The Colorado Division of Workers’ Compensation (DOWC) held an informal stakeholder meeting on August 4th to gather feedback on proposed revisions to Rules 16 and 18 before the August 27 rulemaking hearing, which affect multiple aspects of medical management and reimbursement within Colorado’s workers’ compensation system.

Healthesystems attended the meeting to engage and monitor the rulemaking process

The Division described this year’s rulemaking process as unusual because the proposal includes both accessibility-related reformatting requirements and substantive revisions, prompting an extended 60-day comment period and an additional stakeholder meeting.

During the meeting, the Division identified several provisions under consideration for revision, removal, or reinstatement, including language related to prior authorization requests exceeding medical treatment guidelines, Level 2 physician reviewers, record retention, CARC/RARC code definitions, physician reviewer documentation for administrative denials, alignment of telemedicine RVUs with standard office visits, and QPOP documentation.

Stakeholders also raised several operational and policy concerns, including:

• Rulemaking Process: The volume of formatting and substantive changes made the proposal difficult to evaluate, raising concerns about unintended consequences and prompting requests for greater transparency, access to comments and testimony, and additional stakeholder dialogue
• Pharmacy and Topical Medication Reimbursement: Concerns focused on coding requirements, payer system impacts, and access to certain topical and over-the-counter medications
• Home Health and Attendant Care: Concerns included caregiver qualifications, family caregiver participation, care planning requirements, and potential restrictions on covered services
• “Physician Managing the Claim” Terminology: Providers questioned replacing “attending physician” with “physician managing the claim,” citing potential statutory conflicts and uncertainty over provider responsibilities
• Prior Authorization and Treatment Guidelines: Requests focused on clearer standards for documenting care that exceeds or deviates from Colorado’s Rule 17 Medical Treatment Guidelines and concerns that some guidelines may not reflect current medical practice
• Telemedicine Billing: Requests included additional guidance on documentation, coding, and medical necessity standards
• Forms and Record Retention: Clarification was requested on medical record retention obligations and continued use of existing documentation processes, including timely delivery of the WC-164 form

The Division encouraged stakeholders to submit written comments before the August 27th hearing but did not commit to issuing a revised draft before then. Stakeholders were encouraged to use the current proposed rule text, supplemental document, and the meeting transcript to inform additional comments; the transcript is available upon request by emailing cdle_dowc_communications@state.co.us.