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Montana Self Insurers' Association

March 2026 Update

  • New DOLI Rules & Medical Billing
  • MSIA is Moving
  • NCCI Filing -5% Effective 7/1/2026
  • CMS Webinar on MSA Reporting - 3/25 11a MDT
  • WCRI Meeting – It’s All About Health Care


New DOLI Rules & Medical Billing

During the fall last year, the Department of Labor amended rules to permit medical providers to charge for the Medical Status Form. MSIA testified in opposition to the changes which permitted for the first time charges to be applied for completing and providing the forms to payers. The rules do NOT require payment of those charges – it is discretionary on the part of the carrier/employer. One of the rationales the Department identified was the potential that carriers/employers and medical providers could work together to identify timeliness and quality standards that warranted payment. The new rules went into effect on January 10.

MSIA was the only organization to identify an issue with this change. MSIA members are beginning to report seeing the first charges for Medical Status Forms.

We are asking MSIA members to share with us, confidentially, what you are seeing, some background on your relationship with the medical provider and how you are responding. We will be collecting information from MSIA members, and others who may wish to provide information, and sharing it with public policymakers regarding how best to respond. ALL INFORMATION PROVIDED TO MSIA IS HELD IN THE STRICTEST CONFIDENCE AND INDIVIDUAL EMPLOYER/MEMBER NAMES WILL NEVER BE RELEASED.

MSIA testified that in situations where the medical provider charged for the form, and was not paid, an ‘unofficial’ adversarial relationship could be created. While not an issue that could be mediated, per se, our thought was if someone was charging for perceived work, and not getting paid for it – that could create more of an adversarial relationship than currently exists.

In talking with the Department staff and MSIA members, an alternative can be for benefit payers (employers – MSIA members) to enter into contracts with medical providers they deal with on a regular basis to define what standards would have to be met to provide payment for Medical Status Forms. These contracts could include standards for when a completed form was required, timeliness of providing that form and completeness of the information provided. The contract language would also provide an agreed level of reimbursement for an acceptable Medical Status Form report.

We are aware that some medical providers are beginning to apply a charge for providing a Medical Status Form. Payment of that charge is not required by statute or by rule – however based on the response, there may be a change in the relationship between the medical provider and the payer.

 

MSIA is Moving

Effective April 10, the MSIA office will be moving to 4923 Smallwood Court, Helena, MT 59601. There is no change in email or phone contact information – only our physical mailing address. There is no change regarding our banking information (for those members who use EFT/ACH services).

Please make note of the new address - - 4923 Smallwood Ct, Helena, MT 59601 - - effective April 10, 2026.

 

NCCI Filing -5% Effective 7/1/2026

Late in January NCCI filed and in February CSI approved an overall average -5% change in loss costs for Montana, effective July 1. This filing used Policy Year data from 2021, 2022 & 2023, meaning there was information through the end of 2024 used to support the filing. There was a slight increase in indemnity trend and the medical trend remained stable – the results were driven by increases in indemnity benefits, attributed to the increase in the State’s Average Weekly Wage (SAWW) and a continued decrease in frequency (fewer claims in the system).

Overall – as reported as part of the WCRI Annual Meeting - the workers’ compensation line is driving the profits for the entire P & C industry – making this a very, very competitive market as carriers seek premium in this line. The WC Combined Loss Ratio was reported to be 86 (with 100 being a break-even point).

MSIA has a copy of the filing and the A-sheets, identifying how each class code will change. If you would like a copy, please contact us.  

CMS Webinar on MSA Reporting - 3/25 11a MDT

The Centers for Medicare & Medicaid Services (CMS) has announced their next webinar regarding WC MSA reporting. CMS has recently started auditing WC MSA reporting with the intent of providing potentially significant civil monetary penalties (CMPs) for inadequate reporting. This was also the topic of our most recent Webinar on Feb 25 – if you would like more details, please contact our office for a copy of the presentation.

