SC Workers’ Compensation Commission SC Hospital Association Managed Care Directors October 9, 2012

SC Workers’

Compensation Commission

SC Hospital Association

Managed Care Directors

October 9, 2012

System Overview

Perspective

South Carolina Workers’ Compensation Commission

General InformationOrganization

Budget

Statistical Information

System Cost, Premiums Paid, Taxes Paid

Current Issues/Ongoing Efforts


Organization

Commissioners - 7


Commissioners

T. Scott BeckChairman

Term Expires June 30, 2014

Susan S. Barden


Andrea C. Roche


Avery B. Wilkerson, Jr.Term Expires June 30, 2014

Derrick L. WilliamsTerm ExpiresJune 30, 2014

Gene McCaskillTerm Expires June 30, 2018

Melody L. JamesTerm ExpiresJune 30, 2014


Organization

Executive DirectorAdministrationClaims JudicialInformation TechnologyInsurance and Medical Services


FTE’s 54 employees

64 approved FTEs(81 in 2001)


Annual Budget

$4.99 million (FY12-13)

General Fund $1.7 million

Earmarked Funds $ 3.2 million


Claim Review Process

•Injured Worker Files Claim– Minor Medical

•No lost time•Medical Cost < $ 2,500

– Form 12 A•Submitted to Commission•Coverage determined


Hearing Process

•Informal Conference•Single Commissioner•Appeal - Full Commission•Appeal - Court System

Circuit Court (Pre 2007)

Court of Appeals (Post 2007)



Statistical Abstract

Accidents Filed

FY 2007 – 2012


Informal Conferences

Assigned & ConductedFY 2006-2012


Hearings Assigned & Conducted

FY 2006-2012



Appeals to Commission FY2006-12


Appeals to Higher Court FY06-FY12


Compensation & Medical Cost

FY2008-12($ millions)


Compensation by Category

FY2008-FY12(millions)

Work Comp Premiums (millions)

FY11 FY12Commercial Market CY 2011 $ 540.3 $ 576.5

Self Insurance FY 2012 $ 215.8 $ 210.9

State Accident Fund FY 2012 $ 86.7 $ 69.2Total $ 842.8 $ 856.3


Work Comp Premium Taxes (millions)

FY11 FY12Commercial Market $ 11,424,000 $ 14,407,303

Self Insurance FY 2011 $ 4,775,811$ 4,663,681

Total $ 16,199,811$ 19,070,984



Statutory Changes

&Regulatory Changes

StatutoryH 3111

• Impacts Physicians Fee Schedule

• Service providers may appeal to ALJ

• 10% change in fee schedule

• Governor Signed June 7, 2012


Regulations

•Mediation 67-1801

•Oral Argument 67-706


Mediation 67-1801•Admitted Cases 42-9-10 & 42-9-30•Occupational diseases•Third party lien reduction•Contested death•Mental/mental injury•Concurrent jurisdiction•Federal Longshore and Harbor Workers Comp Act•Multiple employees with same employer admitted or not


Oral Argument Regulation 67-706

•Require parties to be present 30 minutes before appellate hearing


Ongoing Efforts

Transparency

CommunicationEmails to StakeholdersUpdate Website


Ongoing Efforts

Stakeholder Advisory CommitteesFee SchedulesSurgical Implantable

DevicesCommuted Values


Cost Control Fee SchedulesImproved ProcessesFiling ClaimsScheduling Hearings


Physician’s Fee Schedule

Medicare based2010 RBRVS – Conversion Factor $50


Inpatient Fee Schedule

Ambulatory Surgery Fee Schedule

Medicare plus 40%


Pharmacy Fee Schedule•Adopted Advisory Committee•Repackaged pharmaceuticals•Physicians may dispense •MAP based on original NDC

Surgical Implantable Devices •Advisory Committee


Information Technology•Electronic Filing •Proof of Coverage – Notice of cancellation •Notices/Orders

Informal Conference Process•Adjusters Roundtable


NCCI Rate Filing

SC Vocational Rehabilitation Department

Claimant Referrals


Medical Services

Payment Dispute Resolution Process

SC Code of Laws - Section 42-9-360(d)

Payment to an authorized health care provider for services shall be made in a timely manner but no later than thirty days from the date the authorized health care provider tenders request for payment to the employer's representative, unless the commission has received a request to review the medical bill.


Medical Services

Payment Dispute Resolution Process

http://www.wcc.sc.gov/insurance/Pages/MedicalProvidersPaymentDispute.aspx





How can we serve you better?

System….

Processes…..


Contact

Gary M. [email protected]

(803) 737-5744

www.wcc.sc.gov


THANK YOU


Documents

SC Workers’ Compensation Commission SC Hospital Association Managed Care Directors October 9, 2012