Q4, 2017 – March 16, 2018
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Research Preliminary Data on WC Prescription Drug/Opioid Use Look Promising… Upcoming CWCI research will look at the utilization and cost of prescription drugs in California workers’ comp, offering a close look at current trends in the volume, cost, potency and types of opioids used in the system. Preliminary results indicate that for the most part, efforts to contain the growth of opioids continue to pay off. The final results will be published in Q1 2018, after data through June 2017 become available. Executive Memo (11/30/17) (members only) DIR’s 2016 Injury & Illness Data... DIR data on California’s 2016 occupational injuries & illnesses based on employers’ OSHA 300 reports show the nonfatal occupational injury & illness rate edged down slightly in 2016, hitting a 15-year low of 3.7 cases/100 full time employees. The figures, issued by the DIR Director’s Office of Policy, Research and Legislation are based on estimates provided by the U.S. Bureau of Labor Statistics’ Survey of Occupational Injuries and Illnesses (SOII), and offer an alternate view of the state’s work injury and illness experience than WC claim counts, as they include cases recorded by employers for which no WC claims were filed. Executive Briefing (11/30/17) (members only) Opioids in Workers’ Compensation Medicare Set-Asides… An in-depth look at the prevalence and cost of prescription drugs included in Workers’ Compensation Medicare Set-Aside plans, with a focus on opioid analgesics. Using data from 7,926 California Workers’ Compensation Medicare Set-Aside arrangements completed, submitted and approved by the Centers for Medicare and Medicaid Services in 2015 and 2016, the study shows that nearly 70% of these federally mandated and approved Medicare settlements for injured workers require funding for decades of opioid use, often at dangerously high levels and in conjunction with other high-risk drugs, even though such a requirement exceeds federal and state clinical guidelines and places patients at high levels of risk. The report includes background information on WCMSAs, looks at average amounts submitted and approved for the plans, the distribution of the top 20 drug groups and prescription drug allocations in WCMSAs, compares WCMSA allocations for opioids to the utilization and cost of these drugs in a control sample of workers’ comp PD claims involving similar injuries and provides data on the strength, dosage and duration of the opioids included in WCMSA plans. CWCI Report to the Industry (10/28/17) (members only) Bulletin (10/28/17) (members only) News Release (10/28/17) (public) Executive Briefing (10/25/17) (members only) IRIS Regional Scorecard Interactive Research An overview of CWCI’s interactive application based on updated IRIS data on claims from the last decade (AY 2007 through 2016). The application allows users to compare results from each region to statewide results on key metrics, compare results between different regions, and identify regional and statewide trends that have developed. Executive Memo (10/11/17) (members only) CWCI Interactive Research Report (9/29/17) (members only) Interactive Application Tool (9/29/17) (members only)
Statutory/Regulatory Formulary Takes Effect 1/1/18. On 12/7/17, OAL approved MTUS Formulary regs submitted by DWC and filed them with the Secretary of State. The Formulary, effective for all drugs dispensed to injured workers on or after 1/1/18, is based on ACOEM’s evidence-based treatment guidelines. The MTUS Drug List in the Formulary includes 82 “Exempt” drugs that treating doctors will be able to prescribe in accordance with the MTUS treatment guidelines without prospective review, and 193 “Non-Exempt” drugs (including opioids) that in most cases will be subject to prospective review. All compounded drugs will be subject to UR. The regs include rules to allow treating physicians to prescribe a limited quantity of certain drugs for Special Fills (15 drugs) and Perioperative Fills (14 drugs, including pain meds). To preclude abrupt, potentially harmful changes in an injured worker’s drug regimen, the rules also require treating physicians to submit a report no later than 4/1/18 with a plan to safely wean or transition workers injured before 1/1/18 to medically necessary Exempt drugs; alternatively, the physician must submit a report explaining why a change in the worker’s drug treatment is not medically