Recent Regulatory Updates

There have been several noteworthy items of note over the past few weeks.??

Tennessee UR Rule Changes

The proposed UR changes from last year are almost in place.? For a reminder, click here.

The effective date is 9/29/22, pending approval by the government operations committee. Stay tuned.

Tennessee Certified Physician Program

The Tennessee Bureau of workers compensation has launched its Certified Physician Program.? The primary goals are:

1. Increase access for injured workers to trained physicians
2. Reduce the number of days that injured workers are out of work.

The Bureau has been worried about providers not having the adequate training to understand the workers compensation system. Additionally, some providers have elected to discontinue treating WC patients as the administrative nuance isn't worth it for them.

The biggest takeaway incentive for providers…

Enhanced fees for completing forms and reports

While enhanced fees is likely the largest draw for providers, they’ll certainly understand more details of the WC system, including:

• The importance of the UR process;
• It’s role in patient recovery, and;?
• Evidence based guidelines that UR physicians use when making decisions

California

IMR cases continued to decline in the first half of 2022 according to CWCI.??

The drop is still largely attributed to the prescription drug formulary implemented in 2018. Since those changes, disputes over prescription drug requests dropped from 47.3% of all IMRs in 2017 to 33.9% of the IMR disputes in the first half of 2022.

Physical therapy requests are up, prescription drug requests are down.