInfo/index.html?redirect=/FeeScheduleGeninfo/

n On November 20, 2015, CMS posted updated files for ASC final rule for files Addendum AA, BB, DD1, DD2, and EE.

https://www.cms.gov/apps/ama/license.asp?file=/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/Downloads/CMS-1633-FC-CY2016-FR-ASC-Addenda-AA-BB-DD1-DD2-EE.zip

n On November 5, 2015, Centers for Medicare and Medicaid Services (CMS) MLN Connects Provider eNews releasedinformation that the final payment rules for 2016 were posted. To read the Provider eNews in its entirety use the linkbelow.


n On October 30, 2015, Medicare posted the final adoption to the FY 2016 Ambulatory Surgery Center (ASC) Fee Schedule,effective January 1, 2016.

The update can be found at the following link.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/ASC-Regulations-and-Notices-Items/CMS-1633-FC.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending

n On October 30, 2015, Medicare posted the updates to the Two-Midnight rule, effective January 1, 2016.


https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-10-30-3.html






https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AmbulanceFeeSchedule/index.html

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FeeScheduleGenInfo/index.html/?redirect=/FeeScheduleGeninfo/

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FeeScheduleGenInfo/index.html/?redirect=/FeeScheduleGeninfo/








n On October 30, 2015, Medicare posted the final rule under the Physician Fee Schedule for CY 2016, effective January 1,2016.


https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-10-30.html

n On October 29, 2015, Medicare posted the FY 2016 Home Health Prospective Payment System Rate Update, effectiveJanuary 1, 2016.



n On October 26, 2015, Medicare posted the FY 2016 Hospital Value-Based Purchasing (VBP) Program, effective January 1,2016.


https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2016-IPPS-Final-Rule-Home-Page-Items/FY2016-IPPS-Final-Rule-Tables.html

n On October 26, 2015, Medicare posted the FY 2016 update to the Acute Inpatient PPS Hospital Value-Based PurchasingProgram, effective October 1, 2015.


n On October 9, 2015, Medicare posted the October quarterly Provider Specific Files (PSF) for Inpatient, Skilled NursingFacility, Home Health Agency, Hospice, Inpatient Rehab, Long Term Care and Inpatient Psychiatric Facility, effectiveOctober 1, 2015.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/psf_text.html

n On October 8, 2015, Medicare posted a Final Rule and Correction Notice FY 2016 Impact File for the Acute Inpatient PPS.The corrected files can be found on the CMS web site at the link provided below.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2016-IPPS-Final-Rule-Home-Page-Items/FY2016-IPPS-Final-Rule-Data-Files.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending

n On October 5, 2015, Medicare posted Q4 2015 DMEPOS Rural Zip Codes and Revised CY 2016 Fee Schedule PUF Formatsregarding changes to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) data file formats,effective January 1, 2016 and July 1, 2016.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/DMEPOS-Fee-Schedule-Items/DME-Rural-Zip-and-Formats.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending

n On October 5, 2015, Medicare posted an update to the October quarterly Physician Fee Schedule data file (RVU15D),effective October 1, 2015.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files-Items/RVU15D.html

n September 21, 2015, Medicare posted the October quarterly OPPS Addendum A and Addendum B data files, effectiveOctober 1, 2015.

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates.html

n On September 14, 2015, Medicare posted updates to the October quarterly NCCI PTP coding edits for hospital andphysicians, effective October 1, 2015.

http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html


















n On September 14, 2015, Medicare posted updates to the October quarterly MUE edits for practitioner services, facilityoutpatient, and DME supplier services, effective October 1, 2015.

https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html

n On September 8, 2015, CMS posted the annual October ZIP Code file update, effective October 1, 2015.


n On September 2, 2015, CMS posted the quarterly October ASP update, effective October 1, 2015.


n On August 27, 2015, CMS posted the quarterly October DMEPOS Fee Schedule update, effective October 1, 2015.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/DMEPOS-Fee-Schedule-Items/DME15-D.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending

n On August 26, 2015, CMS posted the quarterly Physician Fee Schedule updated data file, effective October 1, 2015.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files-Items/RVU15D.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending

n On August 25, 2015, CMS posted the quarterly October HCPCS C-Codes update, effective October 1, 2015.

https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update.html

n Medicare posted an update to the ICD-10 CM 2016 Present on Admission (POA) Exempt List, effective October 1, 2015.

https://www.cms.gov/Medicare/Coding/ICD10/2016-ICD-10-CM-and-GEMs.html

n Medicare posted an update to the Place of Service Codes for Professional Claims Database on August 6, 2015. Changesinclude new POS 19 and an updated description for POS 22 effective January 1, 2016.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/Website-POS-database.pdf

ColoradoFuture Plans/Proposals


Previous Updates

n On October 5, 2015, the state released an Interpretive Bulletin that provides clarification and interpretation on the newlyreleased Division Rules 16 and 18. These rules are effective January 1, 2016. The Interpretive Bulletin can be found on thestate’s web site and the link provided below.

https://www.colorado.gov/pacific/sites/default/files/IB%20draft-final%20version1.pdf

n The state posted its adopted Rule 16: Utilization Standards and Rule 18: Medical Fee Schedule with exhibits, effectiveJanuary 1, 2016. In the past, the state used the Relative Value for Physicians (RVP) as the reimbursement methodology.The new fee schedule uses Medicare’s Resource Based Relative Value Scale (RBRVS). The updated rules can be found onthe state’s web site at the link provided below.


Colorado (Auto)Future Plans/Proposals

n No future plans are proposed at this time.










https://www.cms.gov/Medicare/Coding/ICD10/2016-ICD-10-CM-and-GEMs.html



https://www.colorado.gov/pacific/sites/default/files/IB draft-final version1.pdf


Previous Updates


ConnecticutFuture Plans/Proposals

n An update to the Hospital/ASC Fee Schedule is expected in April 2016.

n Historically, the state adopts the Practitioner Fee Schedule in July of each year. The next update is expected July 15, 2016.

Previous Updates

n On December 31, 2015, the state issued Memorandum No.2015-12, indicating that effective April 1, 2016 the followingrates for Hospital and Ambulatory Surgical Centers will apply:

- Hospital inpatient - 174% of the Medicare rate

- Hospital outpatient and hospital-based ambulatory surgical center rate - 210% of Medicare rate

- Non-hospital based ambulatory surgical center – 195% of Medicare rate

- In the instance where there is no Medicare rate then the rate for services shall be negotiated

The memorandum can be viewed in its entirety from the link provided below.

http://wcc.state.ct.us/memos/2015/2015-12.htm

DelawareNew Adoptions!

n On January 29, 2016, the state’s vendor posted the 2016 healthcare payment fee schedule, effective January 31, 2016.The fee schedule can be accessed from the link below.

https://dowc.optum.com/info.asp?page=rules


n Historically, the state adopts the fee schedule annually every January.

Previous Updates

n On December 21, 2015, the state of Delaware sent out an email communication to stakeholders indicating the followingregarding the fee schedule update, effective January 31, 2016:

“Fee Schedule Updates:

At its meeting on December 14, 2015 the Workers Compensation Oversight Panel voted to accept the

recommendation of the Fee Schedule Subcommittee for a uniform 7% reduction below the current fee schedule to be

applied to every health care code and service other than anesthesia.

Anesthesia, all applicable codes will be reduced by 27% to bring those codes in line with the current reduction as well

as the 20% reduction that was implemented in the January 2015 fee schedule. These reductions will be reflected in

the fee schedule beginning January 31, 2016. The purpose of these reductions is to meet the 5% reduction in

aggregate workers compensation medical expenses that is required by Title 19, Section 2322B(3)(a).”

At the time of release of this newsletter the January 2016 update was not posted on the state’s web site.

n In the November 1, 2015 edition of the Delaware Register of Regulations, the state posted the adoption of the newformula to calculate anesthesia services, effective January 31, 2016. The new rule can be viewed from the link below.

http://regulations.delaware.gov/documents/November2015c.pdf


http://wcc.state.ct.us/memos/2015/2015-12.htm

https://dowc.optum.com/info.asp?page=rules

http://regulations.delaware.gov/documents/November2015c.pdf

District of ColumbiaFuture Plans/Proposals

n Data file updates from CMS for anesthesia, clinical lab, DMEPOS, HCPCS, inpatient hospital, outpatient hospital, andphysician services are made either annually (based on calendar or fiscal year) or quarterly (January 1, April 1, July 1 andOctober 1 of each year) with an added markup, where applicable, as defined in the district's statute.

Previous Updates


FloridaNew Adoptions!

n On February 10, 2016, the state sent out an email communication indicating that a correction was made to the MRA valuefor 64492, retroactive to January 1, 2016. The email communication is inserted below.

ATTENTION: Self-Insurers, Insurers, Claim Administrators, and Medical Providers

The Florida Division of Workers' Compensation has made a technical correction in the Florida Workers' Compensation

Reimbursement Manual for Ambulatory Surgical Centers, 2015 Edition (Effective Jan. 1, 2016)

(www.myfloridacfo.com/Division/WC/pdf/revised-2015_ASCRM_effective-01.01.16.pdf). The MRA for CPT® code

64492 was incorrectly listed on page 34 of the manual. This has been corrected and the manual now reflects the

correct MRA value for CPT® code 64492 as $1,059.90.

If you have any questions or concerns please contact the Medical Services Section at

[email protected].

n On February 8, 2016, the state posted revised rules under Chapter 69L-8, effective February 18, 2016. The update includesthe following:

- 69L-8-071 Materials for use with the Florida Workers’ Compensation Health Care Provider ReimbursementManual

- 69L-8-072 Materials for use with the Florida Workers’ Compensation Reimbursement Manual for AmbulatorySurgical Centers

- 69L-8-073 Materials for use with the Florida Workers’ Compensation Hospital Reimbursement Manual

- 69L-8-074 Materials for use throughout Rule Chapter 69L-7, F.A.C.


n On February 3, 2016, the state posted the final version of Rule Chapter 69L-7-740, effective February 18, 2016, whichcontains the updates for the EOBR message codes. These changes can be accessed from the link below.



n On November 5, 2015, the state posted a notice of change regarding proposed changes to the Florida ProviderReimbursement Manual. The proposed changes can be viewed from the link below.

https://www.flrules.org/gateway/View_Notice.asp?id=16732905

n On July 23, 2015, the state posted notification that on July 20th, 2015, the Florida Department of Financial Services,Division of Workers' Compensation adopted the changes to the medical reimbursement manual. The changes are to alignwith the 2014 Medicare rates and to also make some policy changes. The manual will not be effective until the legislaturehas ratified the changes. To access the state's notice please use the link below:

http://www.myfloridacfo.com/Division/WC/noticesRules.htm


http://www.myfloridacfo.com/Division/WC/pdf/revised-2015_ASCRM_effective-01.01.16.pdf

http://[email protected]/



https://www.flrules.org/gateway/View_Notice.asp?id=16732905

http://www.myfloridacfo.com/Division/WC/noticesRules.htm

Previous Updates

n Recently, the state posted a change to the proposed ASC Reimbursement manual, which updates reference materials andthe effective date as suggested in the comments received from the Joint Administrative Procedures Committee. Theproposed new effective date for this manual is January 1, 2016. The "Notice of Change" can be found on the FloridaAdministrative web site.

https://www.flrules.org/gateway/ruleNo.asp?id=69L-7.100

Florida (Auto)Future Plans/Proposals

n Data file updates from CMS for anesthesia, ASC, ASP Drug, clinical lab, DMEPOS, HCPCS, home health PPS, inpatienthospital, outpatient hospital, physician services, and rehabilitation PPS are made annually March 1 (based on calendar orfiscal year) with an added markup, where applicable, as defined in the state's statute.

