IWCC Medical Fee Schedule Re-Posted

As of this morning, the Illinois Workers' Compensation Commission's website has the 2013 Medical Fee Schedule re-posted on its fee schedule page.  The following link will take you the website lookup (choose Treatment Year 2013 for the new rates): Medical Fee Schedule/FAQ  

The original link was retracted by the IWCC contractor, Optuminsight, due to data integrity issues. 

Unless there are any further announcements from the IWCC, the 2013 fee schedule is effective January 1, 2013.

2013 Medical Fee Schedule: Status Update

As announced previously at its December Medical Fee Advisory Board meeting, the IWCC posted the 2013 medical fee schedule on its website; however, it pulled the schedule shortly after due to issues identified by the vendor.

The IWCC announcement:

The 2013 fee schedule was posted, but some problems were identified, and the vendor, Optuminsight, took it down to work on it. Optuminsight is working on adding code descriptions and posting the correct surgical codes to the Hospital Outpatient and ASTC fee schedules, so please view the schedule with caution. We will announce when this work has been completed.  

In the meantime, if you identify any issues with the 2013 schedule, please let us know.

The 2013 medical fee schedule is effective on January 1, 2013.  We will post additional updates when the IWCC website rereleases the schedule or Optuminsight announces any additional changes.

New IWCC Arbitration and Commission Review Board Rules

The December 21 edition of the Illinois Register includes two adopted amendment rulemakings from the Illinois Workers' Compensation Commission.  Both rulemakings, effective December 4, deal with complaints and review procedures of IWCC Arbitrators and Commissioners.
 
The IWCC put out an announcement regarding these two updated rules, and included in that announcement was a new form to submit complaints to the Commission Review Board:  IWCC Commission Review Board Complaint Form

New/Update Rules Overview

Arbitration (PDF document page 285)

• 50 Ill Adm Code 7030
• Proposed 8/17/2012
• Effective 12/4/2012 

Differences between Proposal and Final Version: In subsections (f)(1)(B) and (f)(2)(B),  the Final Version specifies that the assignment of a petition to disqualify either an  Arbitrator or Commissioner shall be made randomly by the Commission. The Final Version adds a new subsection (f)(3), which specifies that a petition for substitution may be made to the Commission if reasonable notice of the application has been given to the adverse party or his or her attorney.

Summary and Purpose of Rulemaking: The amendment addresses an audit finding set forth by Auditor General William Holland in the audit directed pursuant to House Resolution 131 of the 97th General Assembly. Specifically, the audit found that the current version of Section 7030.30 conflicts with the changes of Public Act 97-18. Public Act 97-18 provided that the Canons of Judicial Conduct as adopted by the Illinois Supreme Court apply to the hearing and non-hearing conduct of the Arbitrators and Commissioner. Thus, these changes to Section 7030.30 align the bases for disqualification and also the remittal of a disqualification by and Arbitrator or Commissioner with the provisions of Canon 3 of the Canons of Judicial Conduct.  

In addition, the amendment creates a formalized process for the filing of a Petition for Substitution of an Arbitrator or Commissioner. There is one published Appellate Court opinion that calls on the Commission to promulgate such a rule, Preston v. Industrial Comm'n, 332 Ill. App. 3d 708 (3rd Dist. 2002). In that case, a Commissioner who was subject to a petition to disqualify sat on the panel that ruled on the petition. While the majority found no error in the hearing process, the Court recommended that the Commission promulgate a rule to address the procedural handling of petitions to disqualify Commissioners.

 

From everyone here at the IL Workers' Comp Reform Guide & HFN, Inc... 

Merry Christmas and Happy Holidays

 

2012 NCCI IL Statutory Data Report & Advisory Rates

A couple of additional Illinois Department of Insurance updates...

The IDOI recently posted NCCI's 2012 Rating Organization Statutory Data Submission on its website.  NCCI is required by the Illinois Insurance Code to submit the following information annually: 

1. Indemnity and medical paid and paid+case losses for each of the past 10 years, by policy year
2. Medical payments for each of the past 10 years, by policy year
3. Indemnity claim Information including cumulative paid+case losses, by policy year by calendar year of development. This includes losses and frequency of claims in medical only, permanent partial disability, permanent total disability, temporary total disability and fatalities 
4. Frequency and severity by injury type
5. Aggregate (indemnity+medical) paid+case losses, and claim count by class of employee

The IDOI also confirmed that it had completed its review and filed NCCI's proposed 3.8% reduction for the WC Advisory and Lost Cost rates effective 2013 (see our previous overview of the filing & the IDOI's August press release announcing the rate review).

