Recent legislative and regulatory activities impacting workers' compensation pharmacy in CA, CO, DE, and KY
MyMatrixx by Evernorth Regulatory Affairs team tracks and monitors legislation and regulations impacting workers’ compensation pharmacy nationwide. You can follow what's happening state-by-state with our online tracker.
California treatment guidelines update proposed
The California Division of Workers’ Compensation proposed updates to its Medical Treatment Utilization Schedule (MTUS) guidelines to incorporate the Knee Disorders Guideline from the American College of Occupational and Environmental Medicine (ACOEM) dated July 8, 2026. A virtual public hearing is scheduled for October 16, with written comments also due that day. Adopted MTUS guidelines are presumed correct on the issue of extent and scope of medical treatment in the state’s workers’ compensation system and are intended to guide treatment decisions in most cases.
Colorado adopts updated fee schedule and utilization standards rules
The Colorado Division of Workers’ Compensation (DoWC) adopted updates to Rule 18 (Medical Fee Schedules) and Rule 16 (Utilization Standards) and submitted them for review by the Attorney General earlier this month as part of the normal rulemaking process. The adopted rules have an effective date of January 1, 2027.
Rule 18 was revised to meet accessibility standards but also includes the following notable pharmaceutical-related updates:
- Added prior authorization and lowest-cost equivalent/alternative reimbursement limitations for certain combination topical products
- Refined existing prior authorization language for NSAIDs, muscle relaxants, or topical agents with significantly lower-cost therapeutically equivalents/alternatives
- Revised standards for non-sterile compounds
- Updated non-pharmacy dispensing billing instructions
- Added acute opioid prescribing guidance
The Rule 16 revisions impacted some prior authorization provisions and various medical billing and processing provisions.
The MyMatrixx by Evernorth Regulatory Affairs team attended the stakeholder meeting and hearing for these changes during the proposal process and submitted written comments generally in support with several requests for language clarifications or amendments. Our requests for clarifications and amendments were heeded by the DoWC and incorporated into the adopted language.
Delaware provider credentialing bill signed
Delaware Senate Bill 334 was recently signed into law with an effective date of January 1, 2028. The bill establishes a statewide, uniform provider credentialing framework for “carriers” that require provider credentialing before reimbursement or settlement of claims. This includes standardizing credentialing applications, processing timelines, provider rights, and carrier obligations. The bill’s definition of “carrier” encompasses a number of entities, including workers’ compensation carriers and PBMs.
However, the bill states that nothing in it may supersede, limit, or interfere with Delaware's existing workers' compensation provider-certification program; providers already certified under the state’s workers' compensation certification process cannot be required to obtain additional credentialing under this bill to receive reimbursement for workers' compensation services. For context: The state’s current process requires health care providers to be certified in order to be able to provide treatment in the workers’ comp system without the requirement to first preauthorize each procedure, office visit, or service to be provided with the employer or carrier.
Kentucky court ruling on fee schedule access
A Kentucky circuit court ruled that the Kentucky workers’ compensation medical fee schedule is public record and cannot be restricted behind a private vendor’s paywall or licensing agreement. The court found the Kentucky Department of Workers’ Claims (DWC) improperly denied an Open Records Act request by directing requestors to purchase the fee schedule from the state’s contracted vendor. The court emphasized the fee schedule is owned by the DWC, is incorporated into Kentucky workers’ compensation regulations, and carries the force of law, making it subject to public disclosure. The court concluded that the DWC willfully violated the Kentucky Open Records Act. This decision could have notable implications for stakeholders operating in Kentucky’s workers’ compensation system. If the ruling stands, regulated entities may be able to obtain the fee schedule from the DWC without purchase from a vendor.