2. Worker's Compensation
3. Worker's Compensation Advisory Council

Worker's Compensation Advisory Council Meeting Minutes

Madison, Wisconsin

June 20, 2017

The Department of Workforce Development provided public notice of this meeting under Wis. Stat. § 19.84

Members present: Ms. Bloomingdale, Mr. Buchen, Mr. Dernbach (Chair), Mr. Fugina, Mr. Gunderson, Ms. Johnson, Mr. Kent, Mr. Reader, Ms. Seiler; and Mr. Tindall

Member Excused:Ms. Frank, Mr. Redman Mr. Schwanda and Ms. Thomas

Staff present:Mr. Aiello, Mr. Krueger, Ms. McCormick, Mr. Moreth, and Mr. O'Malley

1. Call to Order/Introductions: Mr. Dernbach convened the Worker's Compensation Advisory Council(WCAC) meeting at approximately 10:05 a.m. in accordance with Wisconsin's open Meetings law. Mr. Dernbach called the roll of members. Members of the WCAC, the audience and Worker's Compensation Division staff introduced themselves.
2. Correspondence: Mr. O'Malley reported that the Department received no correspondence since the last meeting.
3. Labor and Management Opioid Proposals:

Motion to Caucus: Ms. Bloomingdale moved the members go into closed caucus before exchanging the proposals related to opioids. Mr. Reader seconded the motion. By unanimous vote, the members went into closed caucus at about 10:10 a.m. The members returned from caucus at about 11:30 a.m.

Ms. Bloomingdale introduced the Labor proposals related to opioid use, which were as follows:

1. Clarify that no physician/chiropractor referral is needed in WI for treatment with a physical therapist.
2. Educate injured workers that "alternative treatment" for chronic pain, in lieu of or in combination with medication, is a medical expense that may be reasonably required to cure and relieve from the effects of the injury and acovered medical expense under the WC Act.
   1. "Alternative treatments" for chronic pain other than medication may include, but are not limited to, manipulation therapy, electrical stimulation, chiropractic care, massage, trigger point injections, dry needling, acupuncture, acupressure, suction (cupping), virtual reality therapy, and psychological treatment.
   2. "Alternative treatment" for chronic pain may include, but is not limited to, medication alternatives to opioids, such as Acetaminophen, anticonvulsants, topicals, interventionals (epidurals, nerve blocks), lidocaine or ketamine infusions, and medical marijuana.
3. If an injured worker is prescribed opioids by a treating physician, and the employer/insurer obtains an IME opinion that opioids are not needed, the following shall apply:
   1. Any IME opinion regarding the cessation of opioid medications MUST contain:
      1. A discussion of "alternative treatments" other than opioid medication for the treatment of the injured worker's pain, and if opining that "alternative treatments" are also unnecessary, an explanation as to why alternatives are unnecessary;
      2. A proposed plan of discontinuation of opioid therapy consistent with the Wisconsin Medical Examining Board's Opioid Prescribing Guidelines
      3. That if the IME opines that the injured worker has developed behaviors indicative of opioid use disorder, affirmatively offer to pay for, and assist the worker in locating and obtaining, addiction treatment therapy at a facility of the patient's choice.
   2. The employer/insurer shall advise the employee that currently prescribed opioids will be continued to be paid by the employer/insurer for no less than 30 days from the date the IME opinion is received by the injured worker;
   3. The employer/insurer shall advise the employee of the right to have an expedited mediation conference with an ALJ to discuss the employee's options regarding opioid use, including the right to continue to rely upon his treating physician's recommendations for continued opioid use and to have a hearing on the issue of continued opioid therapy, “alternatives treatments” to opioid use, and the injured worker's right, if they elect to discontinue opioid use, to all necessary medical treatment, including medical and psychological treatment for addiction.
      1. The Department shall expedite all requests by an injured worker for an opioid mediation conference, with a goal of a conference within the 30 day continued prescription payment period. Should a mediation be requested by the employee but is not held within the 30 day period, the employer/insurer shall continue to pay for prescribed opioids until a mediation is held.
4. Educate injured workers regarding opioid therapies, opioid addiction, and alternatives treatments by providing a mailing to injured workers. The mailing should include language that if one becomes addicted to opioid medications due to a work injury, all reasonable and necessary medical care for the injury includes addiction treatment. Provide information regarding opioid treatment and addiction on the posting of WC rights (Labor Proposal #10).

Mr. Reader introduced Management's two proposals related to opioids, to be added to the prior list of proposals, as follows:

17. Physician Dispensing. Limit physician dispensing of prescription medications for a workplace injury to one 7-day supply per medication per claim.

18. Treatment guidelines for opioid treatment. Ensure treatment guidelines proposed in management item #3 includes guidelines for the use of opioids for treating workplace injuries.

4. Other Business of the Council: The Wisconsin Compensation Rating Bureau (WCRB) is continuing to work on a cost estimate for the proposals. Mr. Dernbach will contact the Department of Health Services (DHS) to obtain information regarding drug rehabilitation facilities in Wisconsin. Mr. Dernbach will also contact the Department of Safety and Professional Services to determine if the Prescription Drug Monitoring Program (PDMP) has any reporting specific for worker's compensation treatment.
5. Adjournment: A motion was made by Mr. Tindall to adjourn the meeting and for the Labor and Management members to go into closed caucus. The motion was seconded by Mr. Kent. The motion passed unanimously. The meeting was adjourned at approximately 12:05 p.m.

The next Worker's Compensation Advisory Council meeting will be held on July 18, 2017, at 10:00 a.m., location to be determined.