Department of Insurance Payment Compliance Bulletin

The Illinois Department of Insurance released a compliance bulletin reminder to all companies licensed/approved to provide workers' compensation coverage in Illinois.  The bulletin covers provider notification and payment requirements included in Sections 8.2(d)(2) & (3) of HB 1698/PA 97-18.

Section 8.2(d)(2) 

If the claim does not contain substantially all the required data elements necessary to adjudicate the bill, or the claim is denied for any other reason, in whole or in part, the employer or insurer shall provide written notification, explaining the basis for the denial and describing any additional necessary data elements, to the provider within 30 days of receipt of the bill.

 

Section 8.2(d)(3) 

In the case of nonpayment to a provider within 30 days of receipt of the bill which contained substantially all of the required data elements necessary to adjudicate the bill or nonpayment to a provider of a portion of such a bill up to the lesser of the actual charge or the payment level set by the Commission in the fee schedule established in this Section, the bill, or portion of the bill, shall incur interest at a rate of 1% per month payable to the provider. Any required interest payment shall be made within 30 days after payment.
 

The Illinois Workers' Compensation Commission also released a notice regarding this IDOI bulletin. 

IWCC Ottawa Trial Date Cancellation

The Illinois Workers' Compensation Commission announced a change to its Ottawa, IL arbitration schedule.  The 12/28/2012 trial date (located at the LaSalle County Courthouse, 119 W. Madison Street, Ottawa, IL) is cancelled due to a scheduling conflict.

Due to a scheduling conflict, we have eliminated the last day of the December call in Ottawa. Arbitrator Falcioni will conduct the call as scheduled on Dec. 24, and trials will be conducted on Dec. 26 and 27. He will not appear on Dec. 28. We apologize for any inconvenience.
 

WC PPP: Dept of Insurance Rulemaking Update

The Illinois Department of Insurance's proposed updates to the Insurance Code, including the workers' compensation preferred provider programs (WC PPPs), are now on JCAR's January meeting agenda.

The General Assembly's Joint Committee on Administrative Rules' (JCAR) meeting is currently scheduled for Tuesday, January 8, 2013.  While most JCAR meetings take place in Chicago, the January meeting will take place at 9:00am in Room D-1 of the Stratton Office Building in Springfield, Illinois.

• Preferred Provider Programs (50 Ill. Adm. Code 2051) proposed 4/27/2012 (PDF Page 286)

The Illinois rulemaking process is detailed on the JCAR website:

2013 Fee Schedule Annual Rate Adjustment

The Illinois Workers' Compensation Commission announced its annual rate adjustment for the Illinois workers' compensation fee schedule. Effective January 1, 2013, the fee schedule rates will increase 1.69%.

Section 8.2(a) of the Illinois Workers' Compensation Act provides that, each year, fee schedule rates shall increase or decrease by the percentage change in the Consumer Price Index-U (CPI-U) in the previous year.  

The IWCC's announcement includes a chart that shows the adjustment rate for each year since 2006.

The medical fee schedule rates will increase 1.69% in 2013, which is less than half the rate of medical inflation (CPI-M). As the chart below shows, the fee schedule amounts are now running 37% below medical inflation over the life of the fee schedule.

The 37% difference between the IL fee schedule and medical inflation does include HB 1698/PA 97-18's 30% fee schedule reduction effective on September 1, 2011.  The remaining 6.96% is the difference between the rate of medical inflation (CPI-M) and Consumer Price Index-U (CPI-U). 
  
As Glen Boyle reported at the IWCC Medical Fee Advisory Board's December meeting, the 2013 annual fee schedule updates and rates are currently scheduled to complete internal review and quality check by December 21, and the new 2013 rates have an anticipated posting date of December 28, 2012. The annual fee schedule updates are effective on January 1 of each year.

 

IWCC & Repackaged/Compounded Pharmacy

With the recent meningitis contamination and push for more oversight over compounding pharmacies (see these articles from Business Insurance & the Chicago Tribune),  we received several questions regarding the new IWCC repackaged pharmacy repricing methodology and compounded drugs.
 
While variations exist,

• Physician-dispensed repackaging usually involves drugs that are purchased in bulk, repackaged into smaller fill amounts, and then dispensed by a provider’s office, rather than from a pharmacy. 
• "Traditional pharmacy compounding in the United States involves the act of combining, mixing or altering ingredients to prepare a customized medication for an individual patient upon receipt of a valid prescription." (University of Southern California, Pharmacy compounding – regulatory issues)

 
Compounded drugs were on the IWCC Medical Fee Advisory Board's December meeting agenda, and the Board made a clear distinction between the new physician-dispensed repackaged pharmacy reimbursement methodology and compounded drug regulations.
 
