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Council on Workers' Compensation
February 10 , 2015
Mr. Beiriger, Ms.
Bloomingdale, Mr. Buchen, Mr. Ginsburg, Mr. Kent, Mr. Metcalf, Ms. Nugent , Ms. Seiler , and Ms. Thomas
Staff present: Mr. Aiello, Ms. Brown, Ms. Endter, Mr. Ezalarab,
Ms.Froehlich, Mr. Krueger, Mr. Moreth, Ms. Smiley, and Mr. O'Malley
Mr. Brand, Ms. Johnson, Mr. Redman, and Mr. Schwanda
- Call to Order/Introductions:
Mr. Metcalf convened the
Worker's Compensation Advisory Council (WCAC) meeting at approximately 10:00
a.m. in accordance with Wisconsin's open meetings law.
WCAC members, staff and members of the audience introduced
themselves. Mr Metcalf also introduced the two new senior administrative law
judges, Janine Smiley and Mary Lynn Endter
Approval of minutes: Ms. Bloomingdale moved to approve the minutes
of the January 13. 2015 meeting. Ms Nugent seconded the motion. The
minutes were unanimously approved without correction.
Correspondence: Mr. O'Malley reviewed correspondence concerning
proposals for changed to ch. 102.
A letter of August 14, 2014,
was received, with a recommendation from the members of
the Health Care Provider Advisory Committee (HCPAC), regarding a proposal
that all medications dispensed through a physician's office and by
compounding pharmacies be paid at the average wholesale price plus a $3.00
dispensing fee. Dr. Mary Jo Capodice, a member of the HCPAC, was present at
the meeting to discuss this issue in further detail
A letter dated December 23, 2014 was received from Mr. Stephen Schnieder,
American Insurance Association; Mr. Mark Johnston, National Association of
Mutual Insurance Companies; Mr. Jeff Junkas, Property Casualty Insurers
Association of America; and Mr. Andy Franken, Wisconsin Insurance Alliance.
They proposed the adoption of a medical provider fee schedule based on
Medicare's Resource Based Relative Value System (RBRVS) with a uniform
conversion factor; and the adoption a pharmaceutical fee schedule for
physician dispensed drugs based on a drug's average wholesale price plus a
modest dispensing fee.
A January 21, 2015, letter was received from Mr. Steve
Mercaitis, Vice President of Lori Knapp Companies, with a proposal that
fiscal employer agencies be allowed to cover employees under a blanket
worker's compensation policy similar to the W2 law where for worker's
compensation purposes there is one employer of record. Mr. Mercaitis and
other representatives from Lori Knapp Companies were present at the meeting
to discuss this proposal in more detail
A letter dated January 30, 2015 was received from Mr.
Kevin Tribout, Executive Director, Government Affairs, Helios Company. The
proposals contained in the letter include the following: (1)
control the practice of physician
dispensed medications or cap reimbursement at existing pharmacy fee schedule
rates; (2) enact regulatory changes for compound drugs that require prior
authorization, require the prescribing physician to document a medical need
for the compound medication and cap reimbursement for compound drugs;
(3) the development and required use of standardized pharmacy billing
processes and forms, specifically the NCPDP Workers' Compensation/Property &
Casualty Universal Claim Form (WC/PC UCF); (4) and, if standardized billing
processes and forms are not adopted, physician dispensed medications should
require both the NDC of the repackaged medication dispensed and the NDC of
the original manufacturer for the drug used in repackaging
- Presentation on WC and Fiscal Employment Agencies:
Mr. Steve Mercaitis, Ms. Jane Bushnell, and Mr. Gerry Born of Lori Knapp
Companies gave a presentation on the proposal to allow fiscal agents to
obtain one policy for worker's compensation insurance to cover a number of
their clients. The company has been in existence since 1972 and was the
first agency to provide community based services to persons with
disabilities. Lori Knapp Companies provides Fiscal Agent services to
disabled persons who want to stay in their own homes and direct their own
care. Lori Knapp Companies handles all of the paperwork involved for
disabled persons who want to hire their own care givers, and sets them up as
employers. Under current
law, each disabled person must purchase a policy for worker's compensation
insurance coverage. The cost of the policy comes out of the individual's
Medicare budget. Lori Knapp Companies proposes that it be allowed to buy one
policy for worker's compensation insurance to cover all of the persons it
serves. This will result in a reduction of the amount of money coming out of
the budget for most people, in some cases significantly. Several scenarios
were discussed with examples showing the amount of savings that would occur
under this proposal. With the
worker's compensation policy constant fee of $220 per year there could be an
overall reduction in costs of $255.94 per year per employer if the FEA
employer is placed under one blanket worker's compensation insurance policy.
