Stakeholder feedback for the audit plan will be accepted until 5:00 PM CST on August 6th.
Stakeholder feedback for the audit plan will be accepted until 5:00 PM CST on August 6th.
The August 20th webinar will discuss the impact of PBM legislation on workers' compensation systems.
Updates to the Practitioner Fee Schedule switch from an AWP-plus reimbursement model to an AWP-discount model.
The Committee is focused on high-cost and high-utilization medications, including GLP-1s, PPIs, anticonvulsants, topical agents, and biologics.
Commenters asked the DWC to clarify the scope of pharmacy and pharmacist definitions and prior authorization requirements.
The hearing will take place on July 15th, allowing interested stakeholders to attend virtually.
Anti-referral provisions do not prohibit physicians from referring injured workers to pharmacies in which they have a financial interest.
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.
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.
