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Workers’ Compensation National Reform:. Affecting and Implementing Jurisdictional Changes. Auto animation. Overview . National Issues. State Reviews. Implications. What’s Next?. Auto animation. National Initiatives. AB 227/SB 228. SB 899. SIP Regulations. HR 635. 3. Auto animation.

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Workers compensation national reform

Workers’ Compensation National Reform:

Affecting and Implementing Jurisdictional Changes


Overview

Auto animation

Overview

National Issues

State Reviews

Implications

What’s Next?


Auto animation

NationalInitiatives

AB 227/SB 228

SB 899

SIP Regulations

HR 635

3


National initiatives

Auto animation

NationalInitiatives

Medicare and Medicaid SCHIP Reporting Extension Act of 2007, Section 111

4


National initiatives1

Auto animation

NationalInitiatives

Brown v. Cassens Transport

5


State trends

Auto animation

State Trends

PPO Discounting

Networks

Utilization Review

Provider Contracting

Rising Costs

6


Workers comp medical losses are more than half of total losses
Workers’ Comp Medical Losses Are More Than Half of Total Losses

Accident Year

  • 2008p: Preliminary based on data valued as of 12/31/2008

  • 1988, 1998: Based on data through 12/31/2007, developed to ultimate

  • Based on the states where NCCI provides ratemaking services, including state funds

  • Excludes high deductible policies


Medical claim costs increased during prior recessions
Medical Claim Costs Increased LossesDuring Prior Recessions

Accident/Calendar Year

  • 2008p: Preliminary based on data valued as of 12/31/2008

  • 1991–2007: Based on data through 12/31/2007, developed to ultimate

  • Based on the states where NCCI provides ratemaking services, including state funds

  • Excludes high deductible policies


Bell weather states

Auto animation Losses

Bell Weather States

California

Florida

Illinois

New York

Texas


California where we were
California - LossesWhere We Were?

  • Subjective permanent disability

  • No control over medical treatment

    • PTP presumption of correctness

    • Multiple surgeries

    • Over utilization

  • Fee schedule issues

    • Pharmacy

    • Outpatient surgeries

  • SIP audit issues

Costs climbed from


Legislative and regulatory changes

AB 749 Losses

AB 227/SB 228

SB 899

Legislative and Regulatory Changes

SIP Regulations


Increase in benefit rates Losses

Repeal of primary treating physician presumption of correctness for injuries after 1/1/03

Settlement of vocational rehabilitation

Medical confidentiality

AB 749

AB 227/SB 228

SB 899

SIP Regulations


AB 227/SB 228 Losses

  • Repeal of primary treating physician presumption of correctness for all injuries

  • Fee schedules

  • Treatment caps

  • Utilization review

  • Supplemental job displacement voucher


Senate bill 899
Senate Bill 899 Losses

SB 899

  • Medical provider network

  • Treatment caps

    • Extended to occupational therapy

  • QME process

  • Immediate medical payment

  • Temporary disability cap

  • Permanent disability

  • Apportionment

  • Return to work


SIP Regulations Losses

  • 3-year rule codified

  • Utilization review

  • Fee schedules

  • Dueling medical reports

  • Present value

  • Apportionment


Florida key changes 2003
Florida: LossesKey Changes2003

  • Compensability threshold

  • Permanent total

  • Medical care

  • Attorneys’ fees

  • Fee schedule

  • Physician changes

Senate Bill 50A


Florida impact of changes
Florida: LossesImpact of Changes

  • Indemnity

  • Medical

  • Frequency of defense attorney involvement

  • Emma Murray v. Mariner Health/ACE USA.

    • NCCI proposed rate increase

    • House Bill 903


Illinois key changes
Illinois: LossesKey Changes

  • Medical fee schedule

  • Utilization review


Illinois impact of key change
Illinois: LossesImpact of Key Change

  • Unintended Consequences

    • Utilization of UR

    • Increase in costs


New york key changes
New York: LossesKey Changes

  • Increase in benefit rates

  • Cap on PPD benefits

  • Medical fee schedules

  • Diagnostic testing networks

  • Pre-authorization

  • Special disability fund

  • Settlement offers

S.3322/A.6163


New york impact of key changes
New York: Impact of Key Changes Losses

  • Insurance commissioner ordered reduction in rates

  • Implementation delays

  • Varying effective dates

  • Preauthorization threshold issues

  • Stakeholder awareness


Texas key changes
Texas: LossesKey Changes

HB 7

  • Health care networks

  • Elimination of DWCC, functions transferred to DWC within TDI

  • Removal of Approved Doctor List (ADL)

  • Fee schedule

  • Peer review licensure

  • E-billing

  • Limit use of required medical exam


Texas impact of key change
Texas: LossesImpact of Key Change

  • Fee schedule

  • Networks

  • Disability Management


What s next
What’s Next? Losses

  • Is the pendulum changing?

  • What is the answer to rising costs?

  • What is effective cost containment?


What should employers do
What Should Employers Do? Losses

  • Legislative Activism

    • Understand what’s happening early

    • Establish coalition

    • Evaluation considerations

    • Determine important issues

    • Define communication protocol

    • Participate in the process

    • Provide data and examples


Questions

Questions Losses


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