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Wednesday, August 5, 2015
CMS to Speed-Up MSP Collection Practices
Friday, July 24, 2015
Social Security Disability Solvency: The Backbone of Workers' Compensation
Over the decades, for numerous economic, social and political factors, the nation's workers' compensation program has continued to diminish in it's ability to deliver as intended. Both the medical and indemnity components have been difficult to obtain, and have restricted what they do deliver.
Thursday, May 28, 2015
In the name of privacy...
The real issue is that while workers' compensation records are supposedly confidential in State systems, the Federal government has consistently neglected to insure that privacy whether be: medical records under HIPPA; by integration of state's motor vehicle or workers' compensation records utilizing Social Security Numbers, or by Medicare Secondary Payer Act electronic data systems.
Additionally, the Federal government will probably be mandating the reporting workers' compensation payment information, in Federal Income Returns shortly. The batting record of the IRS this week on privacy has been dismal.
Time will only tell whether workers' compensation data can actually be shielded from intruders.
CMS announced today:
"As part of the Strengthening Medicare and Repaying Taxpayers (SMART) Act, the Centers for Medicare & Medicaid Services (CMS) will be implementing optional MFA services on the MSPRP. MFA is the use of two or more different authentication factors to verify the identity of an end user. Verified users will have access to view unmasked claim data on the Portal.
"Non debtors will still need to have a Verified Proof of Representation or Consent to Release authorization to perform actions on cases. Please note that MFA and the associated identity proofing process will be optional to portal users. Portal users may continue to use the portal without going through the MFA process but will not have the benefit of viewing un-masked data.
"MFA is scheduled to be available beginning on July 13, 2015. Updated user guides and training materials will be available on CMS.gov and within the portal upon implementation.
Related articles
- 2016 Budget Proposal Would Require Reporting of Workers' Compensation Benefits to Social Security Administration (workers-compensation.blogspot.com)
- Trickle Down Stagnation (workers-compensation.blogspot.com)
- CMS Comments: "No Comment" on The Forthcoming Smart Act Regulations (workers-compensation.blogspot.com)
- CMS Posts Sample Notice To Beneficiaries Regarding Appeal Rights (workers-compensation.blogspot.com)
- On-Demand Labor - Is Workers' Compensation Ready for Flex-Time Employment? (workers-compensation.blogspot.com)
- Is The Reserve Offset Heading for Extinction? (workers-compensation.blogspot.com)
- Coordination of Benefits and Non-Group Health Plan Recovery Transition (workers-compensation.blogspot.com)
Thursday, May 7, 2015
NJ State Bar Association Opposes Workers' Compensation COLA Bill
Thursday, April 23, 2015
US FDA: Designation for CRS-207 in Mesothelioma Treatment
Aduro Biotech, Inc. today announced that the Office of Orphan Product Development of the U.S. Food and Drug Administration (FDA) has granted orphan drug designation to CRS-207, a novel immuno-oncology product candidate, for the treatment of mesothelioma. This designation potentially allows Aduro seven years of limited marketing exclusivity in the United States if it is the first to obtain FDA marketing approval for mesothelioma, and qualifies the company for grant funding to offset the cost of clinical testing as well as tax credits for certain research and a waiver of the Biologics License Application user fee. The FDA previously granted orphan designation to CRS-207 and GVAX Pancreas for the treatment of pancreatic cancer.
“This is an important step for Aduro as we continue to develop CRS-207 for this very difficult to treat cancer,” said Dirk Brockstedt, Ph.D., senior vice president of research and development at Aduro. “We believe the combination of CRS-207 together with chemotherapy may offer the promise of a potential new therapeutic regimen for patients suffering from mesothelioma. Importantly, we plan to report additional data from the ongoing Phase 1b study later this year.”
Click here to read the entire article
Monday, March 9, 2015
Is The Reserve Offset Heading for Extinction?
Social Security-Budget Estimates and Related Information
Budget Overview, February 2015
"10. Establish Workers’ Compensation Information Reporting. Current law requires SSA to reduce an individual’s Disability Insurance (DI) benefit if he or she receives workers’ compensation (WC) or public disability benefits (PDB). SSA currently relies upon beneficiaries to report when they receive these benefits. This proposal would improve program integrity by requiring states, local governments, and private insurers that 23 administer WC and PDB to provide this information to SSA. Furthermore, this proposal would provide for the development and implementation of a system to collect such information from states, local governments, and insurers."
FY 2016 BUDGET OVERVIEW, p. 22
http://www.ssa.gov/budget/FY16Files/2016BO.pdf
With that information, the SSA can determine if the Federal Government is accurately calculating the Federal SSA/Workers' Compensation setoff.
