MONTANA SELF INSURERS' ASSOCIATION

MARCH 2022 Update

• MSIA Announces New Webinar Series – Free & For Members Only
• First Up – Navigating the MSP Landscape: Medicare Set Asides 3/22 - 1 CE Credit Available
• Sanderson MSA Webinar Series Part 2 - 3/15
• Kids Chance Montana Scholarship Applications Open
• NCCI Loss Cost Filing and State Advisory Forum Material
• MSF Board Rate Setting Meeting Friday 3/11   
• MSIA Announces New Webinar Series

   o  First Up - Navigating the MSP Landscape: Medicare Set Asides 3/22 10a MST

   o  Free to MSIA Members and Guests – 1 Hour CE Credit Available

MSIA is proud to announce a new webinar series, starting with exclusive content for MSIA membership (those on this email list). MSIA anticipates providing a webinar series on quarterly basis for members, and ultimately guests. We expect sessions will include Montana based experts, where appropriate to the topic, and nationally recognized experts. The content will be timely, interesting and we hope it will create some discussion.

The first webinar in the series, Navigating the Medicare as Secondary Payer: Medicare Set Asides, will be held March 22 at 10a MST. Attendance is limited to those on the MSIA members email list (if you’re getting this, you are welcome to join us) AND we have arranged for one CE credit for Montana claims examiners to be provided. (The CE credit requires individual registration and attendance – see below for more details)

The webinar will be taught by Amber Worman, a Senior Workers’ Compensation Claims Examiner with MSIA member Montana Municipal Interlocal Authority (MMIA) and Ciara Koba, principal with Allan Koba Compliance Solutions, based in Buffalo, NY.

Worman is the current Board Treasurer of the National Medicare Secondary Payer Network (MSP Network) and Co-chairs the Section 111/Conditional Payment Lien Committee with Koba. With 20 years of health care, patient advocacy, risk management and insurance experience, Worman offers a uniquely helpful perspective regarding MSP regulations and their impact on beneficiaries, medical providers, insurers, and legal climates. Worman’s formal education includes Masters of Health Administration (MHA), BS Business Administration-Management, Certified Insurance Counselor (CIC), Medicare Set-Aside Certified Consultant (MSCC), Certified Medicare Secondary Payer Professional (CMSP), Associate in Claims-Management (AIC-M), Associate in General Insurance (AINS), and Associate in Risk Management (ARM). 

Koba is a Principal at Allan Koba Compliance Solutions. Koba is an attorney and has been a surgical nurse. Koba focuses on MSP Compliance issues that aries in the resolution of workers’ compensation, longshore, Jones Act, FELA and general liability claims and she has been instrumental in settling tens of thousands of cases nationwide involving Medicare issues. Koba is a past President of and continues as a Board of Directors member for MSP Network. Koba co-Chairs the MSP Network Section 111/Conditional Payment Lien Committee with Worman. Koba also represents the MSP Network on the Board of Directors of the Medicare Advocacy Recovery Coalition, the national lobbying organization which was instrumental in the passing of the PAID Act. Based on her surgical nursing and legal backgrounds, Koba brings a unique understanding of the healthcare industry to the resolution of Medicare issues. Koba earned her BSRN and her law degree through Duquesne University programs.

Medicare has recently released a new set of Guidelines, as discussed in the February 2022 MSIA Update, and has held a webinar themselves on the changes. While it addressed some of the questions, the CMS experts continued to leave some questions behind and raised some new ones with their presentation. I am not suggesting Worman and Koba will have all of the answers but this is an opportunity to ask and get straigjht answers from one of our own who is garnering national attention iand an already accomplished leader in the field. They will provide us with their insights and knowledge based on experience garnered over their years of experience working throughout the country with benefit payers in the MSP and MSA space.

You can hear the Worman and Koba’s National Medicare Secondary Payer Network podcast, Set Aside Some Time, Episode 18: https://mspnetwork.transistor.fm/episodes/episode-18-mspn-2022-objectives.

• To sign up for the first MSIA Webinar – Navigating the MSP Landscape: Medicare Set Asides by contact me at the MSIA offices or by email. We will send a meeting invitation and later, the link to the webinar. There are no limitations on how many links can be provided to an individual member or office, however, we do ask that everyone register individually and sign on individually to help us keep track of attendance for the CE credit approved by the Montana Department of Labor for Montana Claims Examiners. Multiple attendees at the same computer will not record as individual attendance for CE credit purposes.

Sanderson MSA Webinar Series Part 2 – 3/15 11:30a MST

Back in January, I sent out one of our MSIA Update Extras regarding a free webinar hosted by the Sanderson Firm and Heather Schwartz Sanderson. On March 15 at 11:30a MST, she will be hosting the second in her series of four webinars on MSA fundamentals. It is entitled, MSP Fundamentals Part 2 Webinar: Medicare Set-Asides in Workers' Compensation and Liability Settlements. This webinar is also free and you can register here: https://us06web.zoom.us/webinar/register/WN_z6Z6Yvl-R5WS-tojdNPB4Q

Sanderson outlines three benefits from attending:

1. Gaining an understanding of when and in which types of settlements MSAs should be utilized;
2. Understanding the process behind submission of WCMSAs to CMS in workers' compensation settlements, as well as Non-Submit/EBMSAs, particularly CMS' recent WCMSA Reference Guide update.
3. For liability settlements, learn and take-away where current legislative activity is around Liability MSAs (Proposed Rule on MSP and Future Medicals) and what parties in liability settlements should do now in the absence of clear guidance from CMS.

