State of the States May 27, 2022

Medical Prices

Workers’ Compensation Research Institute (WCRI) released its latest Medical Price Index Benchmarks showing that states with fee schedules usually paid less than states without.

NationalNational - The Workers’ Compensation Research Institute (WCRI) released its 14th edition of the Medical Price Index for Workers’ Compensation (WCRI). WCRI researchers found that prices paid for a similar set of professional services for treating injured workers varied significantly across the 36 states observed and that states without fee schedules usually paid higher prices. In 2021, the overall level of prices paid ranged from 29 percent below the study median in Florida to 164 percent above the median in Wisconsin. Florida, South Carolina, and Massachusetts saw the lowest prices paid for professional services to treat injured workers, whereas Wisconsin, New Hampshire, and Indiana saw the highest. While states with fee schedules generally paid less than those without fee schedules, states such as Illinois, Nevada, Oregon, and Virginia, which have fee schedules, were in the top 10 for the highest prices paid. Evaluation and Management Services, also known as office visits, were lowest in Massachusetts, Alabama, and Delaware and highest in Wisconsin, New Hampshire, and Oregon. The 36 states covered in the study represented 88 percent of workers’ compensation benefits paid in the U.S. States included in the research comprised AL, AZ, AR, CA, CO, CT, DE, FL, GA, IL, IN, IA, KS, KY, LA, MD, MA, MI, MN, MS, MO, NE, NV, NH, NJ, NM, NY, NC, OK, OR, PA, SC, TN, TX, VA & WI.

In Florida, carriers are challenging a rule regarding physician dispensing.

FLFlorida – A group of carriers is challenging a Department of Workers' Compensation (DWC) policy that requires them to reimburse physician-dispensed prescriptions. A 2020 DWC bulletin stated that carriers cannot deny authorization for prescription drugs solely because they were dispensed by a treating physician. However, the carriers question the policy since it did not go through the whole administrative process to become a formal rule. Carriers say the DWC is enforcing a policy that is yet to be "adopted" through the DWC administrative process and, therefore, should not be enforceable. Further, carriers believe that the 2020 policy is "predicated on an invalid legal fiction that doctors and nurses become pharmacists as soon as they dispense medication in the office." The DWC admits to not completing the formal rulemaking process to make the policy a rule. Nonetheless, they will enforce the policy warning that carriers who do not comply will continue to face sanctions and penalties up to $100,000. 


Kansas lawmakers scrapped a last-minute plan for allowing medical cannabis in 2022.

KSKansas – Despite a plethora of proposals, debates, and compromises, the Kansas legislature will conclude without passing a bill allowing for medical cannabis in the state. The Senate Federal and State Affairs Committee cited a "heavy load" of work this legislation that prevented medical cannabis legislation from being completed. Although the Kansas House of Representatives passed a bill allowing for medical cannabis last year, negotiations with the Senate continued to face difficulties. While the measure is likely defeated for the 2022 legislation session, lawmakers said they will work on medical cannabis policy over the summer in hopes of coming to an agreement that could work in 2023. Currently, 37 states allow for medical cannabis. 


New York’s State Senate passed a measure that would exempt non-resident pharmacies from registration requirements under certain conditions.

NYNew York – Legislators in the state senate passed a bill (S5489) that would exempt registration requirements of non-resident pharmacies in certain instances. The change is likely attributed to the pandemic's effects on supply chains and fulfilling patient needs. Bill language would give an exemption to non-resident pharmacies during state of emergencies or in the case of specific patient need. With the Senate's approval, the legislation will now go to the Assembly for more review. If fully passed, the bill would take effect immediately. 


The Pennsylvania Commonwealth Court upheld a ruling that an employer generally cannot withhold payment to an injured worker for failure to file a form without proper notice.

PAPennsylvania – A state court upheld a ruling that employers generally cannot withhold payment to a worker for failure to file a form. After the workers' injury, the employer Essex Holdings LLC, agreed to settle the claim and a workers' compensation judge entered an order adopting the stipulation between the parties in 2018. The injured worker in 2019 did not file the proper wage & benefits reporting form, and the employers' carrier withheld payment in response. The Court noted that even if the carrier could suspend payments due to an incomplete form, they would have to send a notice of suspension first. By ruling in favor of the injured worker, the employer will now face penalties and resume payments to the injured worker. 


A data breach in Texas has affected the personal information of 1.8 million injured workers in the Lone Star state.

TXTexas – Department of Insurance (TDI) officials say the personal information of 1.8 million injured workers in the state was exposed and publicly available for nearly three years, according to a state audit released earlier this month. Information including Social Security numbers, addresses, dates of birth, phone numbers, and information about workers' injuries became accessible online to members of the public from March 2019 to January 2022. TDI says they only became aware of the issue in January after a routine audit. Officials believe the incident occurred due to a problem with the programming code in the department's web application. The department issued notices to affected individuals informing them of the breach. 


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