On October 14th, Healthesystems joined a stakeholder listening session hosted by Executive Office of Health and Human Services (EOHHS) and Division of Industrial Accidents (DIA), to gather feedback on the Workers’ Compensation Medical Fee Schedule and its impact on access to care for injured workers.

The first listening session held since 2018, this session focused solely on collecting feedback, with no discussions or rule changes proposed. Stakeholder input is critical to shaping policies that directly impact provider networks and ensure compliant pharmacy pricing in Massachusetts. While past sessions haven’t led to fee schedule changes, staying engaged allows stakeholders to track emerging issues, influence future decisions, and protect access to care for injured workers.

Key concerns raised during the listening session include:

• Fee schedule rates haven’t changed since 2009; stakeholders urged annual reviews and increases
• Low rates discourage provider participation, especially in physical and occupational medicine, delaying care
• The “usual and customary fee” in the pharmacy schedule is complex due to frequent price changes and multi-payer contracts that hinder accuracy
• Stakeholders recommended replacing federal benchmarks like NADAC with state-specific pharmacy reimbursement language
• Negotiated fees between insurers and providers often delay care and lack resolution
• Administrative burdens are costly; standardized practices could improve efficiency
• The February Public Consulting Group report to EOHHS on workers’ compensation fees remains unavailable to stakeholders

EOHHS will review the feedback to determine next steps, though no timeline was provided.