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

California

Senate Bill 537 has been signed into law by Governor Newsom.  The law requires networks to provide a standardized disclosure form to their payer clients, if network provider reimbursements are less than 80 percent of the Official Medical Fee Schedule rates.

• Implications

The Division of Workers’ Compensation is given the task of developing the provider reimbursement disclosure form required by this provision, which becomes effective July 1, 2021.  MedRisk will be following the DWC’s work closely to ensure that the form provides information that is clear and operationally useful.

The California Consumer Privacy Act, recently enacted, greatly expands protections for California residents regarding the unauthorized sale and commercial use of personal consumer information gathered through online transactions such as purchases, social networking and use of “free” applications.  A particular target is the undisclosed profiling of individuals without their knowledge, especially when these individuals are children.

• Implications

MedRisk does not sell or commercially use personal consumer information gathered through online transactions. And, because the act specifically exempts from its reach any individually identifiable health information covered by federal or state privacy laws, this legislation has no effect on MedRisk’s communications with providers and payer customers.  Its largest impact will be on business entities that use consumer data mining in their marketing strategies.

Illinois

The Workers’ Compensation Commission has published proposed regulations implementing last year’s SB 904, which clarified Illinois’ prompt payment requirements imposed upon WC payers.  The proposed regulation (50 IL Adm. Code 9110) once adopted would clear up ambiguities contained in the legislation regarding grounds payers can use for denying provider bills.

• Implications

Stakeholders have until October 28 to send comments to the WCC.  Some observers have complained that the proposed regulation should have gone further in addressing such issues as permitted grounds for providers’ lawsuits against payers, criteria for the imposition of interest penalties on unpaid provider bills, and the timing when those interest payments are due.  Unless the WCC reopens its rulemaking process to consider these questions, their answers may be determined only by costly and lengthy litigation.