4-7-2011; Hot news on WC legislative reform from beautiful Springfield, IL—it may be happening as soon as this Friday!

Last week, KC&A reported Governor Quinn was hot on the trail of meaningful WC reform. Last week, he released an outline of reform proposals he was seeking to enact. We would like to report them to you directly. We also note an exhaustive search of the Illinois General Assembly’s website this morning has confirmed the only drafted bills currently in the system are the previously reviewed SB 1349 and HB2883 which were previously discussed.

Per the article released by his administration, the Governor is seeking to have a bill presented by April 15, 2011 (just in time for tax day?). The Governor stated he supports a number of “common sense” reforms – the following is taken directly from his press release:

•           Caps on carpal tunnel disability payments

•           Restoring compensation for temporary total incapacity partial disability to pre-2005 levels (savings as much as $50 million)

•           Denial of claims by intoxicated workers injured due to their inebriation

•           Enhanced authority to investigate and prosecute fraud

•           Capping wage differential awards at the age of 67 or 5 years post-accident, whichever is later (saving as much as $87 million)

•           Increased utilization review of physical therapy, occupational therapy, and chiropractic care (savings estimated at  $16 million)

•           Insurers must accept electronic billing from providers, protecting workers from treatment disruption.

•           Insurers/employers must pay providers on a timely basis, or pay providers interest and penalties.

•           We must enhance enforcement against employers who fail to maintain proper coverage.

•           Current arbitrators’ terms will end and be subject to performance evaluation prior to re-appointment.

•           Arbitrators will serve 3-year terms, be licensed attorneys, act in an unbiased, impartial manner, and follow the same rules that apply to Judges.

•           Attorneys before the commission will follow the same ethical standards as attorneys before a court.

•           Claims by commission appointees or employees will be heard by the Court of Claims, and not arbitrators within the commission.

•           The State of Illinois can engage appropriate outside vendors to operate all or part of the state’s self-insured workers compensation program.

•           An advisory board will be appointed to review and report to the General Assembly about the state's workers’ compensation program, including needed improvements and adherence to best practices.

We have also been repeatedly asked by our readers and other national sources about what we are calling the “Bradley Bill” which is designed to immediately end the Illinois Workers’ Compensation system. We consider this more legislative maneuvering and feel it has literally no chance at passage. If you read today’s news on www.workerscompcentral.com, you may note your editor is quoted as saying legislation to resolve workers’ compensation injury disputes by “belly-bumping” has a better chance of being passed. If you want all the reasons the Bradley Bill won’t be seriously considered, send a reply.

If you have any questions or comments, please forward them to our resident Blog Administrator, Arik D. Hetue, J. D. who can be reached at ahetue@keefe-law.com. Currently the blog archive goes back through January 2009, however we have plans to archive all issues of the Monday Law Update, all the way back to the founding of KC&A in June 2003. Be sure to stop on by.

4-7-2011; The Greater Oak Brook Chamber of Commerce Presents HFN’s Annual Healthcare Showcase If Health Insurance is Just Pre-paying expenses…How Do I Manage Healthcare Risk Today?

HFN is hosting this event and inviting all of our readers to this interesting and challenging presentation.

Topics & Speakers will include:

• Employer Expectations are High for Good Reason!
  • Mary Lynn Fayoumi, CAE, SPHR, GPHR, President/CEO The Management Association of Illinois

• Healthcare Reform and the Rapidly Evolving Self Insurance Market
  • Walter Roland, Senior Vice President, D.W. Van Dyke & Co., Inc.

• Do You Know What You Must Do Now With Your Health Plan? A Checklist to Live By!
  • Ronald Walter, CLU, ChFC, President Professional Benefit Administrators, Inc.

• Why is the Employer’s Opportunity so Significant Today?
  • David Kolb, FACHE, President/CEO HFN, Inc.

Date: Wednesday, May 4, 2011

Time: 7:15 – 8:15 Health Assessments*

7:30 – 8:15 Full Breakfast

8:15 – 10:00 Presentation & Discussion

Location: The Grotto Oak Brook, 3011 Butterfield Rd, Oak Brook, IL 60523 (630) 571-5700

RSVP: Please RSVP By April 27, 2011 to Danielle Kolego 630/990-8501 or email kolegod@hfninc.com

4-7-2011; Will changes to the Medicare Secondary Payer Statute assist in resolving Medicare issues and finally give us a way to appeal what are sometimes incomprehensible MSA values?

On March 14, 2011, the Strengthening Medicare and Repaying Taxpayers Act of 2011 (SMART Act) (H.R. 1063) was introduced in the U.S. House of Representatives. The SMART Act proposes major amendments to the Medicare Secondary Payer Statute (MSP). Track progress here: http://www.govtrack.us/congress/bill.xpd?bill=h112-1063       

The SMART Act’s reform proposals target multiple areas of MSP compliance including:

•       Obtaining CMS’ reimbursable conditional payment amount—this will help the parties confirm amounts which will be owed for past medical. Under CMS’ current process, the parties generally cannot obtain the exact reimbursable conditional payment amount until after the claim settles.

•       Requiring CMS to respond  to requests  for conditional payment information within set timelines—finally you won’t be stuck in the purgatory of never knowing when you will receive information you need to resolve past payments, hopefully within 120 days or less;

•       MSP appeal rights—when you receive the $100k MSA ruling for a person who hasn’t had a surgical procedure, you may have somewhere to turn as review through an administrative law judge and administrative review board, and access to judicial review in the district court of the United States is proposed in a manner which would be similar to the appeals procedure under regulations for hearing procedures respecting notices of determinations of nonconformance of group health plans.

•       MSP threshold exemptions—the SMART Act would require that CMS establish an annual MSP threshold exemption amount below which MSP compliance would not be necessary. The SMART Act’s proposal of a yearly MSP threshold exemption amount replaces the flat $5,000 monetary threshold exemption proposed last year.

•       MSP statute of limitations—you would no longer have to worry about someone looking into a claim well after all parties have retired as the SMART Act would establish a Three (3) year Statute of Limitation for MSP Claims.

We will keep you advised of changes as they occur and as previously noted, Shawn R. Biery has completed course work and testing from two sources to obtain his Medicare Set-aside Consultant Certified (MSCC) credential.

Please feel free to contact Shawn R. Biery, J.D., M.S.S.C. at sbiery@keefe-law.com with any questions regarding Medicare Set-Aside issues.