REGULATORY ACTIVITY:

• Posted notice that the 2019 weekly benefit table is now available. The state average weekly wage and maximum weekly rate should be available in a few weeks and will be posted at that time. To view the announcement, go to https://www.michigan.gov/wca/0,4682,7-191--484378--,00.html.

REGULATORY ACTIVITY:

• Form Submission Reminder: In our continuing efforts to increase efficiency and reduce costs, the Workers' Compensation Agency is in the midst of several modernization and system enhancements. As part of this ongoing effort, we would like to remind you about the Optical Character Recognition (OCR) requirements which were implemented in July 2013. OCR allows us to obtain data from paper and electronically submitted forms. These continued upgrades enable the Agency to better serve our stakeholders through greater efficiency while positioning the agency for future operating system upgrades.  The OCR process requires data to be in very specific locations to prevent processing errors.  Unfortunately, there is very little tolerance for location variation. The Agency requires that all forms 100, 107, 701, 400 and 401 filed must match exactly to those forms found on the Workers' Compensation Agency website, including but not limited to language, block space and positioning, font and dimension.  In addition, when data is input into the various forms, an Arial 10-point font must be used, with each field limited to one line of data. In addition, forms must be submitted either USPS or through the Data Exchange Gateway (DEG). Forms not complying with these requirements will be rejected and returned unprocessed.  Questions regarding these changes should be directed to Caitlin Keene at 517-284-8914.
• For the eighth consecutive year, Michigan workers and job providers will benefit from the Michigan’s workers’ compensation system as the state’s pure premium advisory rate for workers’ compensation insurance will decrease by 8.3 percent for 2019. Comparatively, the national average change in the rate was a decrease of only 0.7 percent. Michigan has seen a decline in workers’ compensation pure premium rates every year since 2011 and will see an overall cumulative decrease of 49 percent from 2011-2019, saving employers an estimated $492 million in workers compensation premiums. “Employers experience real financial savings from these declining rates,” said Workers’ Compensation Agency (WCA) Director Mark Long. “This allows them to invest more in their business by hiring more employees and increasing salaries. These rate decreases play a pivotal role by continuing to add workers and businesses to the state's economy.” In 2011, Gov. Rick Snyder signed legislation that reformed the state’s workers’ compensation system, including improvements for disability and post-injury earning capacity. These changes helped revamp a 100-year-old system and have played an integral role in reducing costs for employers, stabilizing the state’s system, and ensuring the promise to protect injured workers. Pure premium rates are important in calculating employers’ and job providers’ overall expenses for workers’ compensation. The rates also factor into employer insurance claims that cover costs for work-related injuries. In a recent Workers Compensation Research Institute study Michigan had the lowest overall cost per lost-time claim amongst studied states. The most recent comparison data also shows that Michigan’s cumulative pure premium decrease of 45 percent from 2011-18 is again best in the Midwest and third in the nation. Michigan's injured workers and their employers are governed by the Workers' Disability Compensation Act. The Act was first adopted in 1912 and provides compensation to workers who suffer an injury on the job and protects employers' liability. The mission of the WCA is to efficiently administer the Act and provide prompt, courteous and impartial service to all customers.

REGULATORY ACTIVITY:

