Q3, 2016 – October 12, 2016
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Research PY 2013 First Report Data on Insured Claims. First report data on PY 2013 insured claims show total incurred costs increased for the fifth year in a row, led by a $125 million jump in incurred indemnity, most of which was due to increases in incurred indemnity on TD claims. Bulletin (9/23/16) (members only) California’s Proposed WC Formulary: Preliminary Review of Preferred and Non-Preferred Drugs. A CWCI Spotlight Report that uses data on 1.2 million prescriptions dispensed to California injured workers in 2014 to model the impact of the proposed WC prescription drug formulary released by the DWC on August 26. Spotlight Report (8/30/16) (public) Executive Briefing (8/31/16) (members only) News Release (8/30/16) (public) California Workers Comp Regional Score Card: Los Angeles County. The first in CWCI’s series of Regional Score Cards provides detailed data derived from nearly a half million AY 2005-2015 claims filed by Los Angeles County residents. The Score Card notes that L.A. County residents account for 25.6% of all claims in the state, but 31.9% of workers’ comp loss payments and examines factors that make L.A. claims different by providing data comparing key aspects of Los Angeles County Claims to those from other regions of California. Regional Score Card (8/24/16) (members only) Bulletin (8/24/16) (members only) News Release (8/25/16) (public) Impact of the RBRVS Fee Schedule on California Workers’ Comp Physician and Non-Physician Practitioner Service Payments. A detailed analysis of changes in the utilization and reimbursement of California workers’ comp physician and non-physician medical services during the first 2 years of the transition to the RBRVS fee schedule, which began in January 2014. The study documents a major shift in where the medical dollars flow and that as intended, primary care providers now get a bigger share of covered fees while specialists get less. Report to the Industry (8/22/16) (public) Bulletin (8/22/16) (members only) Executive Briefing (8/31/16) (members only) News Release (8/22/16) (public) Regional Distribution of Sleep Studies in California Workers’ Comp. CWCI data show that while L.A. County and the Inland Empire residents combined for roughly 45% of all 2013-2015 claims, together they accounted for nearly 70% of the claims with sleep studies, and a similar proportion of the sleep studies that were conducted. Executive Briefing (7/28/16) (members only)
Legal Beltran v. Structural Steel Fabricators. The WCAB issued a panel decision allowing settlement of the Supplemental Job Displacement Benefit voucher in a Compromise and Release settlement agreement under certain limited circumstances. Executive Memo (8/15/16) (members only) Background Information on Gender Bias Suit. Several women who suffered work injuries joined with the Service Employees International Union of California to file a suit alleging that female injured workers in California are denied equal permanent disability benefits because of systemic gender bias. CWCI General Counsel Ellen Sims Langille’s background piece rebuts many of the arguments put forth in the suit and includes pertinent statutory and case law references on the issue. Executive Memo (7/07/16) (members only)
Statutory/Regulatory CURES Bill Signed Gov. Brown signed SB 482 which will require doctors to check the state prescription drug monitoring program (CURES) at least 24 hours before prescribing a Schedule II, III or IV controlled substance to a patient for the first time. The bill also requires doctors to check CURES at least once every four months when continuing to prescribe a controlled substance. Executive Memo (9/28/16) (members only) Bill Restricts Workers’ Comp Exemptions for Corporate Executives. Governor Brown signed AB 2883 which will affect workers’ compensation exemptions for corporate executives and directors. The bill was designed to address a loophole that some employers had exploited for premium fraud and is expected to take effect January 1, 2017. Executive Memo (9/28/16) (members only) Proposed Home Health Care Fee Schedule: SB 863 mandated adoption of a workers’ compensation Home Health Care Services Fee Schedule that sets forth fees and requirements for service providers, as well as maximum service hours and fees. CWCI comments on DWC’s proposed Home Health Care Services Fee Schedule which sets forth a methodology for payment and maximum allowable rates for payment for the full range of home health care services that may be required by injured workers. 2nd 15-Day Comment (9/26/16) (public) Outpatient Physician Fee Schedule CWCI’s comments on the DWC’s proposed language amending the Hospital Outpatient Departments and Ambulatory Surgical Centers (HOPD/ASC) Fee Schedule component of the Official Medical Fee Schedule. 2nd 30-Day Comment (7/06/16) (public) 1st 15-Day Comment (9/23/16) (public) Workers’ Compensation Drug Formulary: In October 2015, Governor Brown signed AB 1124 mandating that the DWC adopt a prescription drug formulary for the California workers’ compensation system. After gathering input from various stakeholders and others in the community, including the Institute, the Division released its initial draft of its proposed regulations in a regulatory Forum, and CWCI provided comments on that draft for the Division to consider when it revises its proposal. 