The MedRisk Blog
A bill currently being considered by the House Labor and Industry Committee (HB 1141) would, among other things, require that provider payments below fee schedule must be supported “through a bona fide provider network arrangement,” a term that is undefined in the legislation or anywhere else in Pennsylvania’s statutes. Another provision prohibits any sort of channeling, including referring or recommending, injured workers to preferred providers, unless the network performs services that are consistent with the functions of the now dormant Coordinated Care Organization (CCO) mechanism.
The Tennessee Bureau of Workers’ Compensation adopted the ODG medical treatment guidelines in late January. Previously the state had only one guideline addressing opioid administration for chronic pain. The BWC also adopted the ODG drug formulary.
The Texas Division of Insurance recently announced that its Research and Evaluation Group will study a number of workers’ compensation issues in 2016, including the performance of certified HCNs (e.g., RTW outcomes, medical costs, quality-of-care issues, medical dispute resolution) and the utilization of office visits and physical medicine services.
Virginia Governor McAuliffe has signed into law SB 631, which requires the WC Commission to establish a fee schedule effective January 1, 2018. This will be a six-zone “medical community” fee schedule using historical in-state health care payments as the rate base. It will be provider-friendly (i.e., the fee schedule will be generous). The measure permits “employers” (including insurers and TPAs) to contract with “contracting entities” and “PPO network arrangers” for discounted provider payments, but has troubling language allowing employers to contract only “directly” with either providers, contracting entities or PPO arrangers. Further, the definition of “PPO Arrangement” refers to “multiple provider contracts to which the PPO Network Arranger is a direct party.”
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