IWCC Posts Updated Repricing Instructions

On January 24, the Illinois Workers' Compensation Commission posted its Instructions and Guidelines for Treatment On or After 9/1/11 to its website.  These instructions include all of the changes implemented in HB 1698/PA 97-18 and the subsequent rulemakings approved through the JCAR process.  

Previously, the Rules section on the IWCC website was updated with many of the updates and changes, but the Instructions and Guidelines section was pending.

The IWCC maintains all of these documents under the Medical Fee Schedule/FAQs section of its website.

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

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:

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 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.

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/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)

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.

Illinois-Specific NCCI Presentations

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.

9/19/2012 IWCC Medical Fee Advisory Board Update

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.