MSIA has participated in meetings organized by UWC Strategies with the new CMS leadership and while the dialogue has been more productive than it has been in the past, there are a lot of issues and questions remaining. Prior CMS webinars have helped clarify what CMS is thinking, doing and seeking in the required reporting.

Some of the questions that may need to be addressed, for example, deals with the most recent reporting change. That change requires ALL diagnosis code information regarding a beneficiary (injured worker claimant) to be associated with the first claim reported to CMS. So, the injured R knee you reported on in December of 2013, will also have the diagnosis codes associated with the covered subsequent lower back injury from 2023. There may be some questions remaining on reporting and the requirements. From the CMS announcement:

The intent of the webinar is to review the WCMSA reporting process that was implemented in April 2025, discuss some of the issues encountered from CMS’ perspective, and review WCMSA reporting best practices. As parties impacted by the WCMSA reporting, we also welcome anyone else involved in the submission and administration of WCMSAs, including attorneys and Medicare beneficiaries, to join. Please bear in mind that this Webinar is intended to broadly address the WCMSA reporting process and questions regarding specific cases are not appropriate for this setting.

Date: March 25, 2026                     Time 1:00 PM EST (sic)

https://teams.microsoft.com/meet/22876272966889?p=WsvTXDWa93jTlz082i     

Meeting ID: 228 762 729 668 89               Passcode: Wq2xz3Gm

TO connect via telephone: (888) 588-2610,  267-223753# United States (Toll-free)

Phone conference ID: 457 579 086#

Important Note: This is a public webinar and there is no pre-registration needed. The webinar link should only be utilized on the day of the webinar. Due to the number of expected participants, please log in at least 10 minutes prior to the start of the presentation.

In advance of the webinar, participants are encouraged to email general questions to PL110-173SEC111-comments@cms.hhs.gov. Requests for an accessible format of the presentation should also be sent to this resource mailbox.

WCRI 2026 Annual Meeting – It’s All About Health Care

We all know health care is important in workers’ compensation – what we may be less aware of is how important health care insurance coverage is regarding workers’ compensation claims. Much of the 2026 WCRI Annual meeting was focused on not only health care but based on current policies how many people would no longer have access to coverage – and the potential impact on workers’ compensation claims and costs.

There are a couple of points we need to start with. First, people with health care coverage have fewer workers’ compensation claims. At the simplest level, that’s because there are lots of situations (potential claims) where there the issues presented medically could be workers’ compensation, or maybe isn’t workers’ compensation. When alternative coverage exists (health insurance) it is far easier to avoid the question. When there is no alternative coverage available, those bills and those claims almost certainly become workers’ compensation. Second, people who have health insurance coverage tend to be healthier (more on that in a following paragraph).

The public policy discussion of the Affordable Care Act (ACA or Obamacare), Medicaid Un-Winding and the federal subsidies for health care coverage (One Big Beautiful Bill Act – OBBBA) has an out-size impact on workers’ compensation. Out-size in comparison to health care because workers’ compensation medical costs, according to Joe Paduda of Managed Care Matters, represents three quarters of 1 % (.74%) of overall medical costs in the US. Paduda calls workers’ compensation medical costs the unwilling passenger unable to do anything but desperately hang on as the (medical) elephants smash through the landscape.

Access to health care coverage changes behavior. That behavioral change is reflected in the general health of the population. Those with health care coverage are more healthy – those without it, noticeably less healthy. Those who are less healthy have more co-morbidities and a higher mortality rate – both of which will impact workers’ compensation claims, and costs. And again, when health coverage is not available to pay for needed medical care, sometimes that gets picked up by what is available – workers’ compensation.

Dr. Ben Sommers with the Harvard School of Public Health was the keynote speaker the first day. He went through the changes in health care policy stemming from Washington. As a result of those changes, we are seeing large health insurance coverage cost increases with an estimated 3 – 4 million people losing coverage this year. In addition, based on OBBBA people are asked to demonstrate their eligibility for ACA coverage.

