Q2 2022 Legislative Updates

Jul 1, 2022 | Legislative Update

Here is a summary of legislative and regulatory developments and challenges for the second quarter of 2022 and their practical implications:

Maryland Cybersecurity Law: In June, Maryland enacted legislation that sets cybersecurity standards for insurers, TPAs and their third-party service providers. According to the National Association of Insurance Commissioners, Maryland becomes the 18th state to adopt a version of the NAIC Insurance Data Security Model Law (#668). Along with the New York regulation “Cybersecurity Requirements for Financial Services Companies” (addressing the same issues but following a different model), the legislation establishes generally accepted data security standards for workers’ compensation payers and their trading partners.

 

Implications:  The provisions of the model act offer a guidepost for payers’ internally developed cybersecurity standards, since they are now broadly required by state law. Fortunately, they are reasonable, requiring payers to develop and implement a data security program to identify and protect against risks, respond to data incidents and investigate and disclose cybersecurity events to regulatory authorities and affected consumers and trading partners. Payers are also required to oversee compliance of their third-party service providers using or accessing the payer’s confidential information.

 

New York WCB Clarification regarding Payer Objection Notices: The Workers’ Compensation Board has clarified its earlier guidance, stating that Form C-8.4 notices to providers and the Board need not be sent if the reasons for lower payment are standard bill review adjustments, including PPO network reductions. Specifically, the bulletin states:

 

Payments may be appropriately reduced, but objections should not be submitted by the insurer to the Board in the following scenarios:

  • The amount billed for the particular CPT code is in excess of the amount designated by the applicable medical fee schedule and the insurer pays the bill at the appropriate medical fee schedule amount.
  • The insurer reduces the amount of the bill to 12, 15 or 18 relative value units for evaluation services and modalities, as set forth in the applicable medical fee schedule.
  • The insurer reduces the amount of the bill pursuant to a contractual agreement with the provider (e.g., network or PPO discount).
  • There is a duplicate bill.

 

Implications: This revision should greatly reduce the voluminous paperwork burdening claim organizations doing business in New York. On a related topic, the WCB is in the midst of a multiple-year move to electronic submission of filings, a key feature of which is the OnBoard application.  For more information go to the Payers section of the Medical Portal here:  http://www.wcb.ny.gov/medicalportal/.

 

Telehealth Compliance with HIPAA: The Office of Civil Rights (OCR) within the US Department of Health and Human Services has recently issued guidance broadly endorsing the use of audio-only telehealth services to increase access to health services by patients who have limited financial resources or who live in rural areas with limited broadband availability. The guidance can be found here: https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/hipaa-audio-telehealth/index.html.

 

Implications: OCR enforces federal privacy regulations (e.g., HIPAA) that generally don’t apply to WC payers, but health care providers and payers’ third-party service providers don’t enjoy those same exemptions, so this clarification comes as a welcome relaxation of regulatory constraints.

On a related telehealth topic, a new study from physical therapy quality analytics firm Focus on Therapeutic Outcomes (FOTO) found that, for telerehabilitation for low back pain, telerehab (a) was equally effective in improving functional status outcomes for patients with low back pain compared to traditional in-person office visits, (b) usually involved significantly fewer visits, and (c) had roughly equal patient satisfaction ratings (82% for telerehab versus 86% for in-person office visits.

80°, 90°, 100°; summers are getting hotter – are your workers safe?

Jul 1, 2022 | Insights

Solar ultraviolet radiation (UVR) can damage skin without detection meaning a sunburn starts far before your skin reddens or blisters. More than 100 million Americans will experience sunburn this year and thanks to a depleted ozone layer, exposure to UVR has increased, making sunburn and its symptoms, more intense.

How can employers help workers protect themselves from sunburn – and a heightened risk of skin cancer? Here are three tips for keeping your worksite sun-safe no matter the season.

  1. Share sun protection strategies.

Although sunburn prevention measures are no secret, they are not always practiced 100% of the time. It is encouraging that in 2010, 70% of adults reported that they usually or always practice at least one of the three sun-protective behaviors described below. However, given the extended hours that many workers can spend at an outdoor worksite, it is important to remind employees of these proven strategies to block out UV rays.

Dress the part. A quick test to tell if you’re wearing sun-protective garb: place your hand between a single layer of fabric and a light source. If you can see your hand, the clothing does not offer optimal protection. A wide-brim hat also helps protect the head, forehead, ears, eyes, nose and scalp, and UV-absorbent sunglasses can block 99-100% of UVA and UVB radiation.

Apply sunscreen. Sunscreen 15 SPF and above should block 93 percent of UV rays. Tell employees to follow product directions to ensure continuous protection.

Limit exposure and seek shade when appropriate. UV rays are most intense between 10 a.m. and 4 p.m. An easy sun intensity test: if your shadow is shorter than you, the sun’s rays are at their strongest.

  1. Modify working conditions as needed.

In addition to encouraging good habits among your employees, there are many ways to modify your work conditions to protect your workforce from overexposure. UV rays are strongest during mid-day, near the equator, during summer months and at very high altitudes. Bearing this in mind, it’s sometimes useful to train workers to use the UV Index Scale, a rating system established by the World Health Organization. The Index incorporates effects of the position of the sun in the sky, forecast cloud cover and ozone amounts into its level-based scoring system, which is used to warn people of increased risk. At level 3 or higher, the amount of solar UV radiation is strong enough to damage skin. Therefore, many workplaces have their employees adjust their schedules when levels are “very high” or “extreme.” In addition, employers should schedule breaks for workers to seek out workplace-provided shade, such as tents, shelters and cooling stations, and to reapply sunscreen. Schedules that minimize outdoor tasks during mid-day and rotate workers to reduce UV exposure are also recommended.

  1. Incorporate sun safety into policies and training programs.

Making strides toward sun safety is much easier when it is integrated into your company culture and policy. Here are a few ways to get started.

Skin protection is an oft-overlooked aspect to overall wellness, so be sure to incorporate it into your workplace wellness program, perhaps in the same unit as avoiding heat illness.

Teach employees about the signs and symptoms of UV exposure, such as red, warm and tender skin, blistering, headache, nausea fatigue – but also warn them that symptoms may not start for about 4 hours after sun exposure.

Encourage outdoor workers to model sun-safe behaviors and to discuss the importance of sun protection with coworkers and customers alike.

The effects of sunburn may not be immediately apparent. Symptoms may be delayed and signs may not be readily visible. But don’t underestimate the impact it can have on employee health and workplace operations. By adapting your work policies to be more sun-conscious – and simultaneously encouraging workers to keep their skin health top of mind – the risks of UV exposure can be effectively mitigated.