The Division of Industrial Relations (DIR) held an important training this week (11/13/19) to discuss the implementation of new workers’ compensation provider lists after the passing of SB 381. The DIR is part of the State of Nevada Department of Business and Industry. They are the regulatory agency that more or less oversees workers’ compensation insurance companies and doctors in Nevada. The provider lists that are being updated as a result of SB 381 are the lists of treating doctors who can see injured workers’. Insurance companies use doctors from the DIR’s list and compile a list of their own who injured workers’ can see. Each insurance company has their own list.
Issues with the DIR and provider lists prior to SB 381.
It was determined and mentioned at the training that the DIR’s current list of treating physicians contains over 4,000 doctors! The problem is that the majority of doctors on this list do not treat injured workers (either the doctors have died, stopped practicing, no longer want to see injured workers, or have lost their licenses). The DIR started their list of treating physicians back in 1973 and has not done any follow-up to see if their list is accurate…they simply just continue to add doctors. This has led to years of inaccurate provider lists maintained by the state.
Issues with insurance companies and provider lists prior to SB 381.
Besides workers’ compensation insurance companies basing their own providers lists on an inaccurate and outdated list from the DIR, workers’ compensation insurance companies have never had their lists monitored by the DIR. This allowed the insurance companies to have underrepresented provider lists and the ability for the insurance company to change their lists overnight.
Changes post SB 381.
Senate Bill 381 creates some much-needed change and adds regulation in how the DIR complies their treating provider list, as well as how the workers’ compensation insurance company compiles theirs. The DIR is requiring all doctors to complete a new application in order to be put on their new list, which they must complete by July 1, 2020. Workers’ compensation insurance companies will then have until October 1, 2020, to pick and choose doctors from this list to create their provider lists. The insurance companies will then have to submit their specific lists to the DIR, who will publish the lists for each and every company on their website.
Further, SB 381 requires that insurance companies have at least 12 providers/doctors per specialty. The Specialties include: Orthopedic surgery (which has 9 subcategories all which must have 12 providers/doctors), neurosurgery, neurology, cardiology, pulmonology, psychiatry, pain management, occupational medicine, general practice, and chiropractic. All other specialties/disciplines must contain at least 8 providers/doctors unless the DIR’s list contains less than 8.
Lastly, insurance companies will no longer be able to remove doctors without a reason. Doctors/providers can only be removed from the provider list for the following reasons: 1) deceased or disabled, 2) license suspended or revoked, 3) convicted of a felony, 4) convicted of a crime per NRS 616D, 5) removed by DIR for failure to comply with standards of treatment, or 6) if the doctor voluntarily removes themselves.