Division Gets Pushback, Support For Draft QME Regulations

Draft regulations to boost the training and educational requirements for qualified medical evaluators (QMEs), including anti-bias training that the Division of Workers’ Compensation agreed to require of QMEs two years ago, generated significant feedback from employers and providers alike. The Division is reviewing 20-some pages of comments in preparation for starting the formal rulemaking process. … Read More »

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Community Calls For Med-Legal System Reform

The Division of Workers’ Compensation says it will begin forming stakeholder groups to work on rewriting the state’s medical-legal fee schedule (MLFS) and the rules surrounding the delivery and review of medical records. State officials got an earful at a hearing last week from qualified medical evaluators (QMEs) who are fed up with outdated pay … Read More »

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Lower Pharmacy Costs Coming

The Division of Workers’ Compensation is preparing to change the way California’s workers’ comp pharmacy fee schedule works. The idea is to keep the system in check with how Medi-Cal pays for prescription drugs. Medi-Cal is in the process of adopting the changes and Labor Code section 5307.1 requires the workers’ comp system to keep … Read More »

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Geographic Medical Pricing Teed Up

The Division of Workers’ Compensation’s proposal to alter the payments medical providers receive based on where geographically they are practicing is winning converts. The latest iteration of the proposed regulations generated only three responses with only limited suggestions for improvements. The State Compensation Insurance Fund and the California Orthopedic Association submitted comments expressing support for … Read More »

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Workers’ Comp Battles Coming In 2019

Several workers’ comp bills are still making their way through the Legislature this year (see related story), but industry players expect the real battles to begin next year when a new administration takes over. Neither candidate – Gavin Newsom for the Democrats nor John Cox for the Republicans – is making workers’ comp a significant … Read More »

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Drug Formulary Proposal

Department of Industrial Relations officials are still reviewing the feedback they received from a recent public comment period, but expectations are that the formal rulemaking process for a workers’ comp prescription drug formulary will begin next month. Early indications are that the Department is in for a fight over the handling of opioids at the … Read More »

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RBRVS Cost Estimates Changing – Opposition Among Physician Specialists

Specialists are still railing against the Division of Workers’ Compensation’s (DWC) move to a Medicare-type payment system even though the Legislature mandated the switch. Now, new data is likely to increase the volume of the opposition, as the pay cuts are deeper than initially billed. And while supportive of the switch, employers are concerned as … Read More »

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