• WCRI Annual Meeting – The Future of Work
MONTANA SELF INSURERS' ASSOCIATION

4/9/21 - Legislative Week 14

  • Physician Dispensing SB 374, To House Committee
  • Drug Test Refusal/Failure = No Benefits HB 655 to Senate Committee
  • Prosthetics Definition HB 446 To Governor
  • Telemedicine HB 43 To Governor
  • PBM Regulation SB 395 As Amended To House Committee


To review prior Legislative Weekly reports, check out the Members Only Section of our website - Montana Self Insurers' Association

Legislative Action   

Since the legislature has not regularly met on Saturday this year (which has pleased some of us), the legislative calendar has been extended. The last day of session is now set for May 11, instead of May 1. Workers’ compensation legislation has not been a high priority for discussion this session. All the bills MSIA has opposed, have died and all those MSIA needed to see amended have been and most of them have already passed and been signed into law. The remaining few are still somewhere in the process and are expected to be passed and signed.   

SB 374 (C. Smith R-Billings) – Physician Dispensing. Montana is one of four states which does not permit general physician dispensing of prescription drugs. The bill, generated to support Direct Primary Care and to reverse that law, passed the Senate unanimously and has been assigned to the House Business and Labor Committee. The Committee will hear the bill on Tuesday, 4/13. MSIA worked with Senator Smith and MSF to amend the bill to maintain the law as it is regarding workers’ compensation treatments – that is to exclude workers’ compensation treatments from being eligible for physician dispensed drugs. This is significant as any number of studies have demonstrated that physician dispensed drugs are tied to extended recoveries, longer durations, higher costs for drugs and higher indemnity benefit costs. The bill also continues to prohibit physicians from dispensing opioids. With the amendments requested by MSIA and others, we will testify in favor of passage of the amended bill. 

HB 655 (Buttrey R-Great Falls) – Medical Marijuana. This bill, as it relates to workers’ compensation, provides that if an employee fails or refuses to take a drug test after a workplace accident, there is a presumption that the major contributing cause of the accident was the employee’s use of drugs not prescribed by a physician. In that situation the employee is not eligible for workers’ compensation benefits. The bill was assigned to the Senate Business, Labor and Economic Affairs Committee. Expect a hearing to be set sometime next week.

HB 446 – (Marshall R-Hamilton) – Defines Prosthetics in Workers’ Compensation. MSIA worked with both the House sponsor and the Senate floor sponsor to make sure this bill passed without amendment. This bill has been sent to the Governor’s office where he is expected to sign it. 

HB 43 – (R. Knudsen R-Culbertson) – Telemedicine. This makes permanent some of the emergency provisions put in place during the pandemic shutdown supporting telemedicine. This bill has also been sent to the Governor, who is expected to sign the bill. 

SB 395 (Hertz R-Polson) – PBM Regulation. The bill provides further regulation of Pharmacy Benefit Managers and would require annual reports to their clients as well as the Insurance Department regarding prices and pricing. It is primarily aimed at health insurance and originally could have included workers’ compensation as health care coverage. In speaking with the CSI office, they want all PBMs in the state to be regulated and they, and the sponsor have accepted a proposal to properly define workers’ compensation and to limit its’ application to Plan 2 and 3 policies only. With the agreed changes adopted the bill passed the Senate unanimously and has been assigned to the House Business and Labor Committee and they will hold a hearing on it on Wednesday, 4/14. MSIA will monitor the bill.     

SB 367 (Morigeau D-Missoula) This bill changes the independent contractor law so that the Department of Labor cannot automatically assume that absent an Independent Contractors Exemption Certificate, the person is an employee. The bill was subject to clarifying amendments in the House Business and Labor Committee and has passed as amended. It will now go back to the Senate for concurrence on the House amendments. 

