Showing posts sorted by relevance for query federalization. Sort by date Show all posts
Showing posts sorted by relevance for query federalization. Sort by date Show all posts
Friday, October 7, 2016
US Department of Labor Urges Major Changes in the Nation's Workers' Compensation System
Monday, January 18, 2016
Sanders Proposes Universal Health Care: The Path to Federalization
Friday, October 17, 2014
Path to Federalization: Obama May Name ‘Czar’ to Oversee Ebola Response
DALLAS — President Obama raised the possibility on Thursday that he might appoint an “Ebola czar” to manage the government’s response to the deadly virus as anxiety grew over the air travel of an infected nurse.  Schools closed in two states, hospitals and airlines kept employees home from work, and Americans debated how much they should worry about a disease that has captured national attention but has so far infected only three people here.A federal official said that the Centers for Disease Control and Prevention had broadened its search for contacts of Amber Joy Vinson, the second nurse infected with Ebola at Texas Health Presbyterian Hospital here, after interviewing family members who gave a different version of events from Ms. Vinson’s. The nurse had said she had a slight fever before boarding a flight from Cleveland to Dallas on Monday. But family members said she had appeared remote and unwell during her trip to Ohio over the weekend. The C.D.C. said it was now tracking down passengers on Frontier Airlines Flight 1142 from Dallas to Cleveland, which Ms. Vinson took last Friday. It had already been tracing passengers on her Monday flight.Ms. Vinson’s case raised flags for investigators because the day after she arrived home in Dallas, she reported substantial symptoms. Health experts say those would be unlikely to develop in just one day. Seven people in Ohio were voluntarily quarantined because they had contact with Ms. Vinson... |
Read more about the "The Path to Federalization"
Jul 05, 2012
United States Supreme Court has taken a giant leap forward to facilitate the Federalization of the entire nation's workers' compensation system. By it's recent decision, upholding the mandate for insurance care under the ...
Dec 23, 2010
Yesterday the US Congress passed and sent to the President, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program. The Federally ...
Jun 14, 2012
Yesterday the US Congress passed and sent to the President, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program. The Federally .
May 17, 2013
and will put greater control and more choice in the hands of individuals and small businesses." Read more about "Federalization" and workers' compensation: Path to Federalization: A National Workers Compensation System.
Friday, July 14, 2017
The Rise and Fall of Workers' Compensation - The Path to Federalization
Every year The Board of Trustees of the Federal Hospital Insurance and Federal Supplemental Medical Supplemental Medical Insurance Trust Funds makes an actuarial guess as to the future financial solvency of Medicare. The report creates an annual news frenzy in the workers’ compensation community since Medicare is both the safety net for injured workers and playground for employers and their insurance companies to use in cost shifting,
Thursday, June 25, 2015
The Path to Federalization: US Supreme Court Again Validates the Affordable Care Act
The US Supreme Court again affirmed the validity of The Affordable Care Act. The Obamacare program, as it has been nicknamed, will continue to lead to a medical delivery program than eventually will have major repercussions on the antiquated and ineffective medical care system of the existing patch work of state workers' compensation insurance acts.
Friday, May 17, 2013
Obamacare Will Be Collecting Workers' Compensation Medical Records
The implementation of Affordable Care Act data collection regulations will include the collection of medical information concerning work related accidents and injuries. The coalition of this information will broadly advance the concept of universal medical care and impose yet another route for the Centers for Medicare and Medicare to strengthen enforcement under the Medicare Secondary Payer Act.
The largest and most expansive database of personalized medical information is being established under the umbrella of an newly created unit under the authority granted to the Internal Revenue Service, The Federal Data Services Hub. Personal medical records, including electronic medical records, will be incorporated into the program.
"On March 23, 2010, the President signed into law the Patient Protection and Affordable Care Act
(P.L. 111-148). On March 30, 2010, the Health Care and Education Reconciliation Act of 2010
(P.L. 111-152) was signed into law. The two laws are collectively referred to as the Affordable
Care Act. The Affordable Care Act creates new competitive private health insurance markets –
called Exchanges – that will give millions of Americans and small businesses access to
affordable coverage and the same insurance choices members of Congress will have. Exchanges
will help individuals and small employers shop for, select, and enroll in high quality, affordable
private health plans that fit their needs at competitive prices. The IT systems will support a
simple and seamless identification of people who qualify for coverage through the Exchange, tax
credits, cost-sharing reductions, Medicaid, and CHIP programs. By providing a place for onestop shopping, Exchanges will make purchasing health insurance easier and more understandable
and will put greater control and more choice in the hands of individuals and small businesses."