Previous Updates


GeorgiaFuture Plans/Proposals

n Updates to the ASC, DME, home health, hospital, IME, medical records, pharmaceutical, physician, and transportationrates are historically updated April 1 of each year.

Previous Updates


HawaiiFuture Plans/Proposals

n Historically, Hawaii adopts the Medicare Fee Schedule when it is updated January 1 of each year.

Previous Updates

n On November 18, 2015, the fee schedule data used by Workers' Compensation and Auto medical bills was posted. Thedata is effective January 1, 2016, and can be accessed from the link below:

https://med.noridianmedicare.com/web/jeb/fees-news/fee-schedules/mpfs

Hawaii (Auto)Future Plans/Proposals

n Historically, Hawaii adopts the Medicare Fee Schedule when it is updated on January 1 each year.

Previous Updates

n On November 18, 2015, the fee schedule data used by Workers' Compensation and Auto medical bills was posted. Thedata is effective January 1, 2016, and can be accessed from the link below.


IdahoFuture Plans/Proposals

n The state posted proposed revisions to the Medical Fee Rules 17.02.09 in the October 7, 2015 edition of the IdahoAdministrative Bulletin. The proposed rule includes but is not limited to the following:


https://www.flrules.org/gateway/ruleNo.asp?id=69L-7.100



- Some minor definition changes

- Clarifies how an outpatient hospital procedure is reimbursed when a comprehensive ambulatory paymentclassification (C-APC) code with status indicator J1 present or not present.

n “When no medical services with a status code J1 appears on the same claim, two (2) or more medical procedureswith a status code T on the same claim shall be reimbursed with the highest weighted code paid at one hundredpercent (100%) of the APC calculated amount and all other status code T items paid at fifty percent (50%). Whena medical service with a status code J1 appears on the same claim, all medical services with a status code T shallbe paid at fifty percent (50%).”

n “When no medical services with a status code J1 appears on the same claim, status code Q items with anassigned APC weight will not be discounted. When a medical service with a status code J1 appears on the sameclaim, status code Q items shall be paid at fifty percent (50%).”

- The Commission will follow the AMA and Medicare coding guidelines and use of modifiers.

A public hearing regarding the changes will be conducted if the state receives requests in writing from at least 25 peopleby October 21, 2015. The proposed changes can be viewed from the link provided.

http://adminrules.idaho.gov/bulletin/2015/10.pdf#page=369

n The state recently posted proposed rule-making changes to 17.02.09- Medical Fees Section 032.02.c.iii and iv regardingthe use of the status code J1. The following is what is being proposed:

Excerpt from: Proposed Amendment IDAPA Rule 17.209

“Section 032.02.c.iii

iii. When no medical service with a status code J1 appears on the same claim, two (2) or more medical procedures witha status code T on the same claim shall be reimbursed with the highest weighted code paid at one hundred percent(100%) of the APC calculated amount and all other status code T items paid at fifty percent (50%). When a medicalservice with a status code J1 appears on the same claim, all medical services with a status code T shall be paid at fiftypercent (50%).

Section 032.02.c.iv

When no medical service with a status code J1 appears on the same claim, status code Q items with an assigned APCweight will not be discounted. When a medical service with a status code J1 appears on the same claim, status code Qitems shall be paid at fifty percent (50%).”

The link below provides access to the entire proposed rule.

http://iic.idaho.gov/index/NRM%20closure/170209%20Rules%20Language%20Draft_1as%20of%207-17-15.pdf

n On May 12, 2015, the state posted a notification indicating that a Public meeting would be held on June 2, 2015, todiscuss the rule-making process for 17.02.09 Medical Fees. Any comments regarding the proposed changes need to besent to [email protected] and must be received by May 27, 2015.

http://adminrules.idaho.gov/Negotiated_Notices/2015/05May/17-0209-1502_Neg_15-5.pdf

n On May 1, 2015, the state posted the agenda and notification of the Idaho Advisory Committee meeting, which was heldon May 13, 2015. The committee meeting discussed and accepted public comments regarding the proposed legislation forthe medical fee schedule. The next meeting is scheduled for August 12, 2015.

http://www.iic.idaho.gov/advisory_committee/future%20meetings/AGENDA%205-13-15-v1.pdf

n On July 1, 2015, the following changes to Rule 17.02.09 took effect:

- Conversion Factor update for the Medicine-Group One to include the following ranges:

n 90000-90749

n 94000-94999


http://iic.idaho.gov/index/NRM closure/170209 Rules Language Draft_1as of 7-17-15.pdf


http://adminrules.idaho.gov/Negotiated_Notices/2015/05May/17-0209-1502_Neg_15-5.pdf

http://www.iic.idaho.gov/advisory_committee/future meetings/AGENDA 5-13-15-v1.pdf

n 97000-97799

- Conversion Factor update for Medicine-Group Two to include the following ranges:

n 90750-92999

n 93000-93999

n 95000-96020

n 96040-96999

n 99000-99607

- Base rate for Inpatient Hospital Services was increased to $10,200.

- Base rate for Hospital Outpatient services was increased to $140.75.

- Base Rate for ASC services was increased to $91.50.

- Status code N items or items with no CPT or HCPCS code shall receive no payment except in Subsection 032.02.c.ii.(1).or 032.02.c.ii.(2) which states:

“(1) Implantable Hardware may be eligible for separate payment under Subsection 032.02.e.iii. of this rule.

(2) Outpatient laboratory tests provided with no other hospital outpatient service on the same date or outpatientlaboratory tests provided on the same date of service as other hospital outpatient services that are clinically unrelatedmay be paid separately if billed with modifier L1. Payment shall be made in the same manner that services with noAPC weight are paid under Subsection 032.02.c.i.of this rule."

- Prompt pay rule verbiage update to now read:

“Prompt Payment. Unless the Payor denies liability for the claim or, pursuant to Subsection 035.06, below, sends aPreliminary Objection, a Request for Clarification, or both, as to any charge, the Payor shall pay the charge within thirty(30) days of receipt of the bill or upon acceptance of liability, if made after the bill is received from the provider."

The proposed changes were included in the Idaho Administrative Bulletin link provided below.

http://adminrules.idaho.gov/bulletin/2014/10.pdf

At the time of this communication's release, the final adopted version of the rule had not been posted on the state's website.

Previous Updates


IllinoisFuture Plans/Proposals

n Anesthesia, ASC, HCPCS, Hospital, and Physician Fee Schedules are updated January 1 of each year.

Previous Updates

n On December 30, 2015, the state’s vendor posted the 2016 data files for Hospital Inpatient, Outpatient, ProfessionalServices, Dental, HCPCS, ASC, and Anesthesia. The files are effective for services rendered on or after January 1, 2016. Itcan be accessed from the state’s web site from the link below.

https://iwcc.ingenix.com/download.asp

http://www.iwcc.il.gov/faqmed.htm#docs


http://adminrules.idaho.gov/bulletin/2014/10.pdf

https://iwcc.ingenix.com/download.asp

http://www.iwcc.il.gov/faqmed.htm#docs

IndianaFuture Plans/Proposals


Previous Updates


IowaFuture Plans/Proposals


Previous Updates


KansasNew Adoptions!

n On February 3, 2016, the state posted a notification on its web site under “Latest News” that the mileage rate haschanged to $0.54 per mile, effective January 1, 2016. To view this notification, use the link provided below.

http://www.dol.ks.gov/WorkComp/


n The state will adopt a new fee schedule effective in 2017. The state indicated the 2015 fee schedule will remain in effectfor 2016 and until the new fee schedule is released.

Previous Updates


KentuckyFuture Plans/Proposals

n Update to the Hospital Cost-to-Charge Ratio is expected in April 2016.

Previous Updates

n On January 26, 2016, the state posted updated cost-to-charge ratios for out-of-state hospital rates, effective April 1, 2015.The revised rates are availiable at the link below.

http://www.labor.ky.gov/workersclaims/mscc/Pages/Hospital-Cost-to-Charge-Ratio.aspx

Additionally, these rates were previously updated on December 29, 2015.

LouisianaNew Adoptions!

n On February 19, 2016, the state posted the February edition of the Louisiana Register. On page 283 of the register, thereare newly-adopted changes for hospital, dental, utilization review, and miscellaneous fees. The register can be viewedfrom the link below.

http://www.doa.la.gov/Pages/osr/reg/regs2016.aspx


http://www.dol.ks.gov/WorkComp/

http://www.labor.ky.gov/workersclaims/mscc/Pages/Hospital-Cost-to-Charge-Ratio.aspx


n On January 27, 2016, the state posted an emergency rule to change the reimbursement for fees that clerks can receive forcourt costs. To view this rule, click on the link provided and scroll to the top of page 31.



n On October 20, 2015, the state posted in the Louisiana Register the proposed rule changes to the medical treatmentguidelines, dental, hospital and medical reimbursement schedules. The proposed changes are to update the rules,guidelines and reimbursement with the ICD-10 information. The state accepted comments until November 10th andconducted a public hearing on November 30th. The proposed changes can be viewed by accessing the Louisiana Registerand viewing the October 20th edition from the link below.


n The Louisiana OWCA drafted changes to the Louisiana Treatment Guidelines. The redlined changes are posted athttp://www.laworks.net/Downloads/OWC/NoticeOfIntent_RedLine.pdf. Comments on the proposed changes wereaccepted through October 9th. A public hearing was held on October 28, 2015, at 9:30 a.m. at the Office of Workers‘ Compensation at the main campus of the Workforce Commission in Baton Rouge, LA. The public was invited to attend.

