The proposed changes would impact reimbursement rates, telehealth services, and much more.
The proposed changes would impact reimbursement rates, telehealth services, and much more.
The meeting covered fee schedule policies impacting physician-dispensed medication, electronic delivery for EOBs, and more.
The next meeting in October will deliver an expanded formulary list, with a review of the top five to ten exempt drugs based on utilization.
Among other updates, Wisconsin will implement a hospital fee schedule by July 1, 2027.
The proposed changes will be discussed further in the next meeting on July 18th.
Effective July 1st, fee schedule adjustments can be made by the Workers’ Compensation Commission without revenue neutrality.
The study compares workers’ comp fee schedules for professional services to Medicare rates within 44 states, accounting for 41% of medical costs.
Fee schedule clarity and defined reimbursement caps were discussed as ways to reduce ambiguity and prevent payment disputes.
The DIR must adopt the ODG formulary by July 1, 2027.
The meeting will take place on June 12th, aiming to explore current trends, challenges, and proposed solutions related to these drugs.
Medically unlikely edits were updated across DME, outpatient hospital services, and more.
Topics addressed included changes to the fee schedule, utilization review, spinal therapy guidelines, and more.
The exemption reduces unnecessary burden and grows recognition that workers’ comp PBMs operate differently from traditional PBMs.
If enacted, House Bill 117 would trigger the first update to the Louisiana workers’ comp fee schedule in 30 years.
Topics discussed include proposals for a fee schedule by 2027, employer direction of care, and allowing more providers to provide disability opinions.
