reglab/statecodes huggingface dataset:
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 25 - SAFETY AND HEALTH CODES BOARD › Chapter 190 - FEDERAL IDENTICAL AGRICULTURE INDUSTRY STANDARDS › Section 16VAC25-190-1928 - Federal identical Agriculture Industry Standards (29 CFR 1928)

Current through Register Vol. 40, No. 24, July 15, 2024
The following Agriculture Industry Standards ( 29 CFR 1928 )
				  are applicable in the Commonwealth of Virginia.
The regulations which have been published in the Virginia
				  Register of Regulations are shown with the corresponding VR numbers on the
				  table below. The 29 CFR 1928 sections which appear without VR numbers on the
				  table below were mass adopted by the Safety and Health Codes Board in
				  1978.
Since these Agriculture Industry Standards are identical to
				  the federal regulations and are available elsewhere, the Virginia Code
				  Commission excluded the text of these regulations from the Virginia
				  Administrative Code.
For a summary of the effect of amendments, the adoption of
				  new regulations, the repeal of a regulation, or the stay of an effective date,
				  and for a table of the VOSH terms equivalent to the federal terms for each
				  regulation, see the Virginia Register volume and issue (VA.R.) following the
				  effective date of the regulation.
CFR Section
VR Number
Title
Effective Date of VA Reg
Effective Date of Amendment
Agriculture Industry:
1928.1
None
Purpose and Scope
4/1/78
1928.21
425-02-99
Agriculture Standard: Applicable Standards in CFR 1910
7/1/94
6/1/95 9/1/96
1928.51- 1928.57
None
Roll-Over Protective Structures and Agricultural
						  Equipment Safety
4/1/78
(1928.51 amended)
9/1/96
(1928.51 amended)
6/15/06 (VA.R. 22:18)
1928.52, 1928.53, Appendix B
Repealed
9/1/96
1928.52, 1928.53 and Appendix B to Subpart C
none
6/15/06 (VA.R. 22:18)
3/21/2007 (VA.R. 23:12)
1928.1027
425-02-94
Occupational Exposure to Cadmium
9/1/93
9/1/96
Statutory Authority
§§ 40.1-1, 40.1-6, 40.1-22 and 9-6.14:1 et seq.
					 of the Code of Virginia.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 25 - SAFETY AND HEALTH CODES BOARD › Chapter 200 - VIRGINIA VOLUNTARY PROTECTION PROGRAM › Section 16VAC25-200-30 - Categories of participation

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				Categories of participation may include:
1.
				Site-based fixed worksites and long-term construction sites, including
				traditional Star and Merit designations.
2. Challenge participants where employers are
				guided by challenge administrators through a three-stage process, which can
				prepare an employer to achieve VPP Star status.
3. Mobile workforce participants where
				employers often work as subcontractors and move from site to site.
4. Corporate participants that have adopted
				VPP on a large scale.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 25 - SAFETY AND HEALTH CODES BOARD › Chapter 200 - VIRGINIA VOLUNTARY PROTECTION PROGRAM › Section 16VAC25-200-40 - Ways to participate

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				Site-based fixed participation is directed at the owners and site officials who
				control site operations and have ultimate responsibility for assuring safe and
				healthful working conditions of:
1.
				Private-sector fixed worksites in general industry;
2. Construction worksites or projects that
				will have been in operation for at least 12 months at the projected time of
				approval and that expect to continue in operation for at least an additional 12
				months;
3. State and local
				government sector fixed worksites;
4. Resident contractors at participating VPP
				sites for the contractors' operations at those VPP sites; or
5. Resident contractors at nonparticipating
				sites for the contractors' operations at those sites, so long as the resident
				contractors are part of a larger organization approved to participate under the
				corporate option.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 25 - SAFETY AND HEALTH CODES BOARD › Chapter 200 - VIRGINIA VOLUNTARY PROTECTION PROGRAM › Section 16VAC25-200-50 - Application requirements

Current through Register Vol. 40, No. 24, July 15, 2024
A. Term
				of participation.
1. There is no time limit
				to the term of participation in Star, as long as a site continues to meet all
				Star requirements and to maintain Star quality.
2. Fixed-site construction participation
				ceases with the completion of the construction project.
3. There is no time limit to the term of
				participation for mobile worksite, corporate, or Challenge site as long as the
				participant continues to meet all applicable requirements and maintain quality
				systems.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 25 - SAFETY AND HEALTH CODES BOARD › Chapter 200 - VIRGINIA VOLUNTARY PROTECTION PROGRAM › Section 16VAC25-200-60 - Comprehensive safety and health management system requirements

Current through Register Vol. 40, No. 24, July 15, 2024
A. The elements for
				VPP shall include the following requirements for VPP participation:
1. Upper management leadership and active and
				meaningful employee involvement;
2.
				Systematic assessment of occupational hazards;
3. Comprehensive hazard prevention,
				mitigation, and control programs;
4. Employee safety and health training;
				and
5. Safety and health program
				evaluation.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 25 - SAFETY AND HEALTH CODES BOARD › Chapter 200 - VIRGINIA VOLUNTARY PROTECTION PROGRAM › Section 16VAC25-200-70 - Certification process