With several state and federal agencies reviewing potential changes to the review and regulatory oversight of compounded pharmaceuticals, the Medical Fee Advisory Board stated that it will continue to monitor federal and state regulatory actions, and this issue could appear on a future meeting agenda if necessary.



 

JCAR December Meeting Reminder

As a reminder, the General Assembly's Joint Committee on Administrative Rules (JCAR) meets on Tuesday, 12/11/2012 at 11:00am.  The meeting is in Room 600C of the Michael A Bilandic Building, 160 N LaSalle St, Chicago, IL.

As of this morning, the December JCAR agenda includes a Department of Insurance-proposed rulemaking concerning a Medical Malpractice Data Base.

• Medical Malpractice Data Base (50 Ill. Adm. Code 928) proposed 7/6/12 (PDF Page 205)

There are no IL Workers' Compensation Commission-proposed rulemakings on the December agenda, and, as of this post, the Department of Insurance WC PPP rulemaking is on neither the December nor the January JCAR meeting agendas. 

Final Physician-Dispensed Pharmacy Rule Published

The IWCC's final repackaged drug repricing methodology was published in the December 7 edition of the Illinois Register.

 

As we covered in our 11/20/2012 post, the effective date of the change is November 20, 2012.  The Medical Fee Advisory Board did clarify at its December meeting that the pricing methodology is for dates of service of 11/20/2012 and later.  The final adopted amendment did not contain changes to the language from the previously published proposed rulemaking.
 
The implemented rules begin on page 17108 (PDF page 315) of Volume 36, Issue 39 of the Illinois Register.
 

From the IL Workers' Compensation Commission's Notice of Adopted Amendment:

Summary and Purpose of Rulemaking: The amendment implements Section 8.2(a-3) of the Workers' Compensation Act by specifying that when a prescription dispensed outside of a licensed pharmacy is repackaged, the Average Wholesale Price used to determine the maximum reimbursement shall be the Average Wholesale Price for the underlying drug product, as identified by its National Drug Code (NDC) from the original labeler.

Pursuant Section 8.2(a-3) of the Act, only prescriptions dispensed outside of a licensed pharmacy are subject to a fee schedule. The fee schedule sets the maximum reimbursement levels for these prescriptions. For prescriptions dispensed outside of a licensed pharmacy, Section 8.2(a-3) provides that the fee schedule shall not exceed the Average Wholesale Price, plus a dispensing fee of $4.18. Average Wholesale Price is determined by the NDC set forth in Medispan.   

The amendment addresses a practice known as "repackaging" which means that the prescription will be purchased and then repackaged in different quantities. It is then given a new NDC number with a higher Average Wholesale Price. Thus, the "repackaging" avoids the NDC for the drug from the original labeler. "Repackaged" drugs are typically dispensed by physicians in their offices.

IWCC Arbitrator Coverage Update

In 2013, there will be two IWCC "TBA Call" Zones (Chicago & Chicago/Wheaton) without permanently assigned arbitrators for the call (see our recent post regarding Arbitrator Zanotti).

The IWCC recently announced the January-March 2013 arbitrator coverage lists for both "TBA Calls" on its website.

Chicago TBA Call Coverage (previously Arbitrator Zanotti)

Chicago/Wheaton TBA Call Coverage (previously former Arbitrator Kinnaman)

IWCC Fee Schedule Updates

The Illinois Workers' Compensation Commission's Medical Fee Advisory Board met on Wednesday for its December meeting.
 
The agenda covered a range of topics, and this first post will cover a couple of those issues.
 

Physician-Dispensed Repackaged Pharmacy

Our previous update covered the changes to the reimbursement for physician-dispensed pharmacy in Illinois.  The final rule should appear in the Illinois Register tomorrow (12/7/12), and the effective date of the reimbursement modification is November 20, 2012. 
 
The Board did clarify that the modification only applies to bills with dates of service/fills on 11/20/12 and later.
 

2013 State Fee Schedule Updates

Glen Boyle, from Health Systems International, LLC, provided a written update regarding both finalized and potential updates to the Illinois state workers' compensation fee schedule.
 
The 2013 annual fee schedule updates and rates are currently scheduled to complete internal review and quality check by December 21, and the new 2013 rates have an anticipated posting date of December 28, 2012.  The annual fee schedule updates are effective on January 1 of each year.
 
In addition to the annual updates, Glen Boyle also reported out on potential methodology changes to update the POCs. 

(The IWCC defines POCs as "when the Commission is unable to calculate a fee for a procedure, there is a default payment provision. From 2/1/06 - 8/31/11, the default is POC76, meaning payment shall be 76% of the charged amount. Effective 9/1/11, all default payments are 53.2% of the charged amount (POC53.2).")
 
