The IL Workers' Compensation Commission released several updates to its arbitration schedule.
Geneva
Beginning on Monday, 10/1/2012, the IWCC arbitration and review hearings in Geneva will move from the Kane County Courthouse to the Government Center.
- Current Location: Kane County Courthouse, 100 S 3rd St, #240
- New Location: Government Center, 719 Batavia Avenue.
- Status calls will be held in the Auditorium in Building A
- Hearings will be held in Building G
Rockford
The IWCC also announced a change to the Rockford site's hearing cycle.
- Arbitrator Holland's December status call remains 12/14/2012.
- The IWCC added 12/17/2012 & 12/18/2012 to the trial cycle.
- The IWCC removed 1/2/2012-1/3/2013 from the trial
schedule.
For the full and complete IWCC listing of arbitration/hearing sites and dates, please refer to the Calendars, Call Sheets, and Chicago Trials on its website.
IDOI’s Terminology Changes
When the IDOI submitted its proposed WC PPP regulatory modifications, it updated or clarified the preferred provider program terminology:
Health Care Preferred Provider Program (HC PPP) Administrator
Formerly referred to as the Preferred Provider Program Administrator (PPA). The HC PPP is a new term for the current/traditional PPOs and PPAs, which applies to both group health and workers’ compensation (no WC employer direction) networks. The IDOI already updated its website to reflect this change in terminology:
Approved Health Care Preferred Provider Program Administrators
Provisionally Approved Health Care Preferred Provider Program Administrators ("Provisionally approved" refers to previously approved companies with renewal applications submitted to the IDOI).
Workers’ Compensation Preferred Provider Program (WC PPP) Administrator
Created by HB 1698/Public Act 97-18. This term refers to the new workers’ compensation designation that allows employer direction into an IDOI-Approved WC PPP network.
Approved Workers’ Compensation Preferred Provider Program Administrators
IWCC’s WC PPP Notification Form
For any employer with a designated IDOI-approved WC PPP, an employee must receive the IWCC’s official Notice of Preferred Provider Program for Workers’ Compensation Medical Care. That official form is available on the IWCC website in either English or Spanish. All IWCC forms, including optional WC PPP notification forms, are located in the Forms Section of the IWCC website.
Click here for Part 1 of the WC PPP Status Update (IDOI-proposed regulatory changes)
The National Council on Compensation Insurance, Inc. (NCCI) has a couple of Illinois-specific presentations/reports currently available on its website.
On 9/13/2012, NCCI presented its complete overview of the Illinois workers' compensation environment. The Illinois State Advisory Forum presentation provides a detailed comparison of national workers' compensation and employment trends to the economic conditions of the workers' comp industry in Illinois.
- In August, the Illinois Department of Insurance announced it had begun its roughly 60 day calculation confirmation process after NCCI filed for an overall 3.8% decrease to the workers' compensation advisory and loss cost rates.
- This IWCC release contains an overview from the NCCI report regarding the potential rate reductions for several employer categories.
In addition to the 2012 Illinois State Advisory Forum, NCCI has a parallel report and presentation that research the impact of the introduction of the Illinois workers' compensation fee schedule in 2006.
The Illinois Workers' Compensation Commission's meeting scheduled for Tuesday, 9/25/2012 is now slated to begin at 3:00pm. The Commission will meet at the Thompson Center, Chicago in the 8th Floor Chairman's Conference Room.
The agenda does include a Legislative and Rules update for the Commission.
An initial update from the IL Workers' Compensation Commission's Medical Fee Advisory Board September meeting...
IL Administrative Code Updates
At its September 11, 2012 meeting, the IL General Assembly's Joint Committee on Administrative Rules (JCAR) issued Certificates of No Objection for two separate IWCC updates to the IL Administrative code. The IWCC can now adopt the rules by filing them with the Secretary of State for publication in the Illinois Register.
- Miscellaneous (50 Ill Adm Code 7110) proposed 3/2/12 and 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 [PDF page 75 of the document] (50 Ill Adm Code 9140) proposed 6/15/12 and incorporates HB 1698/Public Act 97-18’s intoxication & testing requirements.
The proposed rules set forth the process for the collection of blood, urine, breath and saliva. These proposed rules include requirements for documentation, transportation and disposal of samples collected, as well as associated records. The proposed rules also set forth the qualifications for those collecting samples.
The effective dates of the IL Administrative Codes will appear when published in the Illinois Register.
