Managed Physical Medicine

Q3 2017 Legislative Updates

Here is a summary of legislative and regulatory developments and challenges for the third quarter of 2017 and their practical implications:

Maryland

The Maryland legislature has recently established a one-year bill submission period for Maryland providers. Previously there was no timely submission period prescribed by statute.

Beginning October 1, 2017, however, HB 1484, amending MD Labor & Employment Code § 9-660(D) extends that period to the later of twelve months from (a) date of service, (b) acceptance of claim by the payer or (c) determination of compensability by the Commission. The timely submission period is further extended from one year to three years if the Workers’ Compensation Commission finds that there is good cause for the delay.

Maryland regulation COMAR 14.09.03.06(C) continues to require payers to reimburse providers or to deny in full or in part or within 45 days of receipt of a provider’s bill.

Implications:

  • Payers that are unaware of this new law may mistakenly deny as untimely provider bills submitted within the permitted twelve-month period. Further, the new law may hamper payers’ efforts to promptly close Maryland claims.
Colorado

The Division of Workers’ Compensation has adopted regulations that define acceptable standards for telemedicine delivered to WC claimants. The criteria set forth in Rule 16-2 (7 CCR 1101-3) go considerably further than the statutory definition of telemedicine in Colorado’s Medical Practice Act.

The DWC Utilization Standards now require use of both audio and video equipment during the telemedicine session so that the provider can diagnose and evaluate the patient in order to confirm or alter the treatment plan, including medications and specialized therapy. Previously, the Utilization Standards broadly referenced only “Telehealth,” which doesn’t require interactivity or the use of both audio and video technology.

Implications:

  • The Colorado DWC’s definition of telemedicine focuses on workers’ compensation’s unique emphasis on rehabilitation and return to functionality. A consistent leader in health care utilization management regulation, the DWC is likely to be influential in shaping the emergence of telemedicine as an effective and efficient component of claim management.
Virginia

The Virginia fee schedule law, effective January 1, 2018, also includes “Silent PPO” prohibitions to protect providers from abusive PPO network practices. The law prohibits payers (employers, insurers and TPAs) from “stacking” (shopping for the lowest discount rates for a specific provider among available network contracts) and requires payers, at time of payment, to identify the provider’s agreement that the payer is relying upon for the discount below fee schedule, plus any other intermediate network contracts linking the payer to the discounted rate.

The law also prohibits contracting entities, such as MedRisk, from disseminating the specific provider’s negotiated discount and other contract terms without the provider’s written permission. This provision protects the provider from non-permitted disclosure of confidential business information.

Implications:

  • These new requirements are consistent with MedRisk’s standard operating procedures countrywide and pose no problem to MedRisk’s continuing and expanding business in the commonwealth.