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Déjà vu: Worker’s Comp fee schedule proposed again

As negotiations begin in earnest over potential changes to the state’s Worker’s Compensation (WC) laws, a renewed effort to impose a fee schedule for WC health care services was unveiled Tuesday at a Worker’s Compensation Advisory Council (WCAC) meeting in Madison.

The WCAC has equal representation from the state’s management and labor entities who bargain each legislative biennium over how the state’s WC laws and regulations should be amended, if at all. Once this group reaches a consensus, an “agreed to” bill is drafted as legislation and submitted to the state legislature for consideration. While the legislature has ultimate decision-making authority, historically a WCAC “agreed-to” bill receives significant deference. The Society is one of four non-voting health care liaisons to the WCAC, with other liaisons coming from the state’s hospital, physical therapy and chiropractic communities.

Labor and Management introduced their proposals at Tuesday’s meeting to start the months-long negotiation process. Management’s proposals lead off with three items related to health care:

  • Fee schedule: establishes a fee schedule where services would be compensated at Medicare rates plus an additional 50 percent.
  • Employer-directed care: allows businesses to select a panel of health care professionals that injured employees must use to acquire WC-related care.
  • Treatment guidelines: require physicians and other health care professionals to get pre-authorization from insurance companies for WC services that fall outside treatment guidelines. Those guidelines would need to be based on national standards.

All three proposals are of concern, especially considering that Wisconsin’s WC system is hailed as a national leader. Wisconsin’s system promotes ready access to high quality health care, with injured workers returning to work more quickly than the national average at an overall cost to employers lower than the national average. Worker satisfaction is very high, resulting in below-average amounts of WC-related litigation.

The entire list of Management’s proposals can be found here. Labor’s proposals are here.

Both lists include a placeholder on opioids; Labor and Management each asked the Society to arrange an opioids-centered presentation at the WCAC’s June meeting to help determine any potential proposals in this important area. Negotiations between Labor and Management will continue through the summer, with a goal of submitting an “agreed-to” bill to the state legislature this fall.

The Society last fought a fee schedule proposal in the 2013-2014 biennium, when Labor and Management included a fee schedule scheme in its agreed-to bill proposal, 2013 Assembly Bill 711. The medical liaison groups all vigorously opposed that inclusion, and the bill failed to get a committee vote in either legislative house.

Contact Mark Grapentine, JD, in the Society’s Government and Legal Affairs department for more information.

Back to May 11, 2017 Medigram