Here is a summary of legislative and regulatory developments and challenges for the first quarter of 2019 and their practical implications:

California

In January 2019, California became the first state to adopt a fee schedule using 32 distinct regional rates for MSA-based localities, based on Medicare Geographic Practice Cost Index (GPCI), which is now in the process of a six-year phase-in. Since many jurisdictions currently use other Medicare payment rules, and since use of dominant Medicare regional payment methodology offers both improved health care access to claimants and operational economies to WC agencies, it is probable that other states will follow suit.

• Implications

The primary beneficiaries of the GPCI based regional fee schedule are providers in some of the higher-cost urban areas, who would see regulatory rate increases. Payers would be required to modify their bill review systems in order to properly track regulatory rates and providers’ treatment locations.

Arkansas and Virginia

Arkansas and Virginia have recently enacted legislation to join the PT Compact, an interstate reciprocal agreement permitting physical therapists licensed in one state to practice in another.  There are now 23 member states, and other states including Georgia, Maryland, Massachusetts, Michigan, and Nevada, have legislation pending to join the PT Compact in 2019.

• Implications

The PT Compact facilitates the nationwide rollout of MedRisk’s TeleRehab Program by removing administrative barriers to multi-jurisdictional practice by a MedRisk clinician. Using appropriate telecommunications technology, the MedRisk TeleRehab PT evaluates and treats injured workers in their homes or workplaces, expediting the delivery of care and avoiding needless travel.