One of the issues is work requirements for ACA and subsidized coverage. However, only 5 – 10% of people on medicare or Medicaid are eligible or capable of working. Most are either ‘medically fragile,’ disabled or are care givers for others, and therefore exempt from the work requirements – however, depending on the individual rules – they may have to continually demonstrate that. Work requirements have not demonstrated an impact on the number of people working

The way states implement work requirement eligibility – the level of administrative burden placed on those on Medicaid - has a direct impact on how many people come off the roles. For example, Wisconsin uses the existing reporting structures across the bureaucracy (employment tax payments for example) to help identify those who are working. Arkansas requires the individual to demonstrate they are working, adding at least one administrative task. That effort – just the administrative task of individually reporting to the state - results in fewer people qualifying for coverage. Arkansas saw about a 20% reduction, simply because people could not/would not complete the administrative task of demonstrating eligibility. That alone (across the country, not just AR) is estimated to add another 5 – 6 million people who will no longer have access to health care coverage.

Sebastian Negrusa of WCRI (and an MSIA Webinar presenter) provided the preliminary results of their study of what happens in workers’ compensation when people no longer have access to health insurance. The upshot – for workers’ compensation, based on the research is an increase of 2 – 3% in WC medical costs. And, it will hit different employments/employees differently. There will be larger increases for the lower wage professions, males and important for the Montana system, those in construction, leisure (tourism) and manufacturing. Construction could see medical costs go up 10%, based on the research. The increases will come from higher medical utilization – across the board – although there is not expected to be an increase in the number of claims. Going back to the idea of those with access to health insurance being healthier – those without will have more complex workers’ compensation claims.

Bogdan Savych, also of WCRI presented his preliminary findings on the impact of hospital closures on workers’ compensation outcomes. While the WCRI research database does not include Montana, we can extrapolate some of the results. The impacts were kind of surprising in that one could expect an increase in medical costs, but that was not the result. Access to care was impacted, but it seemed to be replaced by more frequent, but lower cost, care. Hospital provided services were generally down, while Evaluation & Management (office visits), PT and major surgeries were generally up. Indemnity costs were also up – indicating the potential that lower levels of care, resulted in longer durations of claims.

Bob Hartwig with the University of South Carolina’s Darla Moore School of Business provided his usual broad perspective on workers compensation and everything going on in the world. If you have the opportunity to see Dr. Hartwig (a former colleague of mine) I highly recommend it. He is interesting, fast paced and ties what’s going on in our society to our business. As reported under the NCCI filing story, the WC combined ratio is reported at 86 – 2016 was the last year where the combined ratio was over 90. The result is a VERY competitive workers’ compensation market because this line is driving the profitability of the P & C industry. As well, somehow, medical inflation remains stable, and low. General Medical CPI is measured at 3/2% while WC Medical CPI is 2.7%.

WCRI also has panels of employers, medical providers, regulators and labor talking about what they’re doing and how it is working. This year, the employers included United Airlines, Marriott, Publix Markets, Aramark, Disney and Hershey. One of the reasons I like WCRI is that they go out of their way to include labor and regulators – this year they featured the CO Division of WC and the TX Division of WC, as well as the Center for Construction Research and Training.

Among the tidbits that came from the three sessions was United Airlines matched WC data with their group health data to learn more about the comorbidities and their potential impact on WC claims. The results startled them when they found that those with comorbidities were 70% more likely to have ER visits and well as overall higher medical utilization (which kind of was expected). For employers who administer their own WC and group health program, there might be some value in going through this effort because comorbidities always mean higher costs and longer recoveries in WC.

Aramark identified that they have the same level of medical staffing for the third shift as they do for all the other shifts. While there is not much utilization from a WC injury standpoint, the cultural message of that staff being available provides dividends in workers’ understanding that regardless of role, or shift, they are important. The medical staff is used much more for general issues than potential WC issues.