IWCC Posts Updated Repricing Instructions

On January 24, the Illinois Workers' Compensation Commission posted its Instructions and Guidelines for Treatment On or After 9/1/11 to its website.  These instructions include all of the changes implemented in HB 1698/PA 97-18 and the subsequent rulemakings approved through the JCAR process.  

Previously, the Rules section on the IWCC website was updated with many of the updates and changes, but the Instructions and Guidelines section was pending.

The IWCC maintains all of these documents under the Medical Fee Schedule/FAQs section of its website.

IWCC 2013 Regulatory Agenda

In this morning's Illinois Register, the IWCC filed a regulatory agenda update for the Illinois
Insurance Regulations (50 Ill. Adm. Code 7100).

On Page 630 (PDF page 156) of the Illinois Register, the IWCC gives a general overview of its intentions to update both Sections 7100.100 and 7100.70 of the Insurance Regulations.  The IWCC notification lists the anticipated JCAR First Notice submission date as "undetermined."

Description: The Commission anticipates changes to two Sections of Part 7100 of its rules. Section 7100.100 sets forth the procedure for the enforcement of the insurance compliance provisions of Section 4 of the Workers' Compensation Act. This rule has not been updated since 1990 and there have been several significant amendments to Section 4 since that time, including the ability of the Commission to issue a work-stop order for an employer who has knowingly failed to provide workers' compensation insurance. In addition, Section 7100.100 does not include the minimum $10,000 fine for the knowing and willful failure or refusal to obtain workers' compensation insurance set forth in Section 4(d) of the Workers' Compensation Act and the applicability of such fine to corporate officers and directors, which is also set forth in Section 4(d) of the Act. Section 7100.70 sets forth the qualifications required to be approved as a self-insurer in Illinois, as well as the procedural aspects of the application process. This rule has not been updated since 1996. The rule will be updated in order ensure the integrity of the self-insurance program.

 

WC PPP Rulemaking Update

The General Assembly's Joint Committee on Administrative Rules met on January 8, 2012, and the Illinois Department of Insurance's WC PPP rulemaking was on the agenda.  JCAR voted to extend the review process by 45 days, and the updates to the Illinois Insurance Code will now appear on the JCAR's February meeting agenda.

JCAR will meet at 9:00am on February 5 at the Stratton Office Building in Springfield, IL to discuss the proposed rulemakings.

JCAR's Dept of Insurance 2013 Update

The General Assembly's Joint Committee on Administrative Rules' (JCAR) January meeting is currently scheduled for Tuesday, January 8, 2013.  The Committee's meeting will take place at 9:00am in Room D-1 of the Stratton Office Building in Springfield, Illinois.

Pending Department of Insurance Rulemakings

The current meeting agenda includes the IDOI's workers' compensation preferred provider program (WC PPP) administrative code updates.  Our previous update included details surrounding the established JCAR approval process.

• Preferred Provider Programs (PDF Page 286)
• 50 Ill. Adm. Code 2051
• Proposed 4/27/2012
• Pending: on JCAR January meeting agenda 

 

Approved Department of Insurance Rulemakings

In addition to this proposed-rulemaking, the December 28 Illinois Register contains four approved IDOI updates to the Illinois Administrative Code.  All four of the rulemakings are effective December 17, 2012. 

• Accident and Health Expense Reporting (PDF Page 676)
• 50 Ill Adm Code 2043
• Proposed 8/3/12
• Effective 12/17/2012
• Insurance Data Reporting Requirements (PDF Page 686)
• 50 Ill Adm Code 4203
• Proposed 2/3/2012
• Effective 12/17/2012
• Internal Security Standard and Fidelity Bonds (PDF Page 612)
• 50 Ill Adm Code 904
• Proposed 6/22/12
• Effective 12/17/2012 
• Medical Professional Liability Database (PDF Page 619)
• 50 Ill. Adm. Code 928
• Proposed 7/6/12
• Effective 12/17/2012

New IWCC Arbitration and Commission Review Board Rules

The December 21 edition of the Illinois Register includes two adopted amendment rulemakings from the Illinois Workers' Compensation Commission.  Both rulemakings, effective December 4, deal with complaints and review procedures of IWCC Arbitrators and Commissioners.
 
