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:

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)

IL WC PPP Status Update (Part 2)

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)

IL WC PPP Status Update (Part 1)

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.

Approved Workers' Comp Preferred Provider Programs (PPPs)

The Illinois Department of Insurance updated its Approved Workers' Compensation Preferred Provider Program Administrator List on its website.

HFN, Inc. as now listed as an approved Workers' Compensation Preferred Provider Program Administrator.

IWCC Updated Workplace Notice and SSNs

A couple of short updates about the Illinois Workers' Compensation Commission.

The IWCC posted a new employer workplace notice, which incorporates the PPP into the notification language. The workplace notice now includes the following:

If the employer notifies you that it has an approved Preferred Provider Program for workers’ compensation, the PPP counts as one of your two choices of providers.

The IWCC also announced through its website that it will no longer accept Social Security numbers.

Effective immediately, in response to the Illinois Supreme Court Order M.R. 138, the Commission will no longer collect Social Security numbers. The Social Security field has been eliminated from the application and settlement contract forms. Do not enter the number on existing forms. Please update your electronic forms.  

We will request the SSN in those limited circumstances where the information is necessary, and only then at such time as necessary, e.g., to process payment from the Rate Adjustment Fund or Injured Workers Benefit Fund.  

We will remove the numbers from existing files upon request.

IWCC Posts PPP Notification Form

HB 1698 contained several requirements for the creation of Illinois workers' compensation preferred provider programs (PPPs). One of those requirements was an employee PPP notification form promulgated by the Illinois Workers' Compensation Commission (IWCC). An employer with an Illinois Department of Insurance-approved PPP must provide an injured employee with the notification form at the first report of injury.

The IWCC Medical Fee Advisory Board approved a draft version of that form at its October 18 meeting, and the IWCC website now includes its PPP notification form.

Preferred Provider Program Basic Requirements:

In order for employers to implement the PPP direction of care process, HB 1698 lists two basic requirements:

1. The IWCC must promulgate a notification form that the employer will provide to an employee at the time of injury. This form is now available on the IWCC website. 
2. The PPP must be approved by the Illinois Department of Insurance (IDOI). HFN recently confirmed with the Illinois Department of Insurance (IDOI) that there are no approved or provisionally approved workers' comp PPPs. The IDOI has a link on their website of approved workers' compensation Preferred Provider Program Administrators. That list is the source for all approved workers' compensation PPPs in the state of Illinois, and currently it reads, "No Companies have been approved at this time." There is also a permanent link to the IDOI approved list located on the lower right of this blog under the heading Illinois Dept. of Insurance Registered Administrators.

We will continue to provide PPP updates as the IDOI finalizes its regulations and moves towards approving the preferred provider program applications currently under Department review.

IWCC Approves PPP Notification Form & Changes Fee Schedule Regions

There were two major announcements that came out of the IWCC Medical Fee Advisory Board's October 18 meeting.

First, the Board approved its HB 1698-mandated Preferred Provider Program (PPP) employee notification form. The Board made a final change to the proposed form at the meeting, and it approved the modified form for release to the public. It will be available on the IWCC's website in the near future.

The Medical Fee Advisory Board also approved a second document that will appear on the IWCC's website as well. This document is an example of the type of information employers could provide employees to educate them about a PPP before an injury; however, this particular document is not mandatory.

There is only one IWCC PPP notification form required by HB 1698. After an employee reports an injury, the employer with a PPP must provide the employee with the PPP notification form promulgated by the IWCC. An employer with a PPP is allowed to notify its employees about the program at any time, but an employer with a PPP is required to provide the IWCC's PPP injury notification form to an employee after the employee's report of injury.

Second, the methodology for calculating the new fee schedule regions changed. At the September Medical Fee Advisory Board meeting, the Board voted to utilize a weighted average, by geozip population, to calculate the new 14 hospital regions and 4 non-hospital regions. However, at yesterday's meeting, Chairman Weisz announced that the IWCC will utilize a straight average, without weighting, to collapse the current geozip fee schedule amounts into the 1/1/2012 fee schedule regions. There were no further updates on when the new regions' fee schedule amounts would appear on the IWCC's medical fee schedule lookup.

No IDOI-Approved or Provisionally Approved PPPs

Since we have recently received several inquiries regarding "provisionally approved" workers' compensation preferred provider programs (PPPs), we felt the need for a brief clarification.

HFN confirmed with the Illinois Department of Insurance (IDOI) this morning that there are no applications that have been approved or provisionally approved for use as a Workers’ Compensation Preferred Provider Program.

The IDOI has a link on their website of Approved Workers' Compensation Preferred Provider Program Administrators.  That list is the source for all approved workers' compensation PPPs in the state of Illinois, and currently it reads, "No Companies have been approved at this time."  

There is also a permanent link to the list (Approved Work Comp PPPs) located on the lower right of this blog under the heading Illinois Dept. of Insurance Registered Administrators.

We will provide updates once the IDOI begins to approve PPP applications, but, for the moment, there are no approved (provisionally or otherwise) workers' comp PPPs in the state of Illinois.

IL Preferred Provider Programs (PPPs) Approval Process Update

There seems to be a growing consensus that the Illinois Department of Insurance (IDOI) approval process for the new workers’ compensation preferred provider programs (PPPs) could continue through the rest of 2011. Employers would have the ability to designate an IDOI-approved PPP in early 2012. This article from Business Insurance supports our recent conversations with the IDOI regarding the PPP approval timeframe.