WCRI Annual Meeting – The Future of Work

In the last of my reports on the Workers’ Compensation Research Institute’s (WCRI) virtual Annual Meeting reports, today I review the conversation between WCRI President and CEO John Ruser, and Dr. John Howard who is serving an unprecedented third term as the Director of the National Institute of Occupational Safety and Health (NIOSH) regarding the safety and health implications based on the Future of Work. 

This was a conversation about how our work and work environments would look going forward, and what that means for workers and employers. Howard cited a University of Houston approach commonly referred to as Strategic Foresight as a way of attempting to predict the future, preparing for the future and setting up scenarios for the future based on snippets of information. 

As an example, NIOSH is looking at what increased assistive and replacement technologies might mean to all of us from a work, safety and health perspective. 

The difference between assistive and replacement technologies is exemplified by the differences between a desktop computer, an assistive device which we largely did not have in our workplaces in the 80’s, and an drone sent into a confined work-space to measure air quality and ventilation. While a replacement, the drone measurements still require human intervention to interpret their meaning and response. Along those lines, Howard spent some time discussing the idea of technological job displacement. In looking at the statistics going back to WW II, there are 60% more jobs now, than there were in the past. He cited the people dedicated to supporting the virtual conference as examples of jobs that did not exist, even just before the pandemic shutdown. Who had heard of Zoom before March 2020? 

As well, we can relatively easily expect more people to continue to work from remote locations – like home – than before the pandemic hit. As we re-open offices we will continue to have in-person meetings. Like the real estate expression about location, “proximity” will become the watchword for employers. Howard stated, “proximity of workers to each other is going to be numbers one, two and three in importance.” We will have more social distancing, physical barriers and the need for interactive live and virtual participants in meetings. Once workers come back to the office and start working with each other, employers are going to have to look at their ventilation systems and limiting public spaces like never before. Infection control is now a priority for employers, and Howard noted, for those not in the health care industry that may be a challenge.  

For those who continue to work from home as more of the norm, Howard identified a concern for the potential increase in cumulative trauma disorders. Just after shutdown, there was a significant decrease in the BLS data on cumulative trauma injuries in the workplace. However, as we continue, what will be the result of working from home, which provides less ergonomic support than our offices? 

More detail and information regarding the different aspects of the NIOSH Future of Work effort can be found at Future of Work Initiative | NIOSH | CDC

  • Legislative Update
  • Marsh & McLennan Buys PayneWest
  • JAMA: Study Finds Health Care Professionals May be More Likely to Contract COVID from Community Exposure than Work
  • WCRI Annual Meeting – Off Label Prescribing and Opioid Policy Impacts
  • NCCI MT State Advisory Forum and Annual Issues Symposium


MONTANA SELF INSURERS' ASSOCIATION

4/2/21 - Legislative Week 13

  • Physician Dispensing SB 374, As Amended, Passes 2nd Reading
  • Drug Test Refusal/Failure = No Benefits HB 655 Passes House
  • Intern Bill HB 283 Signed into Law
  • Burial Benefit HB 198 Signed into Law
  • Telemedicine HB 43 House Concurs in Senate Amendments
  • PBM Regulation SB 395 – Amendment Proposed to Apply to WC Plan 2 & 3 Only

To review prior Legislative Weekly reports, check out the Members Only Section of our website - Montana Self Insurers' Association

Legislative Action   

SB 374 (C. Smith R-Billings) – Physician Dispensing. (See also the report on the WCRI Annual Meeting Presentation on Opioid Policy Impacts) Montana is one of four states which does not permit general physician dispensing of prescription drugs. The bill, generated to support Direct Primary Care and to reverse that law, was supported by a number of physicians, the MT Medical Association and the MT Pharmacy Association. With the pharmacists supporting the legislation, there is little opportunity to stop the change from happening this time around. The only registered opposition came from MSIA, MSIA member MT School Boards Association and MSF. MSIA worked with Senator Smith and MSF to amend the bill to maintain the law as it is regarding workers’ compensation treatments. The bill now excludes workers’ compensation treatments from being eligible for physician dispensed drugs and the amended version passed second reading yesterday, 4/1, unanimously. It is likely to finally pass the Senate today. The bill also continues to prohibit physicians from dispensing controlled substances (opioids). 