The IWCC put out an announcement regarding these two updated rules, and included in that announcement was a new form to submit complaints to the Commission Review Board:  IWCC Commission Review Board Complaint Form

New/Update Rules Overview

Arbitration (PDF document page 285)

• 50 Ill Adm Code 7030
• Proposed 8/17/2012
• Effective 12/4/2012 

Differences between Proposal and Final Version: In subsections (f)(1)(B) and (f)(2)(B),  the Final Version specifies that the assignment of a petition to disqualify either an  Arbitrator or Commissioner shall be made randomly by the Commission. The Final Version adds a new subsection (f)(3), which specifies that a petition for substitution may be made to the Commission if reasonable notice of the application has been given to the adverse party or his or her attorney.

Summary and Purpose of Rulemaking: The amendment addresses an audit finding set forth by Auditor General William Holland in the audit directed pursuant to House Resolution 131 of the 97th General Assembly. Specifically, the audit found that the current version of Section 7030.30 conflicts with the changes of Public Act 97-18. Public Act 97-18 provided that the Canons of Judicial Conduct as adopted by the Illinois Supreme Court apply to the hearing and non-hearing conduct of the Arbitrators and Commissioner. Thus, these changes to Section 7030.30 align the bases for disqualification and also the remittal of a disqualification by and Arbitrator or Commissioner with the provisions of Canon 3 of the Canons of Judicial Conduct.  

In addition, the amendment creates a formalized process for the filing of a Petition for Substitution of an Arbitrator or Commissioner. There is one published Appellate Court opinion that calls on the Commission to promulgate such a rule, Preston v. Industrial Comm'n, 332 Ill. App. 3d 708 (3rd Dist. 2002). In that case, a Commissioner who was subject to a petition to disqualify sat on the panel that ruled on the petition. While the majority found no error in the hearing process, the Court recommended that the Commission promulgate a rule to address the procedural handling of petitions to disqualify Commissioners.

WC PPP: Dept of Insurance Rulemaking Update

The Illinois Department of Insurance's proposed updates to the Insurance Code, including the workers' compensation preferred provider programs (WC PPPs), are now on JCAR's January meeting agenda.

The General Assembly's Joint Committee on Administrative Rules' (JCAR) meeting is currently scheduled for Tuesday, January 8, 2013.  While most JCAR meetings take place in Chicago, the January meeting will take place at 9:00am in Room D-1 of the Stratton Office Building in Springfield, Illinois.

• Preferred Provider Programs (50 Ill. Adm. Code 2051) proposed 4/27/2012 (PDF Page 286)

The Illinois rulemaking process is detailed on the JCAR website:

JCAR December Meeting Reminder

As a reminder, the General Assembly's Joint Committee on Administrative Rules (JCAR) meets on Tuesday, 12/11/2012 at 11:00am.  The meeting is in Room 600C of the Michael A Bilandic Building, 160 N LaSalle St, Chicago, IL.

As of this morning, the December JCAR agenda includes a Department of Insurance-proposed rulemaking concerning a Medical Malpractice Data Base.

• Medical Malpractice Data Base (50 Ill. Adm. Code 928) proposed 7/6/12 (PDF Page 205)

There are no IL Workers' Compensation Commission-proposed rulemakings on the December agenda, and, as of this post, the Department of Insurance WC PPP rulemaking is on neither the December nor the January JCAR meeting agendas. 

Final Physician-Dispensed Pharmacy Rule Published

The IWCC's final repackaged drug repricing methodology was published in the December 7 edition of the Illinois Register.

 

As we covered in our 11/20/2012 post, the effective date of the change is November 20, 2012.  The Medical Fee Advisory Board did clarify at its December meeting that the pricing methodology is for dates of service of 11/20/2012 and later.  The final adopted amendment did not contain changes to the language from the previously published proposed rulemaking.
 
The implemented rules begin on page 17108 (PDF page 315) of Volume 36, Issue 39 of the Illinois Register.
 

From the IL Workers' Compensation Commission's Notice of Adopted Amendment:

Summary and Purpose of Rulemaking: The amendment implements Section 8.2(a-3) of the Workers' Compensation Act by specifying that when a prescription dispensed outside of a licensed pharmacy is repackaged, the Average Wholesale Price used to determine the maximum reimbursement shall be the Average Wholesale Price for the underlying drug product, as identified by its National Drug Code (NDC) from the original labeler.