Read more about "Federalization" and workers' compensation:
(P.L. 111-148). On March 30, 2010, the Health Care and Education Reconciliation Act of 2010
(P.L. 111-152) was signed into law. The two laws are collectively referred to as the Affordable
Care Act. The Affordable Care Act creates new competitive private health insurance markets –
called Exchanges – that will give millions of Americans and small businesses access to
affordable coverage and the same insurance choices members of Congress will have. Exchanges
will help individuals and small employers shop for, select, and enroll in high quality, affordable
private health plans that fit their needs at competitive prices. The IT systems will support a
simple and seamless identification of people who qualify for coverage through the Exchange, tax
credits, cost-sharing reductions, Medicaid, and CHIP programs. By providing a place for onestop shopping, Exchanges will make purchasing health insurance easier and more understandable
and will put greater control and more choice in the hands of individuals and small businesses."
Read more about "Federalization" and workers' compensation:
Thursday, June 14, 2012
National Experts Call Workers Compensation System Irrational and Unjust
National workers' compensation experts, Law school Dean Emily A. Spieler and Professor John F. Burton, in a recently published article in the American Journal of Industrial Medicine conclude that the present that the present workers' compensation systems is "irrational" and "unjust."
Characterizing the program as "....dizzying and frustrating in its complexity, and apparent irrationality," they conclude that "a substantial proportion of persons with work-related disabilities do not receive workers' compensation benefits." They review such alternatives as universal medical care, "providing healthcare to workers regardless of the source of injuries or disease."
Related Articles on Alternative Compensation Programs
Dec 23, 2010
Yesterday the US Congress passed and sent to the President, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program. The Federally ...
Feb 15, 2011
In December 2010 US Congress passed and President Obama signed, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program.
Jul 05, 2010
The trend toward Federalization of workers' compensation benefits took a giant step forward by recent Presidential action creating the British Petroleum Oil Compensation Fund. While the details remain vague, the broad and ...
Jul 13, 2010
As The Path To Federalization expands, this debate will expand. A recent study by the Center for American Progress addresses these concerns. "Health threats from the oil spill may linger unseen, perhaps for more than a ...
Mar 16, 2011
Historically The Federal government's role has been to rise to the occasion and walk further down a path to federalization. On a smaller scale than the potential consequences of the Japanesse debacle, the US was first in line ...
Mar 05, 2011
Nationally, advocates to improve the delivery of medical benefits to injured workers have urged federalization of the medical delivery system into a single payer approach through universal health care. ... Compensation Claim Draws Major Public Attention (workers-compensation.blogspot.com); Vermont Governor Sets Out to Lead U.S. to True Universal Coverage (huffingtonpost.com); The World Trade Center Health Program Expands The Path to Federalization ...
Thursday, July 5, 2012
Path to Federalization: A National Workers Compensation System--US Supreme Court Validates
United States Supreme Court has taken a giant leap forward to facilitate the Federalization of the entire nation's workers' compensation system. By it's recent decision, upholding the mandate for insurance care under the Affordable Health Care for America Act (ACA) 2009, it has set the precedent to federalize the nation's fragmented and chaotic workers' compensation medical delivery system.
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| John G. Roberts Jr., Chief Justice US Supreme Court |
Validating Mechanism
In a 5 to 4 ruling, Chief Justice Roberts validated the individual mandate as a permissible exercise of congressional power under the Taxing Clause of the US Constitution. Under 26 U.S.C. Section 5000A. The law requires that: (a) an individual must maintain minimum essential coverage for each month beginning after 2012; and (b) if there is a failure to maintain minimum essential coverage, a "penalty" is imposed "on the taxpayer" of $695 per year or 2.5% of family income, whichever is greater. The penalty "shall be assessed and collected in the same manner as taxes."
In a 5 to 4 ruling, Chief Justice Roberts validated the individual mandate as a permissible exercise of congressional power under the Taxing Clause of the US Constitution. Under 26 U.S.C. Section 5000A. The law requires that: (a) an individual must maintain minimum essential coverage for each month beginning after 2012; and (b) if there is a failure to maintain minimum essential coverage, a "penalty" is imposed "on the taxpayer" of $695 per year or 2.5% of family income, whichever is greater. The penalty "shall be assessed and collected in the same manner as taxes."