The obvious inequity, cost shifting, exists in those states where a reverse offset is taken. In those states, ie. NJ, the workers' compensation insurance company takes the offset credit, and NOT the Federal Government (SSA).
The collection and publication of this data will verify the inequity between States and the cost shifting to the Federal government in some states and not others. A demand for the elimination of this inequity may result in the extinction of the Reverse Offset.
See: The Gift That Keeps Giving: The SSA Reverse Offset
Related articles
- 2016 Budget Proposal Would Require Reporting of Workers' Compensation Benefits to Social Security Administration (workers-compensation.blogspot.com)
- CMS: "The Smarter Act" Introduced in the US Senate (workers-compensation.blogspot.com)
Tuesday, March 3, 2015
2016 Budget Proposal Would Require Reporting of Workers’ Compensation Benefits to Social Security Administration
The SSA currently has to rely on beneficiaries to report to the SSA when they receive workers’ compensation or public disability benefits. President Obama’s 2016 budget proposal includes a provision to establish a new federal requirement that workers’ compensation and public disability benefit information be provided by states, local governments, and private insurers to the SSA.
The budget proposal summary includes the narrative below:
Establish Workers’ Compensation Information Reporting. Current law requires SSA to reduce an individual’s Disability Insurance (DI) benefit if he or she receives workers’ compensation (WC) or public disability benefits (PDB). SSA currently relies upon beneficiaries to report when they receive these benefits. This proposal...
[Click here to see the rest of this post]
Sunday, January 11, 2015
High Compensation Medical Costs Raises Concern in New Hampshire
Lawmakers should make 2014 the last year that doctors and other health care providers are guaranteed payment no matter how much they charge when a worker is injured on the job. The workers’ compensation system is broken.
The state, and the employers who pay into its workers’ compensation fund, have been paying two and three times the going rate for medical services when the patient is a workers’ compensation recipient. On average, surgeons charge 156 percent more, according to a report by the state’s Department of Insurance. Bills for radiology are 107 percent higher, 95 percent higher for occupational therapy and for something as simple as an ice pack, 300 percent more.
The extra paperwork required to document workers’ compensation cases and perhaps the added severity of the average injury, probably explains some of the price difference. But, human nature being what it is, it’s likely that, when the bill has to be paid no matter what the provider charges, the temptation to pad it can be irresistible, especially when providers can rationalize the surcharge by using it to offset underpayments in areas such as Medicare or Medicaid.
Sunday, December 28, 2014
Gov. Chris Christie and NJ Workers' Compensation: Declining Approval
NJ continues with high unemployment, a failing infrastructure, steep taxes, a mass migration of both Industry and Labor out-of-the state, high debt, and declining public pension reserves. The State continues with a spiraling rate of income inequality that reflects high and almost unobtainable maximum workers' compensation rates for the vast majority of low and middle income wage earners.
The State's antiquated workers' compensation system continues with a reverse social security offset that favors insurance companies to the detriment of the nation's taxpayers. NJ administratively refuses to allow COLA increases under the Triennial Redetermination Social Security program to those totally disabled workers who receive benefits and NJ continues to allow insurance companies and employers to reap benefits at the detriment of injured employers. NJ still maintains an antiquate, objectionable, obsolescent and costly Second Injury Fund for pre-existing injuries when the vast majority of states have terminated such programs.
Additionally, NJ, that lacks a medical provider fee schedule, continues to control medical treatment by requiring injured workers to obtain only employer authorized medical care and prohibits injured workers freedom to choose their own medical providers.
Unproductive bullying of the public at the NJ Governor's "town hall meetings" has become a trademark of his administration. The excitement and approval of "the entertainment value" of those events in the past caught the attention of the public at the emergence of his administration and allowed him to gain popularity. That has now faded has Governor Christie's public approval, according to recent polls in NJ, is declining.
In the meantime, Gov. Christie criticizes NJ workers' compensation and lacks an announced plan to correct the ailing system.
“'We’re going to be coming up with a package of proposals that’s going to work both sides of that,' Christie told a caller on his monthly NJ 101.5 FM radio show tonight.
'The employers who may not be stepping up and meeting their obligations and also the employees who are committing fraud on the worker’s comp system,' he said."
When the Chris Christie-for-president chatter first started, in 2011, voters in his home state of New Jersey took pride in having a celebrity governor. As Nancy Reagan escorted Mr. Christie to his speech at her husband’s presidential library, and hedge fund billionaires, The Weekly Standard and The Wall Street Journal’s editorial pages urged him to run, his approval ratings jumped. Voters told pollsters the national attention made him more effective, and improved their state’s long-maligned image.
