Managed Physical Medicine

Q2 2019 Legislative Updates

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

California

Senate Bill 537 – introduced this past April – has been passed out of the California Senate and the Assembly Insurance Committee and will now be presented to the Assembly Appropriations Committee.  Language from the bill that would have prohibited WC network discounts below 100% of Medicare rates has been removed. Nevertheless, the bill still contains ambiguous language threatening to disrupt the administration of Medical Provider Networks (MPNs) as they currently operate.

  • Implications

Although advocated only by a handful of California physical therapists, the bill broadly applies to all medical services and MPNs. As currently drafted, the bill could disrupt California’s successful MPN system, resulting in higher costs for payers, employers and taxpayers. MedRisk and other organizations are urging the adoption of clarifying wording that would eliminate unnecessary confusion and preserve effective MPN operations. The intervention of employers and commercial payers, however, is also needed.  For more information, please contact your MedRisk account representative.

New York

New York Governor Andrew Cuomo has signed into law an omnibus budget bill containing authorization for providers of acupuncture to treat injured workers within the WC system, provided the patient has a referral from a physician or nurse practitioner.  Physical and occupational therapists are among the clinicians that are permitted to perform acupuncture if they are certified to perform these services.  The Workers’ Compensation Board, which supported this expansion, has proposed a regulation (12 NYCRR 323.1) and is accepting comments through August 18, 2019.

  • Implications

When the regulation is adopted by the WCB, New York will join a handful of other states in authorizing payment for acupuncture under workers’ compensation when the services are deemed medically necessary.  Most of the jurisdictions that affirmatively permit acupuncture for WC claimants require a referral from a treating physician.

Nevada

Nevada has recently enacted two laws that impose new regulatory requirements on workers’ compensation managed care.  Senate Bill 365 requires all “health carriers,” including workers’ compensation payers, to explicitly state contract rights and obligations in provider agreement and to maintain a website listing all customers granted network access via the provider agreement.  The new law is due to take effect on January 1, 2020, after the Division of Industrial Relations has adopted implementing regulations.

Nevada also enacted Senate Bill 381, which permits a WC insurer to limit employee choice of physician or chiropractor to those listed on its provider panel, but only if the panel contains, by discipline or medical specialty, at least twelve providers or, if there are fewer than twelve authorized by the Division, all of the members of the discipline or specialty.

  • Implications

Neither of the new statutes have much impact on MedRisk workflows for operations in Nevada.  MedRisk provider agreements and operations already conform to the “best practices” standards of SB 365.  Further, the increased network access standards of SB 381 relate only to physicians and chiropractors:  Nevada remains an employee choice state for PT.