Current through Register Vol. 40, No. 24, July 15, 2024
A. Evaluation
				periods. The commissioner shall establish written procedures to set time
				periods and scheduling requirements for onsite evaluations in response to
				initial applications accepted by the department and for recertification of
				participants.
B. Scheduling
				exceptions. Onsite evaluations shall be conducted earlier than normal scheduled
				requirements when:
1. Significant changes
				have occurred in management, processes, or products that may require evaluation
				to ensure the site is maintaining a VPP quality safety and health management
				system.
2. VOSH has learned of
				significant problems at the site, such as increasing injury and illness rates,
				serious deficiencies described in the site's annual evaluation of its safety
				and health management system, or deficiencies discovered through VOSH
				enforcement activity resulting from an employee complaint, fatality, accident,
				or other event.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 25 - SAFETY AND HEALTH CODES BOARD › Chapter 200 - VIRGINIA VOLUNTARY PROTECTION PROGRAM › Section 16VAC25-200-80 - Onsite evaluations

Current through Register Vol. 40, No. 24, July 15, 2024
A. Onsite
				evaluation team. An onsite evaluation consists of a thorough evaluation of a
				VPP applicant's or participant's safety and health management system in order
				to recommend approval or re-approval. Onsite evaluations are carried out by a
				team consisting of VOSH staff acting in a nonenforcement capacity, private
				industry volunteers, and other qualified team members.
B. Onsite evaluation procedures. The
				commissioner shall establish written procedures for onsite evaluations of
				applicants and participants undergoing recertification. The procedures shall
				address issues including:
1. Prioritizing and
				scheduling onsite evaluations;
2.
				Inclusion of union representatives, if any, in the opening and closing
				conferences and the opportunity to accompany the onsite evaluation team on the
				site walkthrough;
3. Onsite
				evaluation team composition, qualifications, preparation, and assessment of
				personal protective equipment needed;
4. Opening conference subjects, review of
				injury and illness records, incentive programs, document review, walkthrough,
				review of safety and health management system elements and sub-elements, formal
				and informal interviews of employees, including applicable contractor
				employees, and closing conference subjects and recommendations;
5. Employee rights under the program and
				under VOSH laws, standards, and regulations; and
6. Assuring that employees performing safety
				and health duties as part of the applicant's safety and health management
				system will be protected from discriminatory actions resulting from their
				carrying out such duties, pursuant to §
										40.1-51.2:1 of the Code of
				Virginia.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 25 - SAFETY AND HEALTH CODES BOARD › Chapter 200 - VIRGINIA VOLUNTARY PROTECTION PROGRAM › Section 16VAC25-200-90 - Annual submissions

Current through Register Vol. 40, No. 24, July 15, 2024
A. Annual
				self-assessment.
1. Participation in VPP
				requires each site or participant to annually evaluate the effectiveness of its
				safety and health management system, including the effectiveness of all VPP
				elements and sub-elements.
2. The
				commissioner shall establish written procedures establishing the content and
				reporting requirements of participant annual submissions.
3. Annual submissions are due on or before
				February 15 each year.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 25 - SAFETY AND HEALTH CODES BOARD › Chapter 200 - VIRGINIA VOLUNTARY PROTECTION PROGRAM › Section 16VAC25-200-100 - Enforcement activity at Voluntary Protection Program sites

Current through Register Vol. 40, No. 24, July 15, 2024
A. Types of enforcement activity. Two types
				of enforcement activity trigger additional VPP assessment:
1. Unprogrammed VOSH inspections, which occur
				in response to all referrals, formal complaints, fatalities, and certain
				accidents.
2. Other incidents or
				events, whether or not injuries or illnesses have occurred and whether or not
				normal enforcement procedures apply to the situation.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 25 - SAFETY AND HEALTH CODES BOARD › Chapter 200 - VIRGINIA VOLUNTARY PROTECTION PROGRAM › Section 16VAC25-200-110 - Withdrawal, suspension, or termination

Current through Register Vol. 40, No. 24, July 15, 2024
A. Withdrawal.
1. Participants may withdraw of their own
				accord or be asked by VOSH to withdraw from the programs.
2. Any participant may choose to withdraw
				voluntarily at any time.
3. VOSH
				shall request that a participant withdraw from VPP if it is determined that it
				is no longer meeting the requirements for VPP participation.
4. The commissioner shall establish written
				withdrawal procedures that (i) provide for the participant's formal
				notification to the department, (ii) the commissioner's acknowledgment of
				receipt and notification to the participant of the status change, (iii)
				notification to department personnel of the status change, (iv) return of the
				participant to the VOSH programmed inspection list, and (v) disposition of the
				VPP participant file.
5. The
				commissioner shall establish written procedures to address a VPP participant's
				change of location that establishes criteria for determining whether the
				participant can retain its VPP status or must withdraw.
6. The commissioner will consider the
				employer's reapplication to VPP if and when eligibility requirements are
				met.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 12 - PUBLIC PARTICIPATION GUIDELINES › Part I - Purpose and Definitions › Section 16VAC30-12-10 - Purpose