The Chief Justice, writing for himself, stated, "Every reasonable construction must be resorted to in order to save a statute from unconstitutionality." If it is "fairly possible" to interpret the statute as merely imposing a tax on those who've failed to purchase insurance. Writing for the majority, the Chief Justice stated, that the penalty is not a tax for anti-injunction act purposes. The Court, he wrote, needs to look beyond the label when assessing the constitutionality. For constitutional purposes Justice Roberts reasoned that the penalty may be considered as a tax when: it is not so high that there is no choice; and it is not limited to willful violations; and the penalty is collected by the IRS through normal means.
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| Constitution of the United States |
The Court indicated that the assessment is not really a "penalty." "Taxes that seek to influence conduct are nothing new," the Chief Justice wrote. He reasoned for the Court that there are no negative legal consequences to not buying health insurance, because beyond requiring a payment to IRS, Congress anticipated that some 4 million people would pay the penalty, and Congress did not treat them as "outlaws."
While certain taxes are prohibited under the U.S. Constitution, the penalty under the Affordable Health Care for America Act 2009 is not barred. The Court reasoned that the Constitution states, "No Capitation, or other direct, Tax shall be laid, unless in Proportion of the Census or Enumeration herein before directed to be taken." The majority of the Court held that a tax on "going without health insurance" does not fall within any recognized category of direct tax since it is triggered by certain specific circumstances.
The US Supreme Court previously validated compulsory workers' compensation programs. Compulsory compensation systems have been held not to be an arbitrary classification contrary to the equal protection clause of the United States Constitution, 14th Amendment. The state-enacted systems were created for the protection of the lives, health and safety of the employees. The systems provide payment of compensation through a state mandated system for injuries to employees or for the death of employees resulting from injuries related to work, regardless of fault. The compensation systems are held as a simple, inexpensive and expeditious method of providing recovery to employees who are injured in a highly organized and modern industrial employment environment. New York Central Railroad Company v. White, 243 U.S. 188, 37 S.Ct. 247, 61 L.Ed. 667 (1917). See also, Lower Vein Coal Co. v. Industrial Board of Indiana, 255 U.S. 144, 41 S.Ct. 252, 65 L.Ed. 555 (1921) and In re Asbestos Litigation, 829 F.2d 1233 (3d Cir.1987), cert. denied 485 U.S. 1029, 108 S.Ct. 1586, 99 L.Ed.2d 901 (1988).
The US Supreme Court previously validated compulsory workers' compensation programs. Compulsory compensation systems have been held not to be an arbitrary classification contrary to the equal protection clause of the United States Constitution, 14th Amendment. The state-enacted systems were created for the protection of the lives, health and safety of the employees. The systems provide payment of compensation through a state mandated system for injuries to employees or for the death of employees resulting from injuries related to work, regardless of fault. The compensation systems are held as a simple, inexpensive and expeditious method of providing recovery to employees who are injured in a highly organized and modern industrial employment environment. New York Central Railroad Company v. White, 243 U.S. 188, 37 S.Ct. 247, 61 L.Ed. 667 (1917). See also, Lower Vein Coal Co. v. Industrial Board of Indiana, 255 U.S. 144, 41 S.Ct. 252, 65 L.Ed. 555 (1921) and In re Asbestos Litigation, 829 F.2d 1233 (3d Cir.1987), cert. denied 485 U.S. 1029, 108 S.Ct. 1586, 99 L.Ed.2d 901 (1988).
Medical Delivery & Fees
Generally, the ACA provides a much needed national structure for the regulation, delivery, and enforcement of medical coverage. The ACA contains significant fraud and abuse provisions. In 2010 the law significantly expanded the government's authority to prosecute Faults Claims Act (FCA) cases. In 2011-2012 the ACA triggers increased provider screening, oversight and reporting. The ACA also establishes the Independent Payment Advisory Board to evaluate fee schedules and expands the scope of Medicaid and CHIP payments.
