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Montana Self Insurers' Association

Fall 2025 BOnus UPdate

DOLI Sets 11/6 Hearing for Rules Changes – MSIA Opposes One Change

DOLI has set November 6, at 1p (MST) as an electronic hearing date and time for their most recent proposed rules changes. MSIA encourages members and others to share their thoughts on the changes proposed for adoption. A copy of the new proposed rules is attached and links with information regarding the electronic hearing, and an electronic version of the rules is below.

Earlier this summer DOLI had released an exposure draft of potential rule changes impacting workers’ compensation. At the time, the proposals included:

  • an extension of the time for suspending benefit payments for lack of medical information from 30 to 90 days,
  • repeal of the prohibition for charging for the Medical Status Form and
  • permitting updates to the Medical Treatment Guidelines.

At the time, MSIA and members did not identify a concern with the changes.

Last week, DOLI published the formal proposed rule changes which have eliminated the proposed extension of time for benefit suspension.

As well, MSIA and members recognized we may have made a mistake in not opposing the repeal of the prohibition of charging for the Medical Status Form. When the Medical Status Form was initially introduced as a result of Montana’s participation in the 60 Summits in the late ’00’s, it was designed and pitched as a quick and easy way to provide necessary information regarding the treatment process and functional changes as treatment progressed.

The implemented reality has turned out to be somewhat different in that getting a completed form from a provider has been less than consistent. Moreover, the information provided has not been as consistently useful as hoped for.

We may have mistakenly failed to recognize that employers can reward positive Medical Status Form information without this change. We are now aware that some employers already do. However, the norm is more along the lines of not getting the form or having the form so poorly filled out that it does not provide useful information. As one employer has stated, “Activity as tolerated” is particularly useless in terms of recovery or functional abilities.

  • In repealing the prohibition of charging for the form – while the intent is to provide employers the opportunity to reward positive information and timely reporting by providers - it may have the opposite effect.

With this change, when providers are permitted to charge for providing the form we can expect they will. Based on an employers’ perspective that the information provided does not add to the knowledge of medical improvement or functional gains, they will likely not pay for it.

  • This will likely lead to a worsening of the relationship between the medical professionals and employers in that there may be a perception on the part of the providers that work is being charged for and not paid.

The potential result would be fewer opportunities for treatment for injured workers.

Public Hearing: Thursday, November 6, 2025, at 1:00 p.m. to receive public comment for the rules proposal will be held via Zoom. Zoom meeting ID : 816 7255 2694

Zoom meeting passcode: 1529968275

    Written comment deadline: Friday, November 7, 2025, at 5:00 p.m.

    Written comments may be submitted at dli.mt.gov/rules.

    An electronic version of the rule proposal is available at dli.mt.gov/rules

  

Medical Costs per Claim Rose 5–12% Across Majority of States

This was originally published by WCRI and is copied verbatim The reports referenced were released earlier this month. There will be a more comprehensive review of the results in the MSIA November UPDATE. Please note, each state studied has an individual study.

Waltham, MA, October 9, 2025 — After a period of relative stability post-COVID, new studies from the Workers Compensation Research Institute (WCRI) show that medical costs per claim have begun to rise.

“Medical payments per claim remained relatively stable, but recently, they started increasing, fueled by an increase in medical utilization, medical prices, and updates to state fee schedules,” said Sebastian Negrusa, WCRI vice president of research.

The studies, CompScope™ Medical Benchmarks, 2025 Edition, examine medical payments, prices, and utilization overall, by provider, and by type of service across 18 states, showing how these metrics have changed over time. Key findings from a few of the individual studies include the following:

  • California: After several years of stable medical payments since 2018, California recently saw a 5% increase in medical payments per claim, with increases in payments per claim for several nonhospital services, including physical medicine services, contributing to that growth.
  • Delaware: Medical payments per claim grew 7% per year between 2021 and 2023, driven by price increases in professional and hospital outpatient services. These trends align with Delaware’s fee schedule, which is adjusted based on the Consumer Price Index for All Urban Consumers (CPI-U).
  • Pennsylvania: Medical payments per claim for care provided to injured workers increased 14 percent in 2023 after years of decreases, reflecting, in part, larger recent annual updates to the state’s medical fee schedule, which is tied to the statewide average weekly wage.
  • Wisconsin: Medical payments per claim grew 6% per year from 2021 to 2023 after years of small changes. Wisconsin, which has had some of the highest medical payments per claim among the study states, recently passed legislation introducing a medical fee schedule for hospital services.

The results reflect the experience of non-COVID-19 claims through March 2024. The 18 states in the study—Arkansas, California, Delaware, Florida, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Texas, Virginia, and Wisconsin—represent about 60% of all workers’ compensation benefit payments nationwide. (Ed. Note – Montana is not part of this study. Our results in the years I have been in the Montana system are similar to the national averages, with specific Montana law exceptions.)

 

MSIA, through one of our members, is a member of WCRI – copies of their work are available to members upon request.