MONTANA SELF INSURERS' ASSOCIATION

november 2021 Update

ERD Announces Next Meeting on AMA Guides 2021 Update – Nov. 12
AMA Guides Laypersons “Cheat Sheets”
Special Members Only Meeting on Response Wed Nov. 10
MSIA Effort to Create Labor Business Communications Council
Welcome New MSIA Member – PAM Health Specialty Hospital
ERD Announces Next Meeting on AMA Guides 2021 Update

The Employment Relations Division of the MT Department of Labor (ERD), through Medical Director Dr. Maggie Cook-Shimanek, has announced a meeting November 12 at 2:00p MDT of interested parties in Montana regarding potential responses to the AMA Guides to the Evaluation of Permanent Impairment 6th Edition 2021 update (the Guides), and the potential of dealing with the 2022 updates. The AMA Guides are used to create Impairment Ratings for workers’ compensation injuries in Montana (and most of the rest of the country). The 6th Edition was first published in 2008 and had not been updated until earlier this year. In that time other resources the Guides relied on had been updated, making the 6th Edition more difficult to work with, and medically, somewhat out of step. The 6th Edition was first published in 2008 and had not been updated until this year. As a result, they have become out of date and more difficult for medical professionals to use since at least some of their reference documents are also no longer available.

At the September 22 ERD meeting with the AMA and Montana stakeholders, the AMA shared two things of note – we can expect annual updates from here on and, the Guides will be offered as part of an electronic subscription service and no longer as a hard-copy publication.

Current Montana law (MCA 39-71-711) requires the use of the 6th Edition of the American medical association Guides to the Evaluation of Permanent Impairment (the Guides). The law does not appear to make accommodation for updates or revisions. As well, the 2011 statutory changes identified that Class 1 impairment ratings (reflecting more minor permanent injuries) generally did not qualify for wage loss benefits – which has been upheld by the Supreme Court.

The 2021 changes focused on the psychological aspects of the Guides. The 2021 update references the more current Diagnostic and Statistics Manual of Mental Disorders (DSM-V versus the DSM-IV which was in effect in 2008 and replaced in 2013), eliminates the use of the Global Assessment of Functioning (GAF) rating scale, provides more definition for “malingering” and greater discussion around patient motivation.

Guides 2021 and 2022 Lay “Cheat Sheets”

Below are links I received from the AMA regarding the 2021 and 2022 6th Edition of the Guides updates. We have discussed the 2021 updates already. The updates for 2022, based on my reading of the link below, is a largely a clarification of who the Guides are prepared for and who should use them for impairment ratings. There seems to be a concern to emphasize that the individual jurisdiction defines who is eligible to provide an impairment rating, including repetition of the idea that impairment evaluation requires medical knowledge.

Finally, the 2022 cheat sheet, as one of its first highlights states, “No changes impairment ratings or methodology.”

https://ama-guides.ama-assn.org/books/pages/2022_summary_of_updates

https://ama-guides.ama-assn.org/books/pages/2021_summary_of_updates

MSIA Action and Special Members Only Meeting Nov. 10, 1p MDT

MSIA has asked ERD to request of NCCI their perspective on potential cost implications based on the changes. Frankly, I do not expect much from that effort. I do not know how much data NCCI will have regarding the usage of the GAF scale, nor the impacts of the DSM-V versus the DSM IV, particularly since in workers’ compensation they are rarely used independently of the AMA Guides for impairment ratings. At the same time, state systems, particularly since the pandemic, are more accepting of emotional impairments.

MSIA has called for a special members only meeting for all members, including Associate members, via Zoom on November 10 at 1p MDT to review the following questions:

1. Our perspective on how the recent and proposed updates to the AMA Guides will impact workers’ compensation in Montana – in terms of the updated medical content, magnitude of impairment ratings, or other factors.

2. The advantages and disadvantages of a subscription-based approach to the AMA Guides and the associated fee as compared to the 2008 hard copy current version.

3. The Department’s assessment that legislative change would be necessary to implement the 2021 version of the AMA Guides to the Evaluation of Permanent Impairment, based on review of MCA 39-71-711.

4. Next steps.

This members only special meeting will not be a business meeting and we will not review the meeting minutes from the last business meeting held in September at the Governor’s Conference. The agenda is discussion on the questions and experience members may have from other states that may have adopted the 2021 updates. We will discuss the AMA Guides updates and the potential position we should take regarding adopting the 2021 updates, maintaining the existing Guides language within our workers’ compensation system and whether we should support a law change to use the most recently published Guides or continue to require legislative action for the expected annual updates. This is members only meeting – if you have not received the Zoom invitation, we respectfully request you do not attend.

If you need more information or have questions, please don't hesitate to contact me.

MSIA Effort to Create Labor Business Communications Council (LBCC)

Your Board of Directors has authorized MSIA to try to resurrect meetings of labor and business interests to discuss workers’ compensation issues, challenges and potential changes. MSIA had approached the Governor to request he re-appoint a Labor Management Advisory Council. The Governor did not want to create more governmental sponsored organizations and offered the support of the Department of Labor and ERD if a private group wanted to get together for similar purposes. MSIA then contacted all the former members and organizations involved with LMAC seeking their input on a DRAFT Charter for a new effort, currently dubbed the Labor Business Communications Council (LBCC).

Comments from labor and business representatives and others are due at the end of this week. After that, should there be general agreement, MSIA can release the DRAFT Charter to you. We hope to put together a first meeting in November. The focus is expected to be on those issues – like the above AMA Guides 6th 2021 updates and potential statutory changes – where we can improve the Montana workers’ compensation system efficiency, benefits and impact on injured workers’ lives. The LBCC DRAFT Charter asks participants not to focus on issues the sides cannot agree on, but to provide the courtesy of letting others know they will try to pursue those changes beforehand.

The purpose, from the DRAFT Charter is “To provide a forum for organized communication and public policy discussion on the Montana workers’ compensation system with a primary outcome to find mutual agreement on system improvements to forward to the Montana Legislature, policymakers and regulators.”

MSIA will keep you updated as the effort progresses.

Welcome New MSIA Member – PAM Health Specialty Hospital

PAM Health provides long term acute care (LTACH) and rehabilitation inpatient hospital services across the US. We focus on putting the patient first and providing best in class care for the medically complex (LTACH) and those needing physical rehabilitation. After a critical injury or illness – we provide comprehensive, individualized treatment to return the individual to his or her highest functional status.

Through the communities we serve, PAM Health offers hope and acts as a catalyst for achieving an optimal quality of life.