Previous Updates

n The state adopted emergency regulations in the September 2015 Louisiana Administrative Register, effective October 1,2015, for 120 days. There were updates to several rules within Title 40, which included:

- Medical Treatment Guidelines

- Update to ICD-10 for AIDS, Acute Myocardial Infarction, and Severe Burns

- Support of ICD-9 and ICD-10 after the compliance date for pre-authorized services and/or treatment or timely filing

- Utilization Review Form 1010 update with ICD-10 fields

- CDT coding changes and addition of a list of modifiers

- CDT reimbursement updates

The complete emergency regulations can be accessed in the link provided below.


MaineFuture Plans/Proposals

n On June 3, 2015, the state sent an e-mail notification stating that a public hearing took place on June 29, 2015. The publichearing gave stakeholders the chance to discuss the repeal and replace of Chapter 5 and the amendment of Chapters 12and 17. The proposed rules can be accessed from the link provided below.

http://www.maine.gov/wcb/Departments/legaldivision/proposed.html

The state accepted comments through July 9, 2015, on these proposed changes.

Previous Updates

n On December 22, 2015, the state posted its PDF version of the fee schedule along with the appendices that contain therate tables, effective January 1, 2016. These can be accessed from the link below.

http://www.maine.gov/wcb/Departments/omrs/medfeesched.html

n On December 7, 2015, the state posted the date files for anesthesia, professional fees, durable medical equipment,prosthetics, orthotics and supplies (DMEPOS), and inpatient and outpatient hospital facilities. These files are effectiveJanuary 1, 2016 and can be accessed from the link below.

http://www.maine.gov/wcb/




http://www.laworks.net/Downloads/OWC/NoticeOfIntent_RedLine.pdf


http://www.maine.gov/wcb/Departments/legaldivision/proposed.html


http://www.maine.gov/wcb/

Additionally, the state posted an update to the Maine Fee Schedule, effective October 1, 2015. The original files posted onthe web site in early October were found to have some discrepancies that the state needed to correct.

n The state’s web page now contains a FAQ section regarding the Medical Fee Schedule. This can be accessed from the linkbelow.


n On October 5, 2015, the state posted the adopted changes to the Maine Fee Schedule, effective October 1, 2015. The feeschedule can be accessed from the link below.

http://www.maine.gov/wcb/Departments/omrs/medfeesched/Medical_Fee_Schedule_Oct_2015.pdf

MarylandFuture Plans/Proposals

n The next Medical Fee Schedule update is planned for January 1, 2017.

Previous Updates

n On December 3, 2015, the state posted the updated files for the Medical Fee Schedule that included the followingsections:

- Maryland specific Conversion Factor

- Medical Services and Treatment Reimbursement Rates

- Ambulatory Surgery Center (ASC)

- Anesthesiology

- Orthopedic/Neurological Surgical Current Procedural Terminology (CPT) Codes

- CPT Codes Not Valued by CMS

- Miscellaneous Information: WCC adoption of CMS rules, DME, Prescriptions, Dental, Hospital, Depositions and IME.

The entire update can be viewed on the state’s web site.


MassachusettsNew Adoptions!

n On February 17, 2016, the state posted the final adoptions for 101 CMR 309.00 Independent Living Services for thePersonal Care Attendant Program, effective January 1, 2016. The final changes can be accessed from the link below.

http://www.mass.gov/eohhs/gov/laws-regs/hhs/provider-payment-rates.html


n On December 31, 2015, the state posted a notification that it will be conducting a public hearing on February 5, 2016regarding proposed emergency adoption of rate changes for certain substance abuse programs. The notification as well asthe proposed changes can be viewed at the links below.

http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/101-cmr-346-public-hearing.pdf

http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/101-cmr-346-redline.pdf



http://www.maine.gov/wcb/Departments/omrs/medfeesched/Medical_Fee_Schedule_Oct_2015.pdf


http://www.mass.gov/eohhs/gov/laws-regs/hhs/provider-payment-rates.html

http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/101-cmr-346-public-hearing.pdf

http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/101-cmr-346-redline.pdf

Previous Updates

n On October 1, 2015, the state posted an emergency adoption to the Nursing Facility Rules (101 CMR 206) and CertifiedRates, effective October 1, 2015. The rules included changes to per diem add-on amounts and per diem annualizedadjustments. The rates for the facilities were updated in an excel file that was posted on the state’s web site. The entireupdate can be viewed from the link provided below.

http://www.mass.gov/eohhs/gov/laws-regs/hhs/hospitals-nursing-homes-and-rest-homes.html%20-%20114_2_6

n In addition, the state posted a proposed update to the Home Health Services fee schedule. The proposed update includesadding definitions, codes, and values for Remote Monitoring. The public hearing was held on September 2, 2015. Theproposed effective date is October 1, 2015. The update can be accessed on the state's web site.

http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/101-cmr-350-hha-redlined.pdf

MichiganFuture Plans/Proposals


Previous Updates

n On January 20, 2016, the state posted information regarding copying fee charges by healthcare providers undersubpoena. To view this information in its entirety, use the link provided below.

http://www.michigan.gov/wca/0,4682,7-191-26922-41727--,00.html

n The state adopted some new rules for Certified Anesthesiology Assistants and made clarifications on the OpioidReimbursement rule effective dates. For now the conversion factors and RVU remain the same. The new rules can befound on the LARA Workers’ Compensation web site at the link provided below.

http://www.michigan.gov/wca/0,4682,7-191--367064--,00.html

n On August 4, 2015, the state posted the update to the Hospital Cost-to-Charge Ratios, effective August 4, 2015. The stateadded two additional fields to the spreadsheet to include the hospitals affiliation and the NPI number. The updatedspreadsheet can be found on the state's web site.


Michigan (Auto)Future Plans/Proposals

n On February 3, 2015 the state filed a draft proposal with the Secretary of State regarding updated language for theWorkers' Compensation Health Care Services rule. The changes include adding language regarding certifiedanesthesiologist assistant. If adopted, the rules will be effective immediately upon filing an adoption with the Secretary ofState. The proposed document can be found at the following link.

http://www7.dleg.state.mi.us/orr/Files/ORR/1505_2015-008LR_orr-draft.pdf

Previous Updates


MinnesotaFuture Plans/Proposals

n On March 12, 2015, the state released an email communication advising that the Minnesota Department of Labor andIndustry is proposing rule changes for Minnesota Rules, Parts 5221.6040, 5221.6105, and 5221.6110. The rules wouldmake changes to the long term treatment of injured employees on opioid medications. The proposed rules can beaccessed from the link below.


http://www.mass.gov/eohhs/gov/laws-regs/hhs/hospitals-nursing-homes-and-rest-homes.html - 114_2_6

http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/101-cmr-350-hha-redlined.pdf


http://www.michigan.gov/wca/0,4682,7-191--367064--,00.html


http://www7.dleg.state.mi.us/orr/Files/ORR/1505_2015-008LR_orr-draft.pdf

http://www.dli.mn.gov/PDF/docket/5221Draft2.pdf

n Medical Fee Schedules are typically adopted on an annual basis on October 1.

Previous Updates

n The state posted the August 2015 edition of the Compact newsletter. Included in this edition were the changes to theconversion factors, effective October 1, 2015. The changes are as follows:

- Medical/Surgical Services: $65.12

- Pathology/Laboratory Services: $56.08

- Physical Medicine/Rehabilitation Services: $49.18

- Chiropractic Services: $49.09

- IME Services: Will be increased by 0.6% for services on or after October 1, 2015

Additionally, the changes were also posted in the September 14, 2015 edition of the Minnesota State Register. The linksto the Compact and State Register are provided below.

http://www.dli.mn.gov/WC/Pdf/0815c.pdf

http://www.comm.media.state.mn.us/bookstore/stateregister/40_11.pdf

Minnesota (Auto)Future Plans/Proposals


Previous Updates


MississippiFuture Plans/Proposals

n The state typically updates the Inpatient and Outpatient Hospital Fee Schedules annually on October 1 .

Previous Updates

n The state posted the following files to the Fee Schedule Update page:

- 2016 Annual Amounts

- 2016 DRG Relative Weights

- 2016 Cost to Charge Ratio

- 2016 Cost to Charge Ratio for MS LTAC

The change can be found on the state's web page at the link provided below.

http://www.mwcc.state.ms.us/services/feeschedule.asp

n The Mississippi Workers’ Compensation Commission posted a memo entitled, “Notice Regarding Utilization Review Rules,”dated August 13, 2015. The memo clarifies when the two day period to make a utilization review determination starts if asecond level clinical review is conducted. For more information, see the link below.

http://www.mwcc.state.ms.us/services/utilizationreviewnotice.pdf


http://www.dli.mn.gov/PDF/docket/5221Draft2.pdf

http://www.dli.mn.gov/WC/Pdf/0815c.pdf

http://www.comm.media.state.mn.us/bookstore/stateregister/40_11.pdf

http://www.mwcc.state.ms.us/services/feeschedule.asp

http://www.mwcc.state.ms.us/services/utilizationreviewnotice.pdf

MissouriFuture Plans/Proposals


Previous Updates


MontanaFuture Plans/Proposals

n The next update for the Professional fee schedule is expected July 2016.

Previous Updates


NebraskaFuture Plans/Proposals


Previous Updates

n The state posted the data files for the medical, surgical, and hospital DRG rates effective January 1, 2016. The data filescan be accessed from the state’s web site from the link below.

https://www.wcc.ne.gov/apps/IPUBA0008Afrm.aspx

n On December 16, 2015, the state posted the adoption of various rules, including Rule 26 which governs the Schedules ofFees for Medical, Surgical and Hospital Services. This new rule for the Schedule for Medical Services became effectiveJanuary 1, 2016 and will be based on the following:

- Medicare Fee Schedule (RBRVS)

- $63.59 conversion factor for ER Department Services

- $50.01 conversion factor for E/M Services

- $50.77 conversion factor for Anesthesia Services

- $106.07 conversion factor for Orthopedic Surgery Services

- $72.22 conversion factor for All Other Surgery Services

- $86.92 conversion factor for Radiology Services

- $76.32 conversion factor for Pathology and Laboratory Services

- $54.36 conversion factor for Medicine Services

- $48.23 conversion factor for Physical Medicine Services

Additionally, the state published the DRGs to be used effective January 1, 2016

It should be noted that at the time of this newsletter release, the January 1, 2016 Schedule of Fees for Medical Serviceswas not available for download. To view the newly adopted Rule 26 use the link provided:

http://www.wcc.ne.gov/publications/rules.pdf


https://www.wcc.ne.gov/apps/IPUBA0008Afrm.aspx

http://www.wcc.ne.gov/publications/rules.pdf

NevadaNew Adoptions!

n On January 28, 2016, the state posted the updated fee schedule, effective February 1, 2016 – January 31, 2017.Additionally, the state also posted the revised Ambulatory Surgery Group and Outpatient Group List. The fee scheduleand the ASC listing can be accessed from the link below.

http://dirweb.state.nv.us/WCS/medical.htm


n The state conducted Medical Fee Schedule training on February 17, 2016 in Carson City, Nevada via video link from theHenderson, Nevada office. Only 10 seats available, please contact Kimberly Williams for reservations at (775)684-7265.