Four years later, with Governor Christie again considering a run for president, his constituents appear to be tiring of the whole routine.
Polls taken over the last three months reveal a list of home-state complaints: Mr. Christie’s favorability is at its lowest point, with more voters disapproving than approving of his job performance. New Jersey residents think he is making decisions with an eye on his national standing rather than on what is good for their state. They do not think he should run for president — they are, as the slogan goes, ready for Hillary — but most expect he will, and want him to resign if he does. Political talk in New Jersey centers less on Mr. Christie running for president and more on which one of three Democrats quietly seeking to succeed him will win — even though that election is three years away.
Click here to read the entire NY Times article.
Related articles
- NJ Governor Christie to Propose Workers' Compensation Reform (workers-compensation.blogspot.com)
- Governor Christie Vetoes First Responder Workers' Compensation Bill (workers-compensation.blogspot.com)
- Who had the worst week in Washington? New Jersey Gov. Chris Christie (workers-compensation.blogspot.com)
- Christie Vetoes Bill That Would Have Prevented Some Truck Drivers From Being Treated As Independent Contractors (workers-compensation.blogspot.com)
- Using Workers' Compensation Records for Safety and Health Research (workers-compensation.blogspot.com)
Thursday, November 13, 2014
MEDICAL PAYMENTS PER CLAIM IN FLORIDA WERE TYPICAL OF STUDY STATES AND GREW AT A MODERATE RATE FROM 2007 TO 2012, SAYS NEW STUDY
- Florida had higher percentages of outpatient shoulder and knee surgeries done in ambulatory surgery centers (ASCs), and the average ASC payment per episode for those surgeries was in the middle group of study states.
- Prices paid for professional services in Florida were among the lowest of the study states, while utilization of nonhospital care was relatively higher. Both metrics remained fairly stable over the study period.
Related articles
- Fee Schedules and Value (workers-compensation.blogspot.com)
- Where's the New Jersey Conference? (workers-compensation.blogspot.com)
- Formularies in the News (workers-compensation.blogspot.com)
- Data trove shows U.S. doctors reap millions from Medicare (workers-compensation.blogspot.com)
- Spinal fusions serve as case study for debate over when certain surgeries are necessary (workers-compensation.blogspot.com)
- Veterans Health-Care Bill Caught in Dispute Over Funding (workers-compensation.blogspot.com)
Thursday, July 31, 2014
Taking Job-Driven Training to Scale
Connecting the right worker with the right job is key to our vision of opportunity for all. At the Labor Department, it’s how we’re working to help more people punch their ticket to the middle class. That’s why we’re investing in proven strategies that connect ready-to-work Americans with ready-to-be-filled jobs. As part of this effort, in April, we announced the availability of funds through a new Job-Driven National Emergency Grants program to help dislocated workers who have lost a job through no fault of their own. And this week, I am very excited to announce the awards – nearly $155 million to 32 states, Puerto Rico and the Cherokee Tribal Nation – to help fund work-based training programs, like Registered Apprenticeship and on-the-job training, which have a proven record of success. That’s $155 million to give workers the chance to “learn and earn,” developing skills while earning a paycheck. With on-the-job training, employers who participate can use this funding to offset the cost of training and temporarily cover a portion of the wages for the people they hire. We know these programs work. Earlier this year, I met with Gary Locke from New Hampshire, who – after being laid off for more than a year – found a job through the state’s innovative on-the-job training program. The funds we’ve announced this week will expand programs that helped Gary to more states around the country. Nevada, for... |
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- Subway leads fast food industry in underpaying workers
- Inside low-wage workers' plan to sue McDonald's - and win
- US Dept of Labor Combats Child Labor in Global Supply Chain
- Fast-Food Workers Intensify Fight for $15 an Hour
- OSHA kicks off summer campaign to prevent heat-related illnesses and fatalities among outdoor workers
- Administration Urges Rate Changes for US FELA Benefits
Tuesday, April 15, 2014
U.S. Halts Effort to Collect Old Social Security Debts
WASHINGTON — The Social Security Administration said Monday that it would stop trying to collect taxpayers’ debts that were more than 10 years old.
The statement came after a Washington Post article revealed that the Treasury had started intercepting the federal and state tax refunds of debtors’ children — even if the debts were decades old. The debts stem from overpayments by Social Security that the agency had been trying to recoup even if the original recipients had died.
“I have directed an immediate halt to further referrals under the Treasury Offset Program to recover debts owed to the agency that are 10 years old and older,” Carolyn W. Colvin, the acting commissioner of Social Security, said in a statement.