After receiving comments from interested parties on its draft rule, the IDOI is currently reviewing and evaluating the comments in order to create the administrative rules that will finalize the criteria required for IDOI PPP approval. The timeframe is also dependent on the Joint Committee on Administrative Rules’ (JCAR) schedule. JCAR provides an overview of the IL rulemaking process on its website.

For networks, like HFN, currently awaiting final review in the IDOI’s PPP process, the release of the draft rule, and eventually the finalized administrative rules, is the final step towards establishing compliance with the IDOI and gaining its approval for their PPPs.

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'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. 

Illinois WC Preferred Provider Program (PPP) Update

An update on the Preferred Provider Program (PPP) process from the August 23^rd IWCC Workers' Compensation Medical Fee Advisory Board:

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).

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.

During the 8/23/11 IWCC Workers’ Compensation Medical Fee Advisory Board meeting, an Illinois Department of Insurance representative confirmed that the IDOI is ready to accept PPP applications. 

The applications should follow the same format as the current PPA (Preferred Provider Program Administrator) process, and they should include all of the current PPA requirements along with the new PPP requirements specifically outlined in HB 1698.  As of today, the IDOI website does not have a list of approved, or provisionally-approved, WC PPPs on their website. 

Now that some current IDOI–approved workers’ compensation PPAs, such as HFN, have submitted their PPP applications to the state, the IWCC will need to either create a form, or provide employers the required notification criteria, to fulfill its notification form requirement detailed in HB 1698.

As of the 8/23/11 Board meeting, the Commission did not have a draft of the notification form.  The Board members stated any third parties may submit their proposed drafts of notification requirements to the Board before the next scheduled meeting on September 13.   They will discuss the standards for the notification form again at that meeting.

Once that IWCC notification form is available, employers will be able to utilize their PPPs.

As an Illinois-based and Illinois-focused company, HFN understands the requirements and opportunities for providers and employers specific to the Illinois workers’ compensation system.  For more information about the PPP process, or to designate HFN as your PPP, please email Guy Swanson, HFN’s Director of Workers’ Comp, or call 630.990.8609.

Illinois Preferred Provider Programs: PPAs & PPPs

As a follow-up to our earlier post regarding approved preferred provider program administrators, there is some uncertainty and confusion over the terminology involved with preferred provider programs & HB 1698.

Currently, if you are a PPO operating in the state of Illinois, you need to be registered by the Illinois Department of Insurance as a preferred provider program administrator, also known as a preferred provider administrator or PPA.  There is an annual renewal process with the Department for every PPA in Illinois. 

The Department of Insurance keeps two lists of approved PPAs on their website: here & here.  The Provisionally Approved Companies list consists of previously approved companies with renewal applications in house at the Department. As the Department reviews and approves the renewal applications, those companies move to the Approved Companies list.

HB 1698 now allows an employer to utilize a “preferred provider program” (PPP) approved by the Department of Insurance for the direction of medical treatment of injured employees.  These new workers’ comp PPPs must comply with all of the existing PPA requirements, but the law also lays out additional requirements as well.

In addition to the specific PPP requirements described in Section 8.1a of HB 1698, the final portion of 8.1a states,

The Director of the Department of Insurance may promulgate such rules as are necessary to carry out the provisions of this Section relating to approval & regulation of preferred provider programs.

Until the Department releases its additional requirements, and begins the new PPP approval process, none of the currently approved PPAs are Department of Insurance–­approved workers’ comp preferred provider programs.

As a PPA with a successful workers’ comp network, HFN is prepared to meet all of the specific PPP requirements included in HB 1698.  HFN will immediately take the additional steps to become a Department of Insurance–approved WC preferred provider program once the Department establishes those new approval requirements. 

For more detailed information about these changes, or any WC reform issue, you can always use the comments section on the blog or email us directly.

For more information on HFN’s workers’ compensation products and solutions, contact Guy Swanson, HFN’s Director of Workers’ Comp, by email or at (630) 990-8609.

Approved Preferred Provider Program Administrators in Illinois

We will have the first detailed analysis of HB 1698’s employer direction and “preferred provider programs” next week, but numerous individuals have contacted HFN asking which companies are currently approved preferred provider program administrators in Illinois.

The Illinois Department of Insurance manages the application and approval process for all preferred provider program administrators.  Since the Department has a small staff assigned to process and review the annual applications, there is a “provisionally approved companies” list which contains previously approved companies with renewal applications in-house at the Department.

Preferred Provider Program Administrators approved by the Illinois Department of Insurance: Provisionally Approved Companies & Approved Companies

HFN CEO applauds preferred provider program & direction of care in HB 1698

HFN CEO David Kolb’s statement commending Governor Quinn for improving injured workers’ medical care through the use of preferred provider programs appeared yesterday in the TRIB local Oak Brook Business section.  It read in part, “Recognizing the need for integrated and coordinated cost effective medical for injured workers, this bill allows, for the first time, employers the ability to refer workers to a comprehensive network of medical providers, skilled in effectively treating workplace injuries.” 

Overview of New Workers' Comp Regulations

Now that Governor Pat Quinn signed HB 1698 into law on Tuesday, it is time to look ahead to the efforts involved in implementing these changes. From the IWCC Fee Schedule Committee’s rates and repricing methodology decisions to the Department of Insurance’s release of the additional Preferred Provider Program approval requirements, the coming weeks and months are sure to be extremely busy for everyone involved in the workers’ comp system.

Here is HFN’s general overview of the significant changes to the Illinois workers’ compensation regulations included in the bill. Our individual in-depth assessments of these major changes will start shortly, and we will continue to post regular updates regarding their implementation.