On May 20th, Healthesystems attended the Tennessee Medical Advisory Committee (MAC) meeting to gather updates on fee schedule changes and other matters. The committee chair provided an overview of the proposal filed with Secretary of State, and reminded stakeholders of the June 6, 2025 public hearing.

Key changes to the fee schedule include:

• Increased Medicare reimbursement percentages
• Adding Medicare-negotiated prices to pharmaceutical pricing
• Clarifying that 150% Medicare applies only to ground ambulance services
• Aligning rule updates with April 1 rate tables
• Clarification to the employer-provider dispute resolution process

Healthesystems inquired about the Medicare-negotiated drug prices added to the pharmacy section of the fee schedule. Dr. Robert Snyder, BWC Medical Director, explained it addresses potential drug pricing changes due to recent federal actions. Healthesystems’ representatives committed to providing feedback to ensure clarity on how, and if, Medicare-negotiated drug pricing would apply to workers’ compensation claims. Written comments on the proposed rules will be accepted until June 20, 2025.

The committee also discussed House Bill 996 (SB 911), now a summer study bill, which proposes prescribing authority to certain psychologists. Suggestions to improve access to care in Tennessee were invited.

Additional topics included a review of WCRI reports and the BWC’s 2025 Utilization Review (UR) report. A total of 23 UR companies reported approximately 11,184 determinations – 49% approved, 40% denied, and the remaining cases modified. Of those modified cases, 13% were appealed to the BWC.

Dr. Snyder reminded stakeholders that the May 1, 2025 drug formulary updates are now online. Concerns were raised about ODG spinal therapy and discography criteria recommendations. A motion passed to compare ACOEM and ODG spine guidelines. These, along with issues about the 6th edition AMA guides, will be revisited at the next MAC meeting on September 23, 2025.

Attending these meetings allows Healthesystems to stay informed about critical developments impacting the Tennessee workers’ comp system and remain proactive in addressing regulatory updates so that we can advocate for effective solutions.

Healthesystems will remain engaged in the fee schedule rulemaking process to provide expertise and updates as they arise.