State Legislation

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Illinois Regulatory Updates 06/07/2023

HB 4079 – Workers Comp-Various

Issues: Workers’ Compensation, Workers’ Compensation (General)

Summary:

This measure establishes geographic regions for workers’ compensation fee schedules. It establishes 4 regions for non-hospital fees and 14 regions for hospital fees. It sets the fees according to CPT and DRG code relative to percentages of the Medicare fee schedule, though allows for petitioning by providers if the fee is insufficient. Fees are to be set administratively within bands relative to the Medicare rate. This takes effect September 1, 2024.
It also requires development of an evidence-based workers’ compensation formulary. It allows custom compound medications for no more than 7 days unless the compound meets certain qualifications, including no commercial equivalent and a demonstration of clinical appropriateness. It bases reimbursement for these compounds on national average wholesale price, according to proportion of the component within the compound. This section takes effect September 1, 2023.

Most Recent Update:

05/10/2023 – Introduced

HB 4087 – Workers Comp-Compound Drugs Amends the Workers’ Compensation Act. Provides That the Illinois Workers’ Compensation Commission, Upon Consultation With the Workers’ Compensation Medical Fee Advisory Board, Shall Adopt an Evidence-Based Drug Formulary. Requires Prescriptions In Workers’ Compensation Cases to Be Limited to the Drugs on the Formulary. Provides That By September 1, 2023, the Commission, In Consultation With the Workers’ Compensation Medical Fee Advisory Board, Shall Adopt By Rule an Evidence-Based Drug Formulary and any Rules Necessary For Its Administration. Provides That Prescriptions Prescribed For Workers’ Compensation Cases Shall Be Limited to the Prescription Drugs and Doses on the Closed Formulary. Provides That a Custom Compound Medication For Longer Than the One Time 7-Day Supply Shall Be Approved For Payment Only If the Compound Meets Specified Standards. Provides For Charges For Custom Compound Medications. Effective Immediately. 

Issues: Workers’ Compensation (Medical Coverage and Reimbursement), Workers’ Compensation (General)

Summary:

This measure requires administrative development of an evidence-based drug formulary under the workers’ compensation system. It also sets limits on compounded drugs. It allows custom compounds in excess of 7-day amounts only if there is no readily available commercial equivalent and the components are all approved for use and have a National Drug Code number. It also outlines allowable cost, according to proportion of components within the compound. Finally, it allows dispensing fees based on actual cost. It takes effect upon enactment.

Most Recent Update:

05/11/2023 – Introduced

Illinois Services

• Claims Management
• Provider Networks
• Bill Review
• Case Management
• Utilization Review

Illinois Resources

Illinois Compensation Website

Illinois Government Website