Hamberger & Weiss LLP


Board Announces Proposals to Improve Medical Care for Injured Workers

On 4/17/18, the Board issued Subject No. 046-1058, which included a number of proposals the Board purports will improve medical care for injured workers.  The proposals include a planned June 2018 regulatory proposal to raise provider fees for services provided on or after 10/1/18. The Board also plans to eliminate the current Board treatment forms (C-4 and C-4.2) and replace them with the use of the CMS-1500 form commonly used by medical providers to bill health insurers.
The Board claims that this change is based on complaints from health providers that use of the C-4 and C-4.2 forms create significant additional administrative costs.  The Board plans to implement use of the CMS-1500 form by 1/1/19.
We believe that use of the CMS-1500 form will make it more difficult for self-insured employers, carriers, and third-party administrators to determine the appropriate payment rate as well as whether the treatment is casually related if a physician fails to attach a narrative report to the form. The CMS-1500 form does not provide any space to indicate a history of the injury, degree of disability, or indicate causal relationship to a date of injury or specific incident. Additionally, there is no space for a narrative. We recommend that our clients contact the Board and object to this proposed change because it will make it more difficult to administer claims and accurately pay injured workers.
The Board also announced that the first phase of the medical portal, one of the Board's Business Process Re-engineering (BPR) initiatives, will be rolled out later in 2018. An electronic medical portal allegedly will allow medical providers to “quickly and easily” determine whether their course of treatment is consistent with the Board’s Medical Treatment Guidelines. This is the first step in the Board’s transition to a paperless system.
Finally, the Board said that it and the Governor's Office are exploring options, including new legislation that will allow injured workers access to other provider types outside of physicians, chiropractors, podiatrists, and psychologists.  Proposed legislation would amend the Workers’ Compensation Law to allow nurse practitioners, physician’s assistants, licensed clinical social workers, and other providers to treat injured workers. We believe that although this proposed change may increase access to care for injured workers, it will come at the cost of a decline in quality of care.  We would object to the proposed legislation if it empowered such providers to render opinions on causal relationship upon which the Board could establish claims and make awards.

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