2025 Legislative Update

Signed: June 4, 2025 | Effective: January 1, 2028

Key Changes:

• Injured workers can select any provider on the DOWC’s Level 1 or 2 accredited provider list as their authorized treating physician, instead of choosing from a list of designated providers.
• Injured workers have additional time to request a change in authorized provider.
• It is possible that before this bill goes into effect, there will be amendments to the bill as passed in the 2026 and/or 2027 legislative sessions. Governor Polis issued a statement when he signed the bill, calling for the creation of a working group. That group is being asked to consider all topics raised by opponents and proponents and to specifically address:
  • Further clarifying the permissibility of in-house clinics as an option for injured workers
  • Clarifying that nothing precludes an employer from providing workers with a list of recommended doctors
  • Functionality of the DOWC provider directory
  • Accreditation process for providers, including DOWC tracking of licensure and malpractice status
  • Applicability of the premium credit described in DOI Amended Regulation 5-1-1 Section 5(E)
  • Clarification of any timelines
  • Identifying mechanisms to lower costs

Signed: May 29, 2025 | Effective: August 6, 2025

Key Changes:

• The bill expands the types of providers who can receive Level 1 Accreditation.

The Colorado Division of Workers’ Compensation adopted rule language effective April 1, 2025, that significantly changes the DIME program.

Key Changes:

• The new rule changes the qualifications to become a DIME panel member to include those who engaged in at least 384 hours over the past 10 years, completed 384 hours of of direct patient care (including medical/legal evaluations), and demonstrated additional competency in the field of disability evaluation through certification by the American Board of Independent Medical Examiners, the International Academy of Independent Medical Evaluators, or equivalent continuing medical education courses.
• DIME fees were updated such that physicians shall receive a $1000 deposit from the requesting party prior to scheduling the DIME appointment. The rest of the fees mirror Rule 18  based on the total time necessary to complete the DIME, payable in 15-minute increments. The fees will change according to the Fee Schedule. The fee as of July 1, 2025, is $381.48.
• The certification, reimbursement, and cancellations provisions of Rule 18 shall apply to the interpreting services provided during a DIME. Physicians have two options when an interpreter does not show up. The physician can reschedule the exam at the respondent's cost. Alternatively, the physician may use their own interpreter service and impose a $250 fee on the defaulting party. No prior authorization is required for the $250 fee.
• The new rule establishes a Medical Records Unit within the DOWC that manages technologies and processes to collect, organize, and share medical records for use in the DIME process. Under Rule 11, both parties submit medical records to the Medical Records Unit. The Unit then utilizes a new system to create a clean packet of medical records based on criteria established by the DOWC. Each party will receive three files: a cleaned-up packet, the original records, and any unused documents.

The Colorado Division of Workers’ Compensation adopted rule language that eliminates a longstanding requirement that a physician personally examine an injured worker in-person within the first three visits post-injury, effective July 1, 2025. The DOWC also adopted HIPAA X12 standards for electronic billing of medical claims, effective January 1, 2026.

Key Changes:

• Physician oversight of injured workers treated by a Nurse Practitioner or Physician Assistant remains in effect, but physical examinations by a physician are based on medical necessity or by request of an involved party.
• Medical bills will be required to be submitted and processed in a HIPAA-compliant electronic format.

The Colorado Division of Workers’ Compensation adopted rule language, effective January 1, 2025, that updated the Shoulder Injury Medical Treatment Guidelines.

Key Changes:

• The update changed the format and amount of content to make the guidelines more concise and easier to use in practice.
• There is a continued focus on evidence-based care that emphasizes functional goals and gains.
• There are no significant changes to the direction of recommendations; in other words, no treatment went from not recommended to acceptable.
• The guidelines addressed new treatments, including kinesiotaping and stem cell injections, while other topics considered to be no longer relevant were removed.

The Colorado Division of Workers’ Compensation adopted rule language, effective January 1, 2025, that clarified many small but important items, such as status indicators and other associated payment policies. There were also changes to payment percentages for various medical providers.

Key Changes:

• Requires payers to offer reimbursement to providers without an associated fee.
• Requires prescriptions for gabapentin to be filled through a pharmacy.
• Implements conversion factors at an established percentage of Medicare reimbursement.