Pursuant Section 8.2(a-3) of the Act, only prescriptions dispensed outside of a licensed pharmacy are subject to a fee schedule. The fee schedule sets the maximum reimbursement levels for these prescriptions. For prescriptions dispensed outside of a licensed pharmacy, Section 8.2(a-3) provides that the fee schedule shall not exceed the Average Wholesale Price, plus a dispensing fee of $4.18. Average Wholesale Price is determined by the NDC set forth in Medispan.   

The amendment addresses a practice known as "repackaging" which means that the prescription will be purchased and then repackaged in different quantities. It is then given a new NDC number with a higher Average Wholesale Price. Thus, the "repackaging" avoids the NDC for the drug from the original labeler. "Repackaged" drugs are typically dispensed by physicians in their offices.

IWCC & JCAR December Meeting Schedule

With just over a month remaining in 2012, here are the remaining scheduled IWCC and JCAR meetings for December.

Illinois Workers' Compensation Commission

December 5, 2012 

Self-Insurers Advisory Board

• Thompson Center, 100 W Randolph Street, Chicago
• 10:30am in the 8th Floor Chairman's Conference Room
• Self-Insurers Advisory Board meeting agenda

Workers' Compensation Medical Fee Advisory Board

• Thompson Center, 100 W Randolph Street, Chicago
• 1:00pm in Room 9-039 (9th Floor)
• The agenda for the Advisory Board's December meeting contains several updates including
• a report from Glen Boyle
• a discussion on compounded drugs
• updates on the Rules and Commission
• WC Medical Fee Advisory Board meeting agenda

Joint Committee on Administrative Rules

December 11, 2012

• Michael A Bilandic Building, 160 N LaSalle St, Chicago
• 11:00am in Room 600C
• As of this morning, the December JCAR agenda includes
• One (1) Department of Insurance-proposed rulemaking concerning a Medical Malpractice Data Base
• Medical Malpractice Data Base (50 Ill. Adm. Code 928) proposed 7/6/12 (PDF Page 205)
• No IWCC-proposed rulemakings
• JCAR December meeting agenda

 

WC PPP: Pending Second Notice

As part of the JCAR's First Notice process for the new WC PPP rules, all interested parties were permitted to submit public comments about the proposed regulatory changes to the IDOI up until the June 11, 2012 deadline.

At this point, JCAR has not addressed the modifications to 50 Ill. Adm. Code 2051 with the IDOI at its monthly meetings, and, as of this post, the WC PPP rules are not scheduled on the agenda for the December JCAR meeting.

• Preferred Provider Programs (50 Ill. Adm. Code 2051) proposed 4/27/2012 (PDF Page 286)

IWCC Announces Physician-Dispensed Pharmacy Changes Effective Today

In addition to its updated file viewing process, the Illinois Workers' Compensation Commission also announced that the modification to the physician-dispensed pharmacy reimbursement methodology is effective today, November 20, 2012. 

This change was recently discussed at the General Assembly's Joint Committee on Administrative Rules' November meeting.

The final rule will appear in the December 7, 2012 edition of the Illinois Register.

Issue 33 of JCAR's Illinois Register (PDF page 94) contained the actual updated language that states reimbursement for physician-dispensed prescriptions is based on the original manufacturer's NDC code, not the repackaged NDC code:

10) Prescriptions

A) This schedule applies to prescriptions filled and dispensed outside of a licensed pharmacy.

B) Prescriptions shall be billed at the Average Wholesale Price, plus a dispensing fee of $4.18. [820 ILCS 305/8.2(a-3)]

C) Average Wholesale Price or its equivalent as registered by the National Drug Code shall be set forth for that drug on that date as published in Medispan. [820 ILCS 305/8.2(a-3)]

D) If a prescription has been repackaged, the Average Wholesale Price used to determine the maximum reimbursement shall be the Average Wholesale Price for the underlying drug product, as identified by its National Drug Code from the original labeler.

Approved IWCC Rules Published in the Illinois Register (Updated)

In addition to the new Department of Insurance WC EDI proposed rules published in the Illinois Register today, two final IWCC rules appeared as well. 

