REGULATORY ACTIVITY:

• Michigan sent out a notice regarding yearly compensation payment validation report.  “In alignment with the agency’s mission to efficiently administer the Act and provide prompt, courteous and impartial service to all customers, we have begun to implement a series of changes with how we collect and examine weekly benefit payment(s). Some of these changes impact only our internal operations while others will impact how we interact with our external customers. One such change relates to the YEARLY COMPENSATION PAYMENT VALIDATION report. Effective immediately with the 2016 annual report we now require a response from all insurers and self-insurers or their respective third party claims handler. Upon receipt please review the annual report and certify compliance with its requirements.  Select for a sample letter that will accompany the validation reports.   This change will assist in ensuring that our records accurately portray the status of indemnity benefit payments by the industry. Where available, the service company or third party claims handler will receive the report.  However, it remains the responsibility of the self-insurer or the insurer of record writing the policy covering the date of injury to see that all items related to the claim are resolved timely and appropriately reported to the agency in accordance with the Michigan Workers’ Disability Compensation Act.  Another change is the requirement to file form WC-701 to terminate benefits that have been reduced to zero after applying adjustments “A” thru “G” (coordination of benefits) for more than 14 consecutive calendar days.  Form WC-701 must be submitted to terminate benefits for each claim in Category 4 (All Others) of the Validation report for Year Ending 2016 where COMPENSATION RATE of zero was started during 2016.  The WC-701 form should be submitted with filing reason “C” (Terminating Benefits); Through date should be 15^th day after From date, Termination Reason “H” (Other) and “Coordination reduced to 0 more than 14 days” on the comment line provided below Part D of the form. The Form WC-701 instructions have been updated to reflect these changes. If you have open claims where indemnity payments are being made and they do not appear on this report please immediately report them to our agency by completing the appropriate forms.”
• The 2016 Pay Lag Reportshowing the pay lag results by industry group as well as individual company is now available. “We continue to emphasize the need to investigate all claims as soon as possible and to provide payment of benefits to all entitled individuals commencing on the 14th day as required by law. This report only covers claims where an initial Form 701 was submitted from 1/1/16 through 12/31/16. Only voluntary payment claims were selected. We have excluded any claims in which a Form 104A or 104C was filed, a Form 107 was received before the initial Form 701, or in which partial benefits were initially paid. We urge you to review your company's performance over the last year. You should also review the manner in which your Form 701 filings are being made. Filling this form out incorrectly can impact the number of pay lag days. If you have any questions or would like to see the detailed report for your company, please contact Ken Smith at 517- 284-8914 or email him at smithk5@michigan.gov.”

REGULATORY ACTIVITY:

• Governor Rick Snyder announced the appointment of John Housefield of Haslett as well as the reappointments of Keith Castora of Canton, Jane Colombo of Grosse Pointe, Lisa Woons of Grand Rapids, Robert Timmons of Grand Rapids and David Williams of Grosse Pointe Woods to the Workers’ Compensation Board of Magistrates.
• Form WC-104C, Application for Mediation or Hearing, has been updated. Please note that two additional “check box” options for users of Form WC-104C, Application for Mediation or Hearing have been added based on customer feedback.  With the addition of the options outlined below, the Workers’ Compensation Agency, in conjunction with the Board of Magistrates, hopes to continue the efforts to streamline operations and procedures to better serve their customers. The changes to Form WC-104C include new check boxes titled, “Petition to Determine Medical Treatment,” and “Redemption Only.”  Up until these additions, petitioners simply used the description section on the form to state their desire for a “redemption only” hearing.  Utilizing this check box will allow users to more easily indicate their intentions, and aid in processing.  Petitions received with the “Petition to Determine Medical Treatment,” box marked will be scheduled for a telephone mediation facilitated by Agency staff.  This informal dispute resolution forum will be utilized with the intent of providing the parties, including the carrier, the claimant, and the medical providers, with a less formal setting to discuss and resolve relevant issues. We believe that this new option is especially appropriate where issues have arisen surrounding reimbursement for opioid treatment per Rules 101008, 1008(a), and 1008(b).

FEE SCHEDULE NEWS:

• The state has adopted changes to the physician fee schedule effective January 13, 2017.  The updated rules, manual, and fee schedule worksheets are based on 2016 October release CMS Physicians Fee Schedule, as well as 2016 CPT® and HCPCS Level II procedure codes.  Some of the rules revised with the new schedule are:
  • Rules on billing and reimbursement of drug testing, drug screening, and drug confirmation testing
  • Rules on reimbursement for commercially manufactured topical medications, which are over-the-counter or contain over-the-counter ingredients
  • Rules on anesthesia billing and reimbursement with the addition of modifier–AD
  • Rules clarifying reimbursement for ASC facility charges pertaining to multiple procedures.