• Published the following to all interested parties regarding request for workers' compensation records: “Please be advised, in accordance with section 6 of the Freedom of Information Act (FOIA), MCL 15236, the Department of Licensing and Regulatory Affairs (LARA) has appointed a FOIA Coordinator. As part of the implementation, all requests for Workers’ Compensation Agency documents will now be directed to the central LARA FOIA Office for processing. This model centralizes the LARA’s FOIA responsibilities enhancing efficiency through a single point of entry for customer requests and provides resource efficiency by relieving the agency of several FOIA compliance tasks. This process improvement will further allow the agency to focus their resources on research, retrieval, and review/redacting of potentially responsive public records.  Thus, we are advising that as a result of the procedural changes noted above, and to ensure our continued compliance with FOIA guidelines, customers may notice an adjustment in responsive determinations to their requests. Finally, it should be noted that subpoenas will continue to be processed directly by the Workers’ Compensation Agency. Should you have any questions regarding this announcement please do not hesitate to contact me directly at (517) 284-8901or by email at longm1@michigan.gov.   
• Since 2006, all Agency-approved vocational rehabilitation providers have been required to utilize Form WC-500, “Vocational Rehabilitation Provider Professional Disclosure Statement” at the outset of each vocational rehabilitation case, not including wage earning capacity evaluations. This policy remains in place with the introduction of the updated form. Vocational counselors providing services to Michigan’s injured workers are expected to adhere to the Code of Professional Ethics for Rehabilitation Counselors.  The issues outlined in the disclosure statement uphold the requirements of Section A.3 of the Code.  Overall, Form WC-500 is meant to assist with establishing trust, enhancing transparent communication, and building rapport at the start of the counseling relationship.  It also serves as protection for you and your client during the counseling relationship and is frankly just part of professional practice. As before, if your client is not supportive of signing the document, please note this on the form and sign in your designated location to note that the discussion took place, and that informational brochures were provided.  And finally, recognize that you may need to review this document with your client at various times throughout the counseling relationship.  

FEE SCHEDULE NEWS:

• The state has adopted the 2018 Michigan Hospital Cost to Charge Ratios effective August 1, 2018. The next expected hospital rates update is in August 2019.

REGULATORY ACTIVITY:

• The Department of Licensing and Regulatory Affairs, Workers’ Compensation Agency held a public hearing on Friday, August 24, 2018 starting at 10:00 a.m. at the Department of Licensing and Regulatory Affairs, Workers’ Compensation Agency, 2501 Woodlake Circle, Okemos, Michigan to receive public comment on proposed amendments to the Workers’ Compensation Health Care Services rules and fee schedule. The Health Care Services rules are revised in order to provide the Agency’s external customers with updated health care fee schedules for reimbursement to providers for treatment of injured workers and to guide providers and payers on the scope of reimbursement. The following rules of the Michigan Administrative Code are amended: R 418.10106, R 418.10107, R 418.10109, R 418.10117, R 418.10901, R 418.10902, R 418.10904, R 418.10913, R 418.101002, and R 418.101004. These rules are promulgated by authority conferred on the Workers’ Compensation Agency by sections 205 and 315 of 1969 PA 317, section 33 of 1969 PA 306, Executive Reorganization Order Nos. 1982-2, 1986-3, 1990-1, 1996-2, 2003-1, and 2011-4, MCL 205, 418.315, 24.233, 18.24, 418.1, 418.2, 445.2001, 445.2011, and 445.2030.  Rules adopted under these sections will become effective seven days after filing with the Secretary of State. Rule Set 2018-017 LR is published on the state of Michigan website at http://w3.lara.state.mi.us/orr/Rules.aspx?type=dept&id=LR and in the August 15, 2018 issue of the Michigan Register. A copy of the proposed rules may be obtained by contacting Beth VanElls at 517-284-8902 or email at vanellsb@michigan.gov.  Comments on the proposed rules may be presented in person at the public hearing. In addition, written comments will be accepted until 5:00 p.m. on August 24, 2018, at the following address or email: Department of Licensing and Regulatory Affairs Workers’ Compensation Agency-Health Care Services Division ATTN: Beth VanElls 2501 Woodlake Circle Okemos, MI  48864 Email: vanellsb@michigan.gov

REGULATORY ACTIVITY:

• Posted a memorandum regarding Medicaid Recovery. If you experience difficulty obtaining Medicaid recovery information from the subrogation vendors for either Meridian Health Plan of Michigan or Blue Cross Complete, you may contact the following individuals:   Meridian Health Plan of Michigan: Emily Decker     313-324-3700 x22429 ;  Blue Cross Complete:  Dionne Wadi Title:  Manager, 3rd Party Liability & Sub Rec, Ops TPL & Subrogation E-mail: dwaddy@amerihealthcaritas.com Phone: 215-863-5837 .   Before utilizing these contacts, we are asked to be sure to make every attempt to obtain the recovery information directly through the managed care plan.   If you need further assistance, you may contact the Michigan Department of Health and Human Services, Managed Care Plan Division directly at 517-284-1162. They ask that you be prepared to provide support that you have worked directly with the plan to resolve any problems and that the problem remains unresolved. They will request the name of the managed care plan, the beneficiary name, the date you first contacted the plan, and the name of the plan employee you have worked with.  To view a copy of the memorandum, go to https://www.michigan.gov/wca.
• Published an updated application for Mediation or Hearing, DWC from WC - 104C. Please note the addition of a new “check box” option for users of Form WC-104C, Application for Mediation or Hearing .  This new option can be found in the section that allows for adding another employer.  It remains the goal of The Workers’ Compensation Agency and the Board of Magistrates to continue our efforts to streamline operations and procedures to better serve our customers.  The change to Form WC-104C is a new check box option titled, “Add non-employer entity.”  Until this addition, petitioners could add another employer, but found it difficult to simply add another party to the case.  Utilizing this new check box will allow users to more easily indicate their intentions, and aid in processing. Please begin using this new form immediately.  If you have form templates created by outside entities, please have your templates updated, or simply utilize the form from the WCA website for future submissions.  The updated form can be viewed at https://www.michigan.gov/wca/0,4682,7-191--471542--,00.html.

REGULATORY ACTIVITY:

• The State has posted the following information on their web site with regards to Explanation of Benefits (EOB):  The Explanation of Benefits (EOB) serves many purposes, including notifying the parties of reimbursement decisions, educating the injured worker regarding balance billing, and outlining the provider’s right to appeal payment adjustments. Recently, we have seen an increase in the use of third-party medical cost-containment networks and payors within the workers’ compensation arena.  It is important to note that Rule 117 (R 418.10117) of the Workers’ Compensation Health Care Services (HCS) rules states in part: (4) A carrier or designated agent shall record payment decisions on a form entitled “The Carrier’s Explanation of Benefits” using a format approved by the agency.  The carrier or designated agent shall keep a copy of the explanation of benefits and shall send a copy to the provider and to the injured worker.  The carrier’s explanation of benefits shall list a clear reason for the payment adjustment or amount disputed and shall notify the provider what information is required for additional payment. The rules allow carriers and providers to utilize these networks if they choose; however, it is important to reiterate that the carrier or its designated agent must send a copy of the EOB to the provider and to the injured worker. The HCS rules define a provider as a “facility, health care organization, or a practitioner.”  A third-party payor or network is not considered to be the provider. In the event that a third-party payor or network is utilized, they should not be listed as the provider.  The carrier or its designated agent must send an agency-approved EOB form to the provider and the injured worker.  For additional reference, EOB requirements are outlined in R 418.10117, R 418.101001, R 418.101015, and R 418.101301. To view the information as posted, go to https://www.michigan.gov/wca/0,4682,7-191--468700--,00.html.

FEE SCHEDULE NEWS:

• The state has adopted the 2017 Michigan Workers’ Compensation Health Care Services Manual with an effective date of March 15, 2018.

REGULATORY ACTIVITY:

• Published the 2017 Health Care Services Rules and Fee Schedule which became effective March 15, 2018 to replace the current 2016 fee schedule. The updated rules, manual, and fee schedule worksheets are posted, and are based on 2017 source documents such as the 2017 October release CMS Physicians Fee Schedule, as well as 2017 CPT® and HCPCS Level II procedure codes.  Some highlights of the updated rule language include:
  • Updated laboratory procedure codes for drug testing, drug screening and drug confirmation testing.
  • Revised language for reimbursement of dispensed medication.
  • New billing and reimbursement rules for air ambulances.

Please feel free to contact the Agency with any questions or comments on our toll-free line at 1-888-396-5041.

To view the document, go to https://www.michigan.gov/wca/0,4682,7-191--463225--,00.html.

