By Andy Rowlson, City of Bellingham
President, WSIA

Centers of Occupational Health & Education (COHE) Project
The Department of Labor and Industries made a presentation to the WSIA Board on encouraging self-insured employer participation in the COHE project. They want self-insurer participation as a way to help expand the circle of doctors participating in the project, particularly in Renton. The COHE project, started a number of years ago by the Department of Labor and Industries, was initiated as a way to help facilitate communications between the injured worker, the attending physician, and the employer in an effort to wind up with better return to work outcomes. There are currently two Centers: Valley Medical Center in Renton, and St. Luke’s Hospital in Spokane. The project is going to be expanded east of the mountains to include most of Eastern Washington. WSIA’s Board has not made a decision on whether to encourage self-insurer participation in the project.

WSIA Provider Update
As a way to save costs on durable goods and services, WSIA has promoted two negotiated programs over the years to help save you money on your claims: a hearing aid provider program (currently served by HearPO), and a prescription drug program (currently served by NMHC Rx). There are some significant changes occurring with both programs. First, HearPO is changing its fees to parallel that of the Department’s fee schedule. All fees will be at or mostly below fee schedule, with the added value of the utilization review service that comes with the contract. This change will occur shortly. Regarding NMHC Rx, there have been problems related to billing of services and following the state formulary, and these have yet to be resolved. It is likely this program may be terminated within a few months. Please watch the WSIA Web site and your e-mail for more details.

WSIA Website Updated
If you haven’t had a chance to check out the rest of the WSIA Web site, please spend some time looking around here: we’ve updated it and made it easier to navigate. You can register for conferences and training classes online, and get more updated information on just about everything here! This was done specifically to address your needs. If you have suggestions, please email NJ at events@wsiassn.org and offer your thoughts.

SIEDRS Update
The Self-Insured Electronic Data Reporting System (SIEDRS) project is well underway. A working group is helping to define the data elements to be collected, and helping to define the terms being used so that everyone will have a clear understanding of the data to be collected. You will likely be hearing from the Department on this project in the next few weeks, so watch your mailbox.

Self-Insurance Rules, Round 18 (or thereabouts)
In July 2002, the Department of Labor and Industries proposed a new set of self-insurance rule changes. About a year and a half later it floated the first language to a stakeholder committee to review. The stakeholder committee finished its work in August 2004. After a delay to conduct a cost-benefit analysis of the rule, the proposed final rules are due to be issued in October 2005, with a hearing held shortly after that. In theory, implementation will occur on January 1, 2006. The rules will cover the requirements for being certified as a self-insured employer, elimination of the 90 e.a.r. for vocational benefits, and new standards to be eligible to take the claims certification exam administered by the Department. We want to share your thoughts with the Department, so please be prepared to respond as soon as we contact you!

Applying Cockle to Pensions
As you are probably all aware by now, there is an ongoing effort by trial lawyers to try and apply Cockle to pension benefits awarded years earlier, or to the time loss applicable prior to the awarding of the pension. WSIA is following a case to ensure that we win on the argument that medical benefits should have been requested back when the pension order was to be protested. We are looking for additional similar claims to keep track of, particularly if the employer is a public or non-profit entity; and a knowledgeable claimant attorney was the attorney of record when the pension was awarded. If you know of any, please contact the WSIA office.

Amicus Update
On September 29, 2005 the Washington Supreme Court ruled in the consolidated Gallo cases that while medical benefits may be considered “consideration of like nature” for purposes of defining wages and setting time loss, almost all other fringe benefits are not. WSIA filed an amicus brief in this case. While the Court did not consider our argument to overturn Cockle (no thanks to the Department), they essentially supported our contention that fringe benefits are not necessary to sustain the life and health of the worker.

Medicare Secondary Payer – Finally, an Answer!
After about three years of hounding them, according to the Centers for Medicare and Medicaid, because Washington’s workers’ compensation system does not allow for the settling of medical benefits, and because claims can be reopened for additional medical benefits, Medicare set-asides may not be necessary in Washington claims. Please note that this is as clear as it gets from the Federal government; but at least we have an answer!

Strategic Planning Moving Forward
The consulting firm of Moss Adams completed its strategic plan for the Association. Based on feedback from the membership and key stakeholders, you can plan on seeing changes in the way services are provided, and in the frequency and quality of our communications with you. Thank you for your thoughtful comments to us about our services. WSIA will be an even better organization because of your interest and participation.

Updated November 2005

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