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Montana Self Insurers' Association

February 2026 Updates

MSIA Webinar –Section 111 Compliance Trends 2026: Are You Ready?

The next MSIA CE Webinar is set for February 25 at 10a MST and will feature Ciara Koba of MSIA member Allan Koba Medicare Compliance Solutions talking about all things MSA and how we can remain compliant with CMS. Penalties for improper reporting are up to $1000/day per claim (plus inflation). If it sounds like we are trying to scare you – you’re right!

Use this link to register Section 111 Compliance Trends 2026: Are You Ready? – advance registration required. CE credit for MT WC Claims Examiners and MT Insurance Producers is available.

The new CMS administration changed reporting rules that have significant impact on how employers report WC injuries. All diagnostic codes for the injured worker (beneficiary) must be associated with the first claim reported to CMS by that employer/insurer. That sprained knee you reported on in 2011 now also gets all the lower back diagnostic codes from the 2022 injury. Make sense?  MSIA has met with the new CMS leadership twice during the fall and while they have been more receptive to our ideas, they clearly have some of their own.

CMS has started auditing claims reporting this month to apply civil monetary penalties for improper reporting. Are You Ready?

We will learn:

·    The key 2026 deadlines for CMS reporting audits, demands & potential WC penalties for failures to do it right,

·    Practical compliance steps for WC, liability and no-fault obligations to CMS,

·    Strategies to handle Ongoing Responsibility for Medicals (so that’s what ORM is!!) without jeopardizing Medicare reporting protections, and

·    Actionable audit preparations to avoid the up to $365,000 (plus inflation) penalties - - per claim.

Ciara Koba is an attorney with significant surgical nursing experience, providing her a unique understanding of health care to the resolution of Medicare issues. Koba is also a Principal with Allan Koba Medicare Compliance Solutions and has focused the business on Medicare Secondary Payer Compliance issues. Koba is also on the Board of Directors for the National Medicare Secondary Payer Network (MSPN) and is recognized as a leader on Medicare reporting (Section 111 reporting). 

Join us on February 25 at 10a MST to hear from one of the nation’s top voices on CMS, MSAs and the new Section 111 Compliance Trends for 2026: Preparing for Audits Penalties and ORM Challenges – Are You Ready?

 

This MSIA webinar is sponsored by

Rising Medical Solutions and Medivest

Contact:  Mike Wright |  Michael.Wright@RisingMS.com | 312-488-1298                                       

Contact:  Aaran Blanton | ABlanton@Medivest.com | 970-443-1885

 

Annual Business & Economic Research Economic Outlook Seminars - Sales Tax in Montana – Is It Time?

The Bureau of Business & Economic Research (BBER) annual Economic Outlook Seminar has started and will be hitting 9 cities in the state before they’re done in March. By publication time, only Kalispell (2/10), Lewistown (3/10) and Havre (3/11) will be left. In each city, the BBER invites local economic development leaders and the Chamber of Commerce to provide a local perspective on the Montana economy.

The theme this year is Sales Tax in Montana – Is It Time? The economists from the BBER reviewed the pros, the cons and the options for consideration and identified the potential economic impact a statewide sales tax could bring. Their analysis also identifies why it may not be the solution proponents advocate for. Alternatively, they point out the potential of a more limited tax targeting tourists – and tourist season. For a deeper political analysis, BBER invited Bob Story, Executive Director of the Montana Taxpayers Association to provide his perspective on the question. Story pointed out that starting in 1971 Montanans and the legislature have considered a sales tax – - every session. There have been ballot iniitiatives in the past as well. Obviously, since we do not have a sales tax – none of them passed.

Montana’s economy has changed from natural resources and extraction to health care, services and tourism. Visitors to Montana pay a pittance in comparison to what they pay in other states. Could a sales tax could have an impact on property taxes? MSIA does not think a significant sales tax will happen in the next session. At the least, the Governor is not likely to want his legacy to be a sales tax. So – perhaps a smaller, tourist oriented tax system?

We cannot continue a discussion on taxes without talking about property taxes. Montana has one of the most complex property tax systems in the country and last year’s “solution,” wasn’t the solution many people sought. At the MT Chamber of Commerce Business Days at the Capital earlier in January, we heard the commercial property tax system may hinder new business entrants to the state. The real impact of last years’ “solution” will be felt this summer when the new tax bills come out. The law change last year reduced taxes on primary homes under the statewide average home price and increased the taxes on everything else – primary homes higher than the state average, commercial and second homes (the cabin by the lake or in the woods). They will all see a sizeable increase in property taxes. This will be one of the defining issues for the next election in November.

With all that fun, we almost forgot about the economics of the state. Montana growth is back to pre-pandemic levels and the overall US economy is OK. Montana population growth has stopped – a change of only +.5% last year, the lowest in two decades. We remain one of the least affordable states and along with the population growth being flat, so too is the growth in new jobs flat. With our low unemployment rate, lack of population and job creation growth, it may not be a surprise that Montana wage growth continues to lead the nation. We saw an increase, according to the BBER, of 5.4% in wages last year (while inflation remained at 3%). Statewide overall growth is projected to be about the same as the prior year – about 2.5%.