1st Forum Comment (9/16/16) (public) Chronic Pain Treatment Guidelines and New Opioids Treatment Guidelines: The revised Medical Treatment Utilization Schedule regs, including amendments to the Chronic Pain Treatment Guidelines and the new Opioids Treatment Guidelines, were approved by OAL and filed with the Sec’y of State in July and made effective 7/28/16. Executive Briefing (8/31/16) (members only) 2016 Lien Legislation: Late amendments to SB 1160 included a huge new section detailing the legislative intent of the provisions related to fraudulent liens. The bill was approved by both chambers and sent to Gov. Brown, as was AB 1244 (Gray) which would require the DWC to suspend the rights of a provider convicted of health care fraud from participating in WC & prohibit convicted providers from pursuing lien payments. Executive Briefing (8/31/16) (members only) DIR Stakeholder Meeting on SB 863 Issues. The DIR held a series of meetings with various workers’ compensation stakeholders (including representatives from CWCI) to consider proposals that address a number of practical issues related to the 2012 reforms. Among the topics addressed were utilization review, medical liens, and provider fraud. Executive Memo (8/03/16) (members only) Heads Up: OMFS to Be Adjusted to Reflect Updates to ACA Federal Upper Limits. Medicaid has released updated Affordable Care Act federal upper limits (FULs) and states, including California, must implement the updated FULs in their Medicaid programs (Medi-Cal in California) within 30 days from the 8/1/16 effective date. Under LC 5307.1(g)(1)(A), the Official Medical Fee Schedule must be adjusted to conform to these relevant changes in the Medi-Cal payment system no later than 60 days after the effective date of the changes. Executive Memo (7/28/16) (members only) OSHA Penalty Increases. As of August 1, 2016, maximum penalties against employers for OSHA violations – which haven’t increased since 1990 – will increase 78%, with the top penalty for serious violations jumping from $7K to $12,471, while the maximum penalty for willful or repeat violations will jump from $70K to $124,471. Executive Briefing (7/28/16) (members only) FDA Restrictions and Quality Standards for Compound Drugs. The FDA released two draft “guidance documents” describing how it plans to implement the new restrictions & production quality standards for these compound drugs and will accept public comments until October of this year. Executive Briefing (7/28/16) (members only) Other WCIRB Recommends 2.6% Rate Reduction. The WCIRB’s Governing Comtee revised its initial recommended pure premium rate reduction for policies written or renewed o/a 1/1/17, calling for a 2.6% rate cut rather than the initially proposed 0.9% cut because it said faster claim settlements under SB 863 shortened loss development periods, which reduced paid losses. Executive Briefing (8/31/16) (members only) CWCI 2017 Annual Meeting. Save the date announcement. Meeting will be Thursday March 23 at the Oakland Marriott. Executive Briefing (8/31/16) (members only) Expose Reveals WC Medical Fraud. A series of articles by the Center for Investigative Journalism details a multi-million dollar workers’ comp medical fraud ring spearheaded by San Diego applicant attorney Sean O’Keefe. The article chronicles how workers were recruited for referral to providers, who then paid kickbacks to O’Keefe for sleep studies, MRIs, nerve tests, pain creams, etc., which were provided without regard to the workers’ actual medical need, simply to create billing opportunities, leaving workers’ comp payors on the hook to pay millions of dollars in medical liens. Executive Briefing (7/28/16) (members only) Minutes from the Claims and Medical Care Committee Meeting. The meeting was held September 13 at the 5 Star Conference Center in Oakland. The agenda included reviews of CWCI research on the Los Angeles County regional Score Card, the RBRVS analysis, IMR results through 2Q 2016 and upcoming research on CT claims; and provided updates on recent case law, pending and proposed regs, and upcoming research projects including a study on the RFA/UR process. Meeting Minutes (9/13/16) (members only) Minutes from the Legal Committee Conference Call. The conference call was held on Aug 4. The agenda included reports on 6 current and 4 proposed amicus cases, a regulatory update on the prescription drug formulary and the MTUS, a legislative update on 4 bills, a Chamber of Commerce report by Saul Allweiss, and a discussion of the current litigation environment and recent case law. Meeting Minutes (8/04/16) (members only) CWCI Hotlinks Update. Quarterly listings of all CWCI publications, including publication dates, brief summaries of each topic and the various formats in which the information is available (e.g., research report, Bulletin, Executive Briefing, news release), so users can choose the level of detail they want to view. Listings include live links so users can click into the CWCI website to access specific documents quickly and easily. Hotlinks Q2/16 (8/1/16) (members only) |