QUARTERLY REPORT FOR JANUARY, FEBRUARY, MARCH Medical Cost Containment

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1 QUARTERLY REPORT FOR JANUARY, FEBRUARY, MARCH 006 Medical Cost Containment The Medical Cost Containment Division (MCCD) was established pursuant to Ark. Code Ann (987) and is responsible for the implementation, revision and compliance of Commission Rules 0,, and 4. Rule 0 consists of an inpatient and outpatient medical fee schedule. Rule is our managed care rule and Rule 4 refers to the Impairment Rating Guide. In the last quarter the following activities occurred regarding these rules: Rule 0 Rule 0 was revised effective May 5, 000. The AWCC adopted the Medicare RBRVS Medical Fee Schedule with Arkansas specific reimbursement multipliers. The new Medical Fee Schedule is available electronically from the AWCC Home Page. Since the Medical Fee Schedule is available electronically we are no longer printing a medical fee schedule. Effective April, 006 the Medical Fee Schedule reimbursement for anesthesia services will be increased percent, and an additional percent April, 007. Administrative Review Rule 0 contains an Administrative Review Process. This process allows providers or carriers to request assistance from the Medical Cost Containment Division regarding disputes. Each administrative review requested consists of an investigation, desk audit by department staff and the issuance of an order, which determines the disputed issue. During this quarter there were 6 review requests processed, review requests granted and 7 orders issued. The ongoing issues in dispute consist of nonpayment, untimely payment, penalty request, and reimbursement disputes. Balance Billing Rule 0 also contains a prohibition against balance billing by providers. The balance billing process involves: receipt of an allegation of balance billing by a claimant, carrier, employer, self-insured, etc.; notice being sent to all involved parties; an investigation; an audit; and a determination order being issued. During this quarter the MCCD received zero balance billing allegations.

2 January - 59 February March Investigations Rule We currently have certified MCOs. We continue to receive inquiries from self-insured employers regarding IMCS certification, but we still have not received any applications at this time. Medical Reports As a result of a meeting held between the Chief Legal Advisor, the Medical Cost Containment Administrator, and the Chief Administrative Law Judge, the Medical Cost Containment Division is obtaining medical records for carriers or employers that have been unable to do so from the provider. In the past the legal advisors would write to the provider requesting medical records. If the provider did not respond then the Chief Administrative Law Judge would issue a subpoena in order to obtain the records. We thought perhaps there was another approach, especially since the MCCD staff has numerous medical contacts. We have thus far been able to call the provider and obtain the records without any problems. This quarter we received 7 cases involving disputes over obtaining the medical records. Change of Physician To expedite Change of Physician (COP) requests and to comply with recent legislative changes new procedures and policies have been implemented. COP requests are sent to the Clerk of the Commission who then forwards them to the Medical Cost Containment Division (MCCD) for processing. If a WCC file has been established the MCCD calls the carrier/self-insured employer to determine if a Managed Care contract exists. When a response is received and a contract exists, the contract is reviewed to determine if it complies with Rule and if appropriate internal policies were followed. MCCD will review the claimant's medical records and determine an appropriate provider if the claimant has not requested a specific provider. An appropriate provider will be chosen on a case-by-case basis. If the request is to the claimant's treating physician, MCCD must determine if the provider meets the statutory requirements for the regular treating physician. If claimant requests a particular provider, MCCD checks to see if the provider meets the required statutory requirements. Once an appropriate provider is chosen MCCD will determine that the provider is a member of either the carrier/employer's MCO if a contract exists or a certified MCO if no contract exists. MCCD will contact the provider and ask if the provider will treat the claimant. MCCD will issue an order stating this is the claimant's one time only change of physician. This order will contain the provider's name and address. All parties will be copied. If either party objects to the MCCD order they can appeal to an Administrative Law Judge (ALJ). This quarter the MCCD received 99 COP requests. MCCD has issued 6 orders and 6 requests were either returned to open general files, withdrawn, controverted, resolved, or returned to the Clerk of the Commission s office for other action.

3 Audits Requests are received from the ALJ Division as well as outside entities (i.e., caseworkers, attorneys, etc.) for medical bill audits. This quarter the MCCD received 4 audits. Rule 4 There have been no changes at this time in Rule 4. Legislation was written to extend the legislative mandate regarding an impairment rating guide. Speaking Engagements During this quarter the following engagements/activities were attended: AWCC/ASIA Educational Conference

