New regulations: Optum Policy Matters update for 2026
The start of a new year it is often a time of reflection and new beginnings. For state governments, it signals the enactment of new regulations and laws passed the previous year. The new year also prompts the Optum Workers’ Compensation and Auto No-Fault team of public policy experts to renew its cycle of tracking last year’s policy developments as well as reporting on any new policy activity this year.
In 2026, Public Policy and Regulatory Affairs team will work to bring greater visibility on the impact of developing and adopted policy impacting pharmacy, ancillary, medical services, and general workers’ compensation and auto no-fault issues. This greater visibility will help our clients, their injured persons, and the marketplace to understand the trends that impact their return to health. Enjoy the first of many policy updates to come and remember you can always reach our PPRA team with any questions at: optumwc.policymatters@optum.com.
Arizona expected to address topical medications
Every year the Arizona Industrial Commission reviews and revises its standing medical and pharmacy fee schedule. Late in 2025, the Commission reached out to Optum for input on proposed language regarding topical medications. Our Optum Public Policy and Regulatory Affairs (PPRA) team continues to work with the Commission and we expect some type of language related to topical utilization and cost to be published for formal rulemaking in early 2026.
Connecticut planning fee schedule update
The Connecticut Workers’ Compensation Commission is updating its Medical Fee Schedules for 2026. These changes will be released in two phases. In April, the Official Connecticut Fee Schedule for Hospitals and Ambulatory Surgery Centers will be revised; then updates to the Official Connecticut Practitioner Fee Schedule are anticipated in July. The Optum Public Policy and Regulatory Affairs (PPRA) team will continue to monitor these developments and work closely with the Commission throughout the process to keep you informed.
California updates DMEPOS fee schedule
California’s Division of Workers’ Compensation has announced adjustments to the Medical Fee Schedule for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). These changes align with updates to the Medicare payment system adopted by CMS, effective January 1, 2026. In California, DMEPOS rates are tied to Medicare, and the updated Medicare rates file is available under “DME26-A (ZIP).” A copy of the official order can be found on the Division’s website at this link: “DME26-A (ZIP)”, and a copy of the order can be found here.
Maine adopts medical fee schedule update
The Maine Workers’ Compensation Board has updated the state’s medical fee schedule for services provided on or after January 1, 2026. This is part of the Board’s regular update cycle, which occurs twice a year in January and October. The updated fee schedule is available on the Board’s website here.
Massachusetts PBM rulemaking
The Massachusetts Division of Insurance is advancing rulemaking related to the regulation of PBMs, following legislative direction. In late 2025, the Division posted proposed rules for PBM licensure in 2026 and held a public hearing on January. Public comments will be accepted until January 15. Optum is reviewing the proposed rules and discussing potential impacts with our trade association, AAPAN. More details can be found here.
New York proposes medical fee schedule changes
The New York Workers’ Compensation Board (WCB) has proposed changes to its fee schedule to allow residents and fellows, under the supervision of an authorized physician, to treat injured workers. Amendments to Section 329-1.3 of Title 12 of the NYCRR will provide guidance on billing procedures for these services. A notice of proposed rulemaking was published on January 7, 2026, with a 60-day comment period. More information is available here.
New York mandates use of updated C-8.1B Form
The New York WCB recently issued a reminder to all stakeholders that as of January 5, they should be using the most current/updated C-8.1B Form. The C-8.1B Form is also known as the Notice of Objection to a Payment of a Bill for Treatment Provided and is applied by payers to object to or deny payment for medical services rendered to injured workers. The previous and updated forms have been mandated for usage by payers for many years.
There are three key pieces to understanding the updated form and applicability to claims in New York. First, an EOB that is compliant with New York requirements is now sufficient for following objection requirements and payers should not submit a duplicate Form C-8.1B under certain circumstances. Second, utilization of a C-8.1B or compliant EOB must include and apply the most current standard and New York CARC/RARC codes. Finally, when objecting to a bill for a prescription drug that is a non-formulary drug which requires prior approval, payers should make sure they utilize box 3 on the form.
Keep in mind that the WCB has issued a reminder that, as of January 5, 2026, all stakeholders must use the updated C-8.1B form (Notice of Objection to a Payment of a Bill for Treatment Provided), is used by payers to dispute payment for medical services. The updated form includes changes related to EOBs and the proper use of CARC/RARC codes. More details on these requirements can be found on the WCB’s website under “Required CARC and RARC codes for payment objections.”
More information on the updated form and CARC/RARC codes can be found here: Required CARC and RARC codes for payment objections.
Oregon adopts temporary rules adopting 2026 medical billing codes
On January 1, the Oregon Workers’ Compensation Division has adopted temporary rules allowing providers and insurers to use the 2026 AMA CPT, HCPCS, and ADA CDT medical billing codes, along with Version 13.0 of the CMS-1500 form. Formal adoption of these codes is expected by this April. A notice regarding these changes is available here.
Tennessee Medical Payment Committee meeting scheduled for February
The Tennessee Workers’ Compensation Bureau’s Medical Payment Committee is scheduled to meet at 1:00PM Central Time February 17 to discuss the adoption of a new Workers’ Compensation Fee Schedule, a draft of which was previously put forth at the Committee’s December meeting. The new fee schedule is to be published sometime in January with an anticipated adoption date in April.
Texas repeals outdated rules
The Texas Division of Workers’ Compensation (DWC) repealed Texas Administrative Code Sections 133.4, 133.5, and 133.309. Repealing Sections 133.4 and 133.5 was necessary because they expired on January 1, 2011. Repealing Section 133.309 was necessary because the Texas Court of Appeals declared it invalid in 2008.
The repeal will be effective as of January 2, 2026, and more information can be found here: Adopted repeals of expired and invalid rules
Texas seeks suggestions for annual audit plan
The Texas Division of Workers’ Compensation is requesting stakeholder feedback on its proposed Medical Quality Review Calendar Year 2026 Annual Audit Plan. The Division is considering an audit focused on the medical necessity and appropriateness of prescribing topical compounds or evaluating utilization review agent peer review reports for compliance with Official Disability Guidelines and accepted standards of care. Suggestions can be emailed to OMA@tdi.texas.gov by 5 PM Central Time on January 16, 2026. Additional details are available here.