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Thread: Federal change to increase state Medicaid pilot project/Will Workers' Comp Work?(Florida)

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    Senior Member Max's Avatar
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    Jul 2001
    Montreal,Province of Quebec, CANADA

    Federal change to increase state Medicaid pilot project/Will Workers' Comp Work?(Florida)

    Federal change to increase state Medicaid pilot project
    More elderly and disabled Floridians will be able to control their own care, thanks to a change the federal Centers for Medicare and Medicaid Services has approved to the Florida Medicaid Section 1115 cash and counseling demonstration project.

    Known as Consumer Directed Care, the program ensures that Medicaid-eligible senior citizens and disabled have more say in their own care. It also pays for services and items not traditionally covered by Medicaid.

    The patients in the program are able to live more independently, direct and control the budget for their care, make decisions about what type of services best meet their needs and choose who to hire to provide the services.

    Currently Florida's Consumer Directed Care program services about 900 people. The new waiver authorizes service to 3,350 people with developmental disabilities, traumatic brain injuries, spinal cord injuries, adults with other physical disabilities and the frail elderly.

    The program enrollment will expand after Florida receives final federal approval of program operating procedures, trains more consultants and works with patients to complete training, develop purchasing plans and hire workers.

    In order to participate in the program, patients first must be enrolled in one of three Medicaid home and community-based service waivers: developmental services waiver, aged/disabled adult waiver or traumatic brain injury/spinal cord injury waiver.

    Florida, Arkansas and New Jersey were the first states to test a cash and counseling demonstration project under federal waivers and grant funding from the Robert Wood Johnson Foundation.

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    [This message was edited by Max on 06-08-03 at 02:10 PM.]

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    Senior Member Max's Avatar
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    Jul 2001
    Montreal,Province of Quebec, CANADA

    Will Workers' Comp Work?

    Will Workers' Comp Work?

    TALLAHASSEE - It was a contentious hearing, helping set the tone for a legislative session that was just getting under way.
    One evening in early March, construction workers, business owners, insurers, doctors, injured employees and lobbyists regaled members of a House committee on Workers' Compensation reform with often- conflicting accounts of problems in the Florida system and potential fixes.

    ``If we end up with a bill that everyone is equally disappointed with, maybe we're getting somewhere,'' quipped Rep. Bob Henriquez, D-Tampa, a member of that committee.

    Three months later, a Workers' Compensation reform bill awaits Gov. Jeb Bush's signature. And there is no shortage of people disappointed with it.

    Not among them, however, is the state's big-business and insurance lobby.

    The final product closely resembles a bill put forward by the Coalition of Business and Insurance Industry, whose members included the Florida Chamber of Commerce, National Federation of Independent Business, Florida Retail Federation, Associated Industries of Florida and every carrier writing Workers' Compensation insurance in the state.

    Those groups, and the Republican-dominated Legislature that passed their recommendations, promise greater availability and lower workers` compensation insurance rates for Florida employers.

    Opponents say any savings will come at the expense of worker benefits. One of the most vocal critics, Sen. Walter ``Skip'' Campbell, D-Tamarac, said during final debate that it was ``beginning to look more and more like [the legislation] will benefit only the insurance industry's profit margins.''

    A clearer picture of what the Legislature accomplished - or failed to accomplish - should come soon. This summer, an insurance industry group will file its annual statewide Workers' Compensation rate request. And on Oct. 1, most of the provisions of the bill become law.

    This year's skirmish over Workers' Compensation may be remembered not only for what made it through the Legislature, but also for what did not: two high-profile efforts to significantly overhaul the Workers' Compensation system in Florida.

    Warts And All

    There were at least six Workers' Compensation reform bills submitted or considered as the Legislature convened in March. Some were never heard. Others fell by the wayside as the business/insurance coalition measure gathered steam.

    Virtually all of the bills intended to attack what analysts considered the major cost drivers in Florida's system: fraud, litigation, and a too-loose definition of what constitutes a permanent total disability, or PTD.

    Lawmakers generally agreed on tactics to fight fraud in the system: greater penalties, more accountability, increased enforcement.

    The other issues weren't as easy to resolve.

    The bill that passed eliminates a provision of state law that, in some cases, required insurance carriers to pay the hourly legal fees of lawyers who successfully represented injured workers. The bill caps the amount workers' attorneys can collect from their adversaries at $1,500, often a fraction of what the litigation can cost.

    Senate ubercritic Campbell led a noisy Democratic revolt, claiming on the Senate floor that undoing the hourly-fee provision would make Florida's Workers' Compensation law ``so lopsided and so stacked in favor of employers and carriers'' as to make it unconstitutional. He failed to sway the Republican majority.

    Meanwhile, a furor ensued over new standards for a permanent total disability, with lawmakers engaging in sometimes comical, sometimes surreal arguments over what body parts had to be amputated in order to qualify.

    At one point, the House passed language that would have redefined a ``catastrophic'' injury - one that would automatically qualify a worker for PTD benefits - as one involving ``the loss of both hands, both arms, both feet, both legs or both eyes, or any two thereof, or paraplegia or quadriplegia.'' That could have ruled out spinal cord injuries involving paralysis, amputation of a single limb, burns and industrial blindness as permanent total disabilities.

    The Senate rejected the language, and the bill retains the status quo on the definition of a ``catastrophic'' injury.

    Nonetheless, other language was tightened. The more liberal Social Security disability standard has been scratched. Being declared totally permanently disabled will be tougher under the bill.

    There were plenty of other revisions to existing Workers' Compensation law in the 200-page bill. Various provisions irked Republicans and Democrats. But the regular legislative session expired May 2 in a stalemate, and as an ensuing special session wound down, lawmakers under pressure from constituents acknowledged they may have to hold their nose and pass a bill.