Bulletin 98-05
November 19, 1998


Two DWC Medical Regulations Approved, Three Fee Schedules Delayed

 
 Two sets of revised medical regulations -- treating physician reporting requirements and utilization review standards -- have been approved by the state Office of Administrative Law and will go into effect on Jan. 1, 1999, the Division of Workers' Compensation has announced.

 However, approval of the three DWC medical fee schedules -- the Official Medical Fee Schedule (OMFS), the medical-legal fee schedule, and the inpatient hospital fee schedule -- has been delayed pending receipt by OAL of the Department of Finance's concurrence in the economic impact statement.  It is unclear at this point when these regulations will go into effect.

 Of the two approved sets of rules, utilization review is used by some carriers to manage costs and improve patient care and decision making on a case by case basis.  The revisions clarify what constitutes a  "request for authorization" under these regulations, triggering the utilization review process.

 The revisions to the treating physician reporting requirements establish new optional forms for physicians to use in filing required reports with claims administrators.  The physician may choose not to use the form, but must still provide all of the information requested on it in their written reports.

 All five sets of new and revised rules were originally proposed at public hearings in November 1997 and subsequent changes have gone through several rounds of public comment periods since then.  The California Labor Code requires that the medical fee schedules be updated at regular intervals.  In addition, fees for hospital services provided to admitted patients will, for the first time, be covered by a fee schedule.

When the implementation date of the fee schedules is finally determined, DWC will schedule a series of five free one-day training sessions around the state to help providers, claims administrators and other interested parties.  It is currently anticipated that these sessions will be held in Los Angeles, Santa Ana, San Diego, San Francisco and Sacramento.

Exact dates and locations of the training sessions, as well as ordering information for the new OMFS, will be announced once they are known.   This information will also be posted at the DWC website.  Go the Department of Industrial Relations' home page at http://www.dir.ca.gov ; click on "Workers' Compensation," then on "Division of Workers' Compensation."

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