REGULATORY ACTIVITY:

• Announced that the 25th Annual Missouri Division of Workers' Compensation Educational Seminar is now open for registration.  The conference is being held May 2-3, 2019 at Tan-Tar-A Resort in Osage Beach Missouri.  For additional information or to register, go to  https://labor.mo.gov/DWC-Conference.

REGULATORY ACTIVITY:

• The State Average Weekly Wage (SAWW) used to determine maximum workers' compensation benefits for the fiscal year beginning July 1, 2018 and ending June 30, 2019 is $902.51. This SAWW produces the maximum weekly benefit rates for injury and illness occurring on or after July 1, 2018, as follows:
  • Temporary Total Disability $947.64
  • Permanent Total Disability $947.64
  • Permanent Partial Disability $496.38 Death $947.64
• The actual weekly wage rate necessary to attain the maximum benefit rate is $1,421.45 for Death, Temporary Total Disability and Permanent Total Disability and $744.57 for Permanent Partial Disability.
• Also, as of July 1, 2018, the mileage allowance for travel expenses is 54.2 cents per mile.

REGULATORY ACTIVITY:

• Posted a notice regarding Docketing Changes.  The notice was released on January 29, 2018 however the document was Dated January 24, 2018.  To view the docketing changes notice, go to: https://labor.mo.gov/sites/labor/files/Docketing-Changes-Jan-24-2018.pdf

REGULATORY ACTIVITY:

• Announced docketing changes on July 31, 2017.  The Hannibal Docket is being transferred to the Louis Adjudication Office. The contact persons for the Hannibal Docket are Dineika Jefferson (314-340-7965) and TaQuerria Cawa (314-340-7909). The docket will still be held in Hannibal. All correspondence regarding the Hannibal Docket should be sent to the St. Louis Adjudication Office, 250 Wainwright Building, 111 N. 7^th Street, St. Louis, MO 63101.The Lebanon Docket is being transferred to the Jefferson City Adjudication Office. The contact person for the Lebanon Docket is Doris Brondel (573-751-4231). The docket will still be held in Lebanon. All correspondence regarding the Lebanon Docket should be sent to the Jefferson City Adjudication Office, P.O. Box 58, Jefferson City, MO 65109.The Rolla Docket and the West Plains Docket are being transferred to the Cape Girardeau Adjudication Office. The contact person for the Rolla Docket and for the West Plains Docket is Alice Schweer (573-290-5759). The Rolla Docket will still be held in Rolla. The West Plains Docket will be held in Willow Springs until further notice. All correspondence regarding the Rolla Docket or the West Plains Docket should be sent to the Cape Girardeau Adjudication Office, 3102 Blattner Dr., Suite 101, Cape Girardeau, MO 65703.The Marshall Docket and the Sedalia Docket are being transferred to the Kansas City Adjudication Office. The contact person for the Marshall Docket and for the Sedalia Docket is Lisa Willard (816-889-6232). The Marshall Docket will be held in Sedalia. The Sedalia Docket will still be held in Sedalia. All correspondence regarding the Marshall Docket or the Sedalia Docket should be sent to the Kansas City Adjudication Office, 1410 Genessee St., #210, Kansas City, MO 64102.

REGULATORY ACTIVITY:

• The State Average Weekly Wage (SAWW) used to determine maximum workers' compensation benefits for the fiscal year beginning July 1, 2017 and ending June 30, 2018 is $879.06. This SAWW produces the maximum weekly benefit rates for injury and illness occurring on or after July 1, 2017.

REGULATORY ACTIVITY:

• The state has posted a form regarding mesothelioma liability election of self-insured employer or group trust member pursuant to Section 287.200.43, RSMo.
• Published statewide average weekly wage and benefit maximums effective July 1, 2017.

REGULATORY ACTIVITY:

• Missouri has posted two new forms involving employers electing to become self-insured. The new forms are WC 304-G and WC 304-I.

REGULATORY ACTIVITY:

• Posted Adoption of Division 50 Division of Workers’ Compensation Chapter 2-Procedure Rule as proposed on August 3, 2015.  The rule will become effective February 3, 2016.

LEGISLATIVE ACTIONS:

• House Bill 2194
  This bill repeals provisions which require individual risk premium modification rating plans used by workers’ compensation insurers to be actuarially justified, not result in premiums which are excessive, inadequate, or unfairly justified, and be applied on a statewide basis. The bill also removes the prohibition on the removal or reduction of premium credits unless there is a change in the insurer, the insurer amends or withdraws the rating plan, or there is a change in the insured employer’s operations. When premium modifications result due to a schedule rating plan with an underwriter determining individual risk characteristics, then up to an additional 10% credit may be given for a reduction in the insurer’s expenses, rather than “an additional 10%” reduction. The legislation allows insurance companies to file one affidavit, when market conduct reports from the Department of Insurance, Financial Institutions and Professional Registration are adopted, indicating acceptance of such reports rather than requiring all directors of a company to file an affidavit. This affidavit will be executed by its general counsel or chief legal officer. It specifies that when an insurer transfers an insurance policy among affiliated insurers within an insurance holding company, it is not considered to be a cancellation or nonrenewal. If the transfer policy is substantially different than the original policy the insurer must notify the insured at least 15 days in advance of the effective date of the assignment or transfer. INSURERS (Section 379.125) This enacted legislation will allow property and casualty insurers and reinsurers to write limited amounts of life insurance business outside of the United States which is written or assumed as a rider attached to a base policy, provided the aggregate premium assumed annually does not exceed 3% of the capital and surplus of the company as of December 31 of the previous year. This bill creates a regulatory system for self-service storage insurance and the selling of such insurance. A limited lines self-service storage producer is allowed to offer and disseminate self-service storage insurance. Producers shall meet certain licensing and training criteria and maintain a register of individuals that offer self-service storage insurance for the producer and provide such information to the Department of Insurance, Financial Institutions and Professional Registration upon request. Employees and authorized representatives offering self-service storage insurance shall receive training that meets minimum standards as outlined, which shall be reviewed and approved by the department director. Producers offering self-service storage insurance shall provide brochures or other print materials to prospective purchasers that meet minimum standards as outlined in the bill. Self-service storage insurance producer’s employees and authorized representatives shall not engage in certain activities including evaluating the technical terms of the policies or holding themselves out as insurance producers. Limited lines self-service storage insurance producers, operators, employees and authorized representatives can offer self-service storage insurance policies in an amount not to exceed $5,000 per customer per unit.  Effective Date August 28, 2016.
• Senate Bill 613
  This act permits volunteer fire protection associations to apply to the State Fire Marshal for grants for the purpose of funding the workers’ compensation insurance premiums for the association’s volunteer firefighters. Grants shall be disbursed by the Marshal, subject to appropriations, based upon the number of volunteer firefighters which received workers’ compensation benefits from claims arising out of and in the course of the prevention or control of fire or the underwater recovery of drowning victims in the preceding calendar year. The schedule is as follows:
  • Associations which had 0-5 claims shall be eligible for $2,000;
  • Associations which had 6-10 claims shall be eligible for $1,500;
  • Associations which had 11-15 claims shall be eligible for $1,000; and
  • Associations which had 16-20 claims shall be eligible for $500.

Currently, the uniform experience rating plan of workers’ compensation insurance must prohibit an adjustment to the experience modification of an employer if the total medical cost does not exceed $1,000, the employer pays all of the medical costs, there is no lost time from the employment (subject to exceptions), and no claim is filed. This act changes the medical cost amount limit to 20% of the current split point of primary and excess losses under the uniform experience rating plan.

The act further provides that, for purposes of calculating the premium credit under the Missouri contracting classification premium adjustment program, an employer within the construction group of code classifications may submit to the advisory organization the required payroll record information for the first, second, third, or fourth calendar quarter of the year prior to the workers’ compensation policy beginning or renewal date, provided the employer clearly indicates for which quarter the payroll information is being submitted.  Effective Date August 28, 2016.

• Senate Bill 700
  This act permits volunteer fire protection associations to apply to the State Fire Marshal for grants for the purpose of funding the workers’ compensation insurance premiums for the association’s volunteer firefighters. Grants shall be disbursed by the Marshal, subject to appropriations, based upon the number of volunteer firefighters which received workers’ compensation benefits from claims arising out of and in the course of the prevention or control of fire or the underwater recovery of drowning victims in the preceding calendar year. The schedule is as follows:
  • Associations which had 0-5 claims shall be eligible for $2,000;
  • Associations which had 6-10 claims shall be eligible for $1,500;
  • Associations which had 11-15 claims shall be eligible for $1,000; and
  • Associations which had 16-20 claims shall be eligible for $500.

Currently, the uniform experience rating plan of workers’ compensation insurance must prohibit an adjustment to the experience modification of an employer if the total medical cost does not exceed $1,000, the employer pays all of the medical costs, there is no lost time from the employment (subject to exceptions), and no claim is filed. This act changes the medical cost amount limit to 20% of the current split point of primary and excess losses under the uniform experience rating plan.

The act further provides that, for purposes of calculating the premium credit under the Missouri contracting classification premium adjustment program, an employer within the construction group of code classifications may submit to the advisory organization the required payroll record information for the first, second, third, or fourth calendar quarter of the year prior to the workers’ compensation policy beginning or renewal date, provided the employer clearly indicates for which quarter the payroll information is being submitted. Effective Date August 28, 2016.