From his written report:

2013 IWCC Calendar & Arbitrator Changes

The Illinois Workers' Compensation Commission announced several changes to its 2013 Downstate Arbitration Calendar. 

Arbitrator McCarthy will cover Zone 2 (Urbana, Springfield, Quincy) while Arbitrator Neal is on leave.

Also in Zone 2, Arbitrator Zanotti will replace former Arbitrator Akemann effective 1/1/2013.  Arbitrator Zanotti's Chicago call will become a "TBA" call with various arbitrators covering the hearing dates.

Per the IWCC update:

Please direct Arb. Zanotti's Zone 2 mail to
P.O. Box 2647
Carbondale, IL 62902-2647
brandon.zanotti@illinois.gov

Please send Arb. McCarthy's Zone 2 mail to
P.O. Box 3130
Decatur, IL 62524-3130
douglas.mccarthy@illinois.gov

Follow this link for the full IWCC announcements.



 

IWCC & JCAR December Meeting Schedule

With just over a month remaining in 2012, here are the remaining scheduled IWCC and JCAR meetings for December.

Illinois Workers' Compensation Commission

December 5, 2012 

Self-Insurers Advisory Board

• Thompson Center, 100 W Randolph Street, Chicago
• 10:30am in the 8th Floor Chairman's Conference Room
• Self-Insurers Advisory Board meeting agenda

Workers' Compensation Medical Fee Advisory Board

• Thompson Center, 100 W Randolph Street, Chicago
• 1:00pm in Room 9-039 (9th Floor)
• The agenda for the Advisory Board's December meeting contains several updates including
• a report from Glen Boyle
• a discussion on compounded drugs
• updates on the Rules and Commission
• WC Medical Fee Advisory Board meeting agenda

Joint Committee on Administrative Rules

December 11, 2012

• Michael A Bilandic Building, 160 N LaSalle St, Chicago
• 11:00am in Room 600C
• As of this morning, the December JCAR agenda includes
• One (1) Department of Insurance-proposed rulemaking concerning a Medical Malpractice Data Base
• Medical Malpractice Data Base (50 Ill. Adm. Code 928) proposed 7/6/12 (PDF Page 205)
• No IWCC-proposed rulemakings
• JCAR December meeting agenda

 

WC PPP: Pending Second Notice

As part of the JCAR's First Notice process for the new WC PPP rules, all interested parties were permitted to submit public comments about the proposed regulatory changes to the IDOI up until the June 11, 2012 deadline.

At this point, JCAR has not addressed the modifications to 50 Ill. Adm. Code 2051 with the IDOI at its monthly meetings, and, as of this post, the WC PPP rules are not scheduled on the agenda for the December JCAR meeting.

• Preferred Provider Programs (50 Ill. Adm. Code 2051) proposed 4/27/2012 (PDF Page 286)

IWCC Announces Physician-Dispensed Pharmacy Changes Effective Today

In addition to its updated file viewing process, the Illinois Workers' Compensation Commission also announced that the modification to the physician-dispensed pharmacy reimbursement methodology is effective today, November 20, 2012. 

This change was recently discussed at the General Assembly's Joint Committee on Administrative Rules' November meeting.

The final rule will appear in the December 7, 2012 edition of the Illinois Register.

Issue 33 of JCAR's Illinois Register (PDF page 94) contained the actual updated language that states reimbursement for physician-dispensed prescriptions is based on the original manufacturer's NDC code, not the repackaged NDC code:

10) Prescriptions

A) This schedule applies to prescriptions filled and dispensed outside of a licensed pharmacy.

B) Prescriptions shall be billed at the Average Wholesale Price, plus a dispensing fee of $4.18. [820 ILCS 305/8.2(a-3)]

C) Average Wholesale Price or its equivalent as registered by the National Drug Code shall be set forth for that drug on that date as published in Medispan. [820 ILCS 305/8.2(a-3)]

D) If a prescription has been repackaged, the Average Wholesale Price used to determine the maximum reimbursement shall be the Average Wholesale Price for the underlying drug product, as identified by its National Drug Code from the original labeler.

New IWCC File Request Process

The Illinois Workers' Compensation Commission announced a new process for requesting and viewing case files from the department.

The announcement on the IWCC website states:

Effective immediately, people who wish to view a case file in which they are not a party or attorney of record (petitioner, petitioner’s attorney, respondent, or respondent’s attorney) must submit a Freedom of Information Act (FOIA) request. We will process your request as quickly as possible, but please understand FOIA gives agencies five business days to respond to a request.    

Please email your request to Deputy General Counsel/FOIA Officer, Dennie Michelle Zankel (312/814-8770) and copy Nicholas Velazquez (312/814-6560). Alternately, you may mail requests to 100 W. Randolph Ste 8-200, Chicago, IL 60601. If you have any questions, please contact Ms. Zankel or Mr. Velazquez.      