Ms. Colvin said the effort would stop until the agency completed a thorough review of its “responsibility and discretion” to collect any debts to the government.
A revision to the Farm Bill passed in 2008 lifted the statute of limitations “applicable to collection of debt by administrative offset.” That allowed the authorities to withhold the tax refunds of 400,000 people who had relatives with debts to Social Security, The Post reported.
Some of the debts were incurred as long ago as the mid-20th century, The Post said, and the taxpayers whose refunds were being intercepted did not know that their relatives had been overpaid or owed any money.
The actions by the Social Security...
|
Related Articles:
CMS Takes a New Direction in the Proposed MSP Appeal ...
Jan 06, 2014
The Centers for Medicare and Medicaid services (CMS) has proposed rules for the Medicare Secondary Payer (MSP) appeals process that will target the “applicable plan” as the primary responsible party for recovery.
http://workers-compensation.blogspot.com/
Federal Court Enjoins CMS From MSP Recovery Procedures
May 18, 2011
"IT IS FURTHER ORDERED that the Defendant's demand that attorneys withhold liability proceeds from clients pending payment of amounts claimed by the Defendant as MSP reimbursement exceeds her authority under the ...
http://workers-compensation.blogspot.com/
US Supreme Court Asked to Review MSP Preemption Issue
Aug 22, 2013
Medicare is not required to abide by a stipulated order of allocation of benefits in a liability case when seeking reimbursement under the Medicare Secondary Payer Act (MSP). Also, the New Jersey Collateral Source Statute .
http://workers-compensation.blogspot.com/
Workers' Compensation: CMS Publishes Rules to MSP ...
Sep 23, 2013
CMS Publishes Rules to MSP Payments Under the SMART Act. Medicare has published proposed Rules to governor obtaining information concerning the conditional payments as required by the recently implemented ...
http://workers-compensation.blogspot.com/
Friday, November 29, 2013
Changes to the Medicare Physician Fee Schedule for Calendar Year 2014
On November 27, 2013, the Centers for Medicare & Medicaid Services (CMS) finalized updates to payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2014. In recognizing the importance of care that occurs outside of a face-to-face visit, CMS finalized policies that will allow us to make a separate payment to physicians for managing select Medicare patients’ care needs beginning in calendar year (CY) 2015. The rule also finalizes changes to several of the quality reporting initiatives that are associated with PFS payments – the Physician Quality Reporting System (PQRS), as well as changes to the Physician Compare tool on the Medicare.gov website. Furthermore, the rule continues the phased-in implementation of the physician value-based payment modifier (Value Modifier), created by the Affordable Care Act, that will affect payments to certain physician groups based on the quality and cost of care they furnish to beneficiaries enrolled in the traditional Medicare fee-for-service program. Finally, the rule addresses changes to a handful of other programs which are listed in the Table of Contents within the rule.
This fact sheet discusses the changes to payment policies and payment rates for services furnished under the PFS. A separate fact sheet, also issued today, discusses the changes to the quality reporting programs, the Medicare EHR Incentive program, and the policies adopted for implementing the Value Modifier.
BACKGROUND
Since 1992, Medicare has paid for the services of physicians, non-physician practitioners (NPPs), and certain other suppliers under the PFS, a system that pays for covered physicians’ services furnished to a person with Medicare Part B. Under the PFS, relative values are assigned to each of more than 7,000 services to reflect the amount of work, the direct and indirect (overhead) practice expenses, and the malpractice expenses typically involved in furnishing that service. Each of these three relative value components is multiplied by a geographic practice cost index to adjust the payment for variations in the costs of furnishing services in different localities. The resulting relative value units (RVUs) are summed for each service and then are multiplied by a fixed-dollar conversion factor to establish the payment amount for each service. The higher the number of RVUs assigned to a service, the higher the payment.
Sustainable Growth Rate (SGR) and MPFS conversion factor for CY 2014: Under current law, physicians and non-physician practitioners (NPP) will face steep across-the-board reductions in payment rates, based on a formula—the Sustainable Growth Rate (SGR) methodology—which was adopted in the Balanced Budget Act of 1997. Without a change in the law, the conversion factor will be reduced by 20.1 percent for services in 2014. The President’s budget calls for averting these cuts and finding a permanent solution to this problem. The CY 2014 conversion factor is $27.2006, which reflects a smaller reduction in the conversion factor than the 24.4 percent reduction that we projected in March 2013. The smaller reduction is due in part to a 4.72 percent adjustment to the conversion factor to offset the decrease in Medicare physician payments that would otherwise have occurred due to the CY 2014 rescaling of the RVUs so that the proportions of total payments for the work, PE, and malpractice RVUs match the proportions in the final revised Medicare Economic Index (MEI) for CY 2014. This issue is discussed further below. The overall 2014 reduction in physician fee schedule payments required under the SGR methodology is unchanged by this rescaling.