Current through Register Vol. 40, No. 24, July 15, 2024
The purpose of this chapter is to promote public
					 involvement in the development, amendment or repeal of the regulations of the
					 Virginia Workers' Compensation Commission. This chapter does not apply to
					 regulations, guidelines, or other documents exempted or excluded from the
					 provisions of the Administrative Process Act (§ 2.2-4000 et seq. of the
					 Code of Virginia).
Statutory Authority
§§ 2.2-4007.02 and 65.2-201 of the Code of
						Virginia.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 12 - PUBLIC PARTICIPATION GUIDELINES › Part II - Notification of Interested Persons › Section 16VAC30-12-30 - Notification list

Current through Register Vol. 40, No. 24, July 15, 2024
A. The agency shall
				  maintain a list of persons who have requested to be notified of regulatory
				  actions being pursued by the agency.
B. Any person may request to be placed on a
				  notification list by registering as a public user on the Town Hall or by making
				  a request to the agency. Any person who requests to be placed on a notification
				  list shall elect to be notified either by electronic means or through a postal
				  carrier.
C. The agency may maintain
				  additional lists for persons who have requested to be informed of specific
				  regulatory issues, proposals, or actions.
D. When electronic mail is returned as
				  undeliverable on multiple occasions at least 24 hours apart, that person may be
				  deleted from the list. A single undeliverable message is insufficient cause to
				  delete the person from the list.
E.
				  When mail delivered by a postal carrier is returned as undeliverable on
				  multiple occasions, that person may be deleted from the list.
F. The agency may periodically request those
				  persons on the notification list to indicate their desire to either continue to
				  be notified electronically, receive documents through a postal carrier, or be
				  deleted from the list.
Statutory Authority
§§ 2.2-4007.02 and 65.2-201 of the Code of
						Virginia.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 12 - PUBLIC PARTICIPATION GUIDELINES › Part II - Notification of Interested Persons › Section 16VAC30-12-40 - Information to be sent to persons on the notification list

Current through Register Vol. 40, No. 24, July 15, 2024
A. To persons electing to receive electronic
				  notification or notification through a postal carrier as described in
				  16VAC30-12-30, the agency shall
				  send the following information:
1. A notice of
				  intended regulatory action (NOIRA).
2. A notice of the comment period on a
				  proposed, a reproposed, or a fast-track regulation and hyperlinks to, or
				  instructions on how to obtain, a copy of the regulation and any supporting
				  documents.
3. A notice soliciting
				  comment on a final regulation when the regulatory process has been extended
				  pursuant to § 2.2-4007.06 or 2.2-4013C of the Code of Virginia.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 12 - PUBLIC PARTICIPATION GUIDELINES › Part III - Public Participation Procedures › Section 16VAC30-12-50 - Public comment

Current through Register Vol. 40, No. 24, July 15, 2024
A. In
				  considering any nonemergency, nonexempt regulatory action, the agency shall
				  afford interested persons an opportunity to submit data, views, and arguments,
				  either orally or in writing, to the agency. Such opportunity to comment shall
				  include an online public comment forum on the Town Hall.
1. To any requesting person, the agency shall
				  provide copies of the statement of basis, purpose, substance, and issues; the
				  economic impact analysis of the proposed or fast-track regulatory action; and
				  the agency's response to public comments received.
2. The agency may begin crafting a regulatory
				  action prior to or during any opportunities it provides to the public to submit
				  comments.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 12 - PUBLIC PARTICIPATION GUIDELINES › Part III - Public Participation Procedures › Section 16VAC30-12-60 - Petition for rulemaking

Current through Register Vol. 40, No. 24, July 15, 2024
A. As
				  provided in § 2.2-4007 of the Code of Virginia, any person may petition
				  the agency to consider a regulatory action.
B. A petition shall include but is not
				  limited to the following information:
1. The
				  petitioner's name and contact information;
2. The substance and purpose of the
				  rulemaking that is requested, including reference to any applicable Virginia
				  Administrative Code sections; and
3. Reference to the legal authority of the
				  agency to take the action requested.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 12 - PUBLIC PARTICIPATION GUIDELINES › Part III - Public Participation Procedures › Section 16VAC30-12-70 - Appointment of regulatory advisory panel

