Department Announces Mandatory Training

for Certified Claims Administrators

The Department of Labor & Industries has mandatory training scheduled for Certified Claims Administrators.  The full-day training will cover 2007 and 2008 statutory changes, including the new vocational rehabilitation pilot project.  You can register by going HERE.  Space is limited, so Certified Claims Administrators get first opportunity to attend, if they register by April 30th.  Starting May 1, the training is available on a space-available basis.  All of the training will be held at the Self-Insurance Section's offices in Tumwater, WA.

Department Announces Continuing Education Credits

for Certified Claims Administrators

The Department of Labor & Industries has posted the number of CEC's for all programs that have been submitted to them at their website.  You can find them HERE at the WSIA website, or HERE at the Department's website.

Department Adopts New Fee Schedule,

Limitations on Massage Therapy Reimbursement

The Department of Labor & Industries has adopted the new RBRVS converstion factor that takes effect July 1, 2008.  You can read the text of the new factor HERE.   In addition, the Department has adopted a rule limiting massage therapy reimbursement to 75% of the fee schedule for physical therapy and occupational therapy.  You can find the text of that new rule HERE.

Department Proposes New Rules on

Voc Rehab Option 2, Wage and Health Care Revisions

The Department of Labor & Industries has filed a CR101 for two new sets of rules.  The first deals with clarifying the process and requirements for making application for Option 2 vocational costs, and defining which vocational costs require department or self-insurer oversight and the vocational costs that can be paid. The second deals with amending existing rules that conflict with the law and may include new rules that clarify when the employer’s contribution for health care benefits is included in the worker’s monthly wage.  Given that, at the time of the initial rule adoption, we were told that there were no conflicts between the law and the rule, WSIA will be watching this second proposed rule adjustment even more closely.

Department Interprets Requiring Certified Claims Administrators

to Include Those Working from Home

The Department of Labor & Industries has interpreted WAC 296-15-350 (2)(b) [if claims are administered in more than one location, there must be at least one department-approved claims administrator in each location] to mean that, if a claim manager works claims from home, that would constitute a "location", and that claim manager should be certified.  If you have any other questions, please call Jeannie Parr directly at 360-902-6839.

Department Posts Webpages Dealing With

New Domestic Violence and Military Leave Laws

Two bills dealing with leave issues, always a complicating factor when trying to manage workers' compensation claims, became law during the 2008 Legislative session.  The bill granting a "reasonable period of leave" for victims of domestic violence took effect April 1, 2008, and the bill granting 15 days of unpaid leave for the spouse of an armed services member called to deployment, on deployment, or on leave from deployment takes effect June 12, 2008.  The Department of Labor & Industries has posted information on their website for both the DOMESTIC VIOLENCE law and the MILITARY LEAVE law.

National Council of Self-Insurers Annual Conference

to be held June 1-4, 2008 in Naples, Florida

The National Council of Self-Insurers (of which WSIA is a member) is holding its annual conference June 1-4, 2008 at the Naples Grand Resort in Naples, Florida.  Information regarding the agenda, and registration materials can be found at the NCSI website at http://www.natcouncil.com/meet.html.  The National Council blocked a larger number of hotel rooms at the Naples Grande Resort & Club for the 2008 annual meeting than it has ever blocked for a meeting in Florida.  The block, however, has now been totally reserved.  The Council has reserved an additional block of rooms at the Edgewater Beach Hotel, a sister property of the Naples Grande.  The Edgewater Beach is an “all suites hotel” directly on the Gulf of Mexico.  The price per room is the same as the Naples Grande, $169 plus tax per night, with the resort fee being waived.  I suggest that you visit the web site of the Edgewater Beach Hotel, www.edgewaternaples.com  The drive from the Edgewater Beach to the Naples Grande is an easy four miles. Self-parking at both hotels is free.  The Edgewater Beach Hotel has a Group on-line booking system.  You may go to the following link to book your reservation:

https://reservations.ihotelier.com/crs/g_login.cfm?hotelID=3580

After clicking on the link, you will need to put in an attendee code of 8E2203 and then click on Attendee Log-In.

Department to Update List of Examiners

and Registered IME Companies

2008 Examiner Update.  On February 21, 2008, requests for updated information was  mailed to all examiners whose last name begins with one of the following letters: A, D, G, J, M, P, S, V, and Y.  Examiners who are currently listed as temporarily unavailable on the approved examiner list will also be receiving a request for updated information.  Examiners who fail to comply with this required update by June 30, 2008, will be listed as temporarily unavailable to conduct IMEs.  Access to the “Approved IME Examiner Update (F245-051-000)” form is available on the website at www.imes.LNI.wa.gov.

2008 IME Firm Update.  During the month of March 2008, all IME firms are required to verify the information listed on the website “Find a Medical Examiner” is accurate.  Send an e-mail to winc235@LNI.wa.gov if your firm’s listing is correct.  Call 360-902-6815 if there are corrections that need to be made.  Some corrections may need to be submitted in writing.  

New Link on IME website.   The assignment letter is being revised.  General instructions to approved examiners will be listed on the website until it can be incorporated in the next version of the Medical Examiners’ Handbook.

For more information contact Provider Review and Education at 360-902-6815.

New Department Rules Take Effect on

Incident Reporting Requirements and Linear Hearing Aid Replacment

The Department has announced adoption of new rules governing incident reporting, and linear hearing aid replacement.  The rules concerning incident replacement are designed to make the reporting requirements the same for various industries, rather than the multiple exceptions and differences previously in WAC.  To read the new incident reporting rules, go HERE.  The rules concerning the replacement of worn out linear hearing aids was announced via a policy change last summer/fall, but the Department decided it needed to put these policies in statutue.  To read the new linear hearing aid replacment policy, go HERE.