PROVISIONS INCLUDED IN THE CY 2014 PFS FINAL RULE
Primary Care and Chronic Care Management: As part of our ongoing efforts to appropriately value primary care services, Medicare will begin making a separate payment for chronic care management services beginning in 2015. In last year’s final rule, we established separate payment for transitional care management services for a beneficiary making the transition from a facility to the community setting. In this final rule, we further emphasize our support for advanced primary care through our establishment of policies to facilitate separate payment for non-face-to-face chronic care management services for Medicare beneficiaries who have multiple (two or more), significant chronic conditions. This reinforces Department of Health and Human Services (HHS) efforts to support care management through payment reform and incentives and is consistent with HHS’ Strategic Framework on Multiple Chronic Conditions. Chronic care management services include the development, revision, and implementation of a plan of care; communication with the patient, caregivers, and other treating health professionals; and medication management. Medicare beneficiaries with multiple chronic conditions who wish to receive these services can choose a physician or other eligible practitioner from a qualified practice to furnish these services over 30-day periods.
The rule indicates that CMS intends to establish practice standards necessary to support payment for furnishing care management services through future notice-and-comment rulemaking.
Telehealth Services: We are modifying our regulations describing the geographic criteria for eligible telehealth originating sites to include health professional shortage areas (HPSAs) located in rural census tracts of urban areas as determined by the Office of Rural Health Policy. We believe this change will more appropriately allow sites located within HPSAs in MSAs that have rural characteristics to qualify as originating sites and improve access to telehealth services in shortage areas. We are also establishing a policy to determine geographic eligibility for an originating site on an annual basis, consistent with other telehealth payment policies. This change will avoid mid-year changes to geographic designations (sometimes without advance notice to Medicare beneficiaries and providers) that could result in unexpected disruptions to established telehealth originating sites and avoid the need to make mid-year Medicare telehealth payment policy changes. In addition, we are updating the list of eligible Medicare telehealth services to include transitional care management services.
Revisions To The Practice Expense Geographic Adjustment: As required by the Medicare law, CMS adjusts payments under the PFS to reflect the local cost of operating a medical practice as compared to the national average. CMS calculates separate geographic practice cost indices (GPCIs) to adjust the work, practice expenses (PE), and malpractice cost components of each payment. The law requires that we review the GPCIs every three years and adjust them as appropriate with a two-year phase-in of the new GPCIs. We are finalizing new GPCIs using updated data. The updated GPCIs will be phased in over CY 2014 and CY 2015. Additionally, we will apply the statutorily mandated 1.5 work GPCI floor in Alaska and the 1.0 PE GPCI floor for frontier states (Montana, Nevada, North Dakota, South Dakota, and Wyoming), which have no expiration date. There is separate statutory 1.0 work GPCI floor that is scheduled to expire under current law on December 31, 2013. Therefore, the finalized GPCIs reflect the expiration of the 1.0 work GPCI floor.
Medicare Economic Index: CMS is finalizing proposed revisions to the calculation of the MEI, which is the price index used to update physician payments for inflation. The changes are in response to recommendations by a Technical Advisory Panel that met during CY 2012. Application of the MEI along with the SGR determines the conversion factor that is used to determine payments made each year under the PFS. The final rule includes changes in the PFS RVU and GPCI weights assigned to the work and practice expense categories so that the weights used in the PFS payment calculation will continue to mirror those in the MEI. As a result, some payment is being redistributed to work from practice expense. In addition, we are updating the GPCI cost share weights consistent with the revised 2006-based MEI cost share weights.
Misvalued Codes: Consistent with amendments made by the Affordable Care Act, CMS has been engaged in a vigorous effort over the past several years to identify and review potentially misvalued codes, and make adjustments where appropriate. We are continuing to make strides as the values for around 200 codes were finalized and approximately 200 additional codes had their work relative value units changed on an interim basis for 2014. Included in these are services for hip and knee replacements, mental health services and GI endoscopy services. These rates are open for public comment until January 27, 2014.
CMS is not finalizing its proposal to adjust relative values under the PFS to effectively cap the physician practice expense payment for procedures furnished in a non-facility setting at the total payment rate for the service when furnished in an ambulatory surgical center or hospital outpatient setting. Instead, CMS will take additional time to consider issues raised by the public commenters and plans to address this issue in future rulemaking. In addition, for CY 2014, we are finalizing 18 codes that we identified and proposed as potentially misvalued services in consultation with Contractor Medical Directors.
