Integrated disability makes a comeback

Integrated disability makes a comeback

Integrated disability makes a comeback.
Reprints A recent increase in the number of state and municipal leave regulations, along with an expansion of paid family leave laws, is prompting employers to take a fresh look at integrating their workers compensation, disability and benefit programs, either internally or through third-party vendors, and creating a new wave of momentum around the concept of integrated disability management.
Having inconsistent leave policies and practices opens employers to audits and fines, said Terri Rhodes, CEO of the San Diego-based Disability Management Employer Coalition.
“The idea isn’t necessarily new, but the amount of cooperation and partnership is reaching a new level,” said Jeff Smith, a disability and productivity consultant with the Workplace Possibilities program, an absence and disability management program operated by Portland, Oregon-based disability insurer Standard Insurance Co. Decades ago, employers considered ways to create synergies between occupational medical claims and nonoccupational health claims to save on overhead costs.
“Some progressive organizations have managed to work through those silos.
In addition, depending on past administrative practices, employers that implemented integrated disability managed programs saw a 10% to 25% decrease in days away from work, Sedgwick said in a 2014 white paper.
Administrative cost savings are a primary benefit of integrating workers compensation and disability management, said Mr. Sears.
Employers have an opportunity, he said, to incorporate wellness initiatives, such as smoking cessation programs, with workers comp programs to help improve medical outcomes and reduce comp costs.
Workers comp and disability programs can work together and share resources in a mutual effort to get workers back to work quickly and prevent future claims, said Mr. Smith.
“Preventing a short-term disability claim might be preventing a workers comp claim as well,” he said.

Court rulings, big rate increases concentrate reform efforts in Florida

Court rulings, big rate increases concentrate reform efforts in Florida

The National Council on Compensation Insurance Inc. initially sought a 19.6% increase in state workers comp rates in response to these court decisions last year, but the Florida Office of Insurance Regulation approved only a 14.5% rate increase that took effect last December.
The vast majority of the higher rate filing was “due directly to the Florida Supreme Court’s Castellanos decision striking down the statutory attorney fee schedule, and that highlights why it’s so critical that the legislature act to address the attorneys fee cost drivers effectively and as soon as possible,” said Ronald Jackson, Atlanta-based vice president for state affairs, Southeast region at the American Insurance Association.
“The portion attributable to the cost impact of Castellanos is controversial and is expected to continue to develop in subsequent years, which would lead to additional rate increases.
It “seems like a drug formulary is on the horizon in Florida,” said Desiree Tolbert-Render, Orlando, Florida-based assistant vice president, national tech compliance for workers comp at Sedgwick Claims Management Services Inc. Last December, Jacksonville Beach, Florida, state Rep. Cord Byrd, also proposed a bill that would allow companies in Florida to opt-out of purchasing workers comp insurance, but the bill was never formally introduced and experts say that Florida adopting opt-out for workers comp is unlikely.
“All the other states that have tried to put it through have failed.
Other workers comp reform legislation in Florida includes H.B.
The bill has been amended since its introduction and has received support from the business community and organizations such as AIA.
1582 remain because while it provides for a transition to loss-cost ratings, it will not address the primary drivers of workers comp costs: excessive litigation and attorney fees, Mr. Jackson said.
Rob Bradley, would codify Westphal, increasing the time limit on temporary partial disability and temporary total disability benefits from 104 weeks to 260 weeks and change workers comp attorney fees to address Castellanos, which ruled that a cap on workers comp claimant attorney fees was unconstitutional.
“We have to be cognizant in the way we go about handling claims in Florida and doing everything we can to avoid litigating claims that don’t need to be litigated.”

Medical marijuana may hold promise, but federal law curtails research

Medical marijuana may hold promise, but federal law curtails research

Can medical marijuana replace opioids?
That is the question on the minds of those who deal with pain in workers compensation.
Anecdotally, some say yes.
Several states such as New Mexico have seen decreases in opioid use with the widespread availability of medical marijuana for pain management.
Meanwhile, given the lack of research into medical marijuana — including for side effects, effectiveness and dosage — others say the workers compensation industry is more cautious.
So far, 29 states and the District of Columbia have legalized marijuana for medicinal use.
And several other states are considering adoption of regulations that would pave the way.
But the federal government’s stance that medical marijuana remains an illegal substance — along with that of the new presidential administration, which has voiced skepticism — has stalled further research on medical marijuana, which has forced insurers to tread lightly as the industry adopts an evidence-based approach to health care.
And then there is the accessibility issue, she added.
“It very well could reduce the amount of narcotics prescribed,” she said.

