Here is a summary of legislative and regulatory developments and challenges for the first quarter of 2020 and their practical implications:
COVID-19 Pandemic
The global coronavirus emergency has spurred a number of changes to the WC managed care regulatory environment:
Broadening of telehealth authorization: Health regulators have issued orders encouraging the use of telemedicine and telehealth services to maintain health care access while protecting both patients and health care providers from exposure to COVID-19. The Centers for Medicare and Medicaid Services (CMS), in a recently published directive to physicians and other clinicians entitled “CMS Flexibilities to Fight COVID-19,” has announced that Medicare will pay for telehealth physical therapy codes that were previously restricted. Many state workers’ compensation agencies that follow CMS payment rules may follow suit.
Suspension of regulatory activity: Most state WC regulatory agencies have limited their operations to active dispute resolution matters only, and many of these have moved to telephonic rather than in-person hearings. Rulemaking activities generally have paused across the country, and legislative sessions have adjourned. Temporarily, this trend is likely to grow if, as is likely, confirmed cases of COVID-19 increase when testing becomes more available and governors respond with broadly applicable lock-down and stay-at-home executive orders.
Relaxation of deadlines: In recognition of the difficulties that patients, providers and payers are experiencing during the coronavirus lockdown, insurance and WC regulators have suspended filing, bill submission and, in some cases, payment deadlines.
- Implications
WC payers currently have pressing challenges adapting to the rapidly changing regulatory climate. Once the crisis subsides, workers’ compensation regulation may return to pre-coronavirus policies and rules or shift to a “new normal” that welcomes, for example, virtual rather than in-person hearings and greater use telemedicine and telehealth for the convenience as well the safety of patients.