IWCC Dental Fee Schedule
The Medical Fee Advisory Board finalized and voted to recommend a dental fee schedule. For a more detailed overview of the debate and formation of the dental schedule, the Advisory Board’s June meeting minutes are now available on the IWCC website. Previously, all dental care reimbursed at the IWCC default rates:
…For treatment between 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). Parties are always free to contract for amounts different from the fee schedule.
As of this morning, the IWCC website did not include the updated dental fee schedule information. We will post another update when the IWCC publishes the rates and effective date of the new fee schedule.
IDOI-Approved WC PPPs
Beginning shortly after the passage of HB 1698/Public Act 97-18 in 2011, the IDOI began to accept and review applications for the new Workers' Compensation Preferred Provider Programs (WC PPPs).
On January 1, 2012, the IDOI listed three networks, including HFN, as IDOI-Approved Workers’ Compensation Preferred Provider Program Administrators. The application review and approval process was based on the requirements detailed in HB 1698/Public Act 97-18.
Currently, there are six companies that appear on the IDOI’s Approved WC PPP Administrator list. All current and future WC PPP Administrators will need to show compliance with the WC PPP regulatory updates to the Illinois Insurance Code, once those updates are finalized and implemented.
Illinois Insurance Code updates
The definitions, rules, and regulations for IL WC PPPs are not finalized as of this post.
The Illinois Department of Insurance (IDOI) submitted its proposed revisions of the IL Insurance Code to the Legislature’s Joint Committee on Administrative Rules (JCAR), and JCAR published those proposed changes on April 27, 2012 in Volume 36, Issue 17 of the Illinois Register (beginning with PDF page 286).
As part of the JCAR process, 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 50 Ill. Adm. Code 2051 with the IDOI at any of its monthly meetings, and, as of this post, the IDOI is not scheduled on the agenda for JCAR’s next meeting on October 16, 2012.
In addition to the Medical Fee Advisory Board meeting, the Illinois Workers' Compensation Commission's Self-Insurers Advisory Board meeting is also scheduled on Wednesday, September 19, 2012.
The Board is currently scheduled to meet at 10:30am at the Thompson Center in the Chairman’s conference room located on the 8th Floor.
The agenda for the meeting includes three topics that will be covered before the meeting moves to the closed session:
- Chairman's Report
- Manager's Report: Security Fund Forecast 6/30/2012
- Prime Tanning Bankruptcy
Earlier this month, Governor Quinn announced his IL WC arbitrator reappointments for arbitrators whose terms expired on 7/1/2012.
Zone 1 (Collinsville, Herrin, Mt Vernon): Gerald Granada
Zone 2 (Quincy, Springfield, Urbana): Nancy Lindsay
Zone 3 (Bloomington, Kewanee, Peoria): Stephen Mathis & Maureen Pulia
Zone 4 (Geneva, Joliet, Ottawa): George Andros
Zone 5 (Rockford, Waukegan, Woodstock): Douglas Holland
Zone 6 (Chicago, Wheaton): Peter O'Malley
Zone 7 (Chicago): Brandon Zanotti
Neva Neal Mundstock was reappointed and is currently on medical leave.
Governor Quinn did not reappoint two arbitrators, Peter Akemann of Zone 2 (Quincy, Springfield, Urbana) and Jacqueline Kinnaman of Zone 6 (Chicago and Wheaton).
The Illinois Appointments website contains a complete overview and full list of the IL Workers’ Compensation Commission Arbitrators.
The Illinois Workers' Compensation Commission (IWCC) has two proposed regulation updates currently in the Illinois Legislature's Joint Committee on Administrative Rules (JCAR) process.
Issue 33 of JCAR's Illinois Register contains both sets of proposed changes:
Page 13005 (PDF document page 72) details changes to the complaint, substitution, and disqualification processes for IL Arbitrators and Commissioners.
Page 13012 (PDF document page 79) details changes to the language regarding the reimbursement for physician-dispensed prescriptions.
PDF page 94 contains 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.
The IWCC Medical Fee Advisory Board is scheduled to meet at 1:00 pm on Wednesday, 9/19/2012.
The current agenda includes several IL WC state fee schedule issues, including:
- the IL dental fee schedule
- unlisted coding rules
- T-codes and Category III codes
The meeting is currently scheduled for Room 9-039 at the Thompson Center (100 W Randolph St, Chicago)
http://www.iwcc.il.gov/WCMFAB091912notice.pdf