Revisions to the Clinical Laboratory Fee Schedule (CLFS): Under current law, payments on the CLFS remain static and are not revised once a test code has been added to the CLFS and its payment rate has been established. At this point, the CLFS is approximately 30 years old with payment rates that are outdated and potentially excessive. This rule indicates that CMS intends to explore an existing statutory provision that allows updates to the CLFS based on changes in technology. As a result, for the first time, CMS will conduct regular reviews and updates to the payments on the CLFS in order to ensure greater payment accuracy.
Application of Therapy Caps to Critical Access Hospitals: The law applies annual limitations or “therapy caps” on per beneficiary incurred expenses for outpatient therapy services —one for physical therapy and speech-language pathology services combined and another for occupational therapy services. Before the American Taxpayers Relief Act of 2012 directed us to count CAH services towards the caps, the caps were not applied to therapy services furnished in Critical Access Hospitals (CAH). We are finalizing our proposal to apply the therapy caps and related policies to outpatient therapy services furnished by a CAH beginning on January 1, 2014 in order to properly apply the law that established the therapy caps.
Compliance with State Law for Incident To Services: We are requiring as a condition of Medicare payment that “incident to” services be furnished in compliance with applicable state law. This policy strengthens program integrity by allowing Medicare to deny or recoup payments when services are furnished not in compliance with state law. We also eliminated redundant regulations for each type of practitioner by consolidating the “incident to” requirements for all practitioners that are permitted to bill Medicare directly for their services, reducing the regulatory burden and making it less difficult for practitioners to determine what is required in order to bill Medicare for “incident to” services.
The final rule will appear in the December 10, 2013, Federal Register.
For more information, see: www.federalregister.gov/inspection.aspx#special
Tuesday, October 15, 2013
What a Government Default Will Do To Workers' Compensation
Expanding on the problems besieging compensation programs following the US Government Shutdown, things are going to get much worse and very quickly. Social Security will stop paying benefits, its contractors and medical providers. Closing down those contributions will literally suffocate transactional information concerning integration of Medicare Secondary Payer Act benefits and reimbursement. Calculating offsets and reverse offsets will become an impossibility. Insurance companies in reverse offset states will be required to fund more dollars into the system as application flow into the state systems to modify prior awards still being paid.
Employers dependent upon government payments, including funding and contracts, will be unable to pay workers and insurance company premiums. Cascading financial distress will implode the economy and unemployment will become rampant.
Additional burdens will be placed upon injured workers who even already are struggling to make ends meet and obtain medical treatment with absolutely no Federal safety net in place to catch them. Injured workers with pending claims will be unable to seek medical and pharmaceutical benefits from collaterally funded programs.
Federal dollars actually fund over 70% on state rehabilitation programs. These programs will quickly dry up, and the those injured workers who are seeking placement in a new job through rehabilitation will be locked out of the states.
Workplaces will continue to be unregulated as OSHA (The Occupational Health Administration) will be unable to financially fund enforcement programs, new safety programs and even review comments for pending regulations, ie. The Smart Act.
Investigations requirement Federal records, including prior military records, will become increasingly difficult to secure. Stalling this process will delay completed workers' compensation medical records, expert evaluation opinions and the adjudication of workers' compensation claims.
Quite a mess! Not a pleasant prospect to look forward to, as the clock keeps clicking down
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- Study: Calif. workers compensation overhaul too new to parse (workers-compensation.blogspot.com)
- The Government Shutdown is a Kick-In-Gut to Workers' Compensation (workers-compensation.blogspot.com)
- Safety Violations Matter: Wisconsin Court Reaffirms Basis for Employer Safety Penalties (workers-compensation.blogspot.com)
- Is Workers' Compensation Just a Promise That Can't Be Kept? (workers-compensation.blogspot.com)
- Social Security raise to be among lowest in years (workers-compensation.blogspot.com)
- Workers compensation rates to decline in Oregon in 2014 (workers-compensation.blogspot.com)
- Electronic Filing: The Ideal System for Workers' Compensation (workers-compensation.blogspot.com)
- Government Shutdown: Day 8 - Injured Workers Are Being Held for Ransom (workers-compensation.blogspot.com)
Sunday, October 13, 2013
Social Security raise to be among lowest in years
For the second straight year, millions of Social Security recipients, disabled veterans and federal retirees can expect historically small increases in their benefits come January.
