Managed Physical Medicine

Q4 2017 Legislative Updates

Here is a summary of legislative and regulatory developments and challenges for the fourth quarter of 2017 and their practical implications:

New York

During 2017 the New York legislature considered several bills to improve injured workers’ access to high-quality health care. AB 7544 would require the New York State Workers’ Compensation Board to annually revise the rate schedule for health care rendered under the workers’ compensation system.

On a separate but related topic, AB 1419 would require telehealth service expenses to be included as covered expenses within the provisions of the workers’ compensation law. Further, SB 833 would establish a task force to conduct a study on the advisability of utilizing telehealth within the workers’ compensation system.

  • Implications: Although none of these measures were enacted, they represent a growing legislative focus on improving injured workers’ access to health care in New York. The drafting note to AB 7455 mandating annual fee schedule updates states, “ The Workers’ Compensation Board has not adjusted rates of payment for health care providers for over 10 years. . . . Payments for health care services rendered pursuant to the workers’ compensation system do not reflect the current cost health care, including labor, property and energy costs.” Similarly, the memorandum to SB 833 proposing a study on the application of telehealth services in workers’ compensation suggests that telehealth could prove effective to “ensure that all injured workers have access to quality health care services.” In 2018 the New York legislature may focus on WC health care fees and delivery mechanisms.
Wisconsin

The Wisconsin legislature declined to pass an agreed-upon bill proposed by the Wisconsin WC Advisory Council which would have adopted a fee schedule for medical services delivered to WC claimants. By tradition, bills drafted by the Advisory Council, composed of management and labor representatives, are passed without substantive amendments.

Although Wisconsin WC medical services are priced very high compared to other states, which is typical of charge-based systems in the six states without fee schedules, Wisconsin medical costs per claim are moderate because of low utilization. As a consequence, business community support for a fee schedule has been tepid. Further, the proposed fee schedule mechanism, based on in-state average payments made by group health and self-insured health plans, appeared complex and expensive to create and maintain.

  • Implications: Wisconsin House Speaker Robin Vos was quoted as saying that the WC Advisory Committee’s bill was “dead on arrival.” It is unlikely that Wisconsin will attempt another run at establishing a WC fee schedule in the foreseeable future.