Division of Workers Compensation

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Division of Workers Compensation

• Workers Compensation Update
• News Information from DIR and DWC

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Workers Compensation Overview

• Californias economy
• 50 billion system costs saved due to reforms
• Claims are declining
• Medical costs are increasing
• Whats next?

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The average workers compensation insurer rate
dropped

• From a high of 6.45 per 100 of payroll in the
  second half of 2003
• To 2.25 per 100 of payroll in 2008.
• A decline of 65 percent.

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• Helping Californias businesses thrive
•  
• Estimated savings for all employers, both insured
  and self-insured
•  

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Claims are Declining
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Medical Costs reform

• The data shows an increase in medical costs for
  cases with dates of injuries in 2006 and 2007.
  The increase costs are attributable to
• a 4.1 increase in visits per claim,
• 4.9 increase in number of procedures per visit,
  and
• 20 increase in the average number of
  prescriptions per claim.
•  

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Medical Costs reform

• 3.6 increase for average paid per procedure
• 8.2 increase for average paid per prescription

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Possible Cost-Saving Legislative Initiatives

• Amend Labor Code section 5307.1 to mandate
  adoption of the Medicare Ambulatory Surgical
  Center fee schedule.
• Adopt a statute to prohibit claims
  administrators/adjustors from receiving a
  kickback for referral of case to a UROs

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Possible Cost-Saving Legislative Initiatives

• Amend Labor Code section 4610 relating to UR to
  reduce unnecessary administrative burdens/costs
• Amend Labor Code section 4660 to tighten the
  statutory language to avert problems created by
  the Almaraz/Guzman decisions.
• Amend the lien statutes

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What DWC has done to help control medical costs

• Between 2005 and 2008, DWC implemented 18 new
  sets of regulations, an average of 6 regulatory
  packages per year.
• Including MTUS, UR, MPNs, QMEs, IMEs, return to
  work, PDRS, medical-legal fee schedule, audits
  and the Official Medical Fee Schedule.

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Overview of recent DWC regulations related to
containment of medical costs

• http//www.dir.ca.gov/dwc/dwcRulemaking.html
• Medical Treatment Utilization Schedule (MTUS)
  initially ACOEM
• Currently ACOEM acupuncture MEEAC
• Amended ACOEM acupuncture ODG
• Added chapters for postsurgical and chronic pain
  from ODG
• Elbow chapter is from ACOEM
• Chapter format allows easy updates
• Effective July 18, 2009

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Regulations Recently Completed

• Qualified Medical Evaluators (QME)
• Effective Feb. 17, 2009
• Changed all IMC to DWC Medical Unit
• Updated to match reforms
• New fillable forms posted online
• New sections on panel request forms

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Regulations in the Pipeline

• HCO
• On forum in December
• Public Hearing July 27, 2009
• Will reduce HCO fees

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Regulations in the Pipeline

• MPN and notice to employees poster
• On forum in January/February
• Advisory meeting in April
• Public Hearing October 7, 2009
• Simplify and reduce required notices
• Poster updated

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Regulations Later This Year

• PR-2 form
• UR
• WCIS
• Employers first report
• Medical e-billing
• Physician fee schedule
• Pharmacy networks
• EAMS electronic filing

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Other Regulations Recently Completed

• Electronic Adjudication Management System (EAMS)
• Effective Nov. 17, 2008
• Grace period for professionals ended Dec. 12
• Grace period for unrepresented IWs ended Feb. 17
• Forms posted online
• OCR forms handbook posted online

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Other Regulations Recently Completed

• Audit Unit
• Audit procedures and administrative penalty
  schedule
• Mandatory contents of claim file
• Definition of terms
• PAR factor includes Notice of Eligibility for
  SJDB
• File with Secretary of State April 20, 2009
• Effective May 20, 2009

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Whats happening at the district offices ?

• Consolidations/ liens
• Vocational Rehabilitation
• Almaraz/Guzman en banc cases
• Relocated offices

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