Don’t take food away, House panel told

Don’t take food away, House panel told

Changes to the federal food assistance program could make it more difficult for people to get fruits and vegetables, members of a nutrition panel are told.
Democratic members of the House subcommittee on nutrition said they’re anxious about Republican leaders’ talk of separating the Supplemental Nutrition Assistance Program from the 2018 Farm Bill, like they tried in 2013, or creating unrealistic work requirements for eligibility.
Recipients get between $1.40 and $1.90 per person per meal, which is probably inadequate for a healthy diet that includes fresh fruits and vegetables in most areas, said Stacy Dean, vice president for food assistance policy at the Center on Budget and Policy Priorities.
Both the ranking Democrat on the subcommittee Jim McGovern of Massachusetts and the full Agriculture Committee’s top Democrat, Collin Peterson, D-Minn., said the SNAP program belongs in the next Farm Bill.
It was ultimately restored when the Senate made clear the bill wouldn’t move without it.
U.S. Rep. Jimmy Panetta, D-Calif., who represents the salad bowl of the Salinas Valley, asked witnesses how to get the farm workers in his district access to the vegetables they pick.
The program once known as food stamps is now 100 percent electronic.
Much talk involved work requirements and job and skills training for able-bodied adults without dependents.
Under current law, these individuals can get SNAP benefits for only three months in a three-year period unless they are exempt from the work requirement.
In her written testimony, she said a quarter of the able-bodied childless adults haven’t graduated from high school and many have criminal records.

Florida House passes workers comp reform bill

Florida House passes workers comp reform bill

Florida House passes workers comp reform bill.
The Florida House of Representatives approved a workers compensation reform bill Wednesday that extends temporary total and partial disability benefits and addresses attorney fees in comp cases.
House Bill 7085, which passed 82–37, increases the duration of temporary total disability and temporary partial disability benefits to 260 weeks from 104 weeks, addressing a gap that exists when workers comp disability benefits end but an injured worker has not reached maximum medical improvement or been declared permanently impaired.
The bill also addresses attorney fees in workers comp cases by allowing a Judge of Compensation Claims to award an hourly fee different from the statutory percentage-based attorney fee schedule.
Both measures are responses to Florida Supreme Court decisions last year that deemed parts of the state’s workers comp rules unconstitutional.
If enacted, the bill would be effective July 1.
The bill, which also addresses TTD/TPD caps and attorney fees, cleared the state Senate Banking and Insurance committee on April 3 and the state Senate Appropriations committee on April 13.
The bill is now before the full Senate.
Workers comp cost increases stemming from the Bradley Westphal vs. City of St. Petersburg and Marvin Castellanos v. Next Door Co. et al. rulings last year prompted the National Council on Compensation Insurance Inc. to file for a 19.6% workers comp rate hike in Florida.
NCCI said in November that the Castellanos decision has caused workers comp attorney fees to increase 22% in the state, while an earlier NCCI estimate said that both court rulings could cause overall comp costs to increase as much as 38%.

Raid targets millionaire on food stamps

Raid targets millionaire on food stamps

For two years, the family was handed about $300 a month in government food stamps.
While getting welfare, prosecutors say Mahvi had millions in the bank.
Detectives are now looking at Mahvi’s myriad bank accounts, trying to piece together his family’s total worth as they investigate potential theft as well as Medicaid and welfare fraud charges. “I can borrow a hundred million dollars from friends and still get food stamps.”
Records show the family received two personal loans — one in 2014 and another in February — totaling $25,400.
But according to the affidavit compiled by Geauga County investigators, the family has at least 14 bank accounts with a combined value of more than $4.2 million.
Mahvi did not deny the household expenses, but said his lifestyle is relative to others.
Investigators say that while the Mahvis were receiving government assistance, their bank records show the family’s monthly net income ranged from at least $3,200 to more than $8,500.
Mahvi said the money came as loans or donations from friends and cannot be counted as income, according to food stamp rules.
During the investigation, detectives say they uncovered what appears to be “structuring” bank transactions by the family.