• Senate Bill 865
  This act creates the “Missouri Palliative Care and Quality of Life Interdisciplinary Council,” which shall consult with and advise the Department of Health and Senior Services on matters related to the establishment, maintenance, operation, and outcomes evaluation of palliative care initiatives in the state, as well as submit an annual report to the General Assembly assessing the availability of palliative care in the state for patients at early stages of serious disease and analyzing barriers to greater access to palliative care.  This act also creates the “Palliative Care Consumer and Professional Information and Education Program,” which shall be designed to maximize the effectiveness of palliative care in the state by ensuring the public availability of comprehensive and accurate information about palliative care. The program shall encourage hospitals to have a palliative care presence on their intranet or internet website and to develop and distribute information about palliative care to patients. These provisions expire on August 28, 2022. This act provides that all licensees, registrants, and permit holders regulated by the Board of Pharmacy shall report to the Board any final adverse action taken by another licensing jurisdiction against such person or entity’s license, permit, or authorization to practice or operate as a pharmacist, intern pharmacist, pharmacy technician, pharmacy, drug distributor, drug manufacturer, or drug outsourcing facility. Additionally, all licensees, registrants, and permit holders shall report any surrender of a license or authorization to practice while under disciplinary investigation by another jurisdiction, and any exclusion to participate in any government funded health care program for fraud, abuse, or submission of any false claim, payment, or reimbursement request. This act provides that a pharmacist may dispense varying quantities of maintenance medication per fill up to the total number of dosage units as authorized by the prescriber, unless the prescriber has specified that dispensing a prescription for maintenance medication in an initial amount is medically necessary. When the dispensing of the maintenance medication is based on refills then the pharmacist shall dispense no more than a 90-day supply and the patient must have already been prescribed the medication for 3 months. This act provides that the Board of Pharmacy shall not renew a nonresident pharmacy license if the applicant does not hold a current pharmacy license in the state in which the nonresident pharmacy is located. Additionally, the Board shall not renew an out-of-state wholesale drug distributor, out-of-state pharmacy distributor, or drug distributor license if the applicant does not hold a current license in the state in which the distribution facility is located. If the applicant is a drug distributor registrant, then the entity must be authorized and in good standing with the Food and Drug Administration or within the state where the facility is located in order for the Board to renew the registration. This act adds the U.S. Department of Health and Human Services to the list of entities with which the Director of the Department of Insurance, Financial Institutions, and Professional Registration may cooperate to regulate insurance and financial services.  This act requires a health carrier or managed care plan that provides prescription drug coverage in the state to offer medication synchronization services. A health carrier or managed care plan that provides prescription drug coverage shall not charge any amount in excess of the otherwise applicable co-payment for dispensing a prescription drug in a quantity that is less than the prescribed amount and shall provide a full dispensing fee to the pharmacy that dispenses the prescription drug so long as the terms of the medication synchronization services are met. This act also requires each contract between a pharmacy benefit manager (PBM) and a pharmacy or pharmacy’s contracting representative to include sources utilized to determine maximum allowable cost and update such pricing information at least every seven days. A PBM shall maintain a procedure to eliminate products from the maximum allowable cost list of drugs (MAC list) or modify maximum allowable cost pricing within seven days if the drugs do not meet the standards as provided in the act. A PBM shall reimburse pharmacies for drugs subject to maximum allowable cost pricing based upon pricing information which has been updated within seven days. A drug shall not be placed on a MAC list unless there are at least two therapeutically equivalent multi-source generic drugs, or at least one generic drug available from at least on manufacturer and is generally available for purchase from national or regional wholesalers. All contracts shall include a process to internally appeal, investigate, and resolve disputes regarding MAC pricing as provided in the act. Appeals shall be upheld if the pharmacy being reimbursed for the drug on the MAC list was not reimbursed according to the act or the drug does not meet the requirements for being placed on the MAC list. The act creates the “Missouri Health Insurance Rate Transparency Act” to apply to health benefit plans, excluding large group market, long-term care, and Medicare supplemental plans, delivered, issued for delivery, continued, or renewed on or after January 1, 2018. Under this act, no health carrier shall deliver, issue for delivery, continue, or renew a health benefit plan until the rates for that plan have been filed with the Director of the Department of Insurance, Financial Institutions, and Professional Registration in the manner specified in the act. Rates shall be filed for excepted health benefits plans, as defined in the act, and grandfathered health benefit plans 30 days prior to use for informational purposes only. For all other plans, a health carrier may use rates on: (1) the date the Director determines such rates are reasonable, (2) the date the health carrier notifies the Director of its intent to use rates the Director has determined are unreasonable, or (3) 60 days after filing rates with the Director. The Director shall determine by rule when rates filed by health carriers shall be made publicly available and shall provide a means by which the public can submit written comments concerning proposed rate increases. The Director shall review the proposed rate and accompanying documentation and determine whether the rate is reasonable or unreasonable. Within 60 days of rate filing, the Director shall provide the health carrier with written notice detailing whether the proposed rate is reasonable or unreasonable. If the Director deems the rate is unreasonable, the written notice shall specify the deficiencies and detailed reasons why the rate is excessive, inadequate, unfairly discriminatory, or unjustified. Within 30 days of receiving written notice that the proposed rate is unreasonable, the health carrier may amend its rate, request reconsideration, or implement the proposed rate. The health carrier shall notify the Director of its intention within 30 days of receipt of the written notice. If a health carrier implements a rate determined to be unreasonable, the Department shall make such determination public. The Director shall publish final rates on the Department’s website no earlier than 30 days prior to the first day of the annual open enrollment period in the individual market for the applicable calendar year. The act extends the sunset provision for coverage of early refills of prescription eye drops from January 1, 2017, to January 1, 2020. Effective Date August 28, 2016.