Additionally, the state conducted a public hearing on the proposed Medical Fee Schedule changes on January 8, 2016. Thedraft of the fee schedule is available for review from the following link:

http://dirweb.state.nv.us/WCS/docs/2016-01-08_Draft%20MED_FEE_SCHEDULE.pdf

n On December 8, 2015, the state posted a notification of a public hearing held on January 8, 2016. At the public hearingparticipants discussed proposed changes to the Workers’ Compensation Fee Schedule, as well as changes to the lump sumpayments. The proposed fee schedule changes would create a Dental Fee Schedule, increase rates for AmbulatorySurgery Center (ASC) per diem payment rates, and increase rates for hospitals that perform burn care. The notification forthe hearing and proposed changes can be accessed from the links provided below.

http://dirweb.state.nv.us/WCS/docs/2016-01-08_NoticeOfHearingMedicalFeeSchedule.pdf

http://dirweb.state.nv.us/WCS/docs/2016-01-08_Draft%20MED_FEE_SCHEDULE.pdf

n On October 6, 2015, the state conducted a public workshop by videoconference to review the proposed amendments andadditions to the Nevada Medical Fee Schedule, which became effective February 1, 2016. For more information on theworkshop and proposed fee schedule changes, please use the links provided below.

http://dirweb.state.nv.us/wcs/docs/NoticeOfWorkshopR092-15.pdf

http://dirweb.state.nv.us/wcs/docs/MED_FEE_SCHEDULE_9-11-15.pdf

Previous Updates


New HampshireFuture Plans/Proposals


Previous Updates


New Jersey (Auto)Future Plans/Proposals

n The state posted proposed rules that included updates to the Appendix Exhibit 1 Physician's and ASC Fee Schedule.However, the adoption posted on January 6, 2014 does not include the fee schedule update at this time. We are stillmonitoring for any changes to the fee schedule.


http://dirweb.state.nv.us/WCS/medical.htm

http://dirweb.state.nv.us/WCS/docs/2016-01-08_Draft MED_FEE_SCHEDULE.pdf

http://dirweb.state.nv.us/WCS/docs/2016-01-08_NoticeOfHearingMedicalFeeSchedule.pdf

http://dirweb.state.nv.us/WCS/docs/2016-01-08_Draft MED_FEE_SCHEDULE.pdf

http://dirweb.state.nv.us/wcs/docs/NoticeOfWorkshopR092-15.pdf

http://dirweb.state.nv.us/wcs/docs/MED_FEE_SCHEDULE_9-11-15.pdf

Previous Updates

n On November 2, 2015, the Department of Banking and Insurance posted a notice indicating that there will be a yeardelay in the adoption of the amendments N.J.A.C.11:3-4.7( c )6 and New Rule N.J.A.C.11:3-4.7B. The notice can beaccessed from the link below.

http://www.state.nj.us/dobi/proposed/notice151102.pdf

New MexicoFuture Plans/Proposals

n Hospital ratios, the Physician Fee Schedule, and Part 7 of the rules are updated annually.

Previous Updates

n On December 18, 2015, the state posted the updated HealthCare Providers Fee Schedule, which also includes theHospital Cost-to-Charge Ratios, effective January 1, 2016. The schedule can be accessed at the link below.

http://www.workerscomp.state.nm.us/fee_schedule.php

n On December 8, 2015, the state posted the Gross Receipts Tax Rates for January – June 2016. The rate can be found onthe Taxation & Revenue web site.

http://www.tax.newmexico.gov/gross-receipts-tax-historic-rates.aspx

n The state adopted rule changes for Part 7, Payments for Health Care Services. The effective date for the changes is cited atthe end of each section that has changes with a date of 10/1/2015. The changes include but are not limited to:

- Updates to definitions

- Removing the reference/language to ebilling effective July 1, 2015

- Adding language for compound drugs and medical cannabis

To access the adopted rule, Part 7, please see the link below.

http://www.workerscomp.state.nm.us/pdf/rules/temp/part7.pdf

n The state adopted changes to Rule 7, Payment for Health Care services, effective October 1, 2015.


New YorkNew Adoptions!

n On February 9, 2016, the state posted an updated rate for the Eye Surgery Center of New York effective, April 7, 2015 –September 30, 2015. The notification of the new rate can be accessed from the link below.

http://www.wcb.ny.gov/content/main/hcpp/MedFeeSchedules/EyeSurgeryCenterofNewYork.pdf


n On November 12, 2015, the state posted Subject No. 046-828 of the proposed changes to various regulations. The stateaccepted comments on these changes through December 28, 2015. The notification can be accessed from the link below.


n On July 11, 2014, the state posted a "proposed medical fee schedule discussion document." This document can be viewedin its entirety from the link provided below.

http://www.wcb.ny.gov/content/main/hcpp/MedFeeSchedules/MedicalFeeScheduleDiscussionDocument.pdf


http://www.state.nj.us/dobi/proposed/notice151102.pdf

http://www.workerscomp.state.nm.us/fee_schedule.php

http://www.tax.newmexico.gov/gross-receipts-tax-historic-rates.aspx






One of the key factors of the proposed changes is to move the current methodology for repricing to a RBRVS (Medicare)based fee schedule in 2015. The New York Workers' Compensation board plans to publish another document similar tothis one in early 2015 for public discussion and comment. However, in the interim, the WCAB is accepting comments andquestions regarding the proposed changes. Since the New York Insurance Department typically adopts the Worker'sCompensation Fee Schedule, these changes will most likely be applicable to auto claims as well.

Previous Updates

n On December 31, 2015, the state posted revisions to the DME Fee Schedule effective for dates of service on or afterJanuary 1, 2016. This new schedule can be accessed at the link below.

http://www.wcb.ny.gov/content/main/hcpp/MedFeeSchedules/201512_DME_Revision.pdf

n On December 30, 2015, the New York Register posted the notice of adoption for the Ambulatory Surgery Fee Schedule.The fee schedule became effective October 1, 2015 by emergency adoption; however, it has now been adopted as a finalrule. To view the adoption notification, click on the link below and scroll to page 47.

http://docs.dos.ny.gov/info/register/2015/december30/pdf/rulemaking.pdf

n On December 11, 2015, the Governor signed and approved amended changes to Chapter 536 of the Laws of New York.The change to this law deals with the reimbursement for surgical first assistant services and is effective June 8, 2016. Toview the amended law chapter, use the link provided.

http://public.leginfo.state.ny.us/navigate.cgi?NVDTO

n On November 12, 2015, the state posted Subject No. 046-821 regarding the revised reimbursement rates for inpatientexempt units. These rates are revised for the periods July 1, 2014 – December 31, 2014 and January 1, 2015 – December31, 2015. The bulletin and links can be accessed from the link below.


n On December 8, 2015, the state posted newly updated rate information for Mason Eye Surgery Center with effectivedates from March 25, 2015 through September 30, 2015. The new rates can be found in the link provided below.

http://www.wcb.ny.gov/content/main/hcpp/MedFeeSchedules/2015medfee.jsp

n On September 11, 2015, the state posted Subject No. 046-784, which indicates that the Workers’ Compensation Boardadopted emergency regulations for the Ambulatory Surgery Center (ASC) fee schedule using the Ambulatory PatientGroups (APG), effective October 1, 2015. The state posted proposed permanent regulations in the September 16th editionof the Administrative Register. The public had until November 1, 2015, to make comments on these proposed permanentregulations. The subject notice and emergency adoption regulation can be accessed from the links provided below.


http://www.wcb.ny.gov/content/main/wclaws/Emergency/Part329_text.jsp

http://www.wcb.ny.gov/content/main/hcpp/MedFeeSchedules/EAPGTransitionDocument.pdf

n The state recently released an update to the DME fee schedule for just one code, K0108. The updated code is effectiveretroactively for all dates of service on or after January 1, 2015. The update can be accessed from the link below.

http://www.wcb.ny.gov/content/main/hcpp/MedFeeSchedules/DME_Revision_20150716.pdf

n On August 8, 2015, the state posted another update to the DME fee schedule changing the reimbursement for codeE0621 to $76.59, effective August 1, 2015. The updated code can be accessed from the link provided below.

http://www.wcb.ny.gov/content/main/hcpp/MedFeeSchedules/DME_Revision.pdf








http://www.wcb.ny.gov/content/main/wclaws/Emergency/Part329_text.jsp

http://www.wcb.ny.gov/content/main/hcpp/MedFeeSchedules/EAPGTransitionDocument.pdf



New York (Auto)New Adoptions!

n On February 9, 2016, the state posted an updated rate for the Eye Surgery Center of New York effective, April 7, 2015 –September 30, 2015. The notification of the new rate can be accessed from the link below.









Previous Updates

n On December 31, 2015, the state posted revisions to the DME Fee Schedule effective for dates of service on or afterJanuary 1, 2016. This new schedule can be accessed at the link below.


n On December 30, 2015, the New York Register posted the notice of adoption for the Ambulatory Surgery Fee Schedule.The fee schedule became effective October 1, 2015 by emergency adoption; however, it has now been adopted as a finalrule. To view the adoption notification, click on the link below and scroll to page 47.


n On December 11, 2015, the Governor signed and approved amended changes to Chapter 536 of the Laws of New York.The change to this law deals with the reimbursement for surgical first assistant services and is effective June 8, 2016. Toview the amended law chapter, use the link provided.


n On December 8, 2015, the state posted newly updated rate information for Mason Eye Surgery Center with effectivedates from March 25, 2015 through September 30, 2015. The new rates can be found in the link provided below.


n On November 12, 2015, the state posted Subject No. 046-821 regarding the revised reimbursement rates for inpatientexempt units. These rates are revised for the periods July 1, 2014 – December 31, 2014 and January 1, 2015 – December31, 2015. The bulletin and links can be accessed from the link below.











n The state recently released an update to the DME fee schedule for just one code, K0108. The updated code is effectiveretroactively for all dates of service on or after January 1, 2015. The update can be accessed from the link below.


n On August 8, 2015, the state posted another update to the DME fee schedule changing the reimbursement for codeE0621 to $76.59, effective August 1, 2015. The updated code can be accessed from the link provided below.


