Clifford Napier

The committee held an extensive discussion on fee schedule development, focusing on remote therapeutic monitoring, acoustic medical devices and FDA status, compound medications, and physician dispensing. Additionally, the committee addressed fee schedule versioning with CMS updates, clarified provider definitions, telehealth standards, and interpreter services. The discussion also covered physical therapy multiple procedure payment reductions, facility and DME rules, hearing aid and audiology code changes, NCCI regional comparison data, and administrative burdens on medical providers, including documentation and billing for report/review time.

The meeting focused on discussions regarding the fee schedule development, specifically addressing app-based remote therapeutic monitoring codes, acoustic medical devices, and the distinction between FDA-approved and FDA-cleared devices. The committee also discussed compound medications, physician dispensing, and the potential need for clearer definitions of provider categories. Further topics included fee schedule versioning with CMS updates, telehealth standards, interpreter services, and the application of physical therapy multiple procedure payment reductions. Administrative burdens on medical providers, hearing aid coding updates, and data comparison methods were also reviewed to inform future fee schedule planning and adjustments.

The committee held a discussion on the development of the 2026 Fee Schedule, focusing on wording options for EMEs and SIMEs. Key topics included refining the definition of qualified providers for Home Health services to distinguish between skilled medical services and unskilled custodial care, and addressing inpatient rehabilitation reimbursement by reviewing historical data and national models. The committee also examined issues with ambulance services, specifically the lack of an adopted fee schedule leading to unregulated billing codes, and potential solutions such as adopting a Medicare-based schedule. A public comment period addressed inquiries regarding personal care service rates and concerns over the implementation of a fee schedule for Independent Medical Examinations. Finally, the committee confirmed the integration of recent CMS updates into the draft fee schedule.

The Board meeting included a Director's report detailing Division updates, staffing, budget, and 2026-2027 hearing calendars. Key discussions focused on legislation impacting workers' compensation, regulation proposals, ethics training, and the Medical Services Review Committee's work on the 2027 fee schedule. Additional topics covered included American Medical Association Guides updates, Stay-at-Work program developments, and self-insurance program administrative matters.

The meeting featured a director's report covering board vacancies, legislative updates, and revenue trends, along with presentations on staffing and budget. The public comment period addressed challenges in the workers' compensation system, specifically regarding medical fee schedules and regulatory transparency. Statistical reviews were provided for the annual report, including data on the Benefits Guaranty Fund, the Second Injury Fund, Special Investigations Unit activities, and Reemployment Benefits Program performance. Additionally, the Board discussed and took action on the repeal and readoption of medical treatment and service fee regulations, and reviewed notable legal decisions and orders.