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State of the States February 3, 2023

2-2 Medical Fees

Several work comp bills were introduced by one legislator aimed at adopting a closed formulary, updating medical fee schedules, and restricting compounds.

injured-workers-pharmacy-blog-illinoisThe Illinois Work Comp Commission would be required to establish a new medical fee schedule, implement a closed formulary, and restrict reimbursement on compounds if new legislation proposed by Rep. Dan Ugaste (R) passes.  HB 1548 would make all current medical fee schedules invalid after Aug 31, 2024 and require the Commission to establish new rates.  HB 1544 would establish conditions of payment for compound drugs and limit them to a one-time 7-day supply. HB 1546 would require the Commission to adopt an evidence-based formulary by Sept 1st but does not name a specific one. Ugaste also introduced HB 1543, which redefines causation. All the bills are awaiting committee assignments.

The Senate passed bills to expand the cancer presumptions covered.  

injured-workers-pharmacy-blog-virginiaThe Senate unanimously passed SB 904 and SB 906 earlier this week with a vote of 39-0 to expand the types of cancers presumed compensable for first responders and provide coverage for anxiety and depressive disorders. The bill will now move on the House.

A measure was filed to provide benefits to first responders for PTSD, capped at 2 years.  

injured-workers-pharmacy-blog-marylandMD SB 406 was introduced earlier this week to provide benefits to police officers, rescue squads, correctional officers, 911 specialists, and firefighters for post-traumatic stress disorder. The Maryland bill requires the employee to complete at least two years of cumulative service in their role and the benefits are capped at two years. It had its first reading the Finance Committee on February 1st.

A bill, if passed, would make Lyme disease an occupational illness in certain professions.

injured-workers-pharmacy-blog-new-yorkSB 3117, if passed, would make Lyme disease an occupational illness under workers’ compensation.  Workers would qualify if they were working in “any process involving outdoor activity or treatment of animals.”  A similar bill failed in 2022. New York legislators are also considering AB1014 that further modifies the law allowing for social workers to treat in the work comp system and relieve some pressure due to shortages of mental health care providers. The bill permits telemedicine services for mental and behavioral health issues. Here is a relevant article from Business Insurance entitled “Social Workers could bridge mental health cap in comp care” that highlights the states that are taking action to address the shortages.

Legislators aim to provide work comp coverage to national guard members.   

KSNew bill would make members of the National Guard eligible for workers’ compensation benefits. HB 2209 would offer workers’ compensation in lieu of other benefits in Kansas statutes that entitle National Guard to medical treatment and indemnity benefits for work injuries. The calculation would subtract any federal compensation from the final amount Kansas would pay.

A new bill would allow for PTSD for first responders, even without a corresponding physical injury.

injured-workers-pharmacy-blog-idahoThe House of Representatives passed HB 18 with a vote of 69-0. The bill allows first responders to receive benefits for post-traumatic stress disorder without a corresponding physical injury past the sunset clause date of July 1st. If passed, this bill would make the benefits permanent. The bill now awaits Senate approval.

Legislation introduced and failed in short order that would have revised the exclusive remedy to exempt gross negligence.

injured-workers-pharmacy-blog-mississippiSB 2863 would have revised the exclusive remedy provision under the workers’ compensation law to exempt gross negligent claims where the injury was substantially certain to occur. This could have opened up employers to lawsuits by employees or their family members. However, the Republican sponsored bill was introduced on January 16th and referred to the Judiciary Committee where it died on January 31st.

A new WorkCompCentral study on chronic pain found the best way to mitigate chronic pain is to keep people working.  

NationalA new special report from WorkCompCentral entitled Chronic Pain Explained: How to manage chronic pain in the workers’ comp system, finds one of the best ways to mitigate chronic pain is to keep people working.  Two other findings in their highlights section stated, “Exercise and return to work result in the best permanent outcomes” and “opioids are rarely an appropriate treatment for chronic pain.”

A recent Business Insurance article explains how differing states approach attorney fee caps and highlights the confusion in Florida for some judges.

injured-workers-pharmacy-blog-floridaArticle of Interest– A Business Insurance article from February 1, 2023, entitled Approach to attorneys fees varies widely in comp, demonstrates that courts are determining the meaning of caps on attorneys’ fees and some are determining what is reasonable regardless of the statutory cap. In Florida, due to the Florida Supreme Court case of Castellanos v. Next Door Co., that eliminated statutory fee caps, David Langham, deputy chief judge of compensation claims, said “Some judges think there if no fee cap, some judges think the word ‘reasonable’ is the fee cap, and some judges think there is a fee cap. We don’t know the answer.”

State of the States

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