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The MedRisk Blog

Q2 2016 Legislative Updates

Here is a summary of legislative and regulatory developments during the second quarter of 2016 and their practical implications:


Rules of the Arizona Industrial Commission adopting the ODG medical treatment guidelines have been approved by the Governor’s Regulatory Review Council and will be effective for workers’ compensation claims with a date of injury of October 1, 2016 or later. “Until further action of the Commission,” the rules apply only to chronic pain and to opioids for all stages of pain, but the Commission reserves the right to apply ODG more broadly upon publishing its intention to do so, with opportunity for public comment.

  • Implications: Compliance with the ODG guidelines creates a rebuttable presumption of correctness, which may be overcome with “credible medical evidence” including “clinical expertise and judgment.” This relatively low barrier, together with the Commission’s piecemeal condition-by-condition application, exhibits a conservative approach to evidence-based medicine, but it gives payers additional tools to address overtreatment. The regulation can be found at ACC § R20-5-1301 et seq.

Effective April 15, the Colorado Division of Workers’ Compensation has established rules of procedure for dispute resolution which all parties to request mediation or to voluntarily submit to binding arbitration in lieu of adjudication in a DWC hearing.

  • Implications: The availability of alternative dispute resolution mechanisms should assist in expedite closure between payers and providers on reimbursement and medical necessity issues. The new provisions can be found in at 7 CCR 1101-3, Rule 9, Section 9-2.

A bill currently being considered by the House Labor and Industry Committee (HB 1800) would authorize regulators to publish evidence based medical treatment guidelines for resolving issues relating to treatment of work-related injuries. Although the MTGs must be based on nationally recognized guidelines, modifications by a panel of Pennsylvania medical providers would be permitted. By a 14 to 13 vote on June 14, the bill was tabled.

  • Implications: Predictably, the bill has drawn the fire of provider groups but was given a relatively high chance of passage due its support by the Insurance Federation of Pennsylvania. The tabling of the bill on June 14, however, means that it is unlikely that the bill will receive further consideration this year and will not be carried over to the next legislative session. If enacted, the measure would lend some rationality to Pennsylvania’s utilization review procedures.