REGULATORY ACTIVITY:

• Posted notice of a public meeting in the November 1, 2017 Register. The Department of Licensing and Regulatory Affairs, Workers’ Compensation Agency, held a public hearing on Thursday, November 9, 2017, starting at 2:00 p.m. at the Department of Licensing and Regulatory Affairs, Workers’ Compensation Agency, 2501 Woodlake Circle, Okemos, Michigan. The hearing was held to receive public comment on proposed amendments to the Workers’ Compensation Health Care Services rules and fee schedule. The Health Care Services rules are revised in order to provide the Agency’s external customers with updated health care fee schedules for reimbursement to providers for treatment of injured workers and to guide providers and payers on the scope of reimbursement.    The following rules of the Michigan Administrative Code are amended: R 418.10106, R 418.10107, R 418.10207, R 418.10208, R 418.10212, R 418.10214, R 418.10404, R 418.10416, R 418.10904, R 418.10905, R 418.10909, R 418.10912, R 418.10920, R 418.10923b, R 418.101002, R 418.101003, R 418.101003a, R 418.101008a, R 418.101501, R 418.101503 of the Michigan Administrative Code are amended, and R 418.10926 and R 418.101010 are added.  These rules are promulgated by authority conferred on the Workers’ Compensation Agency by sections 205 and 315 of 1969 PA 317, section 33 of 1969 PA 306, Executive Reorganization Order Nos. 1982-2, 1986-3, 1990-1, 1996-2, 2003-1, and 2011-4, MCL 205, 418.315, 24.233, 18.24, 418.1, 418.2, 445.2001, 445.2011, and 445.2030.  Rules adopted under these sections will become effective seven days after filing with the Secretary of State.  Rule Set 2017-040 LR is published on the state of Michigan website at http://w3.lara.state.mi.us/orr/Rules.aspx?type=dept&id=LR and in the November 1, 2017 issue of the Michigan Register. A copy of the proposed rules may be obtained by contacting David Campbell at 517-284-8891 or email at campbelld5@michigan.gov
• The Funds Administration is now accepting the Form 112 – Application for Reimbursement and supporting documentation via upload through the Michigan Data Exchange Gateway (DEG), a secure website. Note: Form 112’s uploaded to the DEG are submitted to a different Mailbox than the Workers’ Compensation Agency forms. If you already have a DEG account established use Mailbox: WCFUNDSA and Application ID: 112FA when uploading the Form 112. Those interested in participating that do not have a DEG User Account can email Diane Harger at hargerd@michigan.gov. An account will be established and the necessary instructions on how to upload the Form 112 via the Michigan Data Exchange Gateway, including user ID, password, etc., will be provided.

FEE SCHEDULE NEWS:

• Hospital fee schedule has been updated with new rates effective August 1, 2017.

REGULATORY ACTIVITY:

• Published its 2016 Annual Report.
• “The Resolution, Rehabilitation and Rules Division will be presenting training seminars on the 2016 Health Care Rule changes effective January 13, 2017.  The seminars will be held on the following dates from 9:30 a.m. to 11:30 a.m.:
  • Lansing: Tuesday, May 9, 2017 at the MDOT Horatio S Earle Learning Center Conference Room, 7575 Crowner Drive, Lansing, MI
  • Detroit:   Wednesday, May 10, 2017 at the Cadillac Place Building, Room L150, 3026 W Grand Blvd., Detroit, MI
  • Grand Rapids:  Tuesday. May 23, 2017 at the GRCC M-Tec Building, Room 206, 622 Godfrey Avenue SW, Grand Rapids.
  • This seminar covers new rules, rule changes, and definitions which became effective January 13, 2017.
  • These seminars are free of charge and are for anyone who is involved in the billing process and the hearing process of medical bills for the treatment of work related injuries.  Your questions are welcomed and encouraged.
  • Please complete the registration form and return, via fax or email, by the date indicated.  Entry into any state office building will require picture identification.”