Copyright

(c) 2010-2024 Jon L Gelman, All Rights Reserved.

Friday, August 8, 2008

CMS Gearing Up for Mandatory Insurance Reporting

CMS will implement mandatory insurance company reporting: GHP January 1, 2009 and liability insurance carriers (workers’ compensation) on July 1, 2009. Mandatory reporting announcements will be posted on the CMS web site and e-mail notices may be requested by e-mail

The new provisions for Liability Insurance (including Self-Insurance), No-Fault Insurance, and Workers' Compensation found at 42 U.S.C. 1395y(b)(8):

Add reporting rules; do not eliminate any existing statutory provisions or regulations. The new provisions do not eliminate CMS' existing processes if a Medicare beneficiary (or his/her representative) wishes to obtain interim conditional payment amount information prior to a settlement, judgment, award, or other payment.

Include penalties for noncompliance.

Who must report: "an applicable plan." "…[T]he term 'applicable plan' means the following laws, plans, or other arrangements, including the fiduciary or administrator for such law, plan or arrangement: (i) Liability insurance (including self-insurance). (ii) No fault insurance. (iii) Workers' compensation laws or plans."

What must be reported: the identity of a Medicare beneficiary whose illness, injury, incident, or accident was at issue as well as such other information specified by the Secretary to enable an appropriate determination concerning coordination of benefits, including any applicable recovery claim.

When/how reporting must be done:

• In a form and manner, including frequency, specified by the Secretary.

• Information shall be submitted within a time specified by the Secretary
after the claim is resolved through a settlement, judgment, award, or other
payment (regardless of whether or not there is a determination or
admission of liability).

• Submissions will be in an electronic format.

Wednesday, July 30, 2008

The Asbestos Debate is Over

Almost 45 years following the historic 1964 NY Academy of Medicine conference in New York experts continue to memorialize the history of asbestos related disease. Now enters, defense expert John E. Craighead, who has written his viewpoint on the subject.

Asbestos is one of the modern world’s most historic occupational medical disasters. Not only is it well documented, it continues not to be banned in the US , in fact, the incidence of asbestos related disease reported has turned upward, according to recently released NIOSH data (1979-2003.

In a recent review of the Craighead volume, the New England Journal of Medicine, has called it, “….highly personalized with strong individual viewpoints. It is less authoritative as a source for risk assessment and litigation issues.”

Yet others have including: Victor L. Roggli (Pathology of Asbestos-Associated Diseases), Barry I. Castleman (Asbestos: Medical and Legal Aspects, Fifth Edition) and Paul Brodeur (Outrageous Misconduct) have followed in the historic footsteps of the late, Irving J. Selikoff, MD and have guided us to seek a remedy and cure for wrongdoings of the past.

The asbestos debate is over. It is no longer time to profit from the debate and sell controversy. It is no longer time to allow this product to be sold anywhere in the world for profit. It is time to direct attention to provide medical treatment to those who suffer from asbestos related illness and draw our attention to find a cure for this disease.

Friday, July 25, 2008

The Future of Workers' Compensation: Navigating the New Benefit Highway

The Future of Workers' Compensation: Navigating the New Benefit Highway

The past and present will predict the future of the new workers' compensation benenfit highway. This Power Point presentation is available in a PDF format and for the next 14 days may be securely downloaded from https://www.yousendit.com/transfer.php?action=download&ufid=Smp1Q3QzTWNtUUZFQlE at no cost to the first 500 requests.

Link available at:
https://www.yousendit.com/transfer.php?action=download&ufid=Smp1Q3QzTWNtUUZFQlE

The Federal Government is Offering Funding for a World Trade Center Non-Responder Medical Program.

An announcement has been for applications for the provision of screening, referral and treatment services for residents, students, and others in the community, related to the September 11, 2001 terrorist attacks in New York City. The program is aimed at the ‘non-responder population.’ Since September 11, 2001, the Department of Health and Human Services, CDC, and NIOSH have been active in assessing the health impact of the World Trade Center disaster. There is currently a program in place to provide health assessment examinations, diagnosis, and treatment for first response emergency personnel (the responder population) in the New York City (NYC) area. The application deadline is August 25, 2008.

The grant awardee would be involved in the following activities:


1. Immediately provide for accessible health assessments, eligibility confirmation, diagnostic, referral and treatment services (including medications and durable medical equipment) to the non-responder population for health conditions associated with WTC dust/debris exposure.


2. Identify the organizational components required to support access to these services, including personnel, examination venues, maintenance of patient records, data platforms and management, compliance with applicable laws, assurance of quality care, coordination of healthcare benefits, and programmatic recordkeeping.


3. Provide referral and treatment services with grant funds only as the Payor of Last Resort. Private health insurance (self-funded or employer-funded), workers’ compensation insurance (employer-funded), and government-funded health insurance (Medicare and Medicaid) shall be used first before grant funds are used. Applicants should demonstrate their capacity to determine insurance status and to seek reimbursement from outside payers. Funds shall not be used to supplant existing activities or for the treatment of the responder population.


4. Establish service information and patient management systems as needed in order to accommodate intake, referral, prompt healthcare services, and reporting of the services provided to the non-responder population. In carrying out these activities, collaborate with other WTC-related healthcare providers, as appropriate and needed.


