Managed Physical Medicine

Q4 2018 Legislative Updates

Here is a summary of legislative and regulatory developments and challenges for the fourth quarter of 2018 and their practical implications:

New York

The New York Workers’ Compensation Board published its long-awaited fee schedule revision on December 26. The new rates and payment rules go into effect on April 1, 2019.

MedRisk’s early analysis indicates that physical therapy regulatory rates will increase significantly, due in large part to a 50% increase (from eight to twelve) in PT relative value units. Rates for chiropractic treatment were also raised. The Board also dropped an earlier proposal to cap physical medicine sessions after 12 visits or 180 days of service, retaining the current rule that permits more than 12 treatments or more than 45 days of therapy or chiropractic treatment if the need is fully documented by a physician.

In other New York news, a New York appellate court in November upheld the WCB’s authority to change its policy regarding application of the New York medical treatment guidelines to out-of-state providers treating New York claimants. Previously, the WCB applied its guidelines to in-state providers and to out-of-state treatment received by New York residents, but now applies them to all in-state and out-of-state providers treating New York claimants, even if the claimant lives outside New York.

  • Implications

The fee schedule increase is the first in 20 years. Because the New York fee schedule is very low compared to other states and to estimates of providers’ cost of care expenses, the increases may expand injured workers’ access to medical care by encouraging more providers to treat WC claimants. Regarding application of New York medical treatment guidelines to out-of-state providers, this initiative may prompt pushback from out-of-state providers unfamiliar with New York’s substantive protocols and administrative procedures.

Texas

Through a complex regulatory process, the delivery of telehealth services to workers’ compensation claimants located in Texas by physical therapists is now permissible in Texas. The regulations broadly support the delivery of these services by a PT provider, regardless of his or her location, who has an unrestricted Texas license or who has a Compact Privilege to practice in Texas. The standard of care is the same as applies in an in-person setting, with customary informed consent and confidentiality requirements.

Earlier in the year, the Division of Workers’ Compensation removed the requirement that the patient must be located in a rural location. Next, a new Texas statute permitting the delivery of telehealth services opened these services to health professionals including physical therapists. Finally, effective November 11, 2018, the Texas Board of Physical Therapy Examiners adopted standards asserting the necessary regulatory authority over telehealth services delivered by PTs.

  • Implications

Texas joins a growing number of major states encouraging telerehab services for injured workers. The increasingly friendly regulatory environment should encourage rapid expansion of these services.

Illinois

On November 27, the Illinois General Assembly overrode outgoing Governor Rauner’s veto of Senate Bill 904, thereby supporting Illinois providers to charge 1% per month interest for late payments for WC-related services. The legislation also requires payers to affirmatively notify providers within 30 days when a payment has been denied.

  • Implications

This measure reinforces providers’ existing rights by giving them an administrative process via the Workers’ Compensation Commission for collecting late-payment interest. The law places corresponding pressure on payers to process medical bills quickly and to ensure that denials are timely communicated.