Website - Division of Worker's Compensation
Email - WC
Council on Workers' Compensation
January 13 , 2015
Mr. Beiriger, Ms.
Bloomingdale, Mr. Buchen, Ms. Johnson, Mr. Kent, Mr.
Metcalf, Ms. Nugent , Mr. Redman, Mr. Schwanda, and Ms. Seiler
Staff present: Mr. Aiello, Ms. Endter, Mr. Ezalarab, Mr. Krueger, Mr. Moreth and Mr. O'Malley
Mr. Brand, Mr. Ginsburg, and Ms. Thomas
- Call to Order/Introductions:
Mr. Metcalf convened the
Worker's Compensation Advisory Council (WCAC) meeting at approximately 10:05
a.m. in accordance with Wisconsin's open meetings law.
WCAC members, staff and members of the audience introduced
Approval of minutes: Ms. Bloomingdale moved to approve the minutes
of the January 23. 2014 meeting. Mr Buchen seconded the motion. The
minutes were unanimously approved without correction.
Correspondence: Mr. O'Malley reviewed correspondence concerning
proposals for changed to ch. 102, Wis. Stats.
A letter of November 18, 2014, from Joe Paduda, President, CompPharma, has
two proposals: require physician dispensing reimbursement to be based on the
original manufacturer's NDC number; and restrict medical providers from
dispensing medication seven days postdate of injury.
Joseph Hulwi, BC-HIS, sent an email message on December 30, 2014, proposing
that if the statue of limitations is changed, that it be reduced to 6 years.
A January 9, 2015, letter from Kay Morgan, VP, Drug Product & Industry
Standards, ELSEVIER Gold Standard, proposed the following change to section
102.425(3)(a)1., Wis. Stats.: "The average wholesale price of the
prescription drug as of the date on which the prescription drug is
dispensed, as quoted in a
nationally recognized pricing resource.
A January 12, 2015, letter from Jennifer Mauer, Director of Government
Affairs, Automated HealthCare Solutions, recommended that physician
dispensed medications be reimbursed at a maximum of 112.5 percent of the
original manufacturer's average wholesale price.
- Public Hearing Comments:
Mr. O'Malley stated that the Public Hearing was held in Madison on December
11, 2014, with video conference hook-ups in Eau Claire, Green Bay, La
Crosse, Milwaukee, and Wausau. Mr. O'Malley said that about 50 persons in
total attended the public hearing, and that 12 of those made comments.
Sharon Belton from the Worker's Compensation Research Institute made a
presentation but did not have any specific proposals. Mr. O'Malley then
directed attention to the hand-out containing a summary of the proposals
from the public. He went over each proposal and the members engaged in
general discussion about them. Mr. Metcalf advised the members that he can
provide the members with the prior department proposals. He also informed
the members that the health cost data bases had been audited and asked if
the members would like to review the audit recommendations. Mr. Metcalf
stated there were no new proposals from the department, from LIRC, or from
the Self-Insurers Council.
- Work Injury Supplemental Benefit Fund [WISBF]Balance:
Mr. Metcalf reminded the members that the WISBF, as of May 14, 2013,
suspended reimbursements of supplemental benefits payments to permanently
and totally disabled individuals, but that all other claims were being paid
from the WISBF. Mr. Krueger provided a handout showing that the WISBF has a
$6.2 million cash balance but with a total balance of $6.9 million after the
accounts receivable of $715,000 are included. He also explained that the
department is still receiving requests for supplemental benefit
reimbursements but the department is holding them in abeyance. The requests
for reimbursement total $7.5 million. Mr. Krueger pointed out that the WISBF
balance had been down to $1.9 million but that the WISBF is now strong. Mr.
Metcalf stated that the department accepts requests for supplemental benefit
reimbursements made within 12 months after the year the payments were made.
The department had an influx of requests once
the 12 month time frame was set but that all of those were cleared out.
recalled that the draw down on the WISBF was a matter of urgency two years
ago and asked if anything else needed to be done. Mr. Metcalf pointed out
that the last agreed upon bill contained a provision for an assessment on
the carriers, not the self-insurers, to pay off this liability over time.
Mr. O'Malley informed the members that these claims for permanent total
disability supplemental reimbursements predate January 1, 2000, there are
fewer than 1,000 of these PTD claims, and that about 20 of these disabled
workers die each year.
- Public Proposals: This was covered in the Public Hearing Comments.
- Other Council Business: A room has been reserved for the Council for the second Tuesday of every month through the end of the year. While the Council traditionally meets until June or July, since the rooms are reserved for them, they can meet later in the year if they choose. Mr. Bieriger asked if it would be possible that all of the proposals are available when they start their deliberations at the February meeting. Mr. Metcalf said that two additional proposals may be coming from the Health Care Provider Advisory Committee. One is a possible proposal to add Opioid treatment language to the treatment guidelines in ch. DWD 81. The second is a letter from the members of the committee on prescription drug cost issues. A member of the Health Care Provider Advisory Committee will appear at a future Council meeting to address these proposals.
Mr. Kent inquired as to where in the process were the rules that they had proposed over 4 years ago. Mr. O'Malley stated that the department now has an administrative rules coordinator and a hearing draft of the rules should be available for the members in the next couple of weeks.
The members inquired as to whether there are any changes in the internal structure or organization of the division. There was nothing to pass along at this time.
Mr. Metcalf said that the division created two senior ALJ positions: a senior ALJ for training and a senior ALJ for health cost disputes. The total number of ALJ positions remains unchanged, and the senior ALJ's will continued to hold hearing calendars. The members asked if there was a hearings backlog. Mr. O'Malley answered that we now scheduled 97 to 98 percent of the cases for hearing about 15 weeks after they are put in ready status, compared to 14 to 15 months in 2007; with about 630 - 640 cases ready to be heard. By comparison, it takes a couple of years to get a hearing in Indiana and from 6 months to several years in Illinois.
- Adjournment: Ms. Bloomingdale moved to adjourn. Mr Bieriger seconded the motion. Meeting adjourned at about 11:00 a.m. by unanimous approval.