Unlike most State compensation systems that presently struggle with both expeditious medical delivery as well the value and responsibility of medical care, the ACA provides a uniform system and expeditious system. The fragmented network of complex, dilatory and inconsistent results in the State programs have been described recently by national experts as "irrational" and "unjust." They characterize the present compensation programs as "....dizzying and frustrating in its complexity, and apparent irrationality," and they conclude that "a substantial proportion of persons with work-related disabilities do not receive workers' compensation benefits," and in need of a better format.
Generally, the ACA provides a much needed national structure for the regulation, delivery, and enforcement of medical coverage. The ACA contains significant fraud and abuse provisions. In 2010 the law significantly expanded the government's authority to prosecute Faults Claims Act (FCA) cases. In 2011-2012 the ACA triggers increased provider screening, oversight and reporting. The ACA also establishes the Independent Payment Advisory Board to evaluate fee schedules and expands the scope of Medicaid and CHIP payments.
Unlike most State compensation systems that presently struggle with both expeditious medical delivery as well the value and responsibility of medical care, the ACA provides a uniform system and expeditious system. The fragmented network of complex, dilatory and inconsistent results in the State programs have been described recently by national experts as "irrational" and "unjust." They characterize the present compensation programs as "....dizzying and frustrating in its complexity, and apparent irrationality," and they conclude that "a substantial proportion of persons with work-related disabilities do not receive workers' compensation benefits," and in need of a better format.
Non-Traditional Revenue Stream
In addition to the widely publicized tax for non-compliance, the ACA contains several other innovative revenue provisions that will provide additional funding from collateral sources without burdening al employers globally. In 2010 an indoor tanning service tax was implemented. In 2011 annual fee was instituted on pharmaceutical companies as well as an increased penalty for early withdrawal from health savings accounts. In 2013 the following provisions go into effect: the Medicare payroll tax will increase for high-income individuals, an excise tax on medical device manufacturers, limits on Flexible Spending Accounts, and the elimination of the deduction for Employer Part D subsidy. In 2014 there will be an annual fee on health insurance plans. In 2018 there will be an excise tax and high-cost plans commonly referred to as the "Cadillac tax."
In addition to the widely publicized tax for non-compliance, the ACA contains several other innovative revenue provisions that will provide additional funding from collateral sources without burdening al employers globally. In 2010 an indoor tanning service tax was implemented. In 2011 annual fee was instituted on pharmaceutical companies as well as an increased penalty for early withdrawal from health savings accounts. In 2013 the following provisions go into effect: the Medicare payroll tax will increase for high-income individuals, an excise tax on medical device manufacturers, limits on Flexible Spending Accounts, and the elimination of the deduction for Employer Part D subsidy. In 2014 there will be an annual fee on health insurance plans. In 2018 there will be an excise tax and high-cost plans commonly referred to as the "Cadillac tax."
"Libby Care"--Universal Care
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| Center for Asbestos Related Disease Libby, MT. |
The Future: Universal Health Care
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| Landmarks on the Path to Federalization |
History reveals that a series of efforts have been made by the Federal government to federalize medical care for industrial accidents and illnesses. Those efforts demonstrate a commitment to bring the nation ever closer to a universal care medical program incorporating the entire patchwork of workers' compensation medical delivery systems. The US Supreme Court has accelerated the nation down that promising path.
....
Jon L.Gelman of Wayne NJ is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson).
Jun 14, 2012
Yesterday the US Congress passed and sent to the President, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program. The Federally .
Dec 23, 2010
Yesterday the US Congress passed and sent to the President, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program. The Federally ...
Feb 15, 2011
In December 2010 US Congress passed and President Obama signed, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program.
Jul 05, 2010
The trend toward Federalization of workers' compensation benefits took a giant step forward by recent Presidential action creating the British Petroleum Oil Compensation Fund. While the details remain vague, the broad and ...
Jul 13, 2010
As The Path To Federalization expands, this debate will expand. A recent study by the Center for American Progress addresses these concerns. "Health threats from the oil spill may linger unseen, perhaps for more than a ...
Mar 16, 2011
Historically The Federal government's role has been to rise to the occasion and walk further down a path to federalization. On a smaller scale than the potential consequences of the Japanesse debacle, the US was first in line ...
Mar 05, 2011
Nationally, advocates to improve the delivery of medical benefits to injured workers have urged federalization of the medical delivery system into a single payer approach through universal health care. ... Compensation Claim Draws Major Public Attention (workers-compensation.blogspot.com); Vermont Governor Sets Out to Lead U.S. to True Universal Coverage (huffingtonpost.com); The World Trade Center Health Program Expands The Path to Federalization ...