appropriate. Executive Briefing (12/19/17) (members only) DWC 2018 Audit Standards. DWC announced the 2018 workers’ comp profile audit review (PAR) standard based on 2014-16 audit results, as well as the full compliance audit (FCA) standard. Executive Briefing (12/19/17) (members only) California Workers’ Comp Medical Mileage Rate. California Workers’ Comp Medical Mileage Rate. The increase in the standard mileage rate for business miles announced by the IRS means that the mileage rate that California workers’ compensation claims administrators pay injured workers for travel related to medical treatment or evaluation of their injuries will need to be adjusted to the new IRS rate of 54.5 cents per mile for travel on or after January 1, 2018, regardless of the date of injury, though the 2017 rate of 53.5 cents per mile rate should still be paid for all 2017 travel. Executive Memo (12/14/17) (members only) Bulletin (12/14/17) (members only) News Release (12/14/17) (public) Executive Briefing (12/19/17) (members only) 2018 User Funding Rates. The California Department of Industrial Relations (DIR) announced the 2018 assessments that workers’ compensation insurers are required to collect from policyholders to cover the budget of the state Division of Workers’ Compensation (DWC) and five related programs set up by state lawmakers. Insurers must apply the rates against their policyholders’ estimated annual assessable premium for policies incepting January 1, 2018 through December 31, 2018. Executive Memo (11/30/17) (members only) Bulletin (12/1/17) (members only) News Release (11/30/17) (public) Executive Briefing (11/30/17) (members only) Year End Reminder on TTD/PTD Rate Increases Effective 1/1/18. Temporary total disability (TTD) and permanent total disability (PTD) rates for injuries o/a 1/1/18 will increase due to last year’s increase in the State Average Weekly Wage. Claims organizations will need to increase maximum TTD and PTD to $1215.27/week for 2018 injuries, and increase the minimum to $182.29/week. Executive Briefing (11/30/17) (members only) DWC Extends SROI Amnesty Program Through March. The DWC announced that it was extending its amnesty program designed to give WC claims administrators time to comply with requirements for reporting historical Subsequent Reports of Injury (SROI) data to the WCIS. The amnesty program will now run through the end of March. Executive Briefing (11/30/17) (members only) 2018 Claims Kits. Claims departments and those compiling claims kits for January renewals may continue to use their current inventories of WC posting notices (CCR §§9881 – 9881.1); new hire pamphlets (CCR §9880); and the DWC-1 claim form/Notice of Potential Eligibility (CCR §10139) as none of the statutory changes enacted in 2017 required revisions to those materials. If claims organizations need to reorder in 2018, CWCI will continue to stock these materials and keep them up to date. Executive Briefing (11/30/17) (members only) CDI Information on SB 189 Waivers for Officers and Directors. In 2016, AB 2883 established a process for officers and directors to “opt-out” of their companies’ workers’ comp policies, which led to a whole host of other requirements and practical problems, especially for in-force policies. In an attempt to correct some of those problems, in 2017 state lawmakers enacted clean-up legislation (SB 189), which amends in Labor Code §§3351 and 3352. To clarify the issues surrounding SB 189, as well as the effective dates for the various provisions, this week the California Department of Insurance issued a notice to insurers, along with answers to frequently asked questions, and two sample waiver forms. Executive Memo (11/20/17) (members only) Proposed Amendment to Benefit Payment and Notice Regulations (CCR Section 9812(i)). CWCI’s forum comments on draft revisions to the Notice Denying Liability for All Compensation Benefits. Forum Comment (10/31/17) (public) Formulary Regs Are at OAL & CWCI’s Free Online Webinar Is Available On Demand. DWC made only minor changes to the formulary regs after the 2nd 15-day comment period and the regs were submitted to OAL in late October for review and approval, so the Formulary could take effect by 1/1/18. Copies of the regs are posted in the Regulation section of our website. CWCI’s 90-minute Formulary webinar provided training to claims, legal and medical professionals, and has been made available free to CWCI members as on-demand webinar for those who missed it. Bulletin (10/25/17) (members only) News Release (10/10/17) (public) Executive Briefing (10/25/17) (members only) CWCI’s Review of 2017 Enacted Legislation. Governor Brown signed only a handful of bills related to workers’ compensation in 2017. CWCI provides a summary of 10 bills that were enacted. Bulletin (10/18/17) (members only)