North CarolinaFuture Plans/Proposals


Previous Updates

n The state posted data files for professional, DME, and Laboratory, effective January 1, 2016. It can be downloaded on thestate’s web site from the link below.

http://www.ic.nc.gov/ncic/pages/feesched.asp

n On October 5, 2015, North Carolina posted an update to the July Physician Fee Schedule data, retroactively effective July1, 2015. The link to the update can be viewed on the state’s web site.

http://www.ic.nc.gov/062515memo.pdf

n On September 18, 2015, the Governor signed into law HB 97. This bill contains many provisions, two of which affectworkers’ compensation: Section 15.13A(a) and 15.13A(b). Section 15.13A(a) is about the implementation of a drugformulary for workers’ compensation claims. The Industrial Commission will study the implementation, and by April 2016,report findings and recommendations on implementing a drug formulary. Section 15.13A(b) is about rule languagechanges made regarding the reimbursement for prescription drugs, prescribed over-the-counter drugs, and professionalpharmaceutical services. Section 15.13A(b) is effective October 1, 2015. To view this bill in its entirety, use the link below.

http://www.ncleg.net/Sessions/2015/Bills/House/HTML/H97v9.html

North DakotaNew Adoptions!

n On February 1, 2016, the state updated the fee schedule data files for ambulance, ASC, DME, inpatient hospital,medical/clinic lab, and outpatient hospital, effective January 1, 2016. Additionally, the state updated the guidelines forambulance, ASC, anesthesia, dental, DME, inpatient hospital, medical provider, clinical lab, outpatient hospital, homehealth, and physician administered drugs, effective January 1, 2016. The files and guidelines can be accessed from the linkbelow.

https://www.workforcesafety.com/WSI/billingfeeschedule/FeeSchedule/FeeSchedule


n Ambulance, Anesthesia, ASC, Clinical Laboratory, Dental, DME, E/M, Guidelines and Medical Services, Home Health,Inpatient Hospital, Medicine, Outpatient Hospital, Pathology, Physician-administered Drugs, physical and OccupationalTherapy, Radiology, and Surgery Fee Schedules are made either annually (based on calendar or fiscal year) or quarterly(January 1, April 1, July 1, and October 1 of each year) as defined in the state's statute.

Previous Updates

n The state posted updates to the DME, Medicine/Clinical Lab and Outpatient Hospital rates, effective October 1, 2015. Theupdated files can be accessed on the state’s web site.





http://www.ic.nc.gov/ncic/pages/feesched.asp

http://www.ic.nc.gov/062515memo.pdf

http://www.ncleg.net/Sessions/2015/Bills/House/HTML/H97v9.html



OhioNew Adoptions!

n On February 1, 2016, the state posted the data files and rules for the inpatient hospital services, effective February 1,2016. The entire update can be accessed from the link below.

https://www.bwc.ohio.gov/provider/services/FeeSchedules.asp


n On February 10, 2016, the state filed proposed changes for the following:

- 4123-6-02.22 Provider access to the HPP - ambulatory surgical center arthroplasty center requirements

- 4123-6-08 Bureau fee schedule

- 4123-6-37.2 Payment of hospital outpatient services

- 4123-6-37.3 Payment of ambulatory surgical center services

The state will conduct a public hearing March 14, 2016 to discuss these changes. The proposed changes can be accessedfrom the links below.

http://www.registerofohio.state.oh.us/pdfs/4123/0/6/4123-6-02$22_PH_OF_N_RU_20160210_1233.pdf

http://www.registerofohio.state.oh.us/pdfs/4123/0/6/4123-6-08_PH_OF_A_RU_20160210_1233.pdf

http://www.registerofohio.state.oh.us/pdfs/4123/0/6/4123-6-37$2_PH_OF_A_RU_20160210_1233.pdf


n The state proposed the following rule changes with the corresponding tentative effective dates:

- Professional Provider Medical Services Fee Schedule, tentatively effective January 1, 2016.

https://www.bwc.ohio.gov/downloads/blankpdf/ProfProviderFeeSchedule0116.xls

- 4123-6-02.22 Provider access to the HPP – ambulatory surgical center arthoplasty center requirements, tentativelyeffective May 1, 2016.

https://www.bwc.ohio.gov/downloads/blankpdf/ASCArthoplastyRule2016.pdf

- Ambulatory Surgical Center Fee Schedule, tentatively effective May 1, 2016.


- 4123-6-37.2 Hospital Outpatient Reimbursement Rule, tentatively effective May 1, 2016.

https://www.bwc.ohio.gov/downloads/blankpdf/HospOutReimburseRule0516.pdf

n On November 13, 2015, the state filed a proposed rule to update 1423-6-37 Payment of Hospital Inpatient Service. Thepublic hearing was held on December 18, 2015. The state is reviewing any comments received and will post additionalinformation in the future. The notice can be viewed on the state's web site.

http://www.registerofohio.state.oh.us/jsps/publicdisplayrules/processPublicDisplayRules.jsp?entered_rule_no=4123-6-37.1&doWhat=GETBYRULENUM&raID=0

n On September 15, 2015, the state posted a notification about a public hearing to address changes to Rule 4123-6-21.3,Outpatient Medication Formulary. The hearing was held on October 21, 2015. The tentative effective date for this updateis December 1, 2015. The link to the notification is provided below.

http://www.registerofohio.state.oh.us/pdfs/phn/4123_NO_287019_20150914_1318.pdf



http://www.registerofohio.state.oh.us/pdfs/4123/0/6/4123-6-02$22_PH_OF_N_RU_20160210_1233.pdf

http://www.registerofohio.state.oh.us/pdfs/4123/0/6/4123-6-08_PH_OF_A_RU_20160210_1233.pdf



https://www.bwc.ohio.gov/downloads/blankpdf/ProfProviderFeeSchedule0116.xls

https://www.bwc.ohio.gov/downloads/blankpdf/ASCArthoplastyRule2016.pdf


https://www.bwc.ohio.gov/downloads/blankpdf/HospOutReimburseRule0516.pdf




n On February 10, 2015, the state indicated that on February 9, 2015 rules 4123-6-08 Bureau Fee Schedule and 4123-6-21.3Outpatient medication formulary were filed and a public hearing is scheduled for March 20, 2015. The public hearingnotification and proposed rule links are provided below.


http://www.registerofohio.state.oh.us/pdfs/4123/0/6/4123-6-08_PH_RV_A_APP2_20150209_1503.pdf

Rule 4123-6-08 Bureau Fee Schedule has an effective date of January 1, 2015 and will most probably be retroactive backto this date and the Rule 4123-6-21.3 Outpatient Medication Formulary has an effective date of May 1, 2015.

n The state sent out an email communication asking for feedback on the proposed changes to the Hospital OutpatientServices Rule, Ohio Administrative Code 4123-6-37.2, and the Ambulatory Surgical Center Fee Schedule, OhioAdministrative Code OAC 4123-6-37.3. The comments could be submitted to [email protected] andwere accepted through December 2, 2014.

Previous Updates

n On January 21, 2016, the state filed the final rules for the Inpatient Hospital Fee Schedule, effective February 1, 2016. Atthe publishing of this newsletter, the link to the final rules was not available.

n On January 6, 2016, the state posted the updated Professional Provider Medical Services Fee Schedule, effective January1, 2016. The new schedule can be found at the link below.


n The state made some minor changes to the text of Rule 4123-6-21 Payment for outpatient medication, effectiveNovember 13, 2015. Some of the changes included the following:

- Added: Approval for reimbursement of non-sterile compounded prescriptions will be for an initial period of ninetydays with subsequent approvals contingent upon clinical documentation of improvement in both pain and function.Not more than one prescription for a non-sterile compounded prescription will be approved for reimbursement in anythirty day period.

- Removed the following from the Exceptions to the single dispensing fee: (iv) Cases where the medication was lost,stolen or destroyed.

- Removed the following reasons for overriding a denial:

n (a) Previous supply was lost, stolen, or destroyed.

n (d) Hospital or police kept the medication (page 7).

The state also updated the Formulary for medication reimbursement, effective December 1, 2015.

The link to the entire rule and formulary can be found at the links provided below.

http://www.registerofohio.state.oh.us/pdfs/4123/0/6/4123-6-21_PH_FF_A_RU_20151102_1021.pdf

http://www.registerofohio.state.oh.us/pdfs/4123/0/6/4123-6-21$3_PH_FF_A_APP2_20151120_0800.pdf

n On September 21, 2015, the state adopted rule 4132-6-36, which rescinded the version of Appendix A with ICD-9 codes,and replaced it with a new Appendix A that contains ICD-10 codes. The effective date of this change is October 1, 2015.

Ohio MedicaidFuture Plans/Proposals


Previous Updates




http://www.registerofohio.state.oh.us/pdfs/4123/0/6/4123-6-08_PH_RV_A_APP2_20150209_1503.pdf



http://www.registerofohio.state.oh.us/pdfs/4123/0/6/4123-6-21_PH_FF_A_RU_20151102_1021.pdf

http://www.registerofohio.state.oh.us/pdfs/4123/0/6/4123-6-21$3_PH_FF_A_APP2_20151120_0800.pdf

OklahomaNew Adoptions!

n The state adopts the most current ODG Status "N" Drugs workers' compensation, which was last updated, effectiveFebruary 29, 2016. The update is available on the ODG web site.

http://www.odg-twc.com/index.html


n The state conducted a public hearing on February 18, 2016 to discuss proposed changes to chapters 1, 20, 15, and 25. Thisincludes proposed changes for reimbursement for advance practice registered nurses, drug screen testing for chronic painmanagement, and a process for appealing previously denied decisions under the closed formulary rule. The state’snotification as well as the proposed rules can be accessed from the links below.

http://204.87.112.100/oar/codedoc02.nsf/frmMain?OpenFrameSet&Frame=Main&Src=_75tnm2shfcdnm8pb4dthj0chedppmcbq8dtmmak31ctijujrgcln50ob7ckj42tbkdt374obdcli00_

https://www.ok.gov/wcc/documents/%281.15.16%2985A%20NRI%20Ch.%2015.pdf

n The state has no proposed plans to update the Medical and Hospital Fees at this time.

