Department Names New Certification

CEC Curriculum Review Committee Members

Effective August 2008, the Department has named Katie Cederburg of Comprehensive Risk Management and Hal Longen of Harrison Medical Center to replace Herb Sherburne and Angie Kritenbrink as the employer community's representatives on the Certification CEC Curriculum Review Committee.  The Department received 12 nominations of people to serve.  They will be meeting for the first time the week of August 4th.  WSIA wants to thank Herb and Angie for their dedication and service to the community.

New Permanent Partial Disability

Award Schedules Took Effect July 1, 2008

The Department announced the new PPD award schedules for the year beginning July 1, 2008.  For a the complete memo sent out by the Department's Self-Insurance Section, please click HERE.

Department Soliciting Feedback

on Activities Prescription Form

After nearly a year in circulation, the Department is soliciting feedback on the Activities Prescription Form (APF).  They would like your input on the clarity of wording or suggestions for minor changes in the formatting that would help the person completing or the person using the information find what they need.  This is an effort to eliminate any confusion or problem with the format.  So far there have only been a few minor changes suggested.  The Department will be meeting in September and October to discuss the suggestions before requesting reprint of the forms, probably in November.  It is quite probable that they would not make any new versions available until January 2009 - simply because they want to exhaust the supply already on hand before sending the newer forms.  They do not anticipate the changes being anything that would require providers to discard forms they already have on hand and reorder.  If you have suggestions, please don't hesitate to send your comments to Carole Horrell at goya235@lni.wa.gov.  Please be sure to copy WSIA Executive Director Dave Kaplan (dave.kaplan@wsiassn.org) when submitting suggestions to the Department.

Public Hearings Set

on Draft Crane Safety Rules

A series of public hearings have been scheduled to consider draft Crane Safety Rules.  The need for these rules was mandated by the Legislature in 2007.  You can find information on all of the draft rules HERE at the Department's website.  The Public Hearings will be held at 10:00am at the following dates and locations:  Tuesday, August 26th, Yakima, Clarion Hotel; Wednesday, August 27th, Spokane, Doubletree Hotel; Wednesday, September 3rd, Vancouver, Heathman Lodge; Thursday, September 4th, SeaTac, Doubletree Hotel Sea-Tac Airport; and Friday, September 5th, Tumwater, Comfort Inn.  Written comments can be submitted up until Friday, September 12th.  Mail your comments to Cindy Ireland, Department of Labor & Industries, P.O. Box 44620, Olympia, WA 98504-4620.  The rules are tentatively scheduled for adoption on November 4th, 2008.

Department Sets Up New Webpage

for Legislative and Budget Issues

The Department of Labor & Industries has set up a dedicated webpage for their Legislative and Budget issues.  http://www.lni.wa.gov/Main/AboutLNI/Legislature  Currently only 2008 Legislative session information is posted there.  Check back periodically for more current updates.

Department Announces Rules

Development Schedule for Second Half of 2008

As required by law, the Department of Labor & Industries has posted it's proposed rule-making schedule for the last half of 2008.  You can find out what issues they intend to tackle by going to
http://www.lni.wa.gov/LawRule/Files/pdfs/RulesAgenda.pdf.

Self-Insurance Section Priority

Goals Laid Out For All to See

Ever wonder how the Department prioritizes your claims?  Well, no more!  Click HERE to go to a chart listing the WCA3 priorities, and estimated time line on various claims decisions.  Generally speaking, unit goals are: 5 days for new claims, denials and employer PPD closures; 30 days for wage orders, PPD closure requests, correspondence and penalty requests; and 45 days for TC closure requests.  This should help you out in determining whether any one claim you're having problems with needs attention, or whether there are other issues.

Federal Law May Have Impact in

Washington Regarding Medicare Benefits

While Washington state has been fairly insolated from the Medicare Secondary Payer Act, mostly due to the fact that we do not have compromise and release and cannot settle out the medical portion of our claims, a provision in a recent federal law might impact self-insurers here in Washington.  WSIA is STILL soliciting feedback from a number of sources to get an idea on how this might apply on our claims.  We await responses from the Department and from UWC, the federal organization we belong to that lobbies on workers' compensation and unemployment issues.  You can be certain we will share that information with you as soon as it becomes available.   Here's the text of their email to us:

On 12/29/2007, President Bush signed the "Medicare, Medicaid, and SCHIP Extension Act of 2007". The bill was sponsored by Senator Chuck Grassley (D-IA) and was passed in the House (12/19) and Senate (12/18) before the signing by the President. The bill passed unanimously in the Senate and 411-3 in the House. Grassley has long been an advocate for increased Medicare Secondary Payer enforcement and the passage of this bill into law has ramifications for Liability Insurance, Self Insurance, No Fault Insurance, and Workers' Compensation Insurance programs nationwide.