Parties and attorneys must provide proof of identity (ARDC card and/or valid State ID) before viewing files. Please allow 24 hours for us to process these requests.      

The IWCC is dedicated to protecting the information of all claimants to ensure that information is not compromised under any circumstances.

Approved IWCC Rules Published in the Illinois Register (Updated)

In addition to the new Department of Insurance WC EDI proposed rules published in the Illinois Register today, two final IWCC rules appeared as well. 

As we covered in several previous updates, JCAR issued "Certificates of No Objection" at its September 11, 2012 meeting for two separate Illinois Workers' Compensation Commission administrative code modifications. The IWCC filed them with the Secretary of State, and they appeared in today's (11/16/2012) Illinois Register.  

• Miscellaneous (50 Ill Adm Code 7110) proposed 3/2/12, effective date of rulemaking 11/5/2012 (PDF document pages 217-239)
  • Incorporates all of HB 1698/Public Act 97-18’s modifications and updates to the medical fee schedule reimbursement and methodology rules. (See our previous post with an outline of the major updates)
• Alcohol and Drug Sample Collection and Testing (50 Ill Adm Code 9140) proposed 6/15/12, effective date of rulemaking 11/5/2012 (PDF document pages 240-273)

These rules do not include the physician-dispensed pharmacy modifications, discussed in our previous posts. While that rulemaking is continuing through the process after the November JCAR meeting, that is a separate rulemaking that will be filed and published at a later date.  **Updated 11/20/2012:  the physician-dispensed pharmacy changes are effective 11/20/2012.  Please see this new post regarding these rules.

The IWCC has an update on its website regarding the publication of these rulemakings in the Illinois Register.

DOI Proposed WC EDI Standards

The Illinois Department of Insurance's proposed-rules for workers' compensation electronic claims submission and payment standards appeared in the Illinois Register this morning. 
 
The publication of these proposed rules means that they are now in the Illinois General Assembly's Joint Committee on Administrative Rules' First Notice phase.  Any interested party or member of the public has 45 days from this publication date to submit any questions, issues, or concerns to the Illinois Department of Insurance regarding this rulemaking.
 
From the published proposed rulemaking (PDF pages 5-23):

A Complete Description of the Subjects and Issues Involved: This rule is required to implement the electronic claims provisions contained in Section 8.2a of the Illinois Workers' Compensation Act [820 ILCS 305/8.2a]. The focus of this proposed rule is to provide a legal framework for electronic billing, processing and payment of medical services and products provided to an injured employee and data reporting subject to Section 8.2a.
 

The EDI standards included in the rulemaking cover various types of provider bills, specifically

• Professional billing
• Institutional/Hospital billing
• Dental billing
• Retail Pharmacy billing

The listed IDOI contacts for public comment submission are:

Time, Place, and Manner in which interested persons may comment on this proposed rulemaking: Persons who wish to comment on this proposed rulemaking may submit written comments no later than 45 days after the publication of this Notice to: 

         

          Joe Clennon, Staff Attorney
          Illinois Department of Insurance
          320 West Washington St.
          Springfield, IL 62767-0001
          217/557-1396
          217/524-9033 (facsimile)

 

          Susan Anders, Rules Coordinator
          Illinois Department of Insurance
          320 West Washington St.
          Springfield, IL 62767-0001
          217/785-8220



 

IWCC Open House Dates

The Illinois Workers' Compensation Commission (IWCC) announced three dates in 2013 for its open house program.

You are invited to an open house at the Commission's Chicago office on January 17, 2013 (9:00 a.m start); March 14, 2013 (9:00 a.m start); or May 16, 2013 (9:00 a.m start). After an overview of our court process, visitors will observe arbitration hearings and review-level oral arguments. After oral arguments end, there will be a question-and-answer period with commissioners. The program will end around 12 noon.      

If you are interested in a Downstate program, please send an email, indicating the city you prefer and how many people would attend. You are always welcome to observe hearings at any site on your own: see the calendars web page for details.      

There is no charge to attend an open house, but registration is limited. To sign up, please send an email with the subject "open house" and the desired date and city.      

When the Commission announced an open house in Chicago in January 2010, the seats filled up on the day it was announced. Subsequent programs also filled up and have been well-received. In all, over 500 people have signed up to attend. Visitors walk away with a greater understanding of how to interact with the Commission and work with the process.
 

We attended one of the 2012 IWCC open houses, and it is an extremely useful experience, especially for those who have never seen an IWCC hearing or appeal.  The Q&A we attended with several of the commissioners lasted for roughly 20 minutes and covered a wide range of topics. 