Previous Updates


OregonFuture Plans/Proposals

n On January 15, 2016, the state posted a notification regarding the public hearing on February 22, 2016. The proposedchanges include a possible 3% increase to the medical fee schedule for physician rates.. To view the notice of publichearing and the proposed rule changes, use the link provided below.

http://www.cbs.state.or.us/wcd/policy/rules/Hearing_20160222/9_10_16XXXp.pdf

n The state posted proposed updates to OAR 436-009 Maximum Allowable Payment tables Appendices B - E and OAR 436-010 rules, effective April 1, 2016. A public hearing was held on February 22, 2016 to discuss the proposed changes. Thesechanges can be viewed on the state’s web site at the following link.

http://www.cbs.state.or.us/wcd/policy/rules/div_009/9_10_16XXXp.pdf

n The state plans on discussing proposals for permanent rules for OAR 436-009 in the first quarter of 2016.

n The state usually updates its cost-to-charge ratio in April and October of each year.

Previous Updates

n On December 22, 2015, the state posted revisions to Bulletin 290 as follows:

- Corrected the name for Pioneer Memorial Hospital – Princeville which is now St. Charles Princeville.

- All references for St. Charles Medical Center to St. Charles were made and updated to the corporate name.

To view this bulletin in its entirety, use the link provided below.

http://wcd.oregon.gov/policy/bulletins/docconv_12819/bul_290.pdf

n On December 8, 2015, the state posted an adopted temporary rule revision to OAR 436-009, effective January 1, 2016.This rule allows health care providers to use the 2016 medical billing codes as of January 1, 2016. The updated rule can befound on the state’s web site.

http://www.cbs.state.or.us/wcd/policy/rules/docconv_21365/9_15066t.pdf


http://www.odg-twc.com/index.html



https://www.ok.gov/wcc/documents/(1.15.16)85A NRI Ch. 15.pdf

http://www.cbs.state.or.us/wcd/policy/rules/Hearing_20160222/9_10_16XXXp.pdf




n The state held an advisory committee meeting on November 9, 2015 to review rules OAR 436-009, Medical Fee andPayment Rules and OAR 436-010, Medical Services Rules. The committee discussed proposed changes to the rules for thefuture. To obtain information about participating in future meetings, please contact Fred Bruyns [email protected].

n On August 21, 2015, the state posted the adopted administrative rules for Chapter 436, Division 010, effective October 1,2015. The update can be found using the link below.


n On August 12, 2015, the state posted the revised Hospital Cost-to-Charge Ratios, effective October 1, 2015. The newratios can be accessed from the link below.


Oregon (Auto)Future Plans/Proposals

n The state posted proposed updates to OAR 436-009 Maximum Allowable Payment tables Appendices B - E, effectiveApril 1, 2016. A public hearing was held on February 22, 2016 to discuss the proposed changes. These changes can beviewed on the state’s web site at the following link.


n The state usually updates its cost-to-charge ratio in April and October of each year.

Previous Updates





n On August 21, 2015, the state posted the adopted administrative rules for Chapter 436, Division 010, effective October 1,2015. The update can be found using the link below.


n On August 12, 2015, the state posted the revised Hospital Cost-to-Charge Ratios, effective October 1, 2015. The newratios can be accessed from the link below.


OWCP (Longshore)Future Plans/Proposals

n The next Medical Fee Schedule is expected to be effective sometime in 2016.

Previous Updates

n The OWCP posted the updated Medical Fee Schedule, effective August 14, 2015. The update to the fee schedule can befound at the link provided below.

http://www.dol.gov/owcp/regs/feeschedule/fee/accept15.htm










http://www.dol.gov/owcp/regs/feeschedule/fee/accept15.htm

PennsylvaniaNew Adoptions!

n On January 28, 2016, the state’s vendor sent out an email communication with revised rates for two HCPCS codes (E0465and E0466), effective January 1, 2016. The new rates are as follows:

- E0465 $1192.41

- E0466 $1192.41


n Chargemaster, Part A (Tables A-I), and physician updates are generally adopted quarterly in January, April, July, andOctober.

Previous Updates

n On December 22, 2015 the data files for Part A (tables A-J) and Part B Medical Providers were received from the state’svendor. The files are effective January 1, 2016. The majority of these files can also be accessed from the state’s web sitewith the exception of Table I.

http://www.portal.state.pa.us/portal/server.pt/community/fee_schedule/10424

n The state released its update to the Fee Schedule for Part A (Tables A through J) and Part B medical providers, effectiveOctober 1, 2015.

Pennsylvania (Auto)Future Plans/Proposals

n Data files from CMS for ambulance, anesthesia, ASC, ASP drug, clinical labs, drug, DMEPOS, HCPCS, home health,inpatient hospital, outpatient hospital, physician, rehabilitation, and skilled nursing services are updated periodically withan added markup, when applicable, as defined in the state's statute. These updates are made either annually (based oncalendar or fiscal year) or quarterly (January 1, April 1, July 1, and October 1 of each year).

Previous Updates

n On December 11, 2015, CMS posted the quarterly additions, deletions and revisions to the MUEs for practitioners,outpatient hospital, and durable medical equipment (DME) supplier services, effective January 1, 2016.




n On December 9, 2015, CMS reposted the Average Sales Price (ASP) Pricing and ASP NDC_HCPCS Crosswalk files,retroactive to January 1, 2015.


n On December 9, 2015, CMS reposted the ASP Pricing, NOC Pricing, and ASP NDC_HCPCS files, retroactive to October 1,2015.


n On December 9, 2015, CMS posted the ASP Pricing, NOC Pricing, and ASP NDC_HCPCS files, effective January 1, 2016.


n On October 29, 2015, Medicare posted the FY 2016 Home Health Prospective Payment System Rate Update, effectiveJanuary 1, 2016.


http://www.portal.state.pa.us/portal/server.pt/community/fee_schedule/10424








n On October 30, 2015, Medicare posted the final adoption to the FY 2016 Ambulatory Surgery Center (ASC) Fee Schedule,effective January 1, 2016.



n On October 30, 2015, Medicare posted the updates to the Two-Midnight rule, effective January 1, 2016.



n On October 30, 2015, Medicare posted the final rule under the Physician Fee Schedule for CY 2016, effective January 1,2016.

































n On September 21, 2015, Medicare posted the October quarterly OPPS Addendum A and Addendum B data files, effectiveOctober 1, 2015.
















Rhode IslandFuture Plans/Proposals

n The state plans to update its fee schedule sometime in early 2016.

n The state is planning to update the medical fee schedule this year. We continue to monitor this closely for its adoption andavailability.

n The hospital cost-to-charge ratio is expected to be updated in July 2015.

Previous Updates


South CarolinaFuture Plans/Proposals

n Medicare ASP drug, inpatient PPS, outpatient PPS, and rehabilitation PPS updates occur in January, April, July, and Octoberof each year.













Previous Updates

n The South Carolina Workers’ Compensation Commission issued an updated 2015 Medical Services Provider Manual(MSPM), effective September 1, 2015. Per the Commission, it is imperative that providers and carriers obtain the newMSPM to assure compliance. Please note that the 2015 MSPM release does not affect SC Workers’ Compensation Hospitaland Ambulatory Surgical Center payment manuals/fee schedules. Click here for information on how to order the newMSPM:http://www.wcc.sc.gov/Documents/What%27s%20New/Medical%20Services%20Notices/2015%20MSPM%20Compliance.pdf

n On August 10, 2015, the state of South Carolina posted a notification indicating that the update to the 2015 MedicalServices Provider Manual is effective September 1, 2015. The fee schedule is available for order from the state's vendor,Optum at https://www.optumcoding.com/Product/45773/. For more information on the ordering of the fee scheduleplease see the link below.

http://www.wcc.sc.gov/Documents/What%27s%20New/Medical%20Services%20Notices/2015%20MSPM%20Requests%20Notice%20UPDATE.pdf

South DakotaFuture Plans/Proposals

n The state plans to update its fee schedule sometime in late April of 2016.

Previous Updates


TennesseeFuture Plans/Proposals

n The state filed a proposed rulemaking to adopt medical treatment guidelines for Workers’ Compensation. The stateproposed using the Work Loss Data Institute Official Disability Guidelines (ODG). If adopted, the new guidelines would gointo effect on February 28, 2016. The rule filing form and proposed rules can be found at the links provided below.

http://share.tn.gov/sos/rules_filings/11-14-15.pdf

http://tnsos.org/rules/PendingRules.php

n The state released a notice regarding a public hearing that was held on December 9, 2014. The Medical PaymentCommittee discussed workers' compensation cases and reviewed the medical fee schedule for possible changes. The statehas not yet released the committees finding.

Previous Updates


TexasNew Adoptions!

n On February 17, 2016, the ODG Workers’ Compensation Status “N” Drugs update was posted, effective February 29,2016.

http://www.tdi.texas.gov/wc/pharmacy/index.html

n On January 14, 2016, the Texas Medicaid DME, Home Health, and Dental fee schedules were updated. The new feeschedule can be accessed from the link below.

http://public.tmhp.com/FeeSchedules/StaticFeeSchedule/FeeSchedules.aspx


http://www.wcc.sc.gov/Documents/What's New/Medical Services Notices/2015 MSPM Compliance.pdf

http://www.wcc.sc.gov/Documents/What's New/Medical Services Notices/2015 MSPM Compliance.pdf

https://www.optumcoding.com/Product/45773/

http://www.wcc.sc.gov/Documents/What's New/Medical Services Notices/2015 MSPM Requests Notice UPDATE.pdf

http://www.wcc.sc.gov/Documents/What's New/Medical Services Notices/2015 MSPM Requests Notice UPDATE.pdf

http://share.tn.gov/sos/rules_filings/11-14-15.pdf

http://tnsos.org/rules/PendingRules.php

http://www.tdi.texas.gov/wc/pharmacy/index.html

http://public.tmhp.com/FeeSchedules/StaticFeeSchedule/FeeSchedules.aspx


n On October 21, 2015, the state posted a notice of an informal draft to make non-substantive changes to Rule 134.204.Comments on this informal draft were accepted until November 4, 2015. The draft can be found on the state's web site.

http://www.tdi.texas.gov/wc/rules/drafts.html

n The TDI-DWC quarterly insurance carrier meeting was held on January 22, 2015. As in prior meetings, the statecommunicated information to the carriers on provider complaints and compliance issues that affect carriers. It also soughtfeedback from the carriers on how to resolve these issues in the early stages. The quarterly insurance carrier meetings arenot open to the public but are intended for insurance carriers only.

n CMS ambulance and HCPCS data file updates are made annually based on calendar year or fiscal year. Clinical laboratory,DMEPOS, drug, inpatient hospital, outpatient hospital, and physician services data from CMS is updated quarterly. Thestate's statutes and rules apply added markups to applicable CMS data files.