Current through Register Vol. 40, No. 24, July 15, 2024
A. The agency may appoint a regulatory
				  advisory panel (RAP) to provide professional specialization or technical
				  assistance when the agency determines that such expertise is necessary to
				  address a specific regulatory issue or action or when individuals indicate an
				  interest in working with the agency on a specific regulatory issue or
				  action.
B. Any person may request
				  the appointment of a RAP and request to participate in its activities. The
				  agency shall determine when a RAP shall be appointed and the composition of the
				  RAP.
C. A RAP may be dissolved by
				  the agency if:
1. The proposed text of the
				  regulation is posted on the Town Hall, published in the Virginia Register, or
				  such other time as the agency determines is appropriate; or
2. The agency determines that the regulatory
				  action is either exempt or excluded from the requirements of the Administrative
				  Process Act.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 12 - PUBLIC PARTICIPATION GUIDELINES › Part III - Public Participation Procedures › Section 16VAC30-12-80 - Appointment of negotiated rulemaking panel

Current through Register Vol. 40, No. 24, July 15, 2024
A. The agency may appoint a negotiated
				  rulemaking panel (NRP) if a regulatory action is expected to be
				  controversial.
B. An NRP that has
				  been appointed by the agency may be dissolved by the agency when:
1. There is no longer controversy associated
				  with the development of the regulation;
2. The agency determines that the regulatory
				  action is either exempt or excluded from the requirements of the Administrative
				  Process Act; or
3. The agency
				  determines that resolution of a controversy is unlikely.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 12 - PUBLIC PARTICIPATION GUIDELINES › Part III - Public Participation Procedures › Section 16VAC30-12-90 - Meetings

Current through Register Vol. 40, No. 24, July 15, 2024
Notice of any open meeting, including meetings of a RAP or
					 NRP, shall be posted on the Virginia Regulatory Town Hall and Commonwealth
					 Calendar at least seven working days prior to the date of the meeting. The
					 exception to this requirement is any meeting held in accordance with §
					 2.2-3707D of the Code of Virginia allowing for contemporaneous notice to be
					 provided to participants and the public.
Statutory Authority
§§ 2.2-4007.02 and 65.2-201 of the Code of
						Virginia.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 12 - PUBLIC PARTICIPATION GUIDELINES › Part III - Public Participation Procedures › Section 16VAC30-12-100 - Public hearings on regulations

Current through Register Vol. 40, No. 24, July 15, 2024
A. The agency shall indicate in its notice of
				  intended regulatory action whether it plans to hold a public hearing following
				  the publication of the proposed stage of the regulatory action.
B. The agency may conduct one or more public
				  hearings during the comment period following the publication of a proposed
				  regulatory action.
C. An agency is
				  required to hold a public hearing following the publication of the proposed
				  regulatory action when:
1. The agency's basic
				  law requires the agency to hold a public hearing;
2. The Governor directs the agency to hold a
				  public hearing; or
3. The agency
				  receives requests for a public hearing from at least 25 persons during the
				  public comment period following the publication of the notice of intended
				  regulatory action.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 12 - PUBLIC PARTICIPATION GUIDELINES › Part III - Public Participation Procedures › Section 16VAC30-12-110 - Periodic review of regulations

Current through Register Vol. 40, No. 24, July 15, 2024
A. The agency shall conduct a periodic review
				  of its regulations consistent with:
1. An
				  executive order issued by the Governor pursuant to § 2.2-4017 of the
				  Administrative Process Act to receive comment on all existing regulations as to
				  their effectiveness, efficiency, necessity, clarity, and cost of compliance;
				  and
2. The requirements in §
				  2.2-4007.1 of the Administrative Process Act regarding regulatory flexibility
				  for small businesses.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 16 - ELECTRONIC MEDICAL BILLING › Section 16VAC30-16-10 - Effective date

Current through Register Vol. 40, No. 24, July 15, 2024
This chapter applies to all medical services and products
				  provided on or after July 1, 2019. For medical services and products provided
				  prior to July 1, 2019, medical billing and processing shall be in accordance
				  with the rules in effect at the time the medical service or product was
				  provided ; however, providers and payers may voluntarily comply with the
				  provisions of this chapter beginning on December 31, 2018.
Statutory Authority: §
											65.2-605.1
					 of the Code of Virginia.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 16 - ELECTRONIC MEDICAL BILLING › Section 16VAC30-16-30 - Formats for electronic medical bill processing

Current through Register Vol. 40, No. 24, July 15, 2024
A. For electronic transactions, the following
				electronic medical bill processing standards shall be used:
1. Billing.
a. Professional billing: The ASC X12
				Standards for Electronic Data Interchange Technical Report Type 3 and Errata,
				Health Care Claim: Professional (837), June 2010, ASC X12,
				005010X222A1.
b. Institutional or
				hospital billing: The ASC X12 Standards for Electronic Data Interchange
				Technical Report Type 3 and Errata, Health Care Claim: Institutional (837),
				June 2010, ASC X12, 005010X223A2.
c. Dental billing: The ASC X12 Standards for
				Electronic Data Interchange Technical Report Type 3 and Errata to Health Care
				Claim: Dental (837), June 2010, ASC X12, 005010X224A2.
d. Retail pharmacy billing: The
				Telecommunication Standard Implementation Guide, Version D, Release 0 (Version
				D.0), August 2007, National Council for Prescription Drug Programs (NCPDP) and
				the Batch Standard Batch Implementation Guide, Version 1, Release 2 (Version
				1.2), January 2006, National Council for Prescription Drug Programs.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 16 - ELECTRONIC MEDICAL BILLING › Section 16VAC30-16-40 - Billing code sets