Legal 4th DCA Grants CWCI Request to Publish Duncan v. Wal-Mart Ruling. The 4th District Court of Appeal granted CWCI’s request to publish its recent ruling in Duncan v. Wal-Mart Stores; The Hartford, a subrogation ruling in which the court ruled that a workers’ comp insurer can be reimbursed for damages that the injured worker did not claim, such as lost wages/TD; and the entire award is subject to the employer’s lien rights, so the insurer can obtain full reimbursement from a civil damages award — even where the civil award is intended to compensate for losses such as pain and suffering that cannot be compensated in workers’ comp. Executive Memo (12/13/17) (members only) Executive Briefing (12/19/17) (members only) Oral Arguments Set for Zuniga. The 1st DCA scheduled oral arguments for 12/19/18 in Zuniga v. WCAB, a case in which the applicant challenged the anonymity provisions of IMR on Constitutional due process grounds. The court requested that the parties address specific questions related to the validity of IMR and applicable conflict of interest provisions. CWCI filed an amicus brief in the case in 2016 Executive Briefing (11/30/17) (members only) Stevens v. WCAB. In 2015, the Court of Appeal found that the statutory review processes for medical care, utilization review, and independent medical review are a constitutional exercise of the Legislature’s plenary authority to create a complete workers’ compensation system. In 2017, the WCAB issued two new Decisions After Remittitur/Reconsideration, invalidating the 2009 MTUS. The Court of Appeal initially granted a new Writ of Review but, after all briefing had been completed, dismissed the case on 12/20/17. Significant Decision Summary (10/29/15) (members only) The Lien Cases (Rodriguez v. Garden Plating and Consolidated Cases). In an en banc decision, the Appeals Board suspended CCR 10859, consolidated and then dismissed as moot more than 1,234 Petitions for Reconsideration, and held that the issue of whether lien Declarations were timely filed must be adjudicated in each case in the first instance at the trial level. Significant Decision Summary (10/27/17) (members only)
Other CWCI 54th Annual Meeting Announcement. The Institute’s 2018 meeting is set for Thurs, March 15, at the Oakland Marriott. The program will begin at 9:30 a.m., and the theme this year will be “Who Wrote the Book of Comp?” Executive Briefing (12/19/17) (members only) Minimum Wage Hike for 2018. In 2016 Gov. Brown signed SB 3 (Leno), mandating incremental increases in the state’s minimum wage, which will boost the minimum from the current $10/hr to $15/hr for “large” employers (those with 26 or more employees) by 2022, and to $15/hr for all employers in 2023. Some municipalities, already have a higher minimum wage: San Francisco’s is currently $14/hr, San Jose’s is $12/hr and L.A.’s is $10.50/hr for employers with 25 or fewer employees, $12/hr for all others.) The increase in the statewide minimum wage slated for 1/1/18 will reset the minimum for “small employers” to $10.50/hr, while the minimum for large employers will rise to $11/hr. Executive Briefing (12/19/17) (members only) WCIRB’s Amended Rate Filing. After reviewing insurer claims experience through June, WCIRB found lower than expected loss development in the 2Q 2017 and amended its earlier rate filing, proposing a cut in the advisory pure premium rates to an avg of $1.96/$100 of payroll. That was 2% less than the average advisory pure premium rate of $2.00 approved for new and renewal policies effective o/a 7/1/17, and 16.1% below the average filed pure premium rate of $2.34 on those policies. Executive Briefing (10/25/17) (members only) CWCI Webinar on the California Workers’ Comp MTUS Formulary Available On Demand. CWCI’s webinar on the MTUS Formulary, originally presented on October 4 was recorded and is now available as an on-demand webinar. The on-demand webinar is free to CWCI members, and is $50 for nonmembers. Executive Memo (10/10/17) (members only) News Release (10/10/17) (public) Executive Briefing (12/19/17) (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 Q3/17 (10/31/17) (members only) |