Previous Updates

n The state posted the following annual Medical Fee Guideline conversion factors for 2016.

- Conversion factor of $56.82 applies to the following services: evaluation and management, general medicine,physical medicine and rehabilitation, radiology, pathology, anesthesia, and surgery when performed in an officesetting.

- Conversion factor of $71.32 applies to surgery when performed in a facility setting.

The bulletin containing all the information regarding the conversion factors can be found at the link provided below.

http://www.tdi.texas.gov/bulletins/2015/b-0029-15.html

n On October 21, 2015, the state posted that the ODG made changes to two drugs listed on the N Drug Formulary, effectiveFebruary 1, 2016. Fentanyl transdermal patches and MS-Contin changed status from "Y" to "N." The notice can be foundat the link below.

http://www.tdi.texas.gov/wc/dm/documents/ndrugm1015.pdf










http://www.tdi.texas.gov/wc/rules/drafts.html

http://www.tdi.texas.gov/bulletins/2015/b-0029-15.html

http://www.tdi.texas.gov/wc/dm/documents/ndrugm1015.pdf













n On September 21, 2015, Medicare posted the October quarterly OPPS Addendum A and Addendum B data files, effectiveOctober 1, 2015.
















UtahFuture Plans/Proposals


Previous Updates

n The state posted the 2016 Medical Fee Standards that updates the general method for computing medical fees andincludes adoption of materials incorporated by reference. The Medical Fee Standards is effective December 1, 2015. Theentire publication can be viewed on the state’s web site.

http://laborcommission.utah.gov/media/pdfs/industrialaccidents/pubs/2016MedFeeStandards.pdf

















http://laborcommission.utah.gov/media/pdfs/industrialaccidents/pubs/2016MedFeeStandards.pdf

Utah (Auto)Future Plans/Proposals


Previous Updates

n The Utah Insurance Department updated Rule R590-267, the Personal Injury Protection Relative Value Study rule. Theupdate rule updates references to the Relative Value for Dentist and the Relative Value for Physicians. It also updates allof the conversion factors, effective January 1, 2016. The updated rule can be found at the following link.

https://insurance.utah.gov/legal-resources/rules/documents/267Amend10-30-2015.pdf

VermontFuture Plans/Proposals

n On January 28, 2015, the state posted a public hearing for Workers' Compensation Rules 1-27. The proposed rules are toincorporate any changes that have been made by the legislature since 2001. The state held a public hearing on March 10,2015. The deadline for public comments was due on March 17, 2015. No further action was taken on these proposedrules.

http://labor.vermont.gov/wordpress/wp-content/uploads/Workers-Compensation-Rules-1-27.pdf

n The state posted proposed changes to Rule 40, which includes the workers' compensation fee schedule. The stateaccepted comments through September 30, 2011, regarding these proposed changes. Proposed amendments to Rule 40were filed with the Interagency Committee on Administrative Rules on August 30, 2012. Since that time, there has beenno move to adopt Rule 40 updates; however, the state indicated that it hopes that the new rules will be adopted possiblyin 2016.

Previous Updates


VirginiaNew Adoptions!

n The state’s vendor, Optum, posted the latest database files, effective February 15, 2016. The files can be obtained directlyfrom Optum.


n On September 16, 2015, the state posted a copy of the proposed rule that repeals provisions put in place by HB 1820regarding the definition of medical communities. The Commission accepted comments on these proposed changesthrough October 15, 2015, then sent them to the attention of Chief Deputy Commissioner James J. Szablewicz, VirginiaWorkers’ Compensation Commission, 1000 DMV Drive, Richmond, Virignia 23220. The link to the proposed rule isprovided below.

http://vwc.state.va.us/content/proposed-rule-14

n On April 23, 2015, the Virginia Workers' Compensation Commission posted the proposed revisions for the VocationalRehabilitation Guidelines. The Commission has asked for public comments regarding the revisions; the proposed changescan be accessed from the link below.

http://vwc.state.va.us/content/vocational-rehabilitation-guidelines-proposed-revisions


https://insurance.utah.gov/legal-resources/rules/documents/267Amend10-30-2015.pdf

http://labor.vermont.gov/wordpress/wp-content/uploads/Workers-Compensation-Rules-1-27.pdf

http://vwc.state.va.us/content/proposed-rule-14

http://vwc.state.va.us/content/vocational-rehabilitation-guidelines-proposed-revisions

Previous Updates

n The state recently adopted changes to Rule 14, effective January 11, 2016. This rule changes the definition of communityand can be viewed at the links below.

http://www.vwc.state.va.us/content/rule-14

http://www.vwc.state.va.us/sites/default/files/documents/Rule-14_0.pdf

n The state adopted emergency regulations regarding rules 16VAC30-50 from the Virginia Workers’ CompensationCommission (amending 16VAC30-50-150). Changes to the regulation include but are not limited to the “definition ofcommunity” and the zip codes associated with the different communities. The regulation changes can be viewed in itsentirety at the link below.

http://register.dls.virginia.gov/details.aspx?id=5455

WashingtonFuture Plans/Proposals

n Historically, the state updates the ASC, Hospital, and Physician Fee Schedules and rules on July 1 each year.

Previous Updates

n On December 18, 2015, the state posted an update to the Ambulatory Surgery Center (ASC) Fee Schedule, added thenew CPT and HCPCS codes for 2016, and updated the list of deleted procedure codes for 2016. The effective date of thesechanges is January 1, 2016.

http://www.lni.wa.gov/ClaimsIns/Providers/Billing/FeeSched/2015/Updates2015.asp

n On September 28, 2015, the state posted an update to the Audiology and Hearing Services portion of the fee schedule,effective November 1, 2015. The update includes:

- The insurer’s responsibility to purchase hearing aid batteries and supplies.

- The addition of two new codes 5094V (visits to replace bilateral tubes and domes for Receiver-in-Canal (RIC) hearingaids) and 5095V (wax guard).

The details of this update can be viewed on the state’s Updates & Corrections web site.


n On August 18, 2015, the state posted an update to the following codes that are effective on October 1, 2015:

- CPT code 99406 and 99407

- HCPCS code Q9979

The updates can be found on the state's web site at the link below.


n On August 3, 2015, the state posted an update to the fee schedule for HCPCS code J7330, which sets reimbursed at$40,231.20. The effective date is retroactive to July 1, 2015.


West VirginiaFuture Plans/Proposals

n The ASC, Clinical Lab, HCPCS, Hospital, Medical, and Pharmacy Fee Schedules will now be conforming to the updateschedule that Medicare adopts on a quarterly basis.


http://www.vwc.state.va.us/content/rule-14

http://www.vwc.state.va.us/sites/default/files/documents/Rule-14_0.pdf

http://register.dls.virginia.gov/details.aspx?id=5455





Previous Updates

n On December 23, 2015, CMS posted updated ASP Pricing files, effective January 1, 2016.


n On December 11, 2015, CMS posted the quarterly additions, deletions, and revisions to the Medical Unlikely Edits (MUEs)for practitioners, outpatient hospitals, and durable medical equipment (DME) supplier services, effective January 1, 2016.




n On December 9, 2015, CMS reposted the Average Sales Price (ASP) Pricing and ASP National Drug Code (NDC)-Healthcare Common Procedure Coding System (HCPCS) Crosswalk files, retroactive to January 1, 2015.


n On December 9, 2015, CMS posted the ASP Pricing, NOC Pricing, and ASP NDC-HCPCS files, effective January 1, 2016.


n On October 30, 2015, Medicare posted the final adoption to the FY 2016 Ambulatory Surgery Center (ASC) Fee Schedule,effective January 1, 2016.This update can be found at the link below.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/ASC-Regulations-and-Notices-Items/CMS-1633-FC.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descendin

n On October 30, 2015, Medicare posted the final rule under the Physician Fee Schedule for CY 2016, effective January 1,2016. This update can be found at the following link.


n On October 29, 2015, Medicare posted the FY 2016 Home Health Prospective Payment System Rate Update, effectiveJanuary 1, 2016.This update can be found at the following link.


WisconsinFuture Plans/Proposals

n The state usually updates its hospital radiology database in January and July of each year.

Previous Updates

n On January 25, 2016, the vendor released the updated UCR Certified database, effective for use on January 1, 2016.

n On August 6, 2015, the state posted the updated hospital radiology database in an excel spreadsheet, effective July 1,2015. The file can be accessed from the state's web site.

http://dwd.wisconsin.gov/wc/insurance/radiology/radiology_data.htm

WyomingFuture Plans/Proposals


Previous Updates

n On September 22, 2015, an update was posted workers' compensation fee schedule, effective January 1, 2015.











http://dwd.wisconsin.gov/wc/insurance/radiology/radiology_data.htm

Fee Schedule Status at a GlanceThis section provides a visual reference of anticipated and adopted fee schedules for each jurisdiction. See the Fee ScheduleAbbreviation Legend for definitions of cell entry abbreviations and shading.