Nationally, the talk of a recession has ended. A.I. has spurred investment and productivity. Consumer spending has remained strong and tariffs have not sparked a global trade war. Tariff collections were less than expected although they are generally considered to have added 1 point to the overall 3 % inflation we’ve recently seen. US employment growth has been almost exclusively in healthcare with hiring in assisted living and nursing homes. Leisure and hospitality saw a small increase, while all other sectors were either flat or negative in growth. 

For more information and registration for the Economic Outlook Seminar near you, use this link: BBER - EOS 2026

20 Things to Watch in 2026

Kimberly George of Sedgwick and Mark Walls of Safety National (an MSIA member) presented their annual “20 Things to Watch” webinar for 2026 on January 13. As industry leaders and experts, their programs are always interesting, insightful and there is always at least one nugget you can use in your work.

There are a number of themes – A.I. and future proofing your business, workforce resiliency, employee benefits, mental health and a changed perspective on risks.

  1. Interconnected Risks – The Tech transformation, our workforce readiness to deal with those changes, global events which include weather pattern changes and geo-politics, mental health and assumptions of supply reliability are all hitting home at the desk level and impact how we do business – and ultimately how successful we will be.
  2. Fraud as a Systemic Risk – Add it up – employer fraud, provider fraud, third party fraud, claimant fraud and tech driven fraud are coordinated as never before. Based on our efforts to secure our data, provide security for our employees, claimants and others we do business with means that we purposefully restrict information sharing and coordination, inadvertently providing more opportunities for fraud growth.
  3. A.I. Lessons Learned From Early Adopters – There are a couple of things we have learned from the early adopters of AI – who have sometimes paid a high price for their lessons. Here’s what’s needed for successful use of A.I.:
  • A clear use case
  • Stakeholder engagement
  • Alignment within the organization and a sound execution plan
  • Data readiness – the more you have to clean up or supplement, the less opportunity to demonstrate advantages
  • Embed Governance throughout the process of implementation and execution
  1. Industry Engagement – since the pandemic, we have traveled less and Zoomed more. Face to face interactions remain critically important to successful enterprises. The industry has to get back to active industry participation with itself and others to continue to positively evolve.
  2. Healthcare Trends – Access to care, rural hospitals crises, telehealth, health technology, remote patient monitoring, ACA subsidies, unrecompensed care and volatility in hospital reimbursement levels from other payers – all will have at least a ripple impact, and often more than just a ripple on workers’ compensation.
  3. Insurance Market Pressure Points - Claims severity inflation, Cat loss frequency, litigation cost, re-insurance constraints, tightening capacity, coverage requirements, or restrictions, are also points that must be addressed. Although the US did not see any hurricane activity hit land in 2025, we have seen significant damage from wildfires and that risk is ever growing. NCCI identified an increase in the line combined ration to 99 reflecting a changing economy in the workers’ compensation line.
  4. Catastrophic Risks – the Sedgwick Global Risk Report identified 76% of respondents expect CAT losses to have a moderate to severe impact on insurance systems in the next year. More carriers are conducting annual CAT risk assessments, signaling that CAT risks and losses are a more routine part of a business approach.
  5. Claims Insights – Accident frequency decreases has been the savior of the WC line for a number of years. Costs are going up, driven by severity changes while frequency continues to go down. Mental health is a routine part of the claims file and no longer a peripheral issue. Wage increases and medical inflation are catching up. As cancer presumptions become more common, anticipate they become $1 million dollar claims. Larger claims are getting larger – survivability increases also drive costs. With 40% of Americans obese, when will the GLP-1 drugs become common in workers’ compensation?
  6. A.I. Business Transformation – A.I. has created the reality of what we only used to talk about – the art of the possible is significantly more important than it has ever been. The implementation of A.I. at so many different levels has created the need for better implementation and adoption models, change management modes, mindset changes, staffing impacts, provider evolutions and the need for radical transparency in way we work and our work itself. The ability to provide critical thinking in the A.I. environment is even more important.
  7. California Workers’ Compensation – with 10% of the population, the CA WC system impacts all of us. It has always been a bellweather of things we will have to address – sometimes in a good way, sometimes providing us challenges. CA reforms starting in 2012 have created significant stability however, CA always finds new ways, almost as soon as they are proposed. The CA system is generating a 127 Combined Ratio, even with the first double digit loss cost increase in years. The latest issue is Cumulative Trauma claims – often as a result of the natural aging process, but compensable under CA law. Thess claims are 21% of all claims and 38% of all litigation in the CA WC system.
  8. Employee Benefits – The purpose of work has become more important than the perks associated with employment. Lifestyle point solutions, mental health and psychological safety are no longer side issues. Leadership, mentoring and upskiing – creating a leadership pipeline, benefits including infertility, weight loss, child care and other benefits once consider too far out there for consideration, are what is required to remain workforce resilient. 
  9. Legal System Abuse & Tort Reform - $10 million dollar verdicts are up 50% since 2020 and $100 million dollar verdicts are up 60%. Third party litigation financing and plaintiff attorney information sharing regarding everything from strategy to judicial tendencies have changed the game. FL and GA have lead the way with litigation abuse reforms (as has MT, thanks to the MT Chamber of Commerce focus the last two sessions). More will be needed.
  10. Workforce Mental Health & Wellbeing – employee retention has come to mean having benefit programs to help people with what they need, when they need it and in that way, creating a workforce resiliency. The new watchword is point solutions to provide benefit programs for where people are and when they need them.
  11. Cyber Risk – With the assistance of A.I., hackers, cyber attackers, ransomware, malware and others are much more sophisticated. These guys are good at what they do. One of the known blind spots in so many systems is third party access – what controls do you have over vendors or customer access to your core systems?
  12. Workforce Considerations – Employee expectations are more important than ever. Engagement, the opportunities for upskilling or re-skilling, mentoring, are all now part of the hiring process.
  13. Public Entity Challenges – providing more statutory access to benefits through the WC system for public entities, ultimately will come around to everyone else. And, since public entities funding source is taxation – we see it already. In simple terms – Public entity challenges are our challenges.
  14. Reputational Risk – your response to an event (Tylenol poisoning as an example) makes all the difference. It is not a question of if an event will impact you but when. Do you have an adequate plan in place to be perceived as a reasonable response?
  15. Regulatory Over-Reach and Unintended Consequences – post-pandemic, we have to ask, why do we have such state specific standards and do they really relate to how the world operates today? Work from home, telehealth and the incredibly more comprehensive inter-connectivity we all have, why do individual state rules continue to make sense? Examples include individual (non-reciprocal) medical licensing, in-state brick and mortar requirements and A.I. regulation conficts between the state and federal regulators will have to be addressed.
  16. Operational Readiness in the Age of A.I. – Looking forward, we have to future-proof our business models. An example of the issue is Blockbuster response to Netflix.
  17. Data Centers as Essential Risks –data centers are much more than physical structure risks. With all the interconnectivity we have – data centers are a life-blood of our economy and our work; society has become dependent on that connectivity. An example of a failure was the 2024 summer Crowdstrike failures – world travel was severely hampered, if not shut down in certain areas. Every airline was impacted a little differently. But everyone what impacted.  

