A hearing from the Committee on Economic Matters saw back and forth discussion but yielded no progress.
A hearing from the Committee on Economic Matters saw back and forth discussion but yielded no progress.
The medical fee schedule would align reimbursement rates with those of similar neighboring states.
The virtual meeting will take place April 1, 2025 at 10:00 AM to discuss outstanding issues related to the Health Care Provider Manual.
The fee schedule would apply to medical care, dental care, and supplies received by injured employees.
Among other changes, the bill would ban effective rate contracts, making it difficult to forecast drug costs.
Introduced in January, the bill was discussed in a February 25th hearing, with supporters and opponents voicing concerns.
The bill would cap nonprescription, over the counter, and non-legend drug reimbursements at the drug’s cost plus 40%.
If passed, employees would be required to use network pharmacies effective December 31, 2025.
If passed, the bill would limit reimbursements to a one-time, seven-day supply if no commercial equivalent exists.
According to claim data from the CWCI, in 2024 dermatological agents made up 12.6% of prescriptions and 18.9% of drug spend.
If enacted, this fee schedule would replace the current usual and customary charges, going into effect October 1, 2025.
The three-member panel will recommend to legislators that the DWC be allowed to update fee schedules without legislative approval.
Effective January 1, 2025, these rules are part of the DWC’s adoption of the 2024 Health Care Provider Reimbursement Manual.
These regulations were proposed shortly after Governor Hochul vetoed a bill with similar intent.
Among other key updates, AWP will be replaced by a new pricing benchmark.