Preliminary figures suggest a benefit increase of roughly 1.5 percent, which would be among the smallest since automatic increases were adopted in 1975, according to an analysis by The Associated Press. Next year's raise will be small because consumer prices, as measured by the government, haven't gone up much in the past year. The exact size of the cost-of-living adjustment, or COLA, won't be known until the Labor Department releases the inflation report for September. That was supposed to happen Wednesday, but the report was delayed indefinitely because of the partial government shutdown. The COLA is usually announced in October to give Social Security and other benefit programs time to adjust January payments. The Social Security Administration has given no indication that raises would be delayed because of the shutdown, but advocates for... |
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- Study: Calif. workers compensation overhaul too new to parse (workers-compensation.blogspot.com)
- Worker Privacy Concerns : Employers' Access to Employees' Prior Worker's Compensation Claims (workers-compensation.blogspot.com)
- Listen to the GAO Podcast: Social Security Administration Improper Disability Insurance Payments (workers-compensation.blogspot.com)
- Media Portrays Social Security as an Avenue to Benefits for the Unemployed - WRONG! It's Not That Simple... (workers-compensation.blogspot.com)
- Workers compensation rates to decline in Oregon in 2014 (workers-compensation.blogspot.com)
- What is the Date Last Insured, and Why Does it Matter? (workers-compensation.blogspot.com)
Thursday, October 10, 2013
California Workers' Compensation Reform: Is The System in a Ditch Now?
Last year, the California Legislature -- with the blessing of Gov. Jerry Brown -- enacted its traditional, once-a-decade overhaul of the state's multibillion-dollar-a-year system of compensating workers for job-related injuries and illnesses.
Employers, insurers, medical care providers and other players in the workers' compensation system are still sorting through what the Legislature and Brown wrought. Generally, the overhaul, Senate Bill 863, raised some cash benefits but also tightened up eligibility for, or even eliminated, other benefits. This earned rare joint support from employer groups and labor unions, which had worked on the changes privately. A new 16-state study of workers' compensation systems, covering 60 percent of the nation's workers, says it's too early to tell what the real-world effects of SB 863 will be, specifically whether its cost-saving provisions will offset the costs of increased cash payments, as its sponsors promised. Because the effects of the 2012 overhaul are still unknown, the study from the Workers Compensation Research Institute in Cambridge, Mass., concentrated its section on California on how it compared to other states during the years following the previous overhaul in 2004. It found that disabled California workers were receiving permanent partial disability payments more often than those in other major states and that those payments tended to be longer in duration -- thus confirming one of employers' complaints,... |
Related articles
- Report Recommends Raising Workers' Compensation Premiums (workers-compensation.blogspot.com)
- Is Workers' Compensation Just a Promise That Can't Be Kept? (workers-compensation.blogspot.com)
- The Government Shutdown is a Kick-In-Gut to Workers' Compensation (workers-compensation.blogspot.com)
- New York Second in Nation for Questionable Workers' Compensation Claims (workers-compensation.blogspot.com)
- To cut costs, New York will close workers' comp hearing sites (workers-compensation.blogspot.com)
- Electronic Filing: The Ideal System for Workers' Compensation (workers-compensation.blogspot.com)
- The uneven playing field of workers' compensation (workers-compensation.blogspot.com)
Sunday, September 29, 2013
The Government Shutdown is a Kick-In-Gut to Workers' Compensation
As the US House of Representatives, under Republican leadership influenced by The Tea Party, likened in Aaron Sorkin's HBO program, The Newsroom, as "The American Taliban," passed legislation to shutdown the US Government this Tuesday, serious concern exists as to the consequences of the shutdown on workers' compensation programs throughout the nation.
In many States, whether or not a reverse offset exists, it is essential to determine what a claimant's Average Current Earnings (ACE) are to calculate, and reach a final determination of temporary and permanent disability, in a state workers' compensation claim. The access to those numbers will become difficult to obtain because of administrative rollbacks, and anticipated further delays in claims processing. Even though Federal payments will be forthcoming under protective measures, the claims process will be derailed.
Likewise, the process to obtain conditional payment information will be delayed or non-existent. The provisions of the Medicare Secondary Payer Act mandating reimbursement to The Center for Medicare and Medicaid Services (CMS) will be put on hold. Similarly, reviews for future medical compromises embodied in the Workers' Compensation Medicare Set-aside Agreements (WCMSA) will be delayed just because of administrative cutbacks in the claims system, including the appeals process.
The recently enacted provisions of The SMART Act. long sought by a coalition of cottage industries, and compensation parties, to the reimbursement process itself, will face its first major challenge to implementation as the Internet web-portable becomes non-functional. Recently proposed final Rules will face delay in implementation as the exchange of comments under the rulemaking process become further delayed in the process of submission and response.