As we covered in several previous updates, JCAR issued "Certificates of No Objection" at its September 11, 2012 meeting for two separate Illinois Workers' Compensation Commission administrative code modifications. The IWCC filed them with the Secretary of State, and they appeared in today's (11/16/2012) Illinois Register.  

• Miscellaneous (50 Ill Adm Code 7110) proposed 3/2/12, effective date of rulemaking 11/5/2012 (PDF document pages 217-239)
  • Incorporates all of HB 1698/Public Act 97-18’s modifications and updates to the medical fee schedule reimbursement and methodology rules. (See our previous post with an outline of the major updates)
• Alcohol and Drug Sample Collection and Testing (50 Ill Adm Code 9140) proposed 6/15/12, effective date of rulemaking 11/5/2012 (PDF document pages 240-273)

These rules do not include the physician-dispensed pharmacy modifications, discussed in our previous posts. While that rulemaking is continuing through the process after the November JCAR meeting, that is a separate rulemaking that will be filed and published at a later date.  **Updated 11/20/2012:  the physician-dispensed pharmacy changes are effective 11/20/2012.  Please see this new post regarding these rules.

The IWCC has an update on its website regarding the publication of these rulemakings in the Illinois Register.

DOI Proposed WC EDI Standards

The Illinois Department of Insurance's proposed-rules for workers' compensation electronic claims submission and payment standards appeared in the Illinois Register this morning. 
 
The publication of these proposed rules means that they are now in the Illinois General Assembly's Joint Committee on Administrative Rules' First Notice phase.  Any interested party or member of the public has 45 days from this publication date to submit any questions, issues, or concerns to the Illinois Department of Insurance regarding this rulemaking.
 
From the published proposed rulemaking (PDF pages 5-23):

A Complete Description of the Subjects and Issues Involved: This rule is required to implement the electronic claims provisions contained in Section 8.2a of the Illinois Workers' Compensation Act [820 ILCS 305/8.2a]. The focus of this proposed rule is to provide a legal framework for electronic billing, processing and payment of medical services and products provided to an injured employee and data reporting subject to Section 8.2a.
 

The EDI standards included in the rulemaking cover various types of provider bills, specifically

• Professional billing
• Institutional/Hospital billing
• Dental billing
• Retail Pharmacy billing

The listed IDOI contacts for public comment submission are:

Time, Place, and Manner in which interested persons may comment on this proposed rulemaking: Persons who wish to comment on this proposed rulemaking may submit written comments no later than 45 days after the publication of this Notice to: 

         

          Joe Clennon, Staff Attorney
          Illinois Department of Insurance
          320 West Washington St.
          Springfield, IL 62767-0001
          217/557-1396
          217/524-9033 (facsimile)

 

          Susan Anders, Rules Coordinator
          Illinois Department of Insurance
          320 West Washington St.
          Springfield, IL 62767-0001
          217/785-8220



 

JCAR November Update

The Joint Committee on Administrative Rules (JCAR) held its November meeting yesterday. 

Our previous JCAR Administrative Rules update details the IL Workers' Compensation Commission and Department of Insurance pending rulemakings on that agenda. 

While there was discussion regarding the internal process utilized by the IWCC with its physician-dispensed pharmacy reimbursement modification, the IWCC and IDOI rulemakings included on the agenda will continue through the process.  The IWCC and IDOI can  adopt the rules by filing them with the Secretary of State, and the effective dates will appear when published in a future Illinois Register.
 
JCAR's next meeting is currently scheduled for December 11, 2012.  As of this post, the IDOI updates to the insurance code, specifically the WC PPP rules, are not on the December agenda.

 

JCAR November/December Meetings & Pending Updates

The next meeting for the General Assembly's Joint Committee on Administrative Rules (JCAR) is scheduled for Tuesday, November 13, 2012.  The committee meeting begins at 11:00am in Room 600C of the Michael A. Bilandic building in Chicago. 

Both the Illinois Workers' Compensation Commission (IWCC) and Illinois Department of Insurance (IDOI) have several proposed changes and updates to the Administrative Code pending with JCAR.

Since our previous pending-Administrative Code post, the Department of Insurance moved another rulemaking to JCAR's Second Notice; however, the Medical Malpractice Data Base update appears on the agenda for JCAR's December meeting on 12/11/2012.

