An article from Risk & Insurance Journal highlights opioids in workers’ compensation following updated guidance from the CDC.
A piece from Risk & Insurance Journal highlights opioids in workers’ compensation following the 2022 Center for Disease Control’s (CDC) revised guidance. Industry stakeholders expect an uptick in opioid prescriptions, particularly for patients with chronic pain, now that the new CDC guidelines are in place. Experts say that most opioid prescriptions in the system today are from older claims. Meanwhile, more recent patients with chronic pain are less likely to be prescribed opioids. Instead, these patients are often redirected to pharmacological (i.e. antidepressants, NSAID’s) and non-pharmacological alternatives (i.e. physical therapy). Some industry leaders caution that renewed access to opioids for chronic pain must not be the primary answer to long-term pain management and that patients should not be “abandoned” to medication, emphasizing alternative approaches.
Researchers at WCRI point to hospitals and ambulatory surgical centers as primary drivers of medical inflation in workers’ compensation.
According to economist Olesya Fomenko of the Workers’ Compensation Research Institute (WCRI) workers’ compensation medical inflation is primarily driven by increases in reimbursement for hospitals and ambulatory surgical centers. From 2012 to 2020, cumulative growth for overall healthcare services was 21.4 percent, at an annual growth rate of 2 percent. Hospital inpatient/outpatient care experienced a rise in pricing greater than 26 percent. Meanwhile, the cumulative growth rate for payment of physician services accounted for just 9.3 percent at the same time. Overall, the cumulative growth rate for inpatient hospital services grew at 44 percent for workers’ compensation, with ambulatory surgical centers at 42 percent. As previous research shows, fee schedules are a proven mitigation tool for medical service price increases per Fomenko.
State regulators revise training requirements for pharmacists.
The state Department of Health (DOH) finalized a rule concerning pharmacist continued training requirements. Regulatory language would mandate that all pharmacists complete a board-approved 2-hour continuing education course on Validation and Counseling of Prescriptions for Controlled Substances and Opioids. An effective date for the training protocols is set for April 5th.
Legislation that would expand prescribing authority for certain nurses and physician assistants received a favorable report from a Senate committee.
HB557 permitting certain nurses and physician assistants (PAs) to prescribe hydrocodone, oxycodone, or compounds thereof for a limited 5-day supply received a favorable report from a Senate Committee late last week and is expected to receive a floor vote in the Senate soon. After receiving bipartisan support, the lower chamber voted in favor of the bill earlier this month.
House members agreed to passage for a bill that would require insurers/employers to pay an injured worker’s legal fees up to $2000 in certain circumstances.
HB1012 introduced earlier this session by Rep. Valderrama of Prince George’s County, would require the Workers' Compensation Commission to order the employer/insurer to pay a fee of no more than $2,000 for legal services conducted on behalf of a covered injured worker if there is no compensation payable and the injured worker is awarded a medical benefit at a hearing. The bill passed the House and is now under consideration in the state Senate.
Legislators seek to expand workers’ compensation eligibility to first responders with PTSD who do not have a corresponding physical injury.
State leaders seek to alter the state’s current post-traumatic stress disorder (PTSD) eligibility criteria for first responders. HB2398 aims to allow first responders to receive workers’ compensation benefits for PTSD without a corresponding physical injury. While the bill will help with the mental injury treatment of state first responders, some restrictions could apply. Current bill language calls for a one-year cap on medical benefits for those who have PTSD without an accompanying physical injury and a limit of $10,000 in prescription care. If the legislation is fully approved, the bill will become effective on November 1st.
A state appellate court ruling permits for medical cannabis reimbursement in workers’ compensation.
A state appellate court determined that an injured worker’s medical cannabis treatment is considered reasonable and necessary for their work injuries. Justices in the majority believe that the Workers’ Compensation Appeal Board erred in its conclusion that an employer/carrier could not be required to pay for medical cannabis. In the majority opinion, the court argued that there is no statutory language that would prohibit insurers from reimbursing injured workers who lawfully use medical cannabis to treat an accepted work injury when such treatment is deemed reasonable and necessary. Insurers point to the federal classification of cannabis as a reason they cannot be compelled to reimburse for such treatment. However, the court countered, claiming that “reimbursement is not the same as manufacturing, distributing or dispensing cannabis.” While the ruling can be seen as a victory, meeting the “reasonable and necessary” threshold will still be hard to prove and likely only reserved for severe or older injury claims. With the U.S. Supreme Court declining to take up the issue of medical cannabis reimbursement in workers’ compensation last year, the decision is now left to the states to decide for themselves.
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