4 Workplace Fatalities Reported to AWCC Carroll Madison Newton Searcy Baxter Stone Fulton Clay Randolph Izard Sharp Greene Lawrence Independence Craighead Mississippi Franklin Pope Van Buren Cleburne Jackson Poinsett Logan White Faulkner Woodruff Yell Scott Perry Prairie Lonoke Saline Monroe Polk Montgomery Garland Howard Hot Spring Grant Jefferson Arkansas Pike Sevier Clark Dallas Cleveland Lincoln Desha Little River Hempstead Nevada Ouachita Drew Calhoun Miller Lafayette Columbia Union Bradley Ashley Chicot Cross Crittenden St. Francis Lee Phillips Out of State Fatalities: FY 005, FY 006 FY 005 FY st Q nd Q rd Q 4th Q Yr. to Date Fatalities: rd Qtr, FY < -5 >5-0 <0 Not Given Years of Service

5 Workplace Fatalities Reported to AWCC Length of Injury Date Employer County of Employer Service (yrs.) Job Type of Injury //006 Mt. Home Concrete, Inc. Baxter 5. Driver Not given /6/006 City of Gassville Baxter. Patrolman Gunshot /9/006 Securitas Security Serv. USA, Inc. Craighead. Security Officer Heart attack //006 Emer. Ambulance Ser. Jefferson.9 EMT MVA //006 Emer. Ambulance Ser. Jefferson. EMT MVA //006 Lafayette County Lafayette.9 Deputy MVA /6/006 Land & Mgmt. Logging Miller 0. Logger MVA /9/006 J.W.N Construction Phillips.6 Equipment Operator Fall //006 Mena Steel Bldgs., Inc. Polk. Foreman Heart attack /0/006 Marriott International 0. Housekeeping Poisoning 9/5/00 (rept. to AWCC /6/006) Mail Contractors of AR 5.8 Truck Driver Heart attack /6/006 Maverick Transportation. Truck Driver MVA /6/06 OK Farms 0. Driver Not given /5/006 Get Rid of It Union 0.6 Transporter Not given /0/006 Union Co. Hwy. Dept. Union 8.9 Operator MVA /7/006 CDX-Dart Drilling & Tech. White 0. Floorhand Not given /8/006 Covenant Transport Out of State.0 Driver MVA

6 Employers Placed in the Rule Program Franklin Scott Carroll 6 Polk Madison Newton Logan Yell Montgomery Howard Pike Sevier Little River Miller Pope Garland Perry Baxter Fulton Randolph Clay Izard Sharp Greene Lawrence Searcy Stone Independence Craighead Van Buren Saline Hempstead Nevada Ouachita Lafayette 5 Clark Columbia Faulkner Hot Spring Grant Cleburne White Dallas Cleveland Lincoln Calhoun Bradley Union Poinsett Jackson Cross Crittenden Woodruff St. Francis Prairie Lee Lonoke Monroe Phillips Jefferson Drew Ashley Arkansas Desha Chicot Mississippi During the, 79 places of employment were placed in the Rule Program. Employers are identified for the Rule Program if they have a higher-than expected number of compensable claims for their industry group. Employers placed in this program are encouraged to work with their workers compensation insurance carrier, in-house staff, or other professional safety sources to develop management tools which will help them run safer workplaces and minimize workers compensation costs through the use of such tools as return-to-work programs, drug-free workplace programs, claims management, etc.

7 Employers Completing the Rule Program Miller Carroll Baxter Fulton Clay Randolph Izard Sharp Greene Madison Lawrence Newton Searcy 4 5 Stone Independence Craighead Mississippi Franklin Van Buren Cleburne Poinsett Pope Jackson Cross Logan White Crittenden Faulkner 4 Woodruff Yell St. Francis Scott Perry Prairie Lee Lonoke Saline Monroe Polk Montgomery Garland Phillips Howard Hot Spring Grant Jefferson Arkansas Pike Sevier Little River Hempstead Lafayette Clark Dallas Cleveland Lincoln Nevada Ouachita Calhoun Drew Bradley Columbia Union Ashley Desha Chicot During the, 7 employers successfully completed the Rule Program.

8 Rule : Accident Prevention Services Program Visits to Arkansas Workers Compensation Insurance Policyholders The Accident Prevention Services (APS) group conducts audits of all insurance companies writing workers compensation insurance policies in Arkansas. During the rd Quarter, FY006, the APS group inspected the following insurance companies: Company Account Premiums No. of Policyholders $ $ $ 99 $ 6 Gray Insurance 96,4.00 T.H.E. Insurance 4, Technology Insurance Company,07, Capitol City Insurance Co.,54, Firemans Fund Insurance Companies American Automobile Insurance Co., American Insurance Company, Associated Indemnity Corporation, Fireman's Fund of Wisconsin, Fireman's Fund Insurance Co., National Surety Corporation,85.00 State Auto Insurance Companies State Auto Mutual Insurance Co, State Auto Mutual (Property & Casualty),7,4.00 U. S. Specialty Insurance Co. 58, Virginia Surety Company,044,59.00 National Farmers Union Property & Casualty Company National Farmers Union Standard Insurance Companies 58,06.00 Amerisure Insurance Companies Amerisure Mutual Insurance Company,6,84.00 $ 57 $ 50 $ 50 $ 57 $ 5 $ 74 State Farm Insurance Companies State Farm General Insurance Company $,870,464.00