Apr 03, 2010
The recent health care reform legislation provided for the Libby Care which will provide universal medical care for victims of asbestos related disease. The plan is a pilot program for occupational disease medical care fully ...
May 19, 2010
The “Libby Care” provisions, and its envisioned prodigies, will embrace more exposed workers, diseases and geographical locations, than any other program of the past. Potential pilot programs will now be available to ...
Related articles
Tuesday, February 25, 2014
Throw The Book At 'Em
There seems to be no limit in the amount of fraudulent conduct that transpires within the workers' compensation system. If employer fraud is not enough, the system is constantly undergoing abuse from business interests, ie. medical provo\iders, who abuse the system. The Federal Governments role in enforcement is ever increasing and expansion is trending wider. The gobal expanssion nationally of a universal program for monitoring and enforcement of medical fraud is encouraging. Today's post is shared from David DePaolo http://daviddepaolo.blogspot.com/
It's a shame that hundreds, if not thousands, of injured workers underwent unnecessary spinal fusion surgeries and must live with the debilitating aftermath of significant disability because of people whose greed overrides the well being of fellow humans.
I had learned about Michael Drobot and Pacific Hospital of Long Beach, and their co-conspirators, preying on workers' compensation patients some time ago.
On Friday though, Federal prosecutors announced that Michael D. Drobot faces up to 10 years in prison after he pleaded guilty to paying kickbacks in a $500 million fraud scheme relating to spinal fusions and admitted to bribing state Sen. Ron Calderon to delay legislation to repeal the separate reimbursement for spinal hardware.
Calderon, D-Montebello, was indicted one day earlier on 24 charges, including bribery, money laundering, wire fraud and filing a false tax return. His brother, former...
[Click here to see the rest of this post]
Related articles
California state Sen. Ron Calderon accepted $88,000 in bribes, FBI affidavit alleges (workers-compensation.blogspot.com)
IMR: DWC Get Out of the Way (workers-compensation.blogspot.com)
One Claim Going OTOC (workers-compensation.blogspot.com)
Work Comp Lost Focus (workers-compensation.blogspot.com)
OK's True Cost Control Feature (workers-compensation.blogspot.com)
The Conflict Between NAFTA and Comp (workers-compensation.blogspot.com)
Being Professional (workers-compensation.blogspot.com)
Read more about "Federalization of Workers' Compensation"
It's a shame that hundreds, if not thousands, of injured workers underwent unnecessary spinal fusion surgeries and must live with the debilitating aftermath of significant disability because of people whose greed overrides the well being of fellow humans.
I had learned about Michael Drobot and Pacific Hospital of Long Beach, and their co-conspirators, preying on workers' compensation patients some time ago.
On Friday though, Federal prosecutors announced that Michael D. Drobot faces up to 10 years in prison after he pleaded guilty to paying kickbacks in a $500 million fraud scheme relating to spinal fusions and admitted to bribing state Sen. Ron Calderon to delay legislation to repeal the separate reimbursement for spinal hardware.
Calderon, D-Montebello, was indicted one day earlier on 24 charges, including bribery, money laundering, wire fraud and filing a false tax return. His brother, former...
[Click here to see the rest of this post]
Related articles
California state Sen. Ron Calderon accepted $88,000 in bribes, FBI affidavit alleges (workers-compensation.blogspot.com)
IMR: DWC Get Out of the Way (workers-compensation.blogspot.com)
One Claim Going OTOC (workers-compensation.blogspot.com)
Work Comp Lost Focus (workers-compensation.blogspot.com)
OK's True Cost Control Feature (workers-compensation.blogspot.com)
The Conflict Between NAFTA and Comp (workers-compensation.blogspot.com)
Being Professional (workers-compensation.blogspot.com)
Read more about "Federalization of Workers' Compensation"
Jul 05, 2012
United States Supreme Court has taken a giant leap forward to facilitate the Federalization of the entire nation's workers' compensation system. By it's recent decision, upholding the mandate for insurance care under the ...
Dec 23, 2010
Yesterday the US Congress passed and sent to the President, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program. The Federally ...
