Destie Overpeck, Esq., DWC Legal Counsel

Division of Workers’ Compensation2011 UpdatesDestie Overpeck, chief counsel

DWC Structure—Leadership• Administrative director:• Deputy administrative director:• Court administrator: Keven Star• Executive medical director:• Chief legal counsel: Destie Overpeck• Chief of programmatic services: Angela Michael• Chief of legislation and policy: Susan Gard• Southern region manager: Mark Kahn• Northern region manager: Joel Harter

12-Point plan to help control medicalcosts as launched in July 20091. Tightening treatment guidelines:Updated MTUS includes guidelines foruse of compounded topical drugs2. Providing a network option:Reducing the HCO fees made HCOs moreon par with MPNs cost-wise and gaveemployers another option for choosing anetwork of doctors and eliminating URcosts3. Simplifying MPN rules:Updated the MPN rules to streamlinenotice requirements, which alleviatesadministrative overheadStatus as of March 2011 completeRegulations took effect 7/18/09. completeRegulations took effect 1/1/10. completeRegulations took effect 10/9/10.3

12-Point plan to help controlmedical costs as launched in July20094. Improving medical cost reporting:The WCIS regulations clarifiedmedical lien reporting, which willallow DWC to better monitormedical costs5. Implementing e-billing:Medical e-billing regulations willencourage electronic billing andfaster payments to physicians6. Creating pharmacy networks:Would allow employers to containpharmacy costsStatus as of March 2011 complete but not yet effectiveRegulations filed with secretary of state11/15/10 and will become effective11/15/11. complete but not yet effectiveRegulations filed with secretary of state4/18/11. Standardized billing effective10/15/11. Electronic billing effective10/18/12.Impediments to completion existAdvisory group held in the fall of 2009.Draft regulations posted on forum forcomment in March 2010.4

12-Point plan to help controlmedical costs as launched in July20097. Streamlining requests for medicalauthorization:Revise physician reporting forms so itis clear when a physician isrequesting medical treatment.8. ASC fees:Reduce ASC fees from 120% to 100 %the Medicare fees for outpatienthospitals9. Reducing duplicate payment forspinal hardware pass-through:Amend inpatient fee scheduleStatus as of March 2011Begun—to be completed in mid-2011Proposed draft regulations posted onforum for comment until 4/5/10. Theseregulations are being implemented inconjunction with UR regulations, which willbe completed in mid-2011.In progress—to be completed soonPublic hearing held on 1/25/11.In progress—to be completed soonPublic hearing held on 1/25/11.5

12-Point plan to help controlmedical costs as launched in July200910. Streamlining UR:Amend UR regulations tostreamline procedures and reduceadministrative costs11. Updating coding for doctorpayments:Converting from the currentphysician fee schedule to a RBRVSsystem12. Considering creation of a drugformulary:Consider an additional revision tothe MTUSStatus as of March 2011Begun—to be completed in mid-2011Stakeholder meeting held on 4/8/10.Proposed draft amended regulations postedon forum for comments 9/23/10. Formalrulemaking will take place in mid 2011.Begun—could be completed in 2011Proposed draft regulations and the Lewinreport posted on forum until 4/5/10; revisedversion posted from 7/6 through 7/20/10.Stakeholder meeting held on 8/17/10.Impediments to completion existThe next MTUS update will address chronicpain and opioids. The rulemaking requiresthe guidance of an executive medicaldirector.6

Subject Regulations Sections AnticipatedNotice DateADA RegulationsQME Regulations(Chiro Specialties)8 CCR §§ 9708.1 – 9708.6 and10226.1 – 10226.6 (Newsections)May 20118 CCR §§ 100, 105, 106 May 2011Benefit Notices 8 CCR §§ 9810-9815 June 2011MTUS(Presumption ofCorrectness, Burden ofProof and Strength ofEvidence)8 CCR §§ 9792.25 and9792.26July 20117

Subject Regulations Sections AnticipatedNotice DateElectronic Filing in EAMS 8 CCR §§ 10210 et seq. July 2011Employers’ First Report ofOccupational Injury or Illness8 CCR §§ 9705 (New section) July 2011PDRS 8 CCR §§ 9805 et seq. August 2011QME Regulations (Part 2) 8 CCR §§ 30, 17 August 2011Interpreter Fee Schedule 8 CCR 9795.1 et seq. Sept. 20118