Current through Register Vol. 40, No. 24, July 15, 2024
Billing codes and modifier systems identified in this section
				  are valid codes for the specified workers' compensation transactions, in
				  addition to any code sets defined by the standards in 16VAC30-16-30.
1. "CDT-4 Codes" are codes and nomenclature
				prescribed by the American Dental Association.
2. "CPT-4 Codes" are the procedural
				terminology and codes contained in the "Current Procedural Terminology, Fourth
				Edition," as published by the American Medical Association.
3. "Diagnosis Related Group" or "DRG" is the
				inpatient classification scheme used by CMS for hospital inpatient
				reimbursement. The DRG system classifies patients based on principal diagnosis,
				surgical procedure, age, presence of comorbidities and complications, and other
				pertinent data.
4. "Healthcare
				Common Procedure Coding System" or "HCPCS" is a coding system that describes
				products, supplies, procedures, and health professional services and that
				includes the American Medical Association's Physician "Current Procedural
				Terminology, Fourth Edition," CPT-4 codes, alphanumeric codes, and related
				modifiers.
5. "ICD-10-CM/PCS Codes"
				are diagnosis and procedure codes in the International Classification of
				Diseases, Tenth Edition, Clinical Modification/Procedure Coding System
				maintained and published by the U.S. Department of Health and Human
				Services.
6. "NDC" are National
				Drug Codes of the U.S. Food and Drug Administration.
7. "Revenue Codes" is the four-digit coding
				system developed and maintained by the National Uniform Billing Committee for
				billing inpatient and outpatient hospital services, home health services, and
				hospice services.
8. "National
				Uniform Billing Committee Codes" are a code structure and instructions
				established for use by the National Uniform Billing Committee, such as
				occurrence codes, condition codes, or prospective payment indicator codes. As
				of February 6, 2019, these are known as UB04 codes.
Statutory Authority: §
											65.2-605.1
					 of the Code of Virginia.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 16 - ELECTRONIC MEDICAL BILLING › Section 16VAC30-16-50 - Electronic medical billing, reimbursement, and documentation

Current through Register Vol. 40, No. 24, July 15, 2024
A. Applicability.
1. This section outlines the exclusive
				process for the initial exchange of electronic medical bill and related payment
				processing data for professional, institutional or hospital, pharmacy, and
				dental services provided to injured workers in accordance with §
										65.2-603
				of the Code of Virginia.
2. Unless
				exempted from this process in accordance with subdivision B 2 of this section,
				payers or their agents shall:
a. Accept
				electronic medical bills submitted in accordance with the adopted
				standards;
b. Transmit
				acknowledgments and remittance advice in compliance with the adopted standards
				in response to electronically submitted medical bills; and
c. Support methods to receive electronic
				documentation required for the adjudication of a bill, as described in
				16VAC30-16-80.
3. Unless
				exempted from this process in accordance with subdivision B 1 of this section,
				a health care provider shall:
a. Implement a
				software system capable of exchanging medical bill data in accordance with the
				adopted standards or contract with a clearinghouse to exchange its medical bill
				data;
b. Submit medical bills as
				provided in 16VAC30-16-30 A 1 to any payers that have established connectivity
				to the health care provider's system or clearinghouse;
c. Submit required documentation in
				accordance with subsection E of this section; and
d. Receive and process any acceptance or
				rejection acknowledgment from the payer.
4. Payers shall be able to exchange
				electronic data by July 1, 2019, unless exempted from the process in accordance
				with subdivision B 2 of this section.
5. Health care providers or their agents
				shall be able to exchange electronic data by July 1, 2019, unless exempted from
				the process in accordance with subdivision B 1 of this section.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 16 - ELECTRONIC MEDICAL BILLING › Section 16VAC30-16-60 - Employer, insurance carrier, managed care organization, or agent's receipt of medical bills from health care providers

Current through Register Vol. 40, No. 24, July 15, 2024
A. Upon receipt of medical bills submitted in
				accordance with 16VAC30-16-30, 16VAC30-16-40, and 16VAC30-16-50, a payer shall
				evaluate each bill's conformance with the criteria of a complete electronic
				medical bill.
1. A payer shall not reject
				medical bills that are complete, unless the bill is a duplicate bill. A payer
				may subsequently reject a complete medical bill or any portion thereof that is
				contested or denied in accordance with the requirements of subsection B of
				§
										65.2-605.1
				of the Code of Virginia.
2. Within
				45 calendar days of receipt of an incomplete medical bill, a payer or its agent
				shall either:
a. Complete the bill by adding
				missing health care provider identification or demographic information already
				known to the payer; or
b. Reject
				the incomplete bill, in accordance with this subsection and the requirements of
				subsection B of §
											65.2-605.1
				of the Code of Virginia.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 16 - ELECTRONIC MEDICAL BILLING › Section 16VAC30-16-70 - Communication between health care providers and payers

