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 Arbitrator Coverage Update

In 2013, there will be two IWCC "TBA Call" Zones (Chicago & Chicago/Wheaton) without permanently assigned arbitrators for the call (see our recent post regarding Arbitrator Zanotti).

The IWCC recently announced the January-March 2013 arbitrator coverage lists for both "TBA Calls" on its website.

Chicago TBA Call Coverage (previously Arbitrator Zanotti)

Chicago/Wheaton TBA Call Coverage (previously former Arbitrator Kinnaman)

IWCC Fee Schedule Updates

The Illinois Workers' Compensation Commission's Medical Fee Advisory Board met on Wednesday for its December meeting.
 
The agenda covered a range of topics, and this first post will cover a couple of those issues.
 

Physician-Dispensed Repackaged Pharmacy

Our previous update covered the changes to the reimbursement for physician-dispensed pharmacy in Illinois.  The final rule should appear in the Illinois Register tomorrow (12/7/12), and the effective date of the reimbursement modification is November 20, 2012. 
 
The Board did clarify that the modification only applies to bills with dates of service/fills on 11/20/12 and later.
 

2013 State Fee Schedule Updates

Glen Boyle, from Health Systems International, LLC, provided a written update regarding both finalized and potential updates to the Illinois state workers' compensation fee schedule.
 
The 2013 annual fee schedule updates and rates are currently scheduled to complete internal review and quality check by December 21, and the new 2013 rates have an anticipated posting date of December 28, 2012.  The annual fee schedule updates are effective on January 1 of each year.
 
In addition to the annual updates, Glen Boyle also reported out on potential methodology changes to update the POCs. 

(The IWCC defines POCs as "when the Commission is unable to calculate a fee for a procedure, there is a default payment provision. From 2/1/06 - 8/31/11, the default is POC76, meaning payment shall be 76% of the charged amount. Effective 9/1/11, all default payments are 53.2% of the charged amount (POC53.2).")
 
From his written report:

2013 IWCC Calendar & Arbitrator Changes

The Illinois Workers' Compensation Commission announced several changes to its 2013 Downstate Arbitration Calendar. 

Arbitrator McCarthy will cover Zone 2 (Urbana, Springfield, Quincy) while Arbitrator Neal is on leave.

Also in Zone 2, Arbitrator Zanotti will replace former Arbitrator Akemann effective 1/1/2013.  Arbitrator Zanotti's Chicago call will become a "TBA" call with various arbitrators covering the hearing dates.

Per the IWCC update:

Please direct Arb. Zanotti's Zone 2 mail to
P.O. Box 2647
Carbondale, IL 62902-2647
brandon.zanotti@illinois.gov

Please send Arb. McCarthy's Zone 2 mail to
P.O. Box 3130
Decatur, IL 62524-3130
douglas.mccarthy@illinois.gov

Follow this link for the full IWCC announcements.



 

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.