This proposal would not affect coverage of employees who could be injured
providing in-home care for disabled people.
- Presentation on Opioid and Drug Compounding Guidelines:
Dr. Mary Jo Capodice, a member of the HCPAC, gave a presentation on physician
dispensed medications, compounding medications, and on a paper entitled
Chronic Opioid Clinical Management
Guidelines for Wisconsin Worker's Compensation Patient Care.
referred to the letter from HCPAC of August 4, 2014. She explained that
companies provide physicians with drugs that the physicians can dispense to
patients in the office. Physicians can charge anything for the drug. For
example, a 30 day supply of Ibuprofen 800 mg might be filled by a pharmacist at
$3.40 for a 30 day supply but a physician might charge the carrier $150.00
because there is no fee schedule for this type of dispensing. HCPAC proposes
that the cost of these physician dispensed drugs be limited to the underlying
manufacture's average wholesale price plus $3.00.
problem concerned the use of compounding medications. Compounding medications
are usually topical creams that are prescribed for patients who cannot take oral
medications. A physician will send a prescription for the cream to the pharmacy,
and the pharmacy can charge a large sum of money for the cream because is it not
included on a fee schedule. Costs for
compounded medications may run from $1,000 to $20,000 for a month's supply.
HCPAC proposes that the cost of the compounding creams also be based on the
average wholesale price plus a $3.00 dispensing fee. However, this is more
complicated because a cream may include from two to five different drugs. The
number of drugs in the cream may need to be considered when determining the
average wholesale price.
On the issue of
opioid use, Dr. Capodice explained that the HCPAC recommended creating
guidelines for physicians to use when prescribing narcotic medicines to worker's
compensation patients. The paper sets out elements that a physician should
consider such as a drug contract with the patient, conduct regular drug
screening to prove that the patient is using the drug, and conduct random pill
counts. The paper points out that narcotic drug use over 90 days is not a
benefit and that a patient should likely be referred to a pain management clinic
at that point. The HCPAC is proposing best practice guidelines to help prevent
addiction and to encourage return to work. The Wisconsin Medical Society has
agreed to help communicate the guidelines to physicians.
- Other Council Business:
BJ Dernbach, DWD Legislative
Liaison, informed the Council that as part of the governor's plan to
streamline state government, the Budget Bill will transfer functions and
staff of the Worker's Compensation Division (WCD) to the Office of the
Commissioner of Insurance (OCI) and Department of
Administration-Division of Hearings and Appeals. He also said
that the Budget Bill includes three amendments that were previously
recommended by the Council: establishing a means for supplemental
benefits reimbursements to insurance carriers; increased solvency
protection for the uninsured employer's fund in the event of very large
claims; and coverage of
student-trainees from institutions of higher education assigned to
unpaid training worksites, along with exclusive remedy protections for
employers operating those worksites.
Mr. Buchen offered the following
Worker's Compensation program enjoys a national reputation for
efficiently delivering quality benefits to injured workers as a
reasonable cost to employers.
Compensation Advisory Council would like to ensure that the proposed
changes to the Division and the dispute resolution process included in
the recently introduced state budget do not result in a diminution in
the level of services and protections that all stakeholders enjoy under
the current system.
Therefore, we ask
that Division staff confer with the OCI and DOA staff to identify and
resolve any issues to insure that the quality and efficiency of the
current program is preserved and enhanced in the transition. Further, we
ask that Division staff report back to the Advisory Council on their
discussions at the next meeting.
Mr. Buchen moved
for adoption of this Resolution; seconded by Ms. Bloomingdale. The
Resolution was adopted by unanimous vote.
- Adjournment: Ms. Bloomingdale moved to adjourn. Ms. Nugent seconded the motion. Meeting adjourned at about
2:00 p.m. by unanimous approval.