HB 655 (Buttrey R-Great Falls) – Medical Marijuana. This bill, as it relates to workers’ compensation, provides that if an employee fails or refuses to take a drug test after a workplace accident, there is a presumption that the major contributing cause of the accident was the employee’s use of drugs not prescribed by a physician. In that situation the employee is not eligible for workers’ compensation benefits. The bill passed the full House yesterday, 4/1 and now goes to the Senate for consideration. 

HB 198 (Harvey D-Butte) - Burial Benefits. This bill has been signed into law by the Governor. The new law increases the burial benefit in the workers’ compensation system from the current maximum of $4000, which is relatively low in comparison to other states, to up to $10,000 which is where at least 20 other states are.   

HB 283 (F. Anderson R-Great Falls) - Interns WC Coverage. This bill has been signed into law by the Governor. The new law clarifies how to address paid and unpaid interns within the workers’ compensation system. MSIA and individual members worked with the sponsor to create amendments to confirm the law will be limited to its’ intent, will not increase employers’ costs and will support internship programs as training for the next generation of our work force. 

HB 446 – (Marshall R-Hamilton) – Define Prosthetics in Workers’ Compensation. MSIA worked with both the House sponsor and the Senate floor sponsor to make sure this bill passed without amendment. This bill passed the Senate this week and will be sent to the Governor’s office where he is expected to sign it. 

HB 43 – (R. Knudsen R-Culbertson) – Telemedicine. This bill has also passed the Senate, with amendments and the House has unanimously agreed to the changes. It will next go to the Governor, who is expected to sign the bill. 

SB 395 (Hertz R-Polson) – PBM Regulation. Senator Hertz was the Speaker of the House last session and is carrying this bill for the Commissioner of Securities and Insurance Troy Downing. The bill requires Pharmacy Benefit Managers to be regulated and provide annual reports to their clients as well as the Insurance Department. It is primarily aimed at health insurance and originally included language which could have included self-insurance workers’ compensation. In speaking with the CSI office, they want all PBMs in the state to be regulated and they, and the sponsor have accepted a proposal to limit workers’ compensation to Plan 2 and 3 only. This was a technical issue within the law, as originally, the language might have been interpreted to include workers’ compensation medical benefits as health care treatments. With the agreed changes, the application to workers’ compensation is clear and is limited to Plan 2 and 3 coverage. MSIA will monitor the bill to confirm the changes agreed to are accepted.     

SB 367 (Morigeau D-Missoula) This bill changes the independent contractor law so that the Department of Labor cannot automatically assume that absent an Independent Contractors Exemption Certificate, the person is an employee. The bill was subject to clarifying amendments in the House Business and Labor Committee and passed as amended on Friday, 3/19. It now goes to the House floor for consideration. 

Marsh & McLennan Buys PayneWest

There are no details yet, but news broke late this afternoon that Marsh & McLennan, part of an international brokerage firm has purchased PayneWest. This is likely to lead to some changes in our market and the market in the northwest. 

JAMA: Study Finds Health Care Providers May be More Likely to Contract COVID from Community, Versus Work

Last week WorkersCompensation.com reported on a new study published by The Journal of the American Medical Association (JAMA) Network which identified that of the almost 25,000 health care professionals studied, they were more likely to contract COVID through their community exposures than their work related exposures. The results “suggest that for HCP [Health Care Professionals], the risk of SARS-CoV-2 infection from community exposures may exceed the risk from patient exposures, especially considering that these finding were estimated across diverse geographic areas and health care systems.” 