9 Presentations and Speaking Engagements Carroll Madison Newton Searcy Baxter Stone Fulton Clay Randolph Izard Sharp Greene Lawrence Independence Craighead Mississippi Franklin Polk Sevier Scott Howard Little River Miller Logan Yell Montgomery Pike Hempstead Lafayette Pope Garland Clark Nevada Columbia Perry Hot Spring Ouachita Van Buren Saline Dallas Faulkner Grant Calhoun Union Cleburne Cleveland White Lonoke Jefferson Bradley Lincoln Drew Ashley Prairie Jackson Woodruff Monroe Arkansas Desha Chicot Poinsett Cross Crittenden St. Francis Lee Phillips The AWCC Health and Safety staff receives frequent requests to speak on a variety of topics related to loss control, drug-free workplace programs, and related topics. If your constituents would like to host a program by the Health and Safety staff on these or other subjects, please contact Patricia Burge at or pburge@awcc.state.ar.us.

10 Franklin 5 9 Polk Sevier Scott Howard Little River Miller Voluntary Drug Free Workplace Program New Approvals and Renewals Carroll Madison Logan Yell Montgomery Pike Hempstead 0 Newton Pope Garland Clark Nevada Perry Hot Spring Ouachita Searcy Baxter Van Buren Saline Dallas Stone Faulkner Grant Calhoun Fulton Izard Cleburne 4 Cleveland Sharp Independence White Lonoke Jefferson Bradley Lincoln Drew Prairie Randolph Lawrence Jackson Woodruff Monroe Arkansas Desha Clay Greene Craighead Poinsett Cross St. Francis Lee Phillips 4 Crittenden Mississippi Out of State Lafayette Columbia Union Ashley Chicot During the, the companies listed on the following page received approval of their Voluntary Drug Free Workplace Programs.

11 Voluntary Drug Free Workplace Program New Approvals and Renewals Company W.O.#9 Hendren Plastics Energy Smart Construction Ace Glass Company Pel-Freez Arkansas Dennis Electric Zero Mountain, Inc. W.O.#8 W.O.# ProActive Transportation John McBride Construction Shaw Material W.O.#0 Turner Inc. W.O.#5 W.O.#5-Depot W.O.#6 W.O.#6 W.O.#5-Subway W.O.# Gas W.O.#8 W.O.#5 W.O.#7 W.O.#4 W.O.#9 J.W. Black Lumber Mobley Contractors Colson Plastics Consolidated Youth Services Bethune Painting J.T. White Lumber T.A.W., Inc. Mahar Mfg. Wilson Brothers Construction Roeder Construction Fortier Inc. City Mt. Home Gravette Rogers Lowell Rogers Rogers Lowell ville Pea Ridge Rogers Gravette Lowell Siloam Springs Bergman Lead Hill Berryville Corning Morrilton Jonesboro Jonesboro Jonesboro Jonesboro Alma Van Buren Alma County Baxter Carroll Clay Craighead Craighead Craighead Craighead Crittenden Faulkner

12 Voluntary Drug Free Workplace Program New Approvals and Renewals Company Allen Engineering Corp. White River Materials Cove Creek Construction Master Made Tanks W.O.# W.O.#-Subway Thornton Hauling Producers Tractor W.O.#55-Subway W.O.#5 Brodix, Inc. F.M. Dix Co. Zero Mountain, Inc. Melton Company Shaw Material Ace Glass Company Golden Eagle of Arkansas BR McGinty Mechanical Action INC. Zero Mountain, Inc. Rodebush Construction Blaylock Heating & Air Construction W.O.# W.O.#66-Subway Mangum Contracting Employment Ser. Hanna's Candle Co. W.O.#8 W.O.# W.O.#4 W.O.#7 W.O.#4 Willis Shaw Logistics WSE Transportation Zero Mountain, Inc. Russell Construction W.O.#0 W.O.# City Paragould Batesville Hartman Paris Yellville Yellville Rosston Helena Salem Salem Mena Mena Russellville Little Rock Little Rock Little Rock Little Rock Bryant Barling Ft. Smith Ft. Smith Ft. Smith Ft. Smith Hardy Hardy El Dorado El Dorado Fayetteville Farmington Fayetteville Fayetteville Springdale Fayetteville Elm Springs Elm Springs Beebe Branson Branson County Greene Independence Logan Nevada Phillips Pike Pike Polk Polk Pope Saline Sharp Sharp Union Union White Out of State Out of State