5. Develop a written Management and Prioritization Plan which identifies the projected service delivery area, explains how the assessment of potential non-responder patient needs will be determined, provides a strategy to ensure meeting those needs, and provides a section focused on ensuring prioritization and management of this program’s health services delivery to meet those needs, within the broader context of all organizational activities and responsibilities. The applicant should state an estimate for the number of non-responders to be served with the requested funds and provide a justification based on an estimation of the projected costs to provide health assessment examinations, and the costs to provide treatment for the expected World Trade Center-related conditions that will be identified.


6. Provide patient encounter reporting on health assessment examinations and treatment to NIOSH for quality assurance. 7. Establish and maintain information and data management systems that will ensure the provision to NIOSH of electronic data in a uniform fashion


Complete Announcement

Thursday, July 24, 2008

New Chemotherapy Treatment Reported "Responsive" to Mesothelioma


A new set of drugs has been reported responsive in treating mesothelioma, a tumor caused by exposure to asbestos fiber. The British Journal of Cancer has reported that cisplatin and vinorelbine effective in the treatment of mesothelioma. “Cisplatin and intravenous vinorelbine is a highly active regimen in MPM with a response rate and survival comparable to the most active regimens so far reported.”

The report appears in the June 10, 2008 edition of The British Journal of Medicine.

Saturday, July 12, 2008

NJ Workers' Compensation Legislative Analysis



Why there is a need to increase “The Cap.”

NJ’s Statutorily Imposed Cap of Benefits
The average worker is dependent upon his weekly wage to provide the necessities to maintain a standard of living for himself and his family. When the flow of salary ceases, immediate concern focuses on the provision of food, clothing and shelter. The Workers' Compensation system is a major social benefit program that addresses the need to provide for benefits to replace earned wages and a “socially adequate” standard of living.
Disability rates for workers' compensation benefits in the State of New Jersey are based upon the computation of the wages of the injured employee. Statutorily, the wages are defined to mean "the money rate" at which the service rendered is compensated.

Since the Act was amended in 1979, New Jersey workers' compensation benefits are based upon the statewide average weekly wage (SAWW). There are both minimum and maximum compensation rates. The Act provides for a sliding scale of maximum allowable weekly benefits through the first 180 weeks of disability, and thereafter eliminates the sliding scale, replacing it with a single percentage rate, which itself increases as the severity of the disability increases. The beginning rate of disability is 20% of the SAWW, and increases by approximately one percent until it reaches the level of 35% of the SAWW for injuries which warrant disability payments of over 180 weeks. [From that point on, as the severity of the disability increases, the percentage of the SAWW which is paid also increases by five (5) percentage points for approximately every 30 weeks of disability paid.

NJ’s Dilemma:
2008 State Average Weekly Wage (SAWW)
NJ State Average Weekly wage (SAWW) for all workers was determined to be $989.23, 39 N.J.R. 3714(a).
NJ State Average Hourly Wage for 2008, calculated as 1/40th of the SAWW = $24.73, NJSA 34:15-12. The Maximum Workers’ Compensation benefit, which is capped at $75% of the SAWW for 2008 is $742 per week.
The Maximum HOURLY Workers’ Compensation SAAW cap is, based on a 40 hour week, $18.55.

Many workers in NJ are earning wages that EXCEED $18.55 per hour!

Where NJ Stands in Comparison to Other States
13 States have SAWW Caps that are higher than 100%. Iowa has 200%. 20 States, including close or nearly adjacent States/Federal District (Pennsylvania, Rhode Island, Connecticut, Massachusetts and District of Columbia.), have 100%.

Of the States with fixed dollar caps on benefits, 33 States have caps that are 100% or greater than New Jersey and only 6 states have dollar caps lower than NJ.What an increase in “the cap” would cost NJ. It has been estimated that in increase in the cap merely from 75% to 80% would cost no more that a 1% percent increase in total cost and therefore an increase to 100% would be no more than 5% or about $100 million.
Cost of NJ System in Comparison to Other Systems
The most current numbers available indicate that the cost of workers’ compensation benefit per $100 payroll compare as follows:NJ = $0.85 (which amounts to 81% of the national average)All States – National Average = $1.05

NJ presently rates14th lowest in cost nationally and a mere increase of only 5% would increase the cost to $0.89 which equates to 85% of the national average which would rank NJ still as 19th lowest in cost.


Friday, June 20, 2008

Florida’s “Circle Solution” Revisited: NJ Struggles to Speed up the Benefit Highway

After a major investigative report entitled “Waiting in Pain,” the Star Ledger, newspaper reflected delays and frustrations in the operation of the NJ Workers’ Compensation system. The NJ Legislature has found itself struggling to define an effective approach to resolve the problems of the century old compensation system.

The Legislature immediately convened a hearing to discuss the issue. It heard testimony from many of the stakeholders, except the victims of the alleged abuse, the injured workers. Their voices were silent.

In a complete about face the leadership of the Legislature turned from the initial comments that the system was “completely dysfunctional” and needed a complete overhaul, to its present course of action, a piecemeal modification of the Act without the benefit of a complete and thorough evaluation of the system.

The enormous delay in the delivery in medical care appears to be a most significant and complex issue facing the Workers‘Compensation system in New Jersey and other jurisdictions throughout the United States. Medical benefits, which have soared in cost, now have now become the epicenter of controversy.

It is obvious that the system is need of more than merely first aid. A complete evaluation of the system is required such as has been proposed by Assemblyman Neil Cohen. Without such an evaluation it is difficult to determine a valid diagnosis, never mind trying to define a plan for treatment.