Overall, the workers who most need the system to function, and who waited the longest time, in waiting for final adjudication of their claims, will become victim of the process. No matter how long the shutdown extends, the Federal action will highlight the continued deterioration of the complex patchwork process know as workers' compensation. The now antiquated, and once expeditious and remedial insurance system, will have suffered yet another devastating blow in its attempt to survive in a radically changing economic and socio-political system.
....
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Friday, September 27, 2013
Mets’ Harvey Is Covered Like Any Other Employee With a Workplace Injury
If Mets pitcher Matt Harvey has Tommy John surgery on his right elbow, it will be paid for, partly, with workers’ compensation insurance. A partly torn ulnar collateral ligament like Harvey’s is considered a workplace injury, just as if he were a truck driver hurt on a loading dock. The basic agreement between major league owners and players requires that teams pay the cost of injuries. “The employer gets to recover, as an offset, any workers’ compensation recovery that is available,” said Rob Manfred, an executive vice president of Major League Baseball. “And the club is on the hook for what workers’ compensation doesn’t pay.” At some point after an operation or procedure, a player signs a form that allows his team to pursue the insurance claim. So if workers’ compensation did not pay the full cost of Derek Jeter’s surgery for a fractured left ankle last year, the Yankees made up the difference — essentially the cost of doing business. “The player never sees a bill,” Manfred said. Another factor is that the cost of Tommy John surgery is not uniform. Dr. James Andrews, the renowned orthopedic surgeon, might charge more than the Hospital for Special Surgery, where the Mets’ medical director, David Altchek, is an orthopedic surgeon. (Andrews prescribed a six- to eight-week rehabilitation program for Harvey earlier this week that would precede any decision to operate.) Altchek... [Click here to see the rest of this post] |
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Sunday, July 28, 2013
The Oklahoma Opt-Out System is Bad Medicine for an Ill System
The changes are dramatic, and a major shift from the traditional based system such as New Jersey has followed since 1911.
Obviously the future statics will be reviewed by all stakeholders to determine if the Opt-Out System can really satisfy the concerns of all stakeholders or just a few.
Radical statutory changes to workers' compensation that have been limited to the interests of specific interest groups in the past have been met with disasters. The Opt-Out System of Oklahoma appears to be one of those programs, and has been bitterly contested by the advocates of injured workers.
In order for the creation of an optimal system of compensation to meet the socio-political-economic changes that are occurring in the world, all parties must sit at the table and work out a plan together. The Oklahoma Opt-Out system just appears to be bad medicine for a very ill system.
The Jersey System:
Case are heard by Compensation Judges nominated by the Governor and the system is administered under the Executive Branch of government. There are 50 Compensation Judges.
The Oklahoma Opt-Out System:
Starting on February 1, an administrative process with three appointed commissioners will replace the current court procedure with 10 judges for litigating workers’ compensation claims.
Temporary Disability Benefits
The Jersey System:
If an injured worker is disabled for a period of more than seven days, he or she will be eligible to receive temporary total benefits at a rate of 70% their average weekly wage, not to exceed 75% of the Statewide Average Weekly Wage (SAWW) or fall below the minimum rate of 20% of the SAWW. These benefits are provided during the period when a worker is unable to work and is under active medical care.The limit is 450 weeks. The maximum temporary disability rate for 2013 is $826.00.
Temporary disability payments will be reduced to 104 weeks instead of 156 weeks, with a cap at 70 percent of the state’s average weekly wage, about $540 per week.
Permanent Disability Benefits:
The Jersey System:
Partial Disability: When a job related injury or illness results in a partial permanent disability, benefits are based upon a percentage of certain "scheduled" or "non-scheduled" losses. A "scheduled" loss is one involving arms, hands, fingers, legs, feet, toes, eyes, ears or teeth. A "non-scheduled" loss is one involving any area or system of the body not specifically identified in the schedule, such as the back, the heart, the lungs. These benefits are paid weekly and are due after the date temporary disability ends.
Total Permanent Disability:
These weekly benefits are provided initially for a period of 450 weeks. These benefits continue beyond the initial 450 weeks provided that the injured worker is able to show that he or she remains unable to earn wages.
Wages earned after 450 weeks offset the weekly computation in proportion to the income at the time of the injury. Permanent Total benefits are paid weekly and are based upon 70% of the average weekly wage, not to exceed 75% of the Statewide Average Weekly Wage (SAWW) or fall below the minimum rate of 20% of the SAWW.
Permanent Total Disability is also presumed when the worker has lost two major members or a combination of members of the body such as eyes, arms, hands, legs or feet. However, permanent total disability can also result from a combination of injuries that render the worker unemployable.
The Jersey System: