AZ: Industrial Commission Posts New Monthly Maximum Wage.

CA: John Duncan, Former DIR Head, Says Job May Be Harder for His Successor.

CA: DWC Counts Down to June 27 Launch of JET File.

CA: DWC Proposes Changes to QME Regulations.

CA: WCIRB Posts 2010 Calif Workers Comp Losses, Expenses.

CA: SCIF President Says AB 228 Would Simplify Workers Comp for Calif Employers.

CA: SCIF Issues Letter to MPN Participants Limiting Prescriptions of Opioids.

CA: Orange County DA Looks for Victims of Alleged $17M Workers Comp Overbilling Scheme.

CA: Samuel Sorich, Former ACIC President, Joins Barger & Wolen as Of Counsel.

CO: Governor, Pinnacol Seek to Change $4.3M Severance Package for Top Executives.

FL: DWC Proposes Changes to Health Care Provider, Ambulatory Surgical Centers Reimbursement Manuals.

FL: DWC Proposes Rule Development for Health Care Provider Certification.

FL: Governor Signs Extraterritorial Workers Comp Reciprocity Bill, Intended to Curb Claims by Injured Pro Athletes.

GA: Crawford & Company Names New Managing Director.

IL: Deveraux Joins IWCC in Fraud Prevention and Efficiency Controller Role.

IL: Governor Expected to Sign Workers Comp Reform Bill on Tuesday.

LA: LUBA Workers Comp Declares $1.9M Dividend to Policyholders.

MD: HB 453 Would Enable Out of Court Settlement Without Giving Up Right to Appeal Prematurely.

MA: DIA Clarifies Massage Therapy Treatment for Injured Workers.

MA: Study Shows Blue Collar Workers in Temp Agencies Have Trouble Filing Workers Comp Claims.

MI: Accident Fund Names Freund as Chief Financial Officer.

MI: Governor Appoints Boyle, Buehler, Tjapkes to Workers Compensation Board of Magistrates.

MN: Annual Minnesota Workers Compensation System Report Shows Drop in Claims.

MN:  Dept of Labor & Industry Posts Notice of Possible Shutdown of Services.

MO: Governor Appoints Curtis Chick to Labor and Industrial Relations Commission.

MT: Commission Seeks Nominees for Workers Comp Judge.

NE: WCC Posts Revised Rules of Procedure.

NJ: Public Employee Benefits Bill Advances.

NY: S 5815 Would Give Group Self-Insured Trusts Extra Year to Post Security for Claims.

NY: Workers Compensation Alliance Opposes CIRB Application to Increase WC Rates.

NY: Lawmakers Consider Changes to Workers Comp Guidelines.

NY: Assembly Passes Bill to Prohibit Retroactive Application of Medical Treatment Guidelines for Injured Workers.

NY: Legislature Passes Historic Same-Sex Marriage Bill; Governor Cuomo Signs Bill.

NC: Governor Signs Workers Comp Reform Bill.

OH: Governor Signs Executive Order to Fight Prescription Drug Abuse.

OH: Industrial Commission Releases New Filing Guidelines.

OH: BWC Reclassifies Solar Installation, Potential Increase in Premiums of 450 Percent.

OK: Dept of Labor Goes After Companies Owing Workers Comp Fines.

OK: Senate Approves Interim Study Plan for Use of ERISA Plans in Dealing With Workers Comp Issues.

OK: OWCC Posts Mileage Reimbursement Rate for 2011.

OR: WCD Proposes New Employer/Insurer Coverage Responsibility Rules.

OR: SAIF Announces $150M Dividend to 47,000 Oregon Businesses.

PA: House Votes 200-1 to Designate Cancer as Occupational Disease for Firefighters.

RI: House Passes Budget Bill, Backs Off on Allowing WCC to Set Accidental Disability Pensions for Municipal Workers Based on Severity of Disability.

TX: Governor Signs Sunset Bill for OIEC, Extends Program by Six Years.

TX: Governor Signs Sunset Bill for DWC, Extends Program by Six Years.