Current through Register Vol. 40, No. 24, July 15, 2024
A. Any communication between the health care
				provider and the payer related to medical bill processing shall be of
				sufficient specific detail to allow the responder to easily identify the
				information required to resolve the issue or question related to the medical
				bill. Generic statements that simply state a conclusion such as "payer
				improperly reduced the bill" or "health care provider did not document" or
				other similar phrases with no further description of the factual basis for the
				sender's position do not satisfy the requirements of this section.
B. The payer's utilization of the Claim
				Adjustment Group Codes, Claim Adjustment Reason Codes, or the Remittance Advice
				Remark Codes, or as appropriate, the National Council for Prescription Drugs
				Program Reject/Payment Codes, when communicating with the health care provider
				or its agent or assignee, through the use of the Health Care Claim
				Payment/Advice ASC X12 835 transaction, provides a standard mechanism to
				communicate issues associated with the medical bill.
C. Communication between the health care
				provider and payer related to medical bill processing shall be made by
				telephone or electronic transmission unless the information cannot be sent by
				those media, in which case the sender shall send the information by mail or
				personal delivery.
Statutory Authority: §
											65.2-605.1
					 of the Code of Virginia.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 16 - ELECTRONIC MEDICAL BILLING › Section 16VAC30-16-80 - Medical documentation necessary for billing adjudication

Current through Register Vol. 40, No. 24, July 15, 2024
A. Medical
				documentation includes all medical reports and records permitted or required in
				accordance with Rule 4.2 of the Rules of the Virginia Workers' Compensation
				Commission, subdivision 2 of
				16VAC30-50-50.
B. Any request by the payer for additional
				documentation to process a medical bill shall conform to the requirements of
				16VAC30-16-60 C.
C. It is the
				obligation of an insurer or employer to furnish its agents with any
				documentation necessary for the resolution of a medical bill.
D. Health care providers, health care
				facilities, third-party biller, third-party assignees, and claims
				administrators and their agents shall comply with all applicable federal and
				jurisdictional rules related to privacy, confidentiality, and
				security.
Statutory Authority: §
											65.2-605.1
					 of the Code of Virginia.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 16 - ELECTRONIC MEDICAL BILLING › Section - DOCUMENTS INCORPORATED BY REFERENCE (16VAC30-16)

Current through Register Vol. 40, No. 24, July 15, 2024
Electronic
				  Billing and Payment Companion Guide, Virginia Workers' Compensation Commission
				  Release 1.0, 12/2018
Statutory Authority: §
											65.2-605.1
					 of the Code of Virginia.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 30 - DESIGNATED REPRESENTATIVES: VIRGINIA WORKERS' COMPENSATION › Section 16VAC30-30-10 - Order

Current through Register Vol. 40, No. 24, July 15, 2024
Each insurance carrier licensed to write workers'
				  compensation coverage in the Commonwealth of Virginia, each employer certified
				  as a self-insurer by the Virginia Workers' Compensation Commission, and each
				  group association licensed as a self-insurer by the State Corporation
				  Commission is hereby ordered to designate and maintain a representative in
				  Virginia in accordance with an agreement between the State Corporation
				  Commission and the Virginia Workers' Compensation Commission, promulgated on
				  January 18, 1991, pursuant to § 65.2-818 of the Code of
				  Virginia.
Statutory Authority
§ 65.2-818 of the Code of Virginia.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 30 - DESIGNATED REPRESENTATIVES: VIRGINIA WORKERS' COMPENSATION › Section 16VAC30-30-20 - Designated representatives

Current through Register Vol. 40, No. 24, July 15, 2024
A. Each
				insurance carrier licensed to write workers' compensation coverage in the
				Commonwealth of Virginia, each employer granted the privilege of individual
				self- insurance by the Virginia Workers' Compensation Commission, and each
				group association approved for self-insurance by the State Corporation
				Commission, shall have one designated representative for all its Virginia
				activities, unless otherwise permitted by Section 14 of the State Corporation
				Commission's Rules Governing Group Self-Insurance Associations, and shall
				maintain on file with the Virginia Workers' Compensation Commission the name
				and current address and phone number of that person.
B. Each designated representative shall have
				the authority to:
(i) issue drafts to provide
				for payment of benefits;
(ii)
				arrange for immediate medical attention;
(iii) investigate the nature and disposition
				of any claim; and
(iv) represent
				the carrier or self-insurer upon request to the Virginia Workers' Compensation
				Commission by phone, by mail, or in person at the commission's
				offices.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 50 - RULES OF THE VIRGINIA WORKERS' COMPENSATION COMMISSION › Section 16VAC30-50-10 - Definitions