In speaking with Worman and Koba about how this webinar fits with their presentation, they recommended attendance here too as the topic of MSP and MSA’s is dense, detailed and important. Failing to properly set up an MSA could leave the payer open to additional and unexpected medical charges down the road or leave the beneficiary in that same position.

We recommend you attend both webinars. The Sanderson webinar, as it is a national presentation, does not offer MT DOLI continuing education credit for claims examiners.

Kids Chance Montana Scholarship Applications Open

Do you know of a person between the ages of 16-26 years whose parent or guardian sustained a serious work-related injury or fatality? They may be eligible for post-secondary educational assistance (not just college) through the Kids Chance of Montana Scholarship program. We are asking for your help in finding these eligible “kids” by sharing this information with your network of people.  

MSIA members play an important role on the Board of Kids Chance of Montana. Vicki Evans, with MCCF, Mike Marsh with Midland Claims Service and Leah Tietz with the Montana University Workers Compensation program serve on the all-volunteer Board of Directors. You can contact them, or MSIA for additional information if you need it.   

NCCI Loss Cost Filing Reflects a -1.9% overall average change

The National Council on Compensation Insurance (NCCI) has had their most recent Montana workers compensation loss cost filing approved by the Commissioner of Securities and Insurance. The new loss costs go into effect July 1, 2022. This filing calls for an overall average decrease in loss costs in the state of 1.9%. MSIA has the public documentation of the filing and the detailed class code information (referred to as A-Sheets) from the filing and can make it available to members.

In my review of the filing, there is a continued overall average decrease in frequency, moderated somewhat by increases in trend and benefits. The change in trend indicates NCCI seems to think we are nearing the bottom of the savings our system will see, absent other changes. It is unusual to see continued decreases this long after a reform enactment.

NCCI has also provided their State Advisory Forum (SAF) material through their website. This information provides a bit more detail into what they see happening in the financial results of our system as reflected in the loss cost filing. NCCI will not schedule a virtual or live review of the material as they have since 1999 in Montana. Waaaaaaay back then, I created what became the SAF program for NCCI with Montana as the first such meeting.

However, as mentioned above, the material regarding the Montana results is available. MSIA is talking to NCCI representatives about hosting a webinar as part of our new series, available to all system participants, regarding their perspectives on the system results. That information is available here: II_StateAdvisoryForumState_MT-StateRpt-WorkersComp-System-2022.pdf (ncci.com). Additional detail is available through their supplement to the SAF Resources, here: II_StateAdvisoryForumState_MT-StateRpt-Supp-Info-2022.pdf (ncci.com).

Loss cost filings are often confused with rate filings. Loss costs are the average costs NCCI finds through insurance company data reported to it to pay claims by individual class code in the state and the expenses associated with paying those claims (Loss Adjustment Expense – LAE). Additional insurance carrier expenses, production costs, fees and other costs are calculated individually by carriers and result in a loss cost multiplier that is filed with CSI for their review and approval. In this way, each carrier, theoretically, creates their own rates. Rates are a function of the approved NCCI loss costs and the application of the individual carrier loss cost multiplier.

 For example, the loss cost for class code 8835 – Home, Public and Traveling Healthcare – All Employees in the NCCI filing is $1.77 per hundred dollars of payroll. If a carrier uses a 1.25 LCM (which is not unusual) they multiply the $1.77 lost cost by 125% to arrive at their manual rate of $2.21 for that class code. Each carrier follows the same process to get their manual rates. LCMs for each licensed carrier with the Commissioner of Securities and Insurance. 

MSF Board Rate Setting Meeting Friday 3/11 8:30a MST

The Montana State Fund Board meetings and their formal decision making process is open to the public for listening or participating. Similarly so are the Board Committee meetings. The MSF Board is next set to meet this Friday 3/11 starting at 8:30a MST.

The MSF March Board meeting is typically the “rate-setting” meeting at which the Board hears from their actuaries, adopts the NCCI loss cost filing, any individual class code changes to those loss costs and determines what loss cost multipliers (LCMs) to adopt for their current rating tiers. Once adopted by the Board, MSF then files their information with the Commissioner of Securities and Insurance for their review. CSI has thirty days from the last interrogatory response to take action on the filing. Failing to take action results in LCMs that are deemed to be approved.

This is the same process every other insurance company in the state goes through, with the exception that the MSF Board meetings and decisions are made in a public setting. The MSF actuarial reports presented at the meetings are also public record and are available to all. The public may tune into the MSF Board meeting on Friday through this link: https://www.youtube.com/user/MTStateFund. 

Know of something we should include or be aware of? Don’t hesitate to contact me. Please stay safe and stay well.