Jul 05, 2010
The trend toward Federalization of workers' compensation benefits took a giant step forward by recent Presidential action creating the British Petroleum Oil Compensation Fund. While the details remain vague, the broad and ...
Jun 14, 2012
Yesterday the US Congress passed and sent to the President, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program. The Federally .
Monday, October 5, 2015
And they didn't see it coming........
Rafael Gonzalez authored a very helpful, and spot on, post today that summarizes the new approach of The Centers for Medicare and Medicaid Services (CMS) to recoup benefits under Medicare Secondary Payer law (42 U.S.C. § 1395y(b)) (MSP) before a final determination is made in the underlying workers' compensation claim.
Additionally, the cottage industries (lawyers, insurance carriers & employers, ie. MARC) who lobbied for The Strengthening Medicare and Repaying Taxpayers (SMART) Act of 2011, never saw the forest from the trees as they tried to stake out their territory.
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| Rafael Gonzalez |
With multiple reporting trigger points CMS is new able to capture data quickly and with the implementation of the expedited US Treasury debt collection procedures, the Digital Accountability and Transparency Act (DATA Act). the process will now ignore the sluggish/delayed workers' compensation program/adjudication.
CMS has now operationalized a new procedure, "As part of the continuing efforts to improve the Coordination of Benefits & Recovery (COB&R) program and claims payment accuracy in Medicare Secondary Payer (MSP) situations, the Centers for Medicare & Medicaid Services (CMS) will be transitioning a portion of the Non-Group Health Plan (NGHP) recovery workload from the Benefits Coordination & Recovery Center (BCRC) to its CommercialRepayment Center (CRC)."
Ironically, this process cuts through the red tape and cottage industry's interests of the State programs and moves the claims to the goal of Federalization of the entire system based also on a uniformity of processing, coding and determinations at the Federal administrative level. See also, D. Torrey, The Federalization Standards Issue, A Short History Before and After NFIB v. Sebelius (2012), ABA, 2013. "These views speak loudly to the expectation of educated observers that state-based workers’ compensation will endure and that federalization is unlikely."
CMS has now operationalized a new procedure, "As part of the continuing efforts to improve the Coordination of Benefits & Recovery (COB&R) program and claims payment accuracy in Medicare Secondary Payer (MSP) situations, the Centers for Medicare & Medicaid Services (CMS) will be transitioning a portion of the Non-Group Health Plan (NGHP) recovery workload from the Benefits Coordination & Recovery Center (BCRC) to its CommercialRepayment Center (CRC)."
Ironically, this process cuts through the red tape and cottage industry's interests of the State programs and moves the claims to the goal of Federalization of the entire system based also on a uniformity of processing, coding and determinations at the Federal administrative level. See also, D. Torrey, The Federalization Standards Issue, A Short History Before and After NFIB v. Sebelius (2012), ABA, 2013. "These views speak loudly to the expectation of educated observers that state-based workers’ compensation will endure and that federalization is unlikely."
Perhaps, the very next step may be an effort to follow the liability program models, wherein pre-disposition, alternate resolution, is possible early in the process, ie. the mass tort specialized programs for resolution.
Of course, workers' compensation (WC) insurers and employers would then need to really expedite WC claims. But then, wasn't that the intent of the now antiquated 1911 system anyway?
Click below to read the post on LinkedIn:
New Process for Primary Payers Resolving Medicare Conditional Payments Begins Today
Click below to read the post on LinkedIn:
New Process for Primary Payers Resolving Medicare Conditional Payments Begins Today
Monday, July 5, 2010
Designing the New Federal Workers Compensation Program
The trend toward Federalization of workers’ compensation benefits took a giant step forward by recent Presidential action creating the British Petroleum Oil Compensation Fund. While the details remain vague, the broad and sweeping concept of inclusiveness is more than obvious.
This is not a surprising turn of events. It is entirely consistent with a broad pattern to sweep the ailing and fragmented patch work of state programs into a unified Federal program. In an era of economic depression, national health care reform and major workforce changes this approach is consistent with the underlying bipartisan national philosophy.
Columnist and an expert in the field, Peter Rousemaniere, recently concluded an analysis of system’s failures that have literally pushed workers’ compensation into a federalized program. “The states and workers' compensation insurers have for decades weaseled on the promise to protect workers from occupational illnesses and to honor their claims.”
