National:
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- Government Shutdown Update:
- The federal government reopened on November 11, 2025, ending the longest shutdown in U.S. history after 44 days. The resolution came after the House passed the Senate-approved funding bill, which President Trump signed into law. The measure extends government funding through January 30, 2026, and includes full-year appropriations for agriculture, military/veterans, and legislative branches. This action restores pay for approximately 775,000 furloughed employees and resumes critical services that were strained during the shutdown.
- The National Council on Compensation Insurance (NCCI) released a report examining trends in home health and skilled nursing services within workers’ compensation claims for Accident Year 2024. It reveals substantial variation based on claim severity: for claims costing $250K–$500K one-year post-injury, home health services accounted for 2.0% and skilled nursing 1.1% of medical costs, while for claims exceeding $1M, those figures jumped to 20.1% and 5.3%, respectively. Across all claims in 2024, home health made up 2.0% and skilled nursing 0.8% of total medical costs.
- This week, Senator James Lankford (R-OK) introduced US S 3159, the Preserving Patient Access to Long-Term Care Pharmacies Act, a companion to US HR 5031. The legislation seeks to amend Title XVIII of the Social Security Act to temporarily provide supply fees for dispensing certain drugs under Medicare Part D. Specifically, it proposes a $30 supply fee per eligible prescription for plan year 2026, with an inflation-adjusted increase in 2027, and includes enforcement through civil penalties to ensure compliance.
Delaware: Workers’ Compensation Research Institute (WCRI) latest study reports that medical payments per workers’ compensation claim in Delaware rose by 7% annually from 2021 to 2023. The increase was driven by higher prices for professional services and hospital outpatient care, with the state’s fee schedule contributing to sustained growth. The analysis explores these trends in the context of system reforms, claim composition changes, inflation, and pandemic-related impacts. Focused exclusively on non-COVID-19 claims, the study provides comparative insights for policymakers and stakeholders.
New Mexico: New Mexico’s Workers’ Compensation Administration announced a new Electronic Data Interchange (EDI) rule which took effect on November 7, 2025, as part of its broader IT modernization initiative. The updated rule mandates that all claims' filers submit electronic data using the IAIABC Release 3.1 standard in XML format, replacing the previous Release 1.0 standard. The rule also introduces new definitions, technical requirements, and corrective action protocols for trading partners and EDI claim administrators.
Pennsylvania: Next week, on November 19 at 9:30 a.m., the Supreme Court will hear oral arguments via live stream in the case of Federated Insurance Company v. Summit Pharmacy. This follows the January 2, 2024, ruling by the Pennsylvania Commonwealth Court, which determined that using Red Book as the pricing source for prescription medications in workers’ compensation is no longer valid. That decision, stemming from the same case, directed the Bureau of Workers’ Compensation (BWC) to identify a new benchmark for calculating average wholesale price (AWP).
Texas:
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- The Texas Department of Insurance (TDI) issued Bulletin B-0016-25, announcing the 2025 data call for insurers writing workers’ compensation in Texas. Insurers must submit annual experience and deductible plan data electronically to TDI. Even insurers with no reportable data must respond. The data call covers the period from January 1, 2025, to December 31, 2025. To learn more, check out the bulletin announcement here.
- The Insurance Council of Texas (ICT) released its 2025 Workers’ Compensation Market Report which reports Texas's workers’ compensation system remains stable and competitive. The report highlights steady premium trends, strong regulatory oversight, and continued insurer participation, all contributing to a healthy and affordable market for employers. Overall, Texas maintains a reliable and balanced system that supports both businesses and workers.
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