IDOI-Approved PPP & PPA Links

We now have permanent direct links to the Illinois Department of Insurance’s lists of approved PPPs and PPAs.  The links will remain on the lower right side of the blog under the heading Illinois Dept. of Insurance Registered Administrators.

PPP Approval Process Clarification

We have received several inquiries in the last couple of days regarding the Illinois Department of Insurance (IDOI) workers' compensation preferred provider program (PPP) approval process.  There seems to be confusion over whether the IDOI has begun to approve PPP applications.  As of our conversation with the IDOI this morning, the Department has not approved any PPP applications.

HFN submitted an application to become an IDOI-approved PPP, and it is still in process with the Department.  We do not have a definitive time frame on when the IDOI will complete its review and approval process. 

The IDOI does have a new approved PPP report on its website.  The report reads, as of 1:30pm on September 26, "No Companies have been approved at this time."

We will continue to provide PPP updates on both the IDOI approval process and the IWCC notification form as the preferred provider program development process continues in the state of Illinois.

IWCC Fee Schedule Region Recalculation Update

The main issue on the agenda at the most recent IWCC Medical Fee Advisory Board meeting, besides the PPP notification form, was a final decision on the fee schedule calculations for the HB 1698-mandated new fee schedule regions.

During the August 23 meeting, the Board narrowed the potential calculation methodologies down to two options: 

1. A straight average of all the included geozips' reprice amounts for each code
2. A weighted average, by geozip population, of all the included geozips' reprice amounts for each code

After that meeting, Glen Boyle and his team ran additional calculations and examples for the two methodologies.  He presented that analysis to the Board at the meeting last Tuesday, September 20.

There was a great deal of debate over legislative intent in regard to whether the calculations for the new regions' fee schedule amounts had to maintain the 30% rate reduction that took effect on 9/1/2011.  By collapsing geozips into new regions and averaging the different geozip fee schedule amounts, some providers will see additional reductions to their current fee schedule base rates, while others in the same region will see their base rates increase.

IWCC's PPP Notification Form Update

The newly appointed IWCC Medical Fee Advisory Board met on Tuesday to discuss both the Preferred Provider Program (PPP) notification form and the potential rate recalculation formulas for the new fee schedule regions effective 1/1/2012.  This post will deal specifically with the PPP notification form.

PPP Notification Form

Once Governor Quinn signed HB 1698 into law, Illinois employers gained the ability to employ a Preferred Provider Program (PPP) to direct their injured workers to participating providers for treatment. In order for employers to implement the PPP direction of care process, HB 1698 lists two basic requirements:

1. The PPP must be approved by the Illinois Department of Insurance (IDOI).
• There is a difference between current IDOI–approved Preferred Provider Program Administrators (PPAs) and the new workers’ compensation Preferred Provider Programs (PPPs).  See our previous PPP updates here & here for more information.
• The IDOI is currently accepting and actively reviewing PPP applications.  We anticipate that the Department will begin to announce approved PPPs in the near future.
2. The Illinois Workers’ Compensation Commission (IWCC) must promulgate a notification form that the employer will provide to an employee at the time of injury.

The Medical Fee Advisory Board did not come to a consensus regarding the PPP notification form.  There was a potential form distributed at the beginning of the meeting and alternative versions were presented during the course of the discussion.
 
The Board recommends that the final version of the form remains a one page document, but there was a great deal of discussion regarding the language and phrasing for that form.  The objective of the form is to provide an injured employee with the necessary PPP information, contact information, and options regarding opting out of the PPP in a clear and concise manner that will help explain a process that will be foreign to most workers when they are injured on the job. The specific wording to accommodate that objective is still under debate. The Board members are going to review the different versions of the form and recommend changes over the next two weeks.

Mitch Weisz, the IWCC Chairman, stated that their goal was to have a finalized version available to the public by early October. 

IWCC Announces Increase to Fee Schedule Rates for 2012

The IWCC announced today that the 2012 medical fee schedule rates will increase 3.77%. The Illinois Workers’ Compensation Act requires the IWCC to update the medical fee schedule rates by the percentage change in the Consumer Price Index-U (CPI-U) during the previous year.

On September 1, 2011, the IWCC implemented a straight 30% decrease in the medical fee schedule rates, as required by HB 1698/Public Act 097-0018.

While the rates will increase by 3.77% for 2012, HB 1698/Public Act 097-0018 also mandates a complete restructuring of the medical fee schedule regions in Illinois. The full impact of this fee schedule region restructuring and rate recalculation is unknown until the Medical Fee Advisory Board makes a final decision on the recalculation methodology.

The new hospital & non-hospital regions were the main topic of discussion at the August 23 Medical Fee Advisory Board meeting, and the Board narrowed the possible rate recalculation methodologies down to two options.

The agenda for the Board meeting on September 20 at 9am includes the collapsing of the geo-zips. Glen Boyle and his team were going to have full samples of both recalculation scenarios for the Board to determine the new regions’ medical fee schedule rates for 2012.

We will provide a full update on the Board’s decisions regarding the new fee schedule regions after the meeting on Tuesday.

Gov. Quinn appoints new IWCC Medical Fee Advisory Board & Board Meeting Postponed

The IWCC Workers’ Compensation Medical Fee Advisory Board meeting on September 13 was postponed until next Tuesday, September 20 at 9am.  The agenda on the IWCC website remains the same for the next meeting, so the Board will address both the new fee schedule regions and the PPP notification form on the 20^th.

The IWCC announced that Governor Quinn appointed new members to the Workers’ Compensation Medical Fee Advisory Board.  The Board members serve four year terms.  The Board will have six new representatives serving alongside returning members Kim Moreland (Rising Medical Solutions) and John Smolk (United Airlines).

The new Workers’ Compensation Medical Fee Advisory Board:

Employee Representatives:

Jason Keller (Illinois AFL-CIO)
Dianne McGuire (College of DuPage Trustee)
vacant employee representative slot

Employer Representatives:

Barb Molloy (Molloy Consulting)
Kim Moreland (Rising Medical Solutions)
John Smolk (United Airlines)

Medical Provider Representatives:

Avi Bernstein, MD (The Spine Center)
William McAndrew (Illinois Hospital Association)
Michael Vender, MD (Hand Surgery Associates)

IWCC Medical Fee Advisory Board September Meeting

The IWCC Workers’ Compensation Medical Fee Advisory Board meeting is Tuesday, September 13 at 1:00pm. The meeting is scheduled for the James R. Thompson Center (100 W Randolph St, Chicago) in Room 9-034.

The current agenda includes an update from Glen Boyle regarding both potential geozip collapsing scenarios discussed at the Board meeting on August 23. His team was going run an extended analysis for the new Hospital and Non-Hospital regions using both recalculation scenarios for the September 13 meeting.

The agenda also includes discussion regarding the HB 1698–mandated IWCC PPP notification form.  The updated note on the IWCC website states

The Department of Insurance is now accepting Preferred Provider Program (PPP) applications. If you have questions, contact Kari Dennison at the Department of Insurance.

The Workers' Compensation Medical Fee Advisory Board is exchanging draft versions of the PPP notification letter. We will post it once it is completed. (revised 9/1/11)

We’ll provide an overview of any updates to the fee schedules, preferred provider program notification form, etc. later this week.