JCAR November Update

The Joint Committee on Administrative Rules (JCAR) held its November meeting yesterday. 

Our previous JCAR Administrative Rules update details the IL Workers' Compensation Commission and Department of Insurance pending rulemakings on that agenda. 

While there was discussion regarding the internal process utilized by the IWCC with its physician-dispensed pharmacy reimbursement modification, the IWCC and IDOI rulemakings included on the agenda will continue through the process.  The IWCC and IDOI can  adopt the rules by filing them with the Secretary of State, and the effective dates will appear when published in a future Illinois Register.
 
JCAR's next meeting is currently scheduled for December 11, 2012.  As of this post, the IDOI updates to the insurance code, specifically the WC PPP rules, are not on the December agenda.

 

JCAR November/December Meetings & Pending Updates

The next meeting for the General Assembly's Joint Committee on Administrative Rules (JCAR) is scheduled for Tuesday, November 13, 2012.  The committee meeting begins at 11:00am in Room 600C of the Michael A. Bilandic building in Chicago. 

Both the Illinois Workers' Compensation Commission (IWCC) and Illinois Department of Insurance (IDOI) have several proposed changes and updates to the Administrative Code pending with JCAR.

Since our previous pending-Administrative Code post, the Department of Insurance moved another rulemaking to JCAR's Second Notice; however, the Medical Malpractice Data Base update appears on the agenda for JCAR's December meeting on 12/11/2012.

 

Illinois Workers' Compensation Commission

There are no additional updates since our previous posts. (Click here for the post covering both the JCAR process and the IWCC "Certificate of No Objection" Administrative Code updates pending publication in the Illinois Register)

JCAR Second Notice: November 13 meeting

• Arbitration (50 Ill Adm Code 7030) proposed 8/17/12 (PDF document page 72)
• Miscellaneous (50 Ill Adm Code 7110) proposed 8/17/12 (PDF document page 79)
• Incorporates the updates to the physician-dispensed pharmacy reimbursement methodology (see our previous update for more information)
• Commission Review Board Procedures (50 Ill Adm Code 7500) proposed 8/17/12 (PDF document page 96)
  
  

Illinois Department of Insurance (updated 11/9/12)

JCAR Second Notice: November 13 meeting

2013 IWCC Board Meeting Schedule



The Illinois Workers' Compensation Commission recently posted the dates and locations for its 2013 IWCC Board meetings.  See the chart below for the scheduled locations, dates, and times.

 

As a reminder, the Self-Insurers Advisory Board and the Workers' Compensation Medical Fee Advisory Board both have a final 2012 meeting scheduled for 12/5/2012 at the Thompson Center in Chicago.

 

State of Illinois & Employee Misclassification

Several State of Illinois departments, including the Illinois Department of Labor, Illinois Department of Employment Security, Illinois Department of Revenue and Illinois Workers’ Compensation Commission, released a press release regarding a renewed education and enforcement initiative concerning independent contractors and employee misclassification.

As part of the initiative, the Illinois Department of Employment Security is providing a reference website regarding these issues.

 

Illinois Legislative and Administrative Code References

• Public Act 95-26:  820 ILCS 185 (Employee Classification Act)
• Illinois Administrative Code: 56 Ill Adm Code 240
• Illinois Workers' Compensation Act: 820 ILCS 305

820 ILCS 305/26.1

Sec. 26.1. Misclassification of employees as independent contractors. The Department of Labor, the Department of Employment Security, the Department of Revenue, the Office of the State Comptroller, and the Illinois Workers' Compensation Commission shall cooperate under the Employee Classification Act by sharing information concerning any suspected misclassification by an employer or entity, as defined in the Employee Classification Act, of one or more employees as independent contractors.
 

(Source: P.A. 95-26, eff. 1-1-08.)

 

IWCC updates its Commissioners' Review Calendars

The Illinois Workers' Compensation Commission posted its Commissioners' Review Calendar update for the first half of 2013.

The Commissioners hear the appeals of IWCC arbitrators' decisions.  The IWCC handbook provides a general overview of the process:

Is it possible to appeal the arbitrator’s decision?

Yes. The employee and the employer each have the right to appeal a decision if dissatisfied. A panel of three commissioners (usually called the Commission) will review the arbitrator’s decision, as well as the evidence and transcript of the trial. Both sides may submit written arguments to the Commission. The Commission will then conduct a hearing (called an oral argument) at which the parties may present a brief, 5-10 minute argument for their position. Within 60 days of that hearing, the Commission will issue its decision.

While an appeal is pending, the employer does not have to pay the benefits awarded by the arbitrator. If the case is ultimately resolved completely in the worker’s favor, interest will be added to the award, based on governmental bond rates at the time of the decision. There is also a 1% per month interest charge on medical bills, payable to the medical provider. 

