Wednesday, January 28, 2015

Early Work Comp Politics

It seems like the entire workers' compensation industry is under attack by legislators and regulators.

Of course it's not, but this morning's headlines certainly lead to that impression:
Some of this activity is the product of previously passed legislation. The California story arises out of a mandate in SB 863 that the Division of Workers' Compensation adopt a fee schedule for home health care by July 2013 - but there were a lot of time deadline mandates in that bill that could not realistically be met with all of the other work necessitated by the new law.
Bowzer wants YOUR vote

Research group, RAND Corporation, was tasked with figuring out how to compensate home health care providers. Looking to Medicare's fee schedule, RAND recommends using what is already in place, and by reference, that would eliminate reimbursement to family members.

Payments under Medicare are limited to services provided by home health agencies that are certified by the U.S. Centers for Medicare and Medicaid Services and can be provided only to individuals whom a physician has certified as homebound and in need of skilled care on a part-time or intermittent basis.

The issue with the limitation is that some family members can't be trusted to provide appropriate care, let alone abuse the position and take advantage of the opportunity to cheat the system.

Other activity arises out of issues with a couple of folks that don't know how to control themselves, so the state has to step in to level the playing field to curb abuses by people who don't like to play fair, which, to a large extent is why we end up with fee schedules.

Minnesota's system has apparently tired from disputes arising out of how much to pay for what services rendered by in-patient providers.

Workers’ Compensation Commissioner Ken Peterson told WorkCompCentral that the present cap on payments has “led to an awful lot of litigation over the years, and a lot of delays and fights.”

“The payers come in with one set of numbers (as to) what the 85% should be, and the hospitals have another set of numbers,” Peterson said. “So you end up using a lot of bill-review services, just leading to broader disagreements over what the bills should be, and higher-cost services.”

Some action is follow up or re-introduction of previously attempted legislative work that never made it to vote, such as New York's mandatory premium audit proposal.

New York Assembly Insurance Committee Chairman Kevin Cahill, D-Kingston, filed Assembly 2199 on Jan. 15, at the request of the New York Insurance Association, seeking a mandatory payroll audit on construction companies annually, and every other business biennially.

Similar legislation filed by Senate Insurance Committee Chairman James Seward, R-Milford, passed the Senate by voice vote on June 20, 2013, but died in the Assembly Rules Committee last year.

And of course law makers have a soft spot in their voting hearts for first responders and public safety workers.

North Dakota state lawmakers have introduced House Bill 1317 by Rep. Amerman, D-Forman, that would provide workers' comp benefits to full-time paid firefighters, law enforcement officers and emergency medical personnel who have been diagnosed with Post Traumatic Stress Disorder stemming from an event that occurred on the job. State Sen. George Sinner, D-Fargo, has introduced a companion measure, Senate Bill 2256.

It's early in the legislative season. Surely there will be more states with more proposed law changes as one special interest or another seeks some particular advantage, or tries to stem actual or perceived abuse.

One thing that doesn't change in workers' compensation: it's a political creation, and a political solution, that doesn't always translate well once put into real world practice.

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