If enacted, this fee schedule would replace the current usual and customary charges, going into effect October 1, 2025.
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.
The bill would have allowed injured workers to fill prescriptions at any pharmacy of their choice, including outside of network pharmacies.
The Bureau of Workers’ Compensation will take additional time to address stakeholder concerns and make necessary revisions.
Changes will impact DME supplier services, facility outpatient hospital services, and practitioner services.
The CWCI notes that cumulative percent increases to the Official Medical Fee Schedule have been lower than economy-wide inflation.
Healthesystems' Advocacy & Compliance team successfully engaged the DFS to create an exemption for workers' comp PBMs
The physician fee schedule will be reduced by 2.93%, while other changes are in store for primary care, telehealth, and more.
Written comments from stakeholders who use the fee schedule will be accepted until December 15th.
According to the DOJ, Medisca Inc. purchased resveratrol at $0.37 a gram, sold it for under $2.00 a gram, but reported an AWP of $777 per gram.
No deadline for feedback has been given, but the Commission will consider feedback for fee schedule changes for 2025.
Public comments for the proposed changes to the fee schedule will be accepted until October 23rd.