Commission decisions are final for cases involving employees of the State of Illinois. In all other cases, either party may appeal to the Circuit Court, the Appellate Court, and in some cases, to the Illinois Supreme Court. A chart at the end of this chapter illustrates the process.
 

All of the IWCC's calendars are available at the Calendars, Call Sheets, & Chicago Trials tab on its website.

Updated IDOI Administrative Code Changes

The next meeting of the General Assembly's Joint Committee on Administrative Rules (JCAR) is currently scheduled for November 13, 2012. Both the Illinois Workers' Compensation Commission (IWCC) and Illinois Department of Insurance (IDOI) have several proposed changes and updates to the Administrative Code pending with JCAR.

Since our previous pending-Administrative Code post, the Department of Insurance moved several additional rulemakings to JCAR's Second Notice.

 

Illinois Workers' Compensation Commission

No additional updates since our previous post. (Click here for our previous post covering both the JCAR process and the IWCC proposed rules status updates.)

 

Illinois Department of Insurance (updated)

JCAR Second Notice

The following proposed updates moved to JCAR's Second Notice review period. JCAR will consider these rules at its November meeting.

• Insurance Data Reporting Requirements (50 Ill Adm Code 4203) proposed 2/3/12 (PDF Page 9)
• Internal Security Standard and Fidelity Bonds (50 Ill Adm Code 904) proposed 6/22/12 (PDF Page 56)
• Accident and Health Expense Reporting (50 Ill Adm Code 2043) proposed 8/3/12 (PDF Page 24)

Pending Second Notice

As part of the JCAR's First Notice process for the new WC PPP rules, all interested parties were permitted to submit public comments about the proposed regulatory changes to the IDOI up until the June 11, 2012 deadline.

 

At this point, JCAR has not addressed the modifications to the existing rules

(50 Ill. Adm. Code 2051) with the IDOI at its monthly meetings, and, as of this post, the IDOI is not scheduled on the agenda for JCAR’s next meeting on November 13, 2012.

 

• Preferred Provider Programs (50 Ill. Adm. Code 2051) proposed 4/27/2012 (PDF Page 286)

 

IWCC Posts 2013 Arbitrators' Calendars

The Illinois Workers' Compensation Commission posted its 2013 Arbitrators' Calendars on the IWCC website.

IWCC Arbitration Calendars

• 2013 arbitration hearing sites
• 2013 Chicago arbitration schedule
• 2013 non-Chicago arbitration schedule

The IWCC maintains a Calendars, Call Sheets, & Chicago Trials page on its website which lists the remaining schedules for 2012 along with the new 2013 schedules referenced above.

IWCC October Board Meetings

There are two Illinois Workers' Compensation Commission board meetings scheduled for next week.

Both the IWCC's Commission Review Board meeting and the Workers' Compensation Advisory Board meeting are scheduled for Wednesday, October 24 at the James R. Thompson Center in Chicago.

Commission Review Board

The Commission Review Board's meeting is currently set for 10:00am in the Thompson Center's 8th Floor Chairman’s Conference Room.

Commission Review Board October agenda

A brief overview of the Commission Review Board from the IWCC's website:

Statutory reference: 820 ILCS 305/14.1. See also Part 7500 of the Rules.

Function: The board investigates complaints regarding misconduct made against arbitrators and commissioners of the Commission. While the board investigates allegations of misconduct, it has no authority to review or change arbitration or Commission decisions. 

Members: There are seven members on the board. The chairman of the Commission is the chairman of this board. The senior labor and management commissioner each serve on the board. Arbitrators elect one Chicago and one Downstate arbitrator. The chairman certifies the election of the arbitrators. Two members who are not commissioners, arbitrators, or Commission employees are selected by the governor.

 

IL Administrative Code Status Updates

Both the IWCC and IDOI are in the process of updating their rules and regulations through the Illinois General Assembly's Joint Committee on Administrative Rules (JCAR).  If you are unfamiliar with the Illinois rulemaking process, JCAR provides a succinct overview of the process on its website. 

The following is a status update on pending IWCC and IDOI additions and modifications to the Illinois Administrative Code:

Illinois Workers’ Compensation Commission

JCAR "Certificates of No Objection"

JCAR issued "Certificates of No Objection" at its September 11, 2012 meeting for two separate IWCC administrative code updates. The IWCC can now adopt the rules by filing them with the Secretary of State. The effective dates will appear when published in a future Illinois Register.