TX: Governor Signs Sunset Bill for Dept of Insurance, Extends Program by Six Years.

TX: Governor Signs Bill to Regulate Pharmacy Benefit Managers.

TX: Governor Signs Bill to Address Prescription Drug Diversion by Doctor Shopping.

TX: Governor Signs Bill to Prohibit Employer Offering a Workers Comp and Non-Subscriber Plan.

TX: Governor Signs Employer Parking Lot Gun Bill.

TX: Governor Signs Various Workers Comp Bills.

TX:  DWC Posts Reminder of Reimbursement for Pharmaceutical Services for Network and Non-Network Claims.

WA: 9th Circuit Denies Man's Claim That Microwave Popcorn Eating Habit Led to Lung Disease.

WV: New Website Explains Volunteer Fire Dept Workers Comp Premium Subsidy Program.

WV: Michael D. Riley Named Acting Insurance Commissioner.

Businesses and injured individuals routinely negotiate a settlement, but cannot close on the settlement until CMS provides a complete list of all medical costs incurred." However, parties have complained that CMS is not providing this information in a consistent or timely manner, and such delays "cause lawsuits to drag on, hinders timely payments to injured individuals, and causes uncertainty and increased costs for both large and small businesses." With respect to set-asides, he noted that "reporting requirements are so weak that CMS may not know about the settlement or whether the set-aside account has been improperly spent on unrelated, non-medical expenses. The result is that CMS continues to pay for an injury that was already paid for by a third party."

Honorable Fred Upton, Chairman, Committee on Energy and Commerce, commented in his opening statement that the Medicare Secondary Payer system is supposed to protect Medicare funds from disbursement when a third-party payer is primarily responsible for the medical bills of a Medicare beneficiary. But the current MSP system is fraught with uncertainty and confusion due to complex repayment and reporting requirements, thereby undercutting the system's goal of prompt repayment. He further noted that "there is no requirement for CMS to provide the parties with the amount due, or the amount they should set aside to cover future payments, before settlement so they can appropriately allocate and resolve these Medicare obligations during settlement."

Deborah Taylor, Chief Financial Officer and Director, Office of Financial Management Centers for Medicare & Medicaid Services, provided an overview of Medicare Secondary Payer law, Medicare's recovery process, mandatory reporting requirements of Section 111, and use of technology to improve the process and increase the rate of return. Ms. Taylor warned that "[a]ny restrictions on existing MSP rights or recovery processes would adversely affect savings that would otherwise accrue to the Medicare Trust Funds through MSP recovery activities, as well as the $1 billion per year in cost-avoided savings that CMS is able to track. Proposals that would impose mandatory process changes may affect Medicare's status as a secondary payer or its priority right of recovery, as well as CMS' ability to prioritize its own workload. These changes may also have the unintended effect of undercutting the underlying intent of the statute, increasing costs, and reducing existing savings."

James C. Cosgrove, Director, Health Care, United States Government Accountability Office, provided an overview of Medicare payments for MSP situations involving Non Group Health Plans (NGHP) and the MSP process for those situations. He also gave detailed illustrations of the MSP process for: (1) auto liability insurers, where a Medicare beneficiary is injured in an auto accident and goes to the hospital, the hospital bills Medicare, and Medicare pays the hospital; (2) no-fault insurance, where a Medicare beneficiary falls down and twists her ankle while visiting a neighbor's yard sale, and the Medicare beneficiary sends her medical bills to the neighbor's homeowner's insurance policy; (3) workers' compensation, where a Medicare beneficiary slips at work, sustaining a head injury, Medicare pays the initial medical expenses, but soon thereafter the employer's workers' compensation plan assumes primary responsibility for payment while a resolution is negotiated.