Federal Law May Have Impact in

Washington Regarding Medicare Benefits

While Washington state has been fairly insolated from the Medicare Secondary Payer Act, mostly due to the fact that we do not have compromise and release and cannot settle out the medical portion of our claims, a provision in a recent federal law might impact self-insurers here in Washington.  WSIA is STILL soliciting feedback from a number of sources to get an idea on how this might apply on our claims.  We await responses from the Department and from UWC, the federal organization we belong to that lobbies on workers' compensation and unemployment issues.  You can be certain we will share that information with you as soon as it becomes available.   Here's the text of their email to us:

On 12/29/2007, President Bush signed the "Medicare, Medicaid, and SCHIP Extension Act of 2007". The bill was sponsored by Senator Chuck Grassley (D-IA) and was passed in the House (12/19) and Senate (12/18) before the signing by the President. The bill passed unanimously in the Senate and 411-3 in the House. Grassley has long been an advocate for increased Medicare Secondary Payer enforcement and the passage of this bill into law has ramifications for Liability Insurance, Self Insurance, No Fault Insurance, and Workers' Compensation Insurance programs nationwide.

Of major importance to liability, self, no fault, and workers' compensation insurers is Section 111 ("Medicare Secondary Payer"), paragraph 8 ("Required Submission of Information by or on behalf of Liability Insurance (including Self-Insurance), No Fault Insurance, and Workers' Compensation Laws and Plans"), items (A)-(H). Here are a couple key sections of the law:

(A) REQUIREMENT - On or after the first day of the first calendar quarter beginning after the date that is 18 months after the date of the enactment of this paragraph (the law was passed on 12/20/07, making the following requirements begin July 1st, 2009), an applicable plan shall-

(i) determine whether a claimant (including an individual whose claim is unresolved) is entitled to benefits under the program under this title on any basis; and (ii) if the claimant is determined to be so entitled, submit information described in subparagraph (B) with respect to the claimant to the Secretary in a form and manner (including frequency) specified by the Secretary.

(B) Required Information - The information described in this subparagraph is -

(i) the identity of the claimant for which the determination under subparagraph (A) was made: and

(ii) such other information as the Secretary shall specify in order to enable the Secretary to make appropriate determination concerning coordination of benefits, including any applicable recovery of claim.

(C) TIMING - Information shall be submitted under subparagraph (A)(ii) within a time specified by the Secretary after the claim is resolved through a settlement, judgment, award, or other payment (regardless of whether or not there is a determination or admission of liability).

(E) ENFORCEMENT

(i) In General - An applicable plan that fails to comply with the requirements under subparagraph (A) with respect to any claimant shall be subject to a civil money penalty of $1000 for each day of noncompliance with respect to each claimant (in addition to any other penalties prescribed by law and in addition to any other Medicare secondary payer claim under this title with respect to an individual).

What does it all mean?

Beginning on 7/1/2009; Liability Insurers, Self-Insurers, No Fault Insurers, and Workers' Compensation Insurers must determine Medicare beneficiary status on all claims and report those claims involving a Medicare beneficiary to the Secretary at the time of settlement, judgment, or award. If the reporting is not done in a timely manner, the Secretary may enforce a civil money penalty of $1000 per day per claim. Beyond the reporting requirements and financial penalties, this now provides Medicare huge amounts of previously difficult to collect primary payer data on liability, self-insured, no-fault, and WC claims which can be utilized to enforce their Secondary Payer rights. It will be very easy for Medicare to review settlements, judgments, and awards to determine if their interests were adequately considered in the settlement. Workers' Compensation has faced a similar situation (on a smaller scale) since 2002 with Medicare Set-Aside Arrangements. The scope of this law is much broader than MSAs though and adds liability and no-fault settlements into the process, with stiff financial penalties for non-compliance.

What can be expected?

The Secretary has two issues to address in this law, (1) what data to collect and (2) what timeframe to receive the information post-settlement, judgment, or award. The timing of the collection of data (post-settlement, judgment, or award) suggests that a copy of the the settlement agreement, judgment or award will be required submission to the Secretary. Since the intent is to enforce Medicare's Secondary Payer rights, it is reasonable to assume injury information, diagnosis codes, and primary payer data will be required. The language is broad enough to allow for the collection of medical information to determine if the settlement adequately protected Medicare's interest. It is likely that the timeframe will be shortly after the date of settlement, judgment, or award, but may be more frequent.

If you are a self-insured employer or TPA and have dealt with this issue in other states, please contact Dave Kaplan at dave.kaplan@wsiassn.org or by phone at 800-736-7296.  Thank you!

Trouble Finding a Medical Examiner?

New Department Search Feature Makes it Quick & Painless

Need help finding a medical examiner for a particular specialty?  The Department has added a search function to their list of approved examiners.  https://fortress.wa.gov/lni/imets/.

Updated Self-Insurance Section

Phone Contact Listing ... Including Team Assignments

Need an updated list of Self-Insurance section phone numbers?  Here’s the link to the latest and greatest list, http://www.lni.wa.gov/ClaimsIns/Files/SelfIns/SelfInsPhoneList.pdf, updated January 1, 2008 .  Note that the list now includes which adjudicator and which consultant work on which claims Team.  Check back at this link periodically for updated information.

Requesting Self-Insured and

Requesting State Fund Claims Files

In response to changes in public disclosure law, the Department of Labor & Industries has changed the way they process and respond to requests for prior industrial insurance claims files.  You will need to submit TWO requests: one to Norm Voiles for information on self insured claims (faxed to 360-902-6900), and then requests for State Fund claims histories to Paula Clayton (faxed to 360-

so please take advantage of them.  You can find these materials at the DOSH webpage at the Department’s website at http://www.lni.wa.gov/safety/.

as of 4/25/2008