Current through Register Vol. 40, No. 24, July 15, 2024
This chapter is issued to provide procedures to identify and
				  resolve disputed issues promptly through informal dispute resolution or
				  hearing.
The following words and terms, when used in this chapter,
				  shall have the following meanings, unless the context clearly indicates
				  otherwise:
"Act" means the Virginia Workers' Compensation Act.
"Commission" means the Virginia Workers' Compensation
				  Commission.
"Employer" includes the employer's insurance carrier unless
				  the context otherwise requires.
"Jurisdiction claim number" or "JCN" is the case number
				  assigned by the commission and should be on all documents filed with the
				  commission. This is different than the claim number from an insurance
				  carrier.
"Signature" is a person's endorsement and may be handwritten,
				  typed, electronic, or any other form allowed by the Code of
				  Virginia.
Statutory Authority: §
											65.2-201 of the Code of
					 Virginia.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 50 - RULES OF THE VIRGINIA WORKERS' COMPENSATION COMMISSION › Section 16VAC30-50-20 - Rule 1 Prehearing Procedures

Current through Register Vol. 40, No. 24, July 15, 2024
A. Employee's
				original claim for benefits. An employee's original claim for benefits shall be
				filed within the applicable statutes of limitation. An original claim for
				benefits shall be in writing, signed, and should set forth the following:
1. Employee's name and address;
2. Employer's name and address;
3. Date of accident or date of communication
				of occupational disease;
4. Nature
				of injury or occupational disease;
5. Benefits sought: temporary total,
				temporary partial, permanent total, permanent partial, or medical benefits;
				and
6. Periods of disability, if
				appropriate.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 50 - RULES OF THE VIRGINIA WORKERS' COMPENSATION COMMISSION › Section 16VAC30-50-30 - Rule 2 Hearing procedures

Current through Register Vol. 40, No. 24, July 15, 2024
A. At the request
				of either party, or at the commission's direction, contested issues not
				resolved informally through prehearing procedures or alternative dispute
				resolution will be referred for decision on the record or evidentiary
				hearing.
B. Decision on the record.
				When it appears that there is no material fact in dispute as to any contested
				issue, determination will proceed on the record. After each party has been
				given the opportunity to file a written statement of the evidence supporting a
				claim or defense, the commission shall enter a decision on the record.
1. Written statements. When the commission
				determines that decision on the record is appropriate, the applicant parties
				shall be given 15 days from the date of the order to submit written statements
				and evidence. The responding party shall be given an additional 15 days (30
				days from the date of the order) to respond with a written statement and
				evidence in reply. For good cause shown additional time may be allowed. Copies
				of all written statements and evidence shall be filed to the commission and
				served on all parties.
2. Review.
				Request for review of decision on the record shall proceed under §
										65.2-705 of the Code of Virginia
				and 16VAC30-50-40.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 50 - RULES OF THE VIRGINIA WORKERS' COMPENSATION COMMISSION › Section 16VAC30-50-40 - Rule 3 Posthearing procedures

Current through Register Vol. 40, No. 24, July 15, 2024
A. Request for
				review. A request for review of a decision, order, or award of the commission
				shall be filed by a party in writing with the clerk of the commission within 30
				days of the date of such decision, order, or award.
A request for review should assign as error specific findings
				  of fact and conclusions of law. Failure of a party to assign any specific error
				  in its request for review may be deemed by the commission to be a waiver of the
				  party's right to consideration of that error. The commission may, however, on
				  its own motion, address any error and correct any decision on review if such
				  action is considered to be necessary for just determination of the
				  issues.
A copy of the request for review shall be furnished to the
				  opposing party.
B. Written
				statements. The commission will advise the parties of the schedule for filing
				written statements supporting their respective positions. The statements shall
				address all errors assigned, with particular reference to those portions of the
				record that support a party's position. No schedules for written statements
				shall be issued in connection with interlocutory appeals, appeals of award
				orders issued pursuant to agreements, or appeals of decisions accepting or
				rejecting a change in condition claim or application. However, where a decision
				accepting or rejecting a change in condition claim or application has been
				appealed, the non-appealing party shall have 10 days from the date the request
				for review was filed to provide a written response.
C. Additional testimony. No new evidence may
				be introduced by a party at the time of review except upon agreement of the
				parties. A petition to reopen or receive after-discovered evidence may be
				considered only upon request for review.
A petition on review will be favorably acted upon only when
				  the party requesting the same is able to conform to the rules prevailing in the
				  courts of this state for the introduction of after-discovered evidence.
D. Oral argument. A party may
				request oral argument at the time of the request for review, and the commission
				may grant it subject to whatever terms and conditions the commissioners apply
				to the case. Otherwise, the review shall proceed on the record.
Statutory Authority: §
											65.2-201 of the Code of
					 Virginia.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 50 - RULES OF THE VIRGINIA WORKERS' COMPENSATION COMMISSION › Section 16VAC30-50-50 - Rule 4 Filing documents

