2021 Stakeholder Meetings MAGGIE COOK-SHIMANEK, MD, MPH

JULY 7TH, 9TH, 13TH

Objectives Petition

- Provide overview of the petition process – 5-year vs. 2-year

- Discuss materials of interest in performing a review

- Potential challenges and solutions

Telehealth

- Workgroup

- Legislative updates

- Plan

Process – typical file contents

5-year reopening

• FROI • Petition form • Medical records • Legal documents• Occasionally, a letter• +/-Panel reviews

2-year subsequent

• Medical records• Legal documents• Occasionally, a letter

Petition typeMedical director only

Panel evaluation - Medical director and two other physicians

- Initial: Panel reviews first and then medical director reviews

- Subsequent: Medical director reviews first

- If same determination as initial – no panel review- If determination differs from initial – return to panel

Joint petition – both parties agree to reopen

Decision-making

Ҥ 39-71-717 MCA requires that medical benefits may be reopened only if the worker's medical

condition is a direct result of the compensable injury or occupational disease and requires

medical treatment in order to allow the worker to continue to work or return to work.”

Work status: Available only on the 5-year petition to reopen benefits

Available only on the 5-year petition to reopen benefits

Process – typical file contents

5-year reopening

• FROI • Petition form • Medical records • Legal documents• Occasionally, a letter• +/-Panel reviews

2-year subsequent

• Medical records• Legal documents• Occasionally, a letter

Recent challenge & potential solutionThere are no medical records in the file

• 5-year – I have the petition form with an explanation from injured worker on how benefits will aid return to/stay at work

• 2-year – becomes more problematic

• Is it true that there really aren’t medical records (implying benefits haven’t been necessary)? OR

• Has medical care been ongoing, but records just weren’t submitted (and benefits really are necessary)?

Potential solution: Ensure timely submission of medical records and/or include a letter to accompany the file

Recent challenge & potential solution

Questions on work status

• 5-year – can become problematic if marked “not working” on form(left to guessing work circumstances).

• 2-year – I depend on medical records to see if this is mentioned

Potential solution: Include a letter to accompany the file

Recent challenge & potential solution

Clear indication that medical benefits are necessary.

- Proposed surgical plan is clearly described in provider note

- Maintenance medical care that allows the IW to continue to work(e.g., medications, periodic injections)

Potential solution: Consider a joint petition, when appropriate*

Recent challenge & solution Uncertainty on maximum medical improvement status

Solution: Added this information to the insurer request

Telemedicine Workgroup

History June of 2020 - Labor-Management Advisory Council recommendation to explore telehealth in workers’ compensation

September of 2020 – First telemedicine workgroup

Created an inventory of relevant matters for workers’ compensation

Reconvened in May of 2021 to review legislative updates

Decision to create a FAQs document for workers’ compensation

House Bill 43Passed 04/19/21 and signed by Governor

Effective date January 1, 2022

Summary of changes:

- Expands telehealth definition to include audio, video, or other telecommunications technology or media, including audio-only communication.

- Eliminates the rural/urban distinction for the use of telehealth services.

- Removes the requirement for an in-person patient and healthcare provider encounter prior to initiating telehealth.

Product

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