 

WCRI Annual Meeting – Boston 3/3 & 4

There are many demands on our time. When the road ahead is unclear, credible evidence provides clarity. MSIA members should know I have a bias towards WCRI because, for me they consistently provide value in a public policy discussion: 

1.  Independent, nonpartisan research focused on evidence—not advocacy or sales.

2.  Early understanding of emerging trends, benchmarks, and cost drivers.

3.  Access to WCRI researchers, with opportunities to ask questions and understand what the data mean.

4.  A cross-stakeholder perspective, employers, insurers, regulators, providers, and labor leaders are all brought into the conversation.

5.  Efficient use of time, delivering the most current and meaningful research and analysis in a format that equips us to act with clarity and confidence.

Our WCRI membership, through an MSIA member, helps us remain one of the few subject matter experts in the capital on workers’ compensation. One of the most important meetings of the year is the Annual WCRI Issues and Research Conference, this year March 3–4 in Boston. Click here to see the 140+ organizations already registered.

2 New WCRI Studies - Joint Replacements & Injectable Therapies

Recent Trends in Joint Replacement Among Workers’ Compensation Claims. In this study, WCRI reviewed lost time claims from 2015 o 2022. With the aging of America and particularly the baby boom generation – perhaps it is not a surprise that joint replacement surgeries increased from 7 to 8.3/1000 claim. Outpatient Joint replacement surgeries are becoming if they have not already become the norm. Workers compensation joint replacement surgeries, based on the study, cost $116,000 - $132,000 per claim, numbers that also include the indemnity costs.

Injectable Therapies in Workers’ Compensation. Along with the above study, WCRI also released this study which kind of piggy backs on the aging of the working population. There are two types of injectable therapies – Clinically Administered injections, which include nerve blocks and platelet rich plasma injections, and Self Injected medications, which include migraine prevention drugs and the anti-diabetic/weight loss agents, commonly referred to as GLP-1.

Both types have seen increases in use in workers’ compensation. Although they are relatively new treatments, and so far represent a small portion of therapies, they come with high costs. These treatments are identifying themselves as a medical cost growth area in workers’ compensation. Both types of injectables are novel and we do not yet know of the long term benefits, nor whether they will be come part of conservative treatment patterns.

 

Through one of our members, MSIA belongs to WCRI and their studies are available to you by request.