2016 Fee Schedules Proposed and Adopted per State per MonthState Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

AL A, AS, C, P, H, HH, X

AK M

AZ M

AR M

CA A, DM, M, P

CO H, M

CT H M

DC AS, M, X

DE H, M, X

FL AS, M

FL Auto AS, M

FR/CMS DM, H A, AS, HH, M, X X

GA H, M

HI M

HI Auto M

IA

ID

IL H, M

IN

KS X

KY H

LA X

LS

MA X

MD M

ME H, M

MI

MN H

MO

MS

MT H, M


State Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

NC M, DM, P

ND AS, H, M

NE M, H

NH

NJ Auto

NM H, M, X

NV M

NY DM

NY Auto DM

OH M H AS

OH MCID

OK

OR M H, M

OR Auto M H, M

PA A, AS, DM, H, HC, HH, M, P

PA Auto DM A, AS, HH, M, X

RI

SC

SD

TN

TX DM, HH AS, M, X

UT

UT Auto M

VA X

VT

WA AS, X

WI H, M H, M

WV AS, H, M

WY M

Code Definition Code Definition Code Definition Code Definition

A Ambulance H Hospital MT Medical TreatmentGuidelines

SN Skilled Nursing

AS Ambulatory Sur-gery

HC HCPCS O Optometry X Other

C Chiropractic HH Home Health P Pharmacy Fee ScheduleAdopted

Fee Schedule Abbreviation Legend


Code Definition Code Definition Code Definition Code Definition

D Dental L Lab & Pathology PT Physical Therapy

DM DMEPOS M Medical R Rehabilitation


AAPC: American Academy of Professional Coders

AASCIF: American Association of State CompensationInsurance Funds

ACA: Affordable Care Act

ACD: Actual Charge Data

ACO: Accountable Care Organization

ACOEM: American College of Occupational andEnvironmental Medicine

ACORD: Association for Cooperative Operations Researchand Development

ADA: American Dental Association

AER: Annual Expenditure Report (New Mexico)

AHIMA: American Health Information ManagementAssociation

AI: At Invoice

AIA: American Insurance Association

ALFA: American Law Firm Association

AMA: American Medical Association

AME: Agreed Medical Evaluator

ANE: Allowance Not Established

ANSI: American National Standards Institute

AOE/COE: Arising Out of Employment/Occurring in theCourse of Employment

APC: Ambulatory Payment Classification

APR-DRG: All Patient Refined-Diagnosis Related Groups

ASA: American Society of Anesthesiologists

ASC: Ambulatory Surgery Center/Accredited StandardsCommittee

ASCX12: The Accredited Standards Committee X12

ASIS: American Society for Industrial Security

ASP: Average Sales Price/Application Service Provider

ASTC: Ambulatory Surgical Treatment Center

AUC: Administrative Uniformity Committee

AWP: Average Wholesale Pharmaceuticals/AverageWholesale Price

AWV: Annual Wellness Visit

BARC: Bill Adjustment Reason Code

BAV: Basic Anesthesia Value

BR: By Report

CAH: Critical Access Hospital

CARC: Claims Adjustment Reason Code

CCR: Cost-to-Charge Ratio

CCWC: California Coalition on Workers’ Compensation

CDC: Centers for Disease Control and Prevention

CDT: Current Dental Terminology (code)

CFR: Code of Federal Regulations

CMR: Code of Massachusetts Regulations

CMS: Centers for Medicare and Medicaid Services

COHE: Centers of Occupational Health and Education

CPI: Consumer Price Index

CPT: Current Procedural Terminology (code)

CRNA: Certified Registered Nurse Anesthetist

CTOB: Client Type of Bill

CWCI: California Workers’ Compensation Institute

DAW: Dispense as Written

DCN: Document Control Number

DISA: Data Interchange Standards Association

DIR: Department of Industrial Relations (California)

DME: Durable Medical Equipment

DMEPOS: Durable Medical Equipment, Prosthetics,Orthotics, and Supplies

DMS: Document Management System

DN: Data Number

Acronym Glossary

Fee Schedule & Legislative News76

DOH: Department of Health

DOI: Date of Injury

DOL: Date of Loss/Department of Labor

DOS: Date(s) of Service

DRG: Diagnosis Related Group

DSH: Disproportionate Share Hospital

DWC: Department of Workers’ Compensation or Division ofWorkers’ Compensation

EAMS: Electronic Adjudication Management System

EDI: Electronic Data Interchange (or Interface)

EFT: Electronic Funds Transfer

EHNAC: Electronic Healthcare Network AccreditationCommission

E/M or E&M: Evaluation and Management

EOB: Explanation of Benefits

EOBR: Explanation of Bill Review

EOR: Explanation of Review

ER: Emergency Room

FAQ: Frequently Asked Question

FEIN: Federal Employer Identification Number

FFS: Fee For Service

FISS: Fiscal Intermediary Standard System

FOIA: Freedom of Information Act

FR: Federal Register

FROI: First Report of Injury

FTP: File Transfer Protocol

GEAP: Generic Equivalent Average Price

GEM: General Equivalence Mapping

GPCI: Geographic Practice Cost Indices

HCO: Health Care Organization

HCPCS: Healthcare Common Procedure Coding System

HHS: Department of Health and Human Services

HIPAA: Health Insurance Portability and Accountability Actof 1996

HIPPS: Health Insurance Prospective Payment System

HITECH: The Health Information Technology for Economicand Clinical Health

HOPPS: Hospital Outpatient Prospective Payment System

HPP: Health Partnership Program

HPSA: Health Professional Shortage Area

HRA: Health Risk Assessment

HRSA: Health Resources and Services Administration

IAIABC: International Association of Industrial AccidentBoards and Commissions

IC: Individual Consideration

ICD-9: International Classification of Diseases 9th Revision

ICD-10: International Classification of Diseases 10thRevision

ICD-10-CM: International Classification of Diseases 10thRevision Clinical Modification

ICD-10-PCS: International Classification of Diseases 10thRevision Procedure Classification System

IME: Independent Medical Evaluation or Impartial MedicalExamination/Examiner

IPF: Inpatient Psychiatric Facility

IR: Impairment Rating

IRF: Inpatient Rehabilitation Facility

IWFC: International Workers’ Compensation Foundation

LOS: Length of Stay

LPM: Liter Per Minute

MAE: Office of Monitoring, Audit and Enforcement (Maine)

MAP: Maximum Allowable Payment

MAR: Maximum Allowable Reimbursement

MCCA: Michigan Catastrophic Claims Association

MCN: Manual Change Notification

MCO: Managed Care Organization

MedPAC: Medicare Payment Advisory Committee

MEEAC: Medical Evidence Evaluation Advisory Committee

MITS: Medicaid Information Technology System

MMA: Medicare Modernization and Improvement Act of2006


MMI: Maximum Medical Improvement

MMSEA: Medicare, Medicaid, and SCHIP Extension Act of2007

MPC: Medical Payments Coverage

MPFS: Medicare Physician Fee Schedule

MPN: Medical/Medicare Provider Network

MRA: Maximum Reimbursement Allowance

MRI: Magnetic Resonance Imaging

MSA: Metropolitan Statistical Area

MSCF: Maryland Specific Conversion Factor

MS-DRG: Medicare Severity Diagnosis Related Group

MT: Message Therapy

MTB: Maximum Therapeutic Benefit

MTC: Maintenance Type Code

MTG: Medical Treatment Guidelines

MTUS: Medical Treatment Utilization Schedule

MUE: Medically Unlikely Edit

NAIC: National Association of Insurance Commissioners

NAMIC: National Association of Mutual InsuranceCompanies

NC: Not Covered

NCCI: National Correct Coding Initiative

NCHS: National Center for Health Statistics

NCOIL: National Conference of Insurance Legislators

NCPDP: National Council for Prescription Drug Programs

NCVHS: National Committee on Vital and Health Statistics

NDC: National Drug Code

NGD: Negotiated Discount

NGHP: Non-Group Health Plan

NHIN: Nationwide Health Information Network

NICB: National Insurance Crime Bureau

NJCRIB: New Jersey Compensation Rating and InspectionBureau

NPI: National Provider Identification (number)

NPPES: National Plan and Provider Enumeration System

NUBC: National Uniform Billing Committee

NUCC: National Uniform Claim Committee

OAL: Office of Administrative Law (California)

OAR: Oregon Administrative Rules

OCE: Outpatient Code Editor (system)

ODG: Official Disability Guidelines

ODS: Organized Delivery System

ODJFS: Ohio Department of Job & Family Services

OESS: Office of E-Health Standards and Services

OIG: Office of the Inspector General

OMFS: Official Medical Fee Schedule

OPPS: Outpatient Prospective Payment System

OSIP: Office of Self Insurance Plans (California)

OWCP: Office of Workers’ Compensation Programs

PAS: Product of Ambulatory Surgery

P&C: Property and Casualty

PBM: Pharmacy Benefit Management

PBN: Pharmacy Benefit Network

PC: Professional Component

PCIAA: Property Casualty Insurers Association of America

PD: Permanent Disability

PDL: Preferred Drug List

PEN: Parenteral and Enteral Nutrition

PEO: Professional Employer Organization

PHDSC: Public Health Data Standards Consortium

PHI: Protected Health Information

PIHP: Prepaid Inpatient Health Plan

PIP: Personal Injury Protection

POS: Place of Service

PPACA: Patient Protection and Affordable Care Act

PPD: Permanent Partial Disability

PPI: Permanent Partial Impairment

PPO: Preferred Provider Organization

PPP: Preferred Provider Program


PPS: Prospective Payment System

PQRS: Physician Quality Reporting System (CMS)

PSF: Provider Specific File (CMS)

PT: Physical Therapy

QIW: Qualified Injured Worker

QME: Qualified Medical Evaluator

RARC: Remittance Advice Remark Code

RBRVS: Resource Based Relative Value Scale

RCC: Ratio of Cost-to-Charge

RCW: Revised Code of Washington

RFA: Request For Authorization

RFP: Request for Proposal

RN: Registered Nurse

RNE: Relative Value Not Established

RUG: Resource Utilization Group

RVD: Relative Values for Dentists

RVP: Relative Values for Physicians

RVS: Relative Value Study (or Scale)

RVU: Relative Value Unit(s)

SERFF: System for Electronic Rate and Form Filing

SGR: Sustainable Growth Rate

SIC: Standard Industrial Classification (code)

SIF: Second Injury Fund

SNF: Skilled Nursing Facility

SOS: Site of Service

SPA: State Plan Amendment(s)

SROI: Subsequent Report of Injury

SSD: Social Security Disability

SSL: Secure Sockets Layer

TC: Technical Component

TD: Temporary Disability

TDI: Texas Department of Insurance

TIN: Tax Identification Number

TOS: Type of Service

TPA: Third Party Administrator

TR3: Technical Report Type 3

TXANS: Texas Association of Responsible Non-subscribers

UB: Uniform Bill Patient Summary

UC: Usual and Customary

UCR: Usual, Customary, and Reasonable

UDF: User-defined Field

UPL: Upper Payment Limits

UR: Utilization Review

URAC: Utilization Review Accreditation Commission

UV: Unit Value

VPN: Voluntary Provider Network

WC: Workers' Compensation

WAC: Wholesale Acquisition Cost

WCA: Workers’ Compensation Administration

WCAC: Workers’ Compensation Advisory Council

WCB: Workers’ Compensation Board

WCC: Workers’ Compensation Commission

WCIO: Workers’ Compensation Insurance Organizations

WCIRB: Workers’ Compensation Insurance Rating Bureau ofCalifornia

WEDI: The Workgroup for Electronic Data Interchange

WHO: World Health Organization

WLDI: Work Loss Data Institute

WSI: Workforce Safety & Insurance (North Dakota)

XML: Extensible Markup Language


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