Join Now Members Only
MONTANA SELF INSURERS' ASSOCIATION

MSIA Update / Leg. Week 2

  • Senate Still Trying to Figure It Out
  • HB 143 – PAs as Treating Physician
  • SB 109 – PTs as Treating Physician
  • HB 197 – “Rainey” Bill
  • LC 660 – Choice of Physician
  • LC 1564 - Permit PTSD Claims for First Responders
  • LC 2784 – Guardian ad Litem

Legislative Week 2

It’s been another interesting week in Helena. There is no question the political games are afoot. Nine Republican members of the Senate joined with the Democrats to adopt alternative rules to those agreed to at their initial majority caucus meetings in December. The message was pretty clear and leadership was, well, less than pleased. The nine who teamed up with the Dems are protecting the Governor from having to deal with ultra conservative proposals – either having to take a public stance against the ultra-conservative bills or having to outright vetoing them.

Medicaid Expansion (which is merely an extension of existing law – not an expansion of programs) is one of the likely drivers of the majority split. Moderate Republicans, all business organizations we are aware of (including MSIA) and many others are in favor of passage of this proposal. The ultra-conservatives are staunchly opposed, based on ideological positions. No matter what happens, Medicaid Expansion will be a significant issue during this session. Leadership in both chambers opposes the proposal but accepts that their caucus is split. However, if it passes, there is likely to be political blood spilled.  

As a result, even by the end of this second week, not much has been scheduled in Senate Committees (though SB 109 has – see below). The House meanwhile is chugging along. In fairness, it seems that bill drafts are still slow to come out, but that could be a combination of a number of different issues – a new legislative bill reporting/tracking system, new staff at Legislative Counsel’s office, the different interpretation of public records in terms of communication on bills before they are released, or a combination of all those and other things.

There were more bill titles with language available and more bill introductions, but still, it seems light. The updated and complete list is attached, along with links to language where it is available. While Committee action was light, it was illuminating. HB 143 (Etchart – R-BIL) which adds PAs to the list of provider who can be treating physicians drew support from everyone – including AFL/CIO – MFT – except the Trial Lawyers Association. The attorneys and two injured workers they brought in, didn’t actually spend much time on the substance of the bill but derided the idea that it is not broadening opportunities for medical providers, as long as employers have the opportunity to choose the provider on a workers’ compensation claim. That proposal, LC 660 (A. Olsen D-MSO) has not yet been released, but it’s a good bet that the language will be very similar to that proposed in 2013, 15, 17, 19, 21 and 23. Last session (’23) saw a Republican sponsor the proposal, and during testimony on HB 143, questions from that sponsor indicated continued support for the idea.

The fact is while employers do have that choice, and when the law changed there was an immediate 8.4% decrease in rates, we don’t use it much. In most claims there is no need to, and forcing someone to see a provider they don’t want to see creates more friction in the system, which only adds costs. However, when we need to use the opportunity, it is significant. Regardless – the substance of this bill is to broaden access to medical care and to recognize that PAs are treating a lot more than they’re given credit for. MSIA supports this bill.

Here’s a rundown of action this week, bills we are interested in and Committee action expected next week (Language that has been introduced has an HB or SB number assigned. A change requested by a legislator is assigned a Legislative Counsel number. Only when the requesting legislator permits it, is that language available. LC bills are still in draft and can change prior to introduction.)

 

HB 143 / Etchart / R-BIL          

See discussion above. Hearing held 1/17 with only the plaintiff attorneys opposed. Business, PAs, Primary Care providers, insurers and AFL/CIO-MFT supported the bill. MSIA supports this bill.

 

HB 197 / Nicastro / R-BIL           

This bill addresses the “Rainey” Workers Compensation Court decision (Nat'l Union-Rainey_2021MTWCC10.pdf) where the judge determined that even with a full duty release, the insurer had to go through a job analysis and 14 day notice before terminating TTD benefits. This bill is set for initial hearing in House Bus & Labor Committee on 1/22. MSIA supports this bill.

 

SB 109 / Hertz / R-Polson

This bill would allow Physical Therapists to be Treating Physicians. PTs have alleged that about 12 other states allow for ‘Direct Access’ to PTs for workers’ compensation claims. That may be, but the requirements for a ‘Treating Physician’ in the Montana WC system require them to make a diagnosis, be the gatekeeper for treatment – referring to other specialists as needed, provide the release to return to work, determine maximum medical improvement and provide impairment ratings – few of which a licensed PT in Montana can do. This proposal takes access to health care providers too far. This bill is set for initial hearing in Senate Bus, Labor & Economic Affairs Committee on 1/24 (one of the few bills set for hearing in the Senate). MSIA opposes this bill.


LC 458 / J. Kassmier / R-Ft Benton      

This bill is the Department of Labor ‘clean up’ bill. It provides a clarification of “employer” in a borrowed employee situation, provides for annual instead of quarterly reporting of losses for Administrative Fund assessments and changes the medical status form so that only one form would be needed, rather than two with the second providing medical information not permitted to be shared with the insurer. MSIA supports this bill.   

 

LC 660 / A. Olsen / D-MSO

This bill would change the choice of physician back to the employee choice, versus the current employer choice (see discussion above). While language has not yet been released, and it exists in title form only, MSIA expects to oppose this bill.   

 

LC 1353 / Buttrey / R-GTF

This is an MSIA bill to limit coverage when an employer provides or pays for vehicle use. The goal is to limit exposure to when an employee is in course and scope of work, rather than anytime they are in an employers vehicle furnished or paid for by the employer. Language is not yet available but will likely be within the week.


LC 1564 / Reavis / D-BIL

This bill provides for PTSD claim opportunities for law enforcement and first responders. Rather than provide a presumption, the language requires claims to go through the WC process for compensability determination. However, it provides a carve out from the existing prohibition on ‘mental-mental’ claims. In so doing, it likely creates an equal protection violation of constitutional language. That argument, which will be made, could lead to a proposal that everyone have access to mental-mental claim benefits. There are only about 12 states which continue to exclude mental-mental claims in their WC systems. And, the trend across the country has been to provide presumptive coverage for first responders. MSIA opposes this bill.

 

LC 2784 / L. Smith / D-HLN

This bill provides the WC Court Judge with the authority to appoint, or terminate an Guardian ad Litem. The new WC Court Judge was asked to appoint a new Guardian ad Litem and he ruled he could not, as the statutory language does not provide him that ability. Although this has been done for the 100 years or so of the WC system in Montana, the statutory language to support it was not there. MSIA supports this bill.


Click here for the spreadsheet of bills.