Illinois Workers' Compensation Preferred Provider Program – WCPPP Update

HFN has been approved as a Workers' Compensation Preferred Provider Program Administrator (WCPPPA) by the Illinois Department of Insurance.

The HFN WCPPP Solution
Employers now have, for the first time, the ability to direct their injured workers into a “Workers' Compensation Preferred Provider Program” for their medical treatment. HFN is uniquely positioned and ready to help you realize the benefits and savings associated with utilizing a WCPPP. The final rules have been published and became effective March 4, 2013. HFN is ready to assist you in understanding these regulations and how they can benefit your organization.   

We are available to discuss designating HFN as your WCPPP. HFN is ready to provide comprehensive or customized solutions that can lower your workers’ compensation costs, improve employee health, reduce indemnity and increase productivity for your entire workforce. To augment our WCPPP HFN has the largest Coordinated Occupational Health Network in Illinois (COP®) with 24 hour coverage and Return to Work initiatives to partner with your healthy workforce goals.

For more information about HFN’s WCPPP, Work Comp Direct and other workers comp services  please contact Guy Swanson at (630) 990-8609 or SwansonG@hfninc.com. Additional information is also available at HFN’s WC blog: http://ilwcreformguide.blogspot.com/

WC PPP Rulemaking Update

The General Assembly's Joint Committee on Administrative Rules met on January 8, 2012, and the Illinois Department of Insurance's WC PPP rulemaking was on the agenda.  JCAR voted to extend the review process by 45 days, and the updates to the Illinois Insurance Code will now appear on the JCAR's February meeting agenda.

JCAR will meet at 9:00am on February 5 at the Stratton Office Building in Springfield, IL to discuss the proposed rulemakings.

JCAR's Dept of Insurance 2013 Update

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

Pending Department of Insurance Rulemakings

The current meeting agenda includes the IDOI's workers' compensation preferred provider program (WC PPP) administrative code updates.  Our previous update included details surrounding the established JCAR approval process.

• Preferred Provider Programs (PDF Page 286)
• 50 Ill. Adm. Code 2051
• Proposed 4/27/2012
• Pending: on JCAR January meeting agenda 

 

Approved Department of Insurance Rulemakings

In addition to this proposed-rulemaking, the December 28 Illinois Register contains four approved IDOI updates to the Illinois Administrative Code.  All four of the rulemakings are effective December 17, 2012. 

• Accident and Health Expense Reporting (PDF Page 676)
• 50 Ill Adm Code 2043
• Proposed 8/3/12
• Effective 12/17/2012
• Insurance Data Reporting Requirements (PDF Page 686)
• 50 Ill Adm Code 4203
• Proposed 2/3/2012
• Effective 12/17/2012
• Internal Security Standard and Fidelity Bonds (PDF Page 612)
• 50 Ill Adm Code 904
• Proposed 6/22/12
• Effective 12/17/2012 
• Medical Professional Liability Database (PDF Page 619)
• 50 Ill. Adm. Code 928
• Proposed 7/6/12
• Effective 12/17/2012

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. 

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:

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. 

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)

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



 

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

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)

 

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.  

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.