By Sandy Shtab, AVP of Advocacy and Compliance, Healthesystems
Our industry, like many others has been significantly impacted by the National State of Emergency related to COVID-19. Though the full impact to injured workers is not yet fully known as things continue to change, we do know there has been a concerted effort by many states to protect injured workers’ rights and benefits during this uncertain time, and in ways that have never been done before.
Federal & State Responses
In the early weeks of the pandemic came a lack of uniform response at the federal and state level, causing challenges for employers, insurers and TPAs. As of the end of March, more than 250 executive actions related to COVID-19 were issued across the nation. More than half the states issued separate executive orders, emergency regulations, or policies directly related to insurers responsibilities, workers’ protections, and medical provider licensing. All states have suspended regular legislative sessions in favor of virtual meetings or have recessed early where not feasible.
It is still too soon to know the full impact this pandemic will have on our healthcare system or our economy, but we must continue to examine current trends in regulatory agency responses, insurance coverage issues and the ability of our government agencies to embrace more technological solutions in order to continue to serve the public.
Coverage for Exposures
A majority of states have taken immediate and decisive action to ensure injured workers have access to medical services and medications during this uncertain time. Washington was first in the nation to declare a state of emergency on February 29th, and soon after their Department of Labor and Industry issued specific guidance for employers related to coverage of COVID-19 exposures for healthcare workers and first responders.
California followed, and despite varying opinions on the compensability of COVID-19 exposure as an occupational hazard, attorneys and labor representatives across the country are calling for Governors to recognize COVID-19 as a workplace hazard that exists beyond healthcare workers and first responders.
This means employees who are not subject to shelter in place orders, who work in “essential” services such as pharmacies, supermarkets, banks, and even postal workers, could receive additional protections such as paid leave while in self-quarantine or paid sick leave.
Relaxing Regulatory Requirements to Ease Access to Injured Worker Care
To prevent further spread of the virus, states have utilized CDC recommendations for social distancing. Local and state government officials have urged hospitals, healthcare providers and patients to carefully weigh the benefit of seeking out medical care against the relative risk of exposure in a brick and mortar healthcare settings. This has opened the existing window for more access to telehealth or virtual healthcare services.
The adoption rate of telehealth services before COVID-19 was relatively underutilized in workers’ compensation, but with these services now more necessary than ever, state workers’ compensation agencies have specifically added billing and payment rules to ensure providers will be paid under the fee schedule. States have temporarily relaxed regulatory requirements for telehealth and HIPAA in alignment with the Center for Medicare and Medicaid Services (CMS) policy memo, which lifts some of the regulatory barriers to delivering virtual healthcare services.
Occupational and Physical Therapy services are being promoted heavily through telehealth platforms to keep injured workers on the path to recovery during this time, and telehealth services are even being expanded to accommodate some opioid use disorder patients who have traditionally been treated face-to-face as required by the DEA and the Substance Abuse and Mental Health Services Administration (SAMHSA).
These entities have relaxed some regulatory requirements for new patients by permitting telehealth visits for new patients for whom buprenorphine will be prescribed. Of note, this exemption is not applicable to patients who are treated with methadone; they will continue to be monitored through a face to face in-person visit in a clinical setting.
Many non-emergency surgeries or diagnostic tests scheduled will be delayed in order to keep injured workers protected from exposure to the virus. While this may delay recovery in some cases, states mandated insurers to lift many of the existing restrictions on early refills of many types of medications to ensure patients can get medications they need as they stay in place.
Disaster Recovery Plans
State have also embraced technology to keep business operations as close to normal as possible. Most Departments of Insurance and Workers’ Compensation Divisions across the country have fully or partially mobilized their staff to work remotely. Prior to COVID-19 few states embraced remote work capability.
Though some agencies are better positioned to work from home, others reported challenges such as lack of reliable internet access, especially in rural communities, or insufficient equipment or infrastructure to permit the entire agency to work remotely for an undetermined time period.
Examples of states utilizing technology include virtual or telephonic hearings to expedite disputes which would impact medical care or indemnity benefits. A few states have conducted advisory committee meetings, emergency rulemaking hearings, and other public events via teleconference. This shift to remote work and virtual hearings is not only necessary in these difficult times, but provides great potential to transform business operations in the future.
While it is too soon to know if these changes will have a lasting effect on workers’ comp, this is a learning opportunity for our industry. State agencies are proving they can support remote work, they can offer telephonic and video connectivity for hearings and rulemaking, and they can simplify regulations and requirements so stakeholders can continue to function. A handful of issues will require some thoughtful problem solving, and perhaps some modernization of their accompanying regulations, for example many state regulations or still require the filing of paper forms with wet signatures, in person notary stamps or payments by check versus electronic/EFT.
As an “essential” industry, we must keep serving injured workers and their employers. In times like these, that can require a sense of creativity and flexibility that our current regulations haven’t widely embraced – yet. Through our technologies and the tools of modern business, we are demonstrating how obstacles can be overcome, while still satisfying the underlying intent of each regulatory mandate. The pandemic has great potential to move us forward with less red tape. After all, it is not reams of paper that place injured workers on the path to recovery, it is about our ability to deliver high quality medical care, ease of communication and responding quickly when facts change.
I am optimistic we will look back on the other side of this and wonder why it took us so long to make the system easier for everyone. We may realize our biggest obstacle of all was our thinking that things could not be done differently, when in fact, they could.
About Sandy Shtab
Sandy Shtab, AVP of Advocacy & Compliance at Healthesystems, oversees the strategic development and execution of all regulatory advocacy efforts for the organization. Ms. Shtab has expertise spanning 20 years in the insurance industry, working primarily in workers’ compensation claims management, medical case management and compliance leadership roles. Her main areas of focus relate to PBM oversight and regulation, medical cost containment, and ensuring broad access to quality healthcare for injured workers across the country. She believes that proactive collaboration is the key to ensuring fair and balanced policy decisions that benefit all stakeholders.
Ms. Shtab’s efforts to improve the system of care within workers’ compensation extend past her work at Healthesystems. She has been an active contributor and collaborator to organizations such as IAIABC, SAWCA and NCPDP. Currently, Ms. Shtab is an active appointee to the IAIABC Associate Member Council and the Medical Issues Committees where she has been recognized for her work towards educating regulators and others about regulatory and legislative policy impacting medical costs and injured worker outcomes. She is a regular contributor to various industry publications, serving on the editorial boards of Perspectives, a digital magazine published quarterly by IAIABC, and Healthesystems’ RxInformer, an industry-recognized publication that offers insights on current and emerging topics that impact workers’ compensation.
Healthesystems is a specialty provider of innovative medical cost management solutions for the workers’ compensation industry. The company’s comprehensive product portfolio includes a leading pharmacy benefit management (PBM) program, expert clinical review services, and a revolutionary ancillary benefits management (ABM) solution for prospectively managing ancillary medical services such as durable medical equipment (DME), home health, physical medicine, transportation and translation services. By leveraging innovation, powerful technology, clinical expertise and enhanced workflow automation tools, Healthesystems provides clients with flexible programs that reduce the total cost of medical care while improving the quality of care for injured workers. To learn more about Healthesystems visit www.healthesystems.com.
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