Current through Register Vol. 40, No. 24, July 15, 2024
A. Agreements. All
				agreements as to payment of compensation shall be reduced to writing by the
				employer and promptly filed with the commission. If the claim is denied the
				employer shall notify the employee and the commission promptly in writing.
If an agreement is offered to a claimant by the carrier, and
				  the agreement is signed and returned unchanged to the carrier within 14 days,
				  then the carrier must either reject the agreement in writing or sign and file
				  the agreement with the commission within 14 days of its receipt or be subject
				  to the penalties from §
										65.2-701B of
				  the Code of Virginia.
B.
				Medical reports.
Each party shall promptly provide the other parties with
				  copies of any medical records each party receives as each party receives them.
				  Copies may be provided electronically, by postal mail, or by facsimile
				  transmission. Unless otherwise directed by the commission or this chapter, the
				  parties shall not file medical records with the commission until a hearing
				  request is filed. The requesting party shall promptly file medical records
				  supporting the request if applicable. After a hearing request has been filed,
				  the parties shall file with the commission only medical records that are
				  related to the hearing request.
Without leave of the commission, the parties shall not file
				  with the commission any of the following medical records.
1. Laboratory reports;
2. Routine nursing notes;
3. X-rays or other diagnostic imagery films
				(except in pulmonary cases);
4.
				Physical therapy records;
5.
				Routine hospital patient observation notes; and
6. Health provider bills or statements of
				account (unless the claim is brought by a health care provider or the
				application seeks payment of specific medical expenses).
Medical records filed in accordance with this section shall
				  be filed upon receipt by the party filing them, and they are required reports
				  subject to the provisions of §
											65.2-902 of the Code of
				  Virginia.
A party is not required to file copies of medical records
				  that another party has already filed.
A health care provider attending an injured employee shall
				  upon request furnish a copy of the medical reports at no cost except for a
				  nominal copying charge.
A health care provider is entitled to a reasonable fee for
				  preparation of a narrative report written in response to a request from a party
				  if the report requires significant professional research or
				  preparation.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 50 - RULES OF THE VIRGINIA WORKERS' COMPENSATION COMMISSION › Section 16VAC30-50-60 - Rule 5. Cost of medical services

Current through Register Vol. 40, No. 24, July 15, 2024
A claimant under an award shall not be liable for the cost
				  of medical services payable under the Act.
Statutory Authority
§ 65.2-210 of the Code of Virginia.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 50 - RULES OF THE VIRGINIA WORKERS' COMPENSATION COMMISSION › Section 16VAC30-50-70 - Rule 6 Award of attorney fees under section 652-714 of the Code of Virginia

Current through Register Vol. 40, No. 24, July 15, 2024
A. Agreement
				between parties as to a fee. An attorney's fee shall be awarded from sums
				recovered for the benefit of a third-party insurance carrier or a health care
				provider pursuant to §
									65.2-714 of the Code of Virginia
				if agreement is reached and an order, endorsed by counsel and the carrier or
				provider, identifying the amount of medical charges recovered and the agreed
				fee is submitted to the commission.
B. Parties fail to agree on a fee.
1. An attorney fee shall be awarded from sums
				recovered for the benefit of a third-party insurance carrier or a health care
				provider pursuant to §
										65.2-714 of the Code of Virginia
				if the parties cannot agree, upon filing of a statement including the name and
				address of each carrier or provider from whom the fee is requested, the amount
				of the medical charge recovered for each carrier or provider and the amount of
				the fee requested, and certification that:
a.
				The claim was contested or that the defense was abandoned;
b. Prior to the filing of a request with the
				commission the attorney and carrier or provider made a reasonable good faith
				effort to resolve the matter;
c.
				The insurance carrier or health care provider was given reasonable notice that
				a motion for an award of such fee would be made; and
d. A copy of the motion has been sent to each
				carrier and health care provider identified.
Virginia Administrative Code › Title 16 - LABOR AND EMPLOYMENT › Agency 30 - VIRGINIA WORKERS' COMPENSATION COMMISSION › Chapter 50 - RULES OF THE VIRGINIA WORKERS' COMPENSATION COMMISSION › Section 16VAC30-50-80 - Rule 7 Employer responsibilities

Current through Register Vol. 40, No. 24, July 15, 2024
A. Proof of
				insurance coverage. Every employer subject to the Act shall file with the
				commission proof of compliance with the insurance provisions (§§
									65.2-800 and
				65.2-801 of the Code of
				Virginia) on such forms as may be required by the commission.
B. Posting notices. Every employer subject to
				the Act shall post and keep posted, conspicuously, in the plant, shop, or place
				of business at a location frequented by employees, notice of compliance with
				the insurance provisions of the Act on such forms as may be required by the
				commission. The commission will supply employers with printed notices upon
				request. Failure by an employer to give such notice to an employee may
				constitute waiver of the notice defense pursuant to §
									65.2-600 of the Code of
				Virginia.
Statutory Authority: §
											65.2-201 of the Code of
					 Virginia.