The MedRisk Blog
The Pennsylvania Bureau of Workers’ Compensation responded to a PA Supreme Court decision invalidating the AMA Guides to the Evaluation of Permanent Impairment as a standard for disability ratings by suspending all Independent rating evaluations. The Court ruled in Protz v. WCAB that statutory reliance on the AMA Guides was an unconstitutional delegation of legislative authority to the American Medical Association.
Texas has enacted legislation giving the Division of Workers’ Compensation greater control over work-hardening and work-conditioning programs. Senate Bill 1494 removes an automatic exemption from pre-authorization and concurrent review which CARF-credentialed facilities previously enjoyed. The amendment to Labor Code §413.014, effective September 1, 2017, permits the DWC by rule to reinstate exemptions for certified facilities if the agency determines exemptions are appropriate.
The Industrial Commission of Arizona has proposed moving from a Fee Schedule based on comparisons with surrounding states’ WC medical payments to the RBRVS (resource-based relative value scale) reimbursement mechanism used by Medicare. Also included in this proposal is a rule that would require providers participating in a network to be reimbursed at 90% of either the fee schedule rate or of the full amount of any negotiated discount rate payable to the network.
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