The knee jerk reaction, one would think, would be this could never happen because of interested stakeholders. In reality, they have been silently distracted by more far reaching issues and have been economically drained of resources to the point where they’ll take anything the Federal Government can offer to save them from extinction.
The Federal government is not unfamiliar with the administration and distribution of benefits. Since 1882 the federal government has been providing benefits to injured workers and their widows: in 1900 the postal workers compensation system was established; in 1908 the Federal government established a program for those who work in hazardous environments; and, in 1932 the Social Security Administration was established. However, the Social Security Act did not embrace workers’ compensation in 1932 since the primary goal of the law was to reduce unemployment.
The federal programs have produced a dismal result over the last few years. The Federal Victims Compensation Fund, enacted following the horrific tragedy of September 11th, 2001, has a very strict eligibility criteria and a limited recovery scheme. The Smallpox Emergency Personnel Protection Act of 2003 (SEPPA) was enacted following an aborted vaccination program after the government reluctantly disclosed available medical research concerning potential fatal cardiovascular reactions. A risk analysis demonstrated that this program may not have been needed at all but was merely implemented to sway public opinion. Ultimately, the federal government halted the Smallpox Vaccination Program and funded $100 million for the purpose of cleaning up the legacy of adverse medical reactions and to ease the burden placed upon the victims and their estates that were struggling to obtain benefits under State compensation programs.
The Energy Employees Occupational Illness Compensation Program Act of 2000 (EEOICPA) (P.L.106-398) was enacted into law in October, 2000 with strong bipartisan support. EEOICPA established a program to provide compensation to employers of the Department of Energy (DOE), its contractors and subcontractors, companies that provided beryllium to DOE, and atomic weapons employers.
The Federal health care reform is a big Federal deal for workers’ compensation as it establishes the Libby Health Care Plan with far reaching impact by involving Medicare to deliver health care. The ongoing integration of conditional payments (Medicare Secondary Payer Act and mandatory reporting) as well as the review of all compromises concerning the provision of future medical care (Workers Compensation Medical Set-aside Agreements) is already anther Federal foot in the door to prevent what in the past was a tradeoff of medical care to US taxpayer without consideration.
While federalization may not be the panacea, the target remains to limit the cost of medical expenses and provide an efficient and remedial benefit delivery system at minimal cost for administration and to hold the appropriate parties financial responsible. The costs of maintaining duplicate medical delivery systems for workers, major medical and workers’ compensation, continues to represent an unnecessary and costly duplicate expenditures in administration and management.
The BP-Federal Oil Compensation Plan is yet another attempt to find a solution. While it may not be perfect, hopefully it will be guided successfully and will learn from past Federal trials and errors dabbling in workers’ compensation. It is obviously not the perfect solution, but that may only exist as an unattainable goal. The first step is a comprehensive and integrated Federal workers’ compensation program. A step in the right direction would be for the Federal Government to take primary responsibility for all occupational workers’ compensation claims. This would be an innovated initial approach to implement a new Federally administered Workers’ Compensation system.
Saturday, March 5, 2011
Vermont Universal Health Care to Embrace Workers Compensation
The legislation " proposes to set forth a strategic plan for creating a single payer and unified health system. It would establish a board …. ; establish a health benefit exchange for Vermont as required under federal health care reform laws; create a public-private single payer health care system to provide coverage for all Vermonters after receipt of federal waivers.”
The plan proposes covering all workers' compensation claims:
"(3) To the extent allowable under federal law, the Vermont health benefit exchange may offer health benefits to employees for injuries arising out of or in the course of employment in lieu of medical benefits provided pursuant to chapter 9 of Title 21 (workers’ compensation)."
"(c) If the Vermont health benefit exchange is required by the secretary of the U.S. Department of Health and Human Services to contract with more than one health insurer, the Vermont health benefit exchange shall determine the appropriate method to provide a unified, simplified claims administration, benefit management, and billing system for any health insurer offering a qualified health benefit plan. The Vermont health benefit exchange may offer this service to other health insurers, workers’ compensation insurers, employers, or other entities in order to simplify administrative requirements for health benefits."
Nationally, advocates to improve the delivery of medical benefits to injured workers have urged federalization of the medical delivery system into a single payer approach through universal health care. The proposed Vermont single payer system is a unified state approach to the co-ordinated delivery of medical care.
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