The proposed rules would align with the February 2026 ruling on physician dispensing in Publix Super Markets, Inc. v. Department of Financial Services.
The proposed rules would align with the February 2026 ruling on physician dispensing in Publix Super Markets, Inc. v. Department of Financial Services.
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.
While injured workers have an absolute choice over their pharmacist, physicians are not considered pharmacists and therefore not entitled to reimbursement.
The state’s definition of “compounded prescription drug” would be updated to fall in line with federal standards.
Additionally, the bill would update the fee schedule and impact billing and utilization requirements.
The updated fee schedule will go into effect April 1st, while a new IME subcommittee will evaluate cost and practice concerns.