Proactive steps to monitor opioid prescriptions may help injured workers

Proactive steps to monitor opioid prescriptions may help injured workers

Proactive steps to monitor opioid prescriptions may help injured workers.
Reprints Louise Esola PHILADELPHIA — Without waiting for regulations to kick in to tell payers and providers when to monitor prescription medications and when to cut back, experts say companies can be successful in keeping injured workers off opioids and dangerous drug combinations by better keeping tabs on pills.
That’s what is working for Lake Buena Vista, Florida-based Walt Disney Parks and Resorts U.S., a representative with its pharmacy benefits management program and its claims manager told attendees at the Risk & Insurance Management Society Inc. conference in Philadelphia on Wednesday.
“(The industry is) starting to understand that we need to help with (opioid prescribing) from an employer standpoint,” said Brigette Nelson, Scottsdale, Arizona-based senior vice president of workers compensation clinical management at Express Scripts Holding Co. Barry Dillard, director of claims management of Walt Disney Parks and Resorts U.S., told attendees the key is to be proactive at the onset of an injury.
He mentioned “compassion” and “triage” as important first steps.
Disney refers to its 70,000 employees who work in all the facets of the resort’s operations—from beverage management and acting to merchandise and theme park operations—as “cast members.” The company operates on-site clinics for injured workers, a step in ensuring the company has a grasp on the worker’s care at the onset, said Mr. Dillard of the company’s self-administered and self-insured workers compensation program.
A key to Disney’s handling of injured workers is its pharmacy program’s clinical oversight, which includes a pharmacy task force to look at trends and outliers among injured workers.
Ms. Nelson, who works with Disney, said as a result, “opioids aren’t a problem with (Disney).” “(Their program) helps us understand what is happening with those injured cast members,” she added.
She said that such a program, put in place before regulations began putting opioid prescribing under the microscope, gave Disney an early edge.
“It’s really the outreach from the nursing case managers and the medical director that makes the difference,” she said.

Will Republicans Finally Repeal Obamacare? It’s Up To Moderates Now

Will Republicans Finally Repeal Obamacare? It’s Up To Moderates Now

It’s Up To Moderates Now.
After moderate Rep. Tom MacArthur of New Jersey proposed an amendment to satisfy conservatives, the Freedom Caucus announced on Wednesday it would support the bill.
At issue is whether moderates Republicans — already loathe to support an Obamacare repeal that would increase the number of uninsured by 24 million — can vote for an unpopular bill many view as even more conservative than before.
If the new Obamacare repeal effort fails, it’ll be moderate Republicans who could face the blame — or the applause.
“I’m not happy with it, but life’s not always fair.” The new amendment was negotiated between Rep. Mark Meadows, the chair of the conservative House Freedom Caucus, and MacArthur, who is a a co-chair of the moderate House Tuesday Group.
Tuesday Group members had said they did not want one of their co-chairs negotiating on their behalf and wanted the bill to be worked through the appropriate committees, Ways and Means and Commerce.
They didn’t like it,” Dent said of the Freedom Caucus.
“My sense is that those who are opposed to the bill are not going to change their votes over this,” he said.
Our work will continue until we fully repeal Obamacare.” Now as Republicans tally the votes and with the Freedom Caucus on board, all eyes are on the moderates.
Collins, the Tuesday Group member, said his own moderate caucus won’t face the heat that Freedom Caucus members faced three weeks ago.

How might fast-food lover Trump change the nation’s diet?

How might fast-food lover Trump change the nation’s diet?

The Obama administration has made healthier, safer and better labeled food a priority in the last eight years, significantly raising the profile of food policy and sometimes drawing the ire of Republicans, farmers and the food industry.
In addition to the healthier school meal rules, the administration ushered a sweeping food safety law through Congress, pushed through several new food labeling regulations, started to phase out trans fats, added calorie labels to menus and suggested new limits on sodium in packaged foods.
The White House has also fended off efforts in the Republican Congress to trim the nation’s food stamp program.
Trump himself hasn’t weighed in on school meal regulations.
While many students have now gotten used to the healthier foods, some schools still complain that they are costly and that it’s difficult to meet the standards.
“I would be very surprised if we don’t see some major changes on the school lunch program” and some other food issues, said Rep. Robert Aderholt of Alabama, the Republican chairman of the House subcommittee that oversees Agriculture Department spending.
Michael Taylor, former FDA deputy commissioner for foods who oversaw the food safety rules, says it wouldn’t be popular with consumers to roll them back.
But they won’t have the backing of a Democratic White House.
“Unwinding things is really hard, especially when most of them have been implemented and industry has moved on,” Kass says.
“The public is more interested than ever in nutrition and will continue to press companies,” she says.