REGULATORY ACTIVITY:

• The Bureau of Labor Market Information & Strategic Initiatives has reported the state average weekly wage as of June 30, 2016, to be $965.62. In accordance with Section 418.355(2) of the Workers' Disability Compensation Act, the 2017 maximum weekly benefit based on 90% of the state average weekly wage is $870.00.
• Michigan has released the 2017 Calculation Program Version 18.  2017.  Please note the following changes contained in PA 266 of 2011 are not included in this version:
  • Old-age SS coordination:
  • Calculation does not reflect the cap specified in section 418.354(1).
  • Interest on judgments:
  • The accrued benefits and interest calculation does not reflect the changes to interest calculation as specified in section 418.801(6) as amended.

• Please note the following hints when installing:
  • This is a single user system. Please do not attempt to install in a network environment and make accessible by more than one user, as both calculation and program errors will occur. This application is also not supported in a Windows NT or Citrix environment.
  • Calculation Program, Version 18.0, is not fully compatible with some of the latest operating systems.
  • Click Calculation Program Help Manualto view the help manual which includes instructions on installing this program. It may be helpful to print these instructions before continuing. If you have a previous version of this program on your PC, it must be uninstalled first.
  • Once you have printed and read the install instructions, click exeto download the new version to your computer. You MUST save this file to your hard drive and install it from there. The file size is 13MB, so it may take a few minutes depending upon the speed of your connection. If you wish to install this program on more than one computer, you can save the setup.exe file to any external media (e.g., flash drive, CD, etc.).
  • The user must have administrator rights in order to be able to uninstall and install the program.
  • Once installed, locate the PARTIAL_DATA folder and grant full read/write permission.  This folder stores partial data files and calculations from existing cases.
  • Running the program in compatibility mode may also be necessary depending on the Windows operating system version.  To do so, right click on the Calculation Program shortcut icon on the desktop, choose "Properties," choose "Compatibility" tab and check "Run this program in compatibility mode for" and then select your operating system.  Also check "Run this program as an administrator."

To gain more information regarding the program go to:  http://www.michigan.gov/wca/0,4682,7-191--401443--,00.html.

FEE SCHEDULE NEWS:

• Hospital fee schedule has been updated with new rates effective August 1, 2016.
• The state has adopted changes to the Physician fee schedule effective September 15, 2015. The fee schedule is based on 2014 CPT codes, descriptions and modifiers.  A new update to the medical fee schedule is expected in December 2016.

REGULATORY ACTIVITY:

• The Bureau of Labor Market Information & Strategic Initiatives has reported the state average weekly wage as of June 30, 2016, to be $965.62. In accordance with Section 418.355(2) of the Workers' Disability Compensation Act, the 2017 maximum weekly benefit based on 90% of the state average weekly wage is $870.00.

LEGISLATIVE ACTIONS:

• House Bill 4362
  The bill would amend the Workers’ Disability Compensation Act to specify that each employer member that participated in a self-insurer group would possess ownership in its proportional share of the assets of the group in excess of the group obligations.  Each employer subject to the Act must secure the payment of compensation by either:
  a) receiving authorization from the Director of the Workers’ Compensation Agency to be a self- insurer, or
  b) insuring against liability with an authorized insurer within this State.  Two or more employers in the same industry with combined assets of $1.0 million or more, or two or more public employers of the same type of unit, may enter into agreements to pool their liabilities for the purpose of qualifying as self-insurers.  Under the bill, each of the employer members that participated in a self-insurer group would possess ownership in its proportional share of the assets of the group in excess of the self- insurer group obligations.  The trustees of a self-insurer group, acting in their fiduciary capacity, would have to establish processes and procedures for distributing excess assets with the Director’s approval.  Effective Date February 14, 2016. 
• Senate Bill 493
  The bill amends the Workers’ Disability Compensation Act to specify when an employee of a franchisee would be considered an employee of the franchisor. Specifically, an employee of a franchisee would not be considered an employee of the franchisor for purposes of the Act unless the following were met:
  a) the franchisee and franchisor shared in the determination of or codetermined the matters governing the essential terms and conditions of the employee’s employment; and
  b) the franchisee and franchisor directly and immediately controlled matters relating to the employment relationship, such as firing, discipline, supervision, and direction.
  Effective Date December 31, 2015.