Delaware: Comp task force report targets medical costs, RTW efforts
The task force was created by the Delaware General Assembly and governor to address two years of rising workers' comp premiums that followed several years of decreases after reforms enacted in 2007. The panel released its report with a total of 18 recommendations, which are expected to be proposed as legislation by mid-June.
"The task force has concluded that a number of statutory and regulatory changes are required in order to avoid significant future increases in workers' compensation premiums," the report says. "The task force's recommendations focus on revisions and improvements to the 2007 statute, not a wholesale rejection of that law and replacement of it with an entirely new system."
While many of the recommendations focus on rising medical costs in the workers' comp system, two fall under the heading of making the state's laws encouraging return to work more effective. Primary responsibility for ensuring that employers are informing doctors of available light-duty work would fall to insurance carriers. Once an injury is deemed a compensable lost time case and the payer and injured worker have made an agreement as to compensation, "the insurance carrier shall be required to send a Modified Duty Availability Report to the employer and ensure that it is completed and delivered to the physician. The trigger for the Modified Duty report will no longer be the Report of Workers' Compensation Injury from the physician," the report says.
In a letter addressing the recommendations, AIG's state relations representative argues against the idea.
"As a carrier, we have no objection to providing a copy of this form to the insured, reminding the insured the form needs to be completed and sent to a physician, but we are in no position to make the insured complete this form," wrote Tom Glasson in a letter to Task Force Chairman Lt. Gov. Matthew Denn. "We submit that the best way to assure completion of a form by an employer is to require the employer to complete the form, either by rule or statute, in order to insure compliance."
Medical-related recommendations. Changing reimbursement rates for providers and pharmaceuticals, and capping drug tests by physicians are among the proposals to reduce medical costs in the workers' comp system.
Nearly all medical procedures would be placed in the state's fee schedule. Inflation increases in reimbursements to medical providers would be frozen for two years. Also, the inflation index for hospital reimbursements would be changed to the nonmedical consumer price index, as is the case for most providers in Delaware.
An additional recommendation would place new price controls on the costs of pharmaceuticals. The Health Care Advisory Panel, created by the 2007 reforms, is being asked to change the pharmacy reimbursement from 100 percent of average wholesale price/actual charge to a system "where AWP is defined and reimbursement is AWP minus 12 percent for brand name drugs or 20 percent for generic drugs, plus a dispensing fee." HCAP is also being asked to recommend a ban on adding charges for repackaging and a ban on OxyContin use for patients who are not already receiving it.
A major increase in utilization has been "the repeat drug tests ordered by doctors treating workers' compensation patients," the report says. The task force recommends a cap of four such tests a year except where preauthorization from the insurer is required, and banning confirmatory testing "unless the point of care testing is not consistent with the prescriber's expectations based on the current prescription and changing the allowed charge from 85 percent of current charge to a maximum of $100."
Read more at the WorkersComp Forum homepage.
June 10, 2013
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