Anti-referral provisions do not prohibit physicians from referring injured workers to pharmacies in which they have a financial interest.
Anti-referral provisions do not prohibit physicians from referring injured workers to pharmacies in which they have a financial interest.
The proposed rules would align with the February 2026 ruling on physician dispensing in Publix Super Markets, Inc. v. Department of Financial Services.
The hearing will take place on July 15th, allowing interested stakeholders to attend virtually.
As part of proposed updates to the Healthcare Service rules and the state fee schedule, additional changes are up for debate.
Payments for unlisted professional service more than doubled from 2017-2024.
If enacted, payers must identify a contact person for whom providers could reach for contract-based medical bill information.
The Office of Workers’ Compensation Administration (OWCA) must evaluate and update reimbursement rates by July 1, 2029.
Targets for consideration include pharmacy rules, physical therapy, DME, and ancillary services.
While progress continues, the guideline updates are delayed due to quorum issues, and the hospital fee schedule is still in early planning stages.
The DWC will work with system participants to develop the audit plan, including timeframe, size, and case selection.
Three in-progress bills impact medical reimbursement and fee schedules, prescription drug authorizations, and medical necessity evaluations.
Senate Bill 1215 was discussed, and it appears unlikely the proposed reimbursement caps will be passed.
The Colorado Division of Workers’ Compensation (DOWC) will host a listening session on April 9, 2026 at 4:00 p.m. MT to gather feedback from employers, insurers, providers, and other workers’ compensation stakeholders on Rule 18 (Medical Fee Schedule).
The updated schedule increases the maximum reimbursement for topical compounds and urges pharmacies to select the lowest-AWP medication when available, among other changes.
Senate Bill 1215 proposes a $400, 30-day supply cap for compound drugs and a $240, 30-day supply cap for non-compound topicals.
