Download - 2021 Stakeholder Meetings - erd.dli.mt.gov
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2021 Stakeholder Meetings MAGGIE COOK-SHIMANEK, MD, MPH
JULY 7TH, 9TH, 13TH
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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
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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
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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
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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.”
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Work status: Available only on the 5-year petition to reopen benefits
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Available only on the 5-year petition to reopen benefits
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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
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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
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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
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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*
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Recent challenge & solution Uncertainty on maximum medical improvement status
Solution: Added this information to the insurer request
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Telemedicine Workgroup
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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
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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.
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Product
Available at
COMING SOON…