The study followed HCP from Emory Healthcare in Atlanta, Johns Hopkins Medicine in Baltimore, University of Maryland Medical System in Baltimore and Rush University System in Chicago. The authors also recognize that before we take this information as gospel, more research is necessary, pointing out that the results were consistent with some studies and conflicting with others. Here’s the link to the JAMA report on the study: [Link]

WCRI Annual Meeting – Off Label Prescribing and the Effects of Opioid-Related Policies

The use of opioids in claims is down significantly since 2015 – down from opioids being prescribed in 21% of claims to 8% of claims in 2020 based on the WCRI study of 28 states. As you know, in our business when you push on one side of the balloon, for example reducing opioids, the other side of the balloon gets pushed out. There is no direct connection between the decrease in the use of opioids in comp systems to the increase in the use of topical analgesics and gabapentinoids, other than time. While the use of topical analgesics and gabapentinoids is not necessarily evidence based, their use in comp systems has increased noticeably, with some states really standing out. According to WCRI, physician dispensed dermatologicals account for 20% of drug payments in FL, GA, IL, MD, SC and VA. (Note: The Lidocaine is not a permitted drug within the MT workers’ compensation system.)

MSIA Comment - For the Montana system, this points to the importance of MSIA’s work to amend SB 374 (see above) to prohibit physician dispensing as part of workers’ compensation treatments. Montana is currently one of a four states which general prohibitions on physician dispensing. We have fought the legislative battle to over-turn that law for a number of years based on WCRI, CWCI and other studies which demonstrate within the workers’ compensation system physician dispensing is related to longer recovery times, longer claim durations and higher costs. For workers’ compensation treatments, as a result of the amendment in effect the law remains as is. 

WCRI also reported on their upcoming study on the potential effects of opioid-related policy implementations. MT was not one of the states studied, we have not enacted some of the recommended public policy recommendations nor have we had the issues other states, which permit physician dispensing, have had. Our opioid use issues are serious enough, but we have not necessarily seen the issues other states have. 

The public policy actions studied to limit opioid use have included:

o  Must-Access Prescription Drug Monitoring Programs

o  Limits on Initial opioid prescriptions

o  Pain Treatment Guidelines

o  Prescriber education, and

o  Drug Formularies

WCRI found that the required access of the PDMP did contribute to reduced opioid use – significantly in low back and soft tissue injuries. There is also some evidence of alternative care increases. (Note – Lidocaine is not a permitted drug within the MT system). And, interestingly, WCRI found that limits on initial opioid prescriptions increased the likelihood of a prescription for some injuries. 

WCRI is hosting a webinar on April 22, at 12 Mountain time on its study, Early Predictors of Longer-Term Opioid DispensingThere is a $50 charge for participating in the webinar. 

NCCI Releases Virtual Montana State Adivisory Forum – Virtual Annual Issues Symposium 5/11 & 12

After the approval of the annual NCCI loss cost filing, and typically after the Annual Issues Symposium, the local NCCI representatives host their State Advisory Forum (SAF) which reviews their perspective on state and national trends and system results. This year, all the SAF’s are virtual and every state is available to all, [Link] (click on the state you are interested in.) The presentations require registration but there is no cost for access to the information.   

As reported earlier, NCCI filed and received approval of an overall -14.6% loss cost decrease for Montana effective July 1, 2021. The Montana SAF presentation goes into more detail regarding the information and data supporting their filing. In addition, the Montana presentation provides comparisons of MT system results to regional states and national averages. All 36 NCCI state reports are available.

NCCI is also hosting their second virtual Annual Issues Symposium (AIS) on May 11, from 10:45a – 2p Mountain time and May 12 from 10:45a – 1:15p Mountain time. Registration is required and is free. [Link]. I have been to a number of AIS meetings in person, and attended last year’s hurriedly put together virtual meeting representing MSIA. The information is good, providing NCCIs perspective on national results and forecasts, as well as some of their most recent research and guest speakers that are typically worth the time. There is no substitute for in-person attendance as there are 600 or so workers’ compensation stakeholders in attendance from everywhere in the country. 

Know of something I should be aware of, or have questions - - don’t hesitate to contact me. Happy Easter everyone!