• Miscellaneous (50 Ill Adm Code 7110) proposed 3/2/12
• Incorporates all of HB 1698/Public Act 97-18’s modifications and updates to the medical fee schedule reimbursement and methodology rules. (See our previous post with an outline of the major updates)
• Alcohol and Drug Sample Collection and Testing (50 Ill Adm Code 9140) proposed 6/15/12 (PDF document page 75)

JCAR Second Notice

The following proposed updates moved to JCAR's Second Notice review period. JCAR will consider these rules at its November 13, 2012 meeting.

• Arbitration (50 Ill Adm Code 7030) proposed 8/17/12 (PDF document page 72)
• Miscellaneous (50 Ill Adm Code 7110) proposed 8/17/12 (PDF document page 79)
• Incorporates the updates to the physician-dispensed pharmacy reimbursement methodology (see our previous update for more information)
• Commission Review Board Procedures (50 Ill Adm Code 7500) proposed 8/17/12 (PDF document page 96)

JCAR October Meeting Reminder

The Illinois General Assembly's Joint Committee on Administrative Rules' (JCAR) monthly meeting is scheduled for Tuesday, October 16, 2012.  The meeting is scheduled for 11:00am in Room 600C at the Michael A Bilandic Building (160 North LaSalle Street, Chicago).
 
The October agenda does not currently include updates from either the Illinois Workers' Compensation Commission or Department of Insurance.

We will provide a status update on the proposed IWCC and IDOI Administrative Code updates early next week.  

National WC Premium Rate Ranking Study

The Oregon Department of Consumer and Business Services' 2012 Oregon Workers’ Compensation Premium Rate Ranking Summary is now available.  This biannual report ranks the WC premiums of all 50 states and the District of Columbia.

Illinois is ranked as the 4th highest premium in 2012 rankings, at 151% of the median states of Georgia & New Mexico, down one spot from 3rd highest premium in the 2010 study. 

The workers' compensation premium rates used for the study are from 1/1/2012, or late 2011 depending on the state, so they do not appear to include any of NCCI's current recommended rate changes for various states.  Our previous post detailed the announcement that the Illinois Department of Insurance is currently reviewing NCCI's recommended 3.8% decrease to the IL workers' compensation advisory and loss cost rates.

IWCC Dental Fee Schedule Effective Date

As previously posted, the Illinois Workers' Compensation Commission modified its dental fee schedule rates and methodology. 

The IWCC updated its website yesterday with the effective date of that schedule.  The IWCC dental fee schedule will apply for all dates of service on or after June 20, 2012. 

The full IWCC post:

The Commission has posted a fee schedule for dental services provided on or after June 20, 2012. Bills should be paid at the lesser of the actual charge or the fee schedule amount.

As part of the changes instituted by HB 1698/PA 97-18, the legislature directed the Commission to create a dental fee schedule. Thanks to the Workers' Compensation Medical Fee Advisory Board and the Illinois State Dental Society for their help in obtaining and analyzing the needed data.

IWCC Dental Fee Schedule Posted

The new IWCC Dental Fee Schedule for Non-Hospital Regions 1-4 is now posted on the Illinois Workers' Compensation Commission's website. 

As of this morning, the IWCC Instructions and Guidelines are still pending publication in the Illinois Register, but the new region-specific fee schedule reprice amounts for dental codes D0120-D9999 are available for review.

The codes are located on the IWCC's Medical Fee Schedule page, under the heading NON-HOSPITAL FEE SCHEDULES.

We will follow-up with additional posts when the IWCC publishes the effective date for the dental fee schedule and its Instructions and Guidelines.

Illinois-Specific WC Statistics

We received several inquiries regarding additional Illinois-specific WC statistics since last week's NCCI Illinois State Advisory Forum presentation post. 
 
In addition to workers' compensation industry research organizations (e.g., NCCI, WCRI, etc.), the IL Workers' Compensation Commission (IWCC), IL Department of Insurance (IDOI), and IL Department of Public Health (IDPH) have annual reports posted on their respective websites. These reports detail numerous components of Illinois' workers' compensation claims and departmental activities.
 

Illinois Workers' Compensation Commission

The most recent Fiscal Year Annual Report (FY 2011) is located under the Annual Report tab on the IWCC website.  Currently, its website contains reports dating back to Fiscal Year 1995.

In addition to its Annual Reports, the IWCC also provides links to other entities for workers' compensation statistics.
 

Illinois Department of Insurance

The IDOI publishes two WC-specific annual reports. 

• The 2012 Annual Report, submitted to the Governor's office on 6/29/2012, details the IDOI Fraud Unit's departmental activities.
• NCCI's 2011 Illinois Workers' Compensation Advisory Organization Data is submitted to the IDOI, and published on its website, on an annual basis. 

Illinois Department of Public Health

The IDPH publishes reports on both fatal and non-fatal occupational injuries under the Epidemiologic Studies tab on its website.