Marc Salm, Vice President, Risk Management, Publix Super Markets, Inc., discussed recommendations for improving the MSP process. He first suggested that a pathway be created to allow settling parties to receive conditional payment amounts from CMS before settlement is completed as a way to avoid pitfalls of the current system, which include delay or denial of benefits to beneficiaries, harm to providers and insurers who are prevented from resolving claims due to the increased risk of potential double liability, and loss to the Medicare Trust Fund due to the inability to recover at all due to settlements that are not concluded. He also suggested that a threshold be imposed for de minimis claims to assure that CMS stopped pursing claims that would yield less than the cost of recovery, especially given the numerous documented examples of Medicare pursuing claims worth no more than several dollars. Other recommendations included eliminating the required use of Social Security numbers, improving the reporting process to avoid punishing good faith compliance efforts in the same manner as intentional evasion attempts, and implementing administrative steps designed to improve customer service on the part of MSPRC.

Scott A. Gilliam, Vice President & Government Relations Officer, The Cincinnati Insurance Companies, outlined the following difficulties with the MSP Section 111 reporting process: (1) the particularly problematic reporting rule requiring insurers to collect Social Security numbers or Health Insurance Claim Numbers from all parties with whom the insurer settles claims, which often results in outright refusal from claimants and causes settlements to be scrapped; (2) the Draconian penalties imposed by the current MSP system, even where companies do their utmost to achieve full compliance; and (3) the misidentification of responsible parties as being liable for all of a beneficiary's current health care costs simply because the paying entity settled a small case with the beneficiary years ago, or in situations where the paying entity has never heard of the beneficiary and never provided them with any coverage or a policy. The witness recommended adoption of the Medicare Part D E-1 Query Process which identifies beneficiaries by the last four digits of their SSN, the imposition of discretionary (rather than mandatory) reporting penalties and a safe harbor for good faith reporting, and additional Congressional monitoring for preventative measures to address misidentification.

Jason Matzus, Partner, Raizman, Frischman & Matzus, Pittsburgh, Pennsylvania, described two significant difficulties that he has observed with the MSP system, based upon problems that his clients encounter in resolving claims with CMS. The foremost issue involves Medicare's refusal to provide a "Final Demand letter" specifying the reimbursement amount due to the Trust Fund from settlement or judgment proceeds until after a case is settled. The witness noted that Medicare's recovery process in this regard creates significant obstacles to settlement by denying all parties access to necessary and critical information, and actually works against the goal of maximizing Trust Fund recovery. Another significant problem involves extreme delays in obtaining Final Demand figures from Medicare, often extending out one year, and even past the point of settlement or trial. Specific examples included a beneficiary in failing health concerned about remaining alive while settlement funds remained in escrow awaiting final demand figures from Medicare as well as a Medicare beneficiaries facing the prospect of foreclosure after counting on settlement proceeds to reimburse them for co-pays and uncovered medical services, the payment of which forced them to skip mortgage payments. The witness called for Congressional action to empower Medicare to provide timely final demand information.

Ilene Stein, Federal Policy Director for the Medicare Rights Center, identified problems with the Medicare secondary payer process as falling into the following five categories: (1) untimely collection of Medicare's share of settlements, resulting from the lack of an established timeframe by which Medicare must notify beneficiaries about the reimbursement amount they owe if they settle a liability case; (2) MSPRC errors, which include miscalculations of amounts owed to Medicare, reimbursement requests for treatment unrelated to injuries associated with a particular injury claim, and improper segregation of claims; (3) difficulty obtaining information about secondary payer cases from MSPRC, caused by telephone wait times that often exceed one hour and the routine receipt of inaccurate or incomplete information from MSPRC representatives; (4) difficulty resolving cases with MSPRC, most often because of MSPRC's failure to properly close a case, thereby leading Medicare to continue functioning as a secondary payer and discontinuing payment for services unrelated to the improperly closed matter; and (5) various issues with notices, appeals, and the hardship waiver process, which arise from consumer notices that are incomplete and poorly written, overly restrictive and arbitrary eligibility requirements for waivers, requirements for extensive and specific documentation, and limited appeal rights. Recommendations to address these problems included administrative negotiations with CMS as well as statutory and regulatory changes relating to reporting rules, a limitations period for collection actions, improvements to notice procedures, increased transparency on the part of MSPRC, and automatic waiver for low-income consumers.

Access the complete transcripts here.