Newsline No. 53-09 printer image Printer friendly

October 29, 2009

 

Notice of rulemaking and public hearing regarding proposed changes to Workers' Compensation Information System rules
New rules part of Division of Workers' Compensation 12-point plan to control medical costs

The Division of Workers' Compensation (DWC) has proposed an update to regulations for the Workers’ Compensation Information System (WCIS) as part of its 12-point plan to monitor and help control medical costs in California’s workers’ compensation system. The 12-point plan includes regulations recently enacted, regulations underway, and a set of proposals to be implemented in 2010.

“Through implementation of workers’ compensation reforms, employers have seen a dramatic reduction in system costs—over $50 billion in savings—since 2003,” said acting Administrative Director Carrie Nevans. “Medical costs also declined steeply following reforms but have begun to escalate again. Our plan allows us to monitor costs more effectively and take decisive action as needed to control medical costs.”

The proposed regulations will update the two WCIS implementation guides (the California EDI Implementation Guide for First and Subsequent Reports of Injury and the California EDI Implementation Guide for Medical Bill Payment Records), refine claim information that must be electronically reported, and clarify the process for medical lien reporting.

The proposed regulations will increase the time for filing the first report of injury (from five business days to 10) and relax some data edits to allow easier transmission of claim information with fewer submission rejections. The proposal is posted on the DWC Web site at http://www.dir.ca.gov/dwc/DWCPropRegs/WCIS_Regs/WCIS_Regulations.htm and has been forwarded to the Office of Administrative Law for publication in the California Notice Registry. A public hearing on the regulations is scheduled for:

Date: Dec. 15, 2009
Time: 10:00 a.m. to 5:00 p.m. or until conclusion of business
Place: Elihu Harris State Office Building – Auditorium
1515 Clay Street
Oakland, California  94612

Members of the public may comment on the proposed regulations until 5 p.m. on Dec. 15, 2009.

The WCIS collects comprehensive workers’ compensation claims information from claims administrators via electronic data interchange (EDI) using standards set by the International Association of Industrial Accident Boards and Commissions (IAIABC). WCIS’s statistical data is used by DWC and researchers to guide policy determinations, evaluate system costs, and assist in measuring indemnity payments for injured workers and their dependents. California workers’ compensation claims administrators began to transmit basic claim information to WCIS in March 2000. In September 2006, claims administrators began to submit medical bill payment data on each claim. 

The proposed WCIS regulations are authorized by Labor Code section 138.6; the proposed changes are found in the California Code of Regulations, title 8, sections 9701 and 9702.

DWC’s complete 12-point plan includes:

1.  Tightening treatment guidelines:

2. Providing a network option:

3. Simplifying MPN rules:

4. Improving medical cost reporting

5. Implementing electronic billing:

6. Creating pharmacy networks:

7. Streamlining requests for medical authorization

8. Ambulatory surgical center fees:

9. Eliminating spinal hardware pass-through:

10. Streamlining utilization review (UR):

11. Updating coding for doctor payments:

12. Considering creation of a drug formulary:

###