December 16, 2017

MI WCA: Amended WC Rules will Reduce Opioid Abuse, Lower Medical Costs

Lansing, MI – The Michigan Workers’ Compensation Agency (WCA) recently announced that amendments to the Workers’ Compensation Health Care Services rules and fee schedule will address the problem of long-term use of opioids by injured workers and help reduce medical costs for the state’s job providers. The amendments are effective December 26, 2014 and have the wide-spread support of the state’s business and medical communities.

The amended rules prevent reimbursements for opioid treatment beyond 90 days for non-cancer related chronic pain, unless detailed physician reporting requirements and other processes are met.

“Prescription drug abuse in Michigan is a serious health concern,” said WCA Director Kevin Elsenheimer. “These amendments aim to limit potential addiction problems for injured Michigan workers, will help to keep them healthy and put them back to work.”

The WCA has been focused on administering a well-developed fee schedule which controls medical costs for work-related injuries. The new rules further modernize the Workers’ Compensation Health Care Services fee schedule by adopting the most recent Medicare-based schedules in conjunction with the state’s updated medical practices. The new rules also provide limitations on the reimbursement for custom compounded topical drugs.

“The new regulations are part of the agency’s continued effort to contain costs for our job providers, stabilize the system and keep the promise of compensation for injured Michigan employees,” added Elsenheimer. “All of these adjustments assure that injured Michigan workers have access to quality medical care.”

A new report from the Workers Compensation Research Institute (WCRI), CompScope™ Medical Benchmarks for Michigan, 15th Edition, found the state’s medical payments per claim were among the lowest of the study states. The report stated this result was likely due to Michigan’s medical fee schedules for professional and hospital services. From 2007 to 2012, medical payments per claim grew slower than in other study states due to prices and utilization.

The WCRI’s June 2014 study, Predictors of Worker Outcomes in Michigan, found that 79 percent of injured Michigan workers were satisfied with their medical care.

Earlier this year, the WCA announced the pure premium advisory rate for workers’ compensation insurance will drop by an average of 6.5 percent in 2015 and will decrease 6.3 percent annually from 2011-15. The pure premium rate will decrease 27.7 percent since 2011, saving Michigan employers an estimated $277 million. The most recent comparison data shows that Michigan’s cumulative pure premium decrease of 22.7 percent from 2011-14 is best in the Midwest and second best in the nation. While Michigan’s rate plummeted, the national average increased 10.8 percent.

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.

The amended rules can be found here (PDF).

Source: MI WCA

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