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The original link was retracted by the IWCC contractor, Optuminsight, due to data integrity issues.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