 

Illinois Workers' Compensation Commission

There are no additional updates since our previous posts. (Click here for the post covering both the JCAR process and the IWCC "Certificate of No Objection" Administrative Code updates pending publication in the Illinois Register)

JCAR Second Notice: November 13 meeting

• Arbitration (50 Ill Adm Code 7030) proposed 8/17/12 (PDF document page 72)
• Miscellaneous (50 Ill Adm Code 7110) proposed 8/17/12 (PDF document page 79)
• Incorporates the updates to the physician-dispensed pharmacy reimbursement methodology (see our previous update for more information)
• Commission Review Board Procedures (50 Ill Adm Code 7500) proposed 8/17/12 (PDF document page 96)
  
  

Illinois Department of Insurance (updated 11/9/12)

JCAR Second Notice: November 13 meeting

State of Illinois & Employee Misclassification

Several State of Illinois departments, including the Illinois Department of Labor, Illinois Department of Employment Security, Illinois Department of Revenue and Illinois Workers’ Compensation Commission, released a press release regarding a renewed education and enforcement initiative concerning independent contractors and employee misclassification.

As part of the initiative, the Illinois Department of Employment Security is providing a reference website regarding these issues.

 

Illinois Legislative and Administrative Code References

• Public Act 95-26:  820 ILCS 185 (Employee Classification Act)
• Illinois Administrative Code: 56 Ill Adm Code 240
• Illinois Workers' Compensation Act: 820 ILCS 305

820 ILCS 305/26.1

Sec. 26.1. Misclassification of employees as independent contractors. The Department of Labor, the Department of Employment Security, the Department of Revenue, the Office of the State Comptroller, and the Illinois Workers' Compensation Commission shall cooperate under the Employee Classification Act by sharing information concerning any suspected misclassification by an employer or entity, as defined in the Employee Classification Act, of one or more employees as independent contractors.
 

(Source: P.A. 95-26, eff. 1-1-08.)

 

Updated IDOI Administrative Code Changes

The next meeting of the General Assembly's Joint Committee on Administrative Rules (JCAR) is currently scheduled for November 13, 2012. Both the Illinois Workers' Compensation Commission (IWCC) and Illinois Department of Insurance (IDOI) have several proposed changes and updates to the Administrative Code pending with JCAR.

Since our previous pending-Administrative Code post, the Department of Insurance moved several additional rulemakings to JCAR's Second Notice.

 

Illinois Workers' Compensation Commission

No additional updates since our previous post. (Click here for our previous post covering both the JCAR process and the IWCC proposed rules status updates.)

 

Illinois Department of Insurance (updated)

JCAR Second Notice

The following proposed updates moved to JCAR's Second Notice review period. JCAR will consider these rules at its November meeting.

• Insurance Data Reporting Requirements (50 Ill Adm Code 4203) proposed 2/3/12 (PDF Page 9)
• Internal Security Standard and Fidelity Bonds (50 Ill Adm Code 904) proposed 6/22/12 (PDF Page 56)
• Accident and Health Expense Reporting (50 Ill Adm Code 2043) proposed 8/3/12 (PDF Page 24)

Pending Second Notice

As part of the JCAR's First Notice process for the new WC PPP rules, all interested parties were permitted to submit public comments about the proposed regulatory changes to the IDOI up until the June 11, 2012 deadline.

 

At this point, JCAR has not addressed the modifications to the existing rules

(50 Ill. Adm. Code 2051) with the IDOI at its monthly meetings, and, as of this post, the IDOI is not scheduled on the agenda for JCAR’s next meeting on November 13, 2012.

 

• Preferred Provider Programs (50 Ill. Adm. Code 2051) proposed 4/27/2012 (PDF Page 286)

 

JCAR October Meeting Reminder

The Illinois General Assembly's Joint Committee on Administrative Rules' (JCAR) monthly meeting is scheduled for Tuesday, October 16, 2012.  The meeting is scheduled for 11:00am in Room 600C at the Michael A Bilandic Building (160 North LaSalle Street, Chicago).
 
The October agenda does not currently include updates from either the Illinois Workers' Compensation Commission or Department of Insurance.

We will provide a status update on the proposed IWCC and IDOI Administrative Code updates early next week.