Of major importance to liability, self, no fault, and workers' compensation insurers is Section 111 ("Medicare Secondary Payer"), paragraph 8 ("Required Submission of Information by or on behalf of Liability Insurance (including Self-Insurance), No Fault Insurance, and Workers' Compensation Laws and Plans"), items (A)-(H). Here are a couple key sections of the law:

(A) REQUIREMENT - On or after the first day of the first calendar quarter beginning after the date that is 18 months after the date of the enactment of this paragraph (the law was passed on 12/20/07, making the following requirements begin July 1st, 2009), an applicable plan shall- (i) determine whether a claimant (including an individual whose claim is unresolved) is entitled to benefits under the program under this title on any basis; and (ii) if the claimant is determined to be so entitled, submit information described in subparagraph (B) with respect to the claimant to the Secretary in a form and manner (including frequency) specified by the Secretary.

(B) Required Information - The information described in this subparagraph is -

(i) the identity of the claimant for which the determination under subparagraph (A) was made: and

(ii) such other information as the Secretary shall specify in order to enable the Secretary to make appropriate determination concerning coordination of benefits, including any applicable recovery of claim.

(C) TIMING - Information shall be submitted under subparagraph (A)(ii) 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).

(E) ENFORCEMENT

(i) In General - An applicable plan that fails to comply with the requirements under subparagraph (A) with respect to any claimant shall be subject to a civil money penalty of $1000 for each day of noncompliance with respect to each claimant (in addition to any other penalties prescribed by law and in addition to any other Medicare secondary payer claim under this title with respect to an individual).

What does it all mean?

Beginning on 7/1/2009; Liability Insurers, Self-Insurers, No Fault Insurers, and Workers' Compensation Insurers must determine Medicare beneficiary status on all claims and report those claims involving a Medicare beneficiary to the Secretary at the time of settlement, judgment, or award. If the reporting is not done in a timely manner, the Secretary may enforce a civil money penalty of $1000 per day per claim. Beyond the reporting requirements and financial penalties, this now provides Medicare huge amounts of previously difficult to collect primary payer data on liability, self-insured, no-fault, and WC claims which can be utilized to enforce their Secondary Payer rights. It will be very easy for Medicare to review settlements, judgments, and awards to determine if their interests were adequately considered in the settlement. Workers' Compensation has faced a similar situation (on a smaller scale) since 2002 with Medicare Set-Aside Arrangements. The scope of this law is much broader than MSAs though and adds liability and no-fault settlements into the process, with stiff financial penalties for non-compliance.

What can be expected?

The Secretary has two issues to address in this law, (1) what data to collect and (2) what timeframe to receive the information post-settlement, judgment, or award. The timing of the collection of data (post-settlement, judgment, or award) suggests that a copy of the the settlement agreement, judgment or award will be required submission to the Secretary. Since the intent is to enforce Medicare's Secondary Payer rights, it is reasonable to assume injury information, diagnosis codes, and primary payer data will be required. The language is broad enough to allow for the collection of medical information to determine if the settlement adequately protected Medicare's interest. It is likely that the timeframe will be shortly after the date of settlement, judgment, or award, but may be more frequent.

If you are a self-insured employer or TPA and have dealt with this issue in other states, please contact Dave Kaplan at dave.kaplan@wsiassn.org or by phone at 800-736-7296.  Thank you!

Requesting Self-Insured and

Requesting State Fund Claims Files

In response to changes in public disclosure law, the Department of Labor & Industries has changed the way they process and respond to requests for prior industrial insurance claims files.  You will need to submit TWO requests: one to Norm Voiles for information on self insured claims (faxed to 360-902-6900), and then requests for State Fund claims histories to Paula Clayton (faxed to 360-902-6970.)  If you have questions on the status of State Fund claims information requests, you can call 360-902-5656.  Most State Fund requests will be handled within 10 business days.

as of 7/31/2008