Statehouse Claims Institute
Workers Comp Policy MonitorNo. 9 · October 2026
Workers Comp Policy Monitor · Q3 2026Data to 30 September 2026
Fee schedule updates lead a busy third quarter
States adopted 35 changes between July and September, 14 of them medical fee schedules. Most take effect on 1 January and will raise medical payments per claim in the states they touch
1What was adopted
Adopted changes held level with a year ago overall, but the mix shifted. Fee schedules and formularies rose while enacted legislation fell, as fewer legislatures met in full session this year.1
| Change type | Q3 2026 | Q3 2025 | Change |
|---|---|---|---|
| Medical fee schedules | 14 | 11 | +3 |
| Drug formularies | 4 | 2 | +2 |
| Hospital payment rules | 5 | 6 | down 1 |
| Claims and procedure rules | 9 | 8 | +1 |
| Legislation enacted | 3 | 7 | down 4 |
| All changes | 35 | 34 | +1 |
Source: state workers' compensation agency notices, state administrative registers, adopted fee schedules and formularies, Statehouse Claims Institute
Source: state workers' compensation agency notices, state administrative registers, adopted fee schedules and formularies, Statehouse Claims Institute
2Fee schedules
Most of the 14 updates are routine annual conversion factor changes. Five are large enough to move payments per claim by a point or more, and one state rebased its ambulatory surgery schedule on a Medicare multiple for the first time.2
| State | Schedule | Change | Effective | Payment effect |
|---|---|---|---|---|
| Georgia | Physician | +4.0% | 1 Oct 2026 | +1.6% |
| Texas | Hospital outpatient | +3.1% | 1 Sep 2026 | +1.2% |
| Pennsylvania | Physician | +2.7% | 1 Jan 2027 | +1.0% |
| Michigan | Physician | +2.1% | 1 Dec 2026 | +0.8% |
| Tennessee | Ambulatory surgery | Rebased | 1 Jan 2027 | +2.3% |
Source: adopted fee schedules and state agency notices, Statehouse Claims Institute estimates
3Formularies
Two of the four formulary changes are first adoptions; the other two update existing drug lists. Both new formularies apply to claims with dates of injury from 1 January 2027 and to existing claims from 1 July 2027.
Source: state workers' compensation agency notices, state administrative registers, adopted fee schedules and formularies, Statehouse Claims Institute
4Against our Medical Cost Benchmarks
5What to watch in the fourth quarter
Annual fee schedule filings that take effect on 1 January, proposed formulary rules in two states with hearings in November, and bills prefiled for the 2027 sessions that would change medical fee schedule methods.
How this monitor is built
- Adopted means a final rule published in the state register or a bill signed into law. Proposed rules are listed for subscribers but not counted
- Payment effect is our estimate of the change in medical payment per claim with more than seven days of lost time, using Benchmark claim mix
- Every change traces to a register notice, adopted schedule or enrolled bill held on file for members who ask
Approved for subscribersHoward LindqvistDirector of Policy Research · 9 October 2026
1 A state can adopt several changes in a quarter. The 35 changes this quarter came from 24 states.
2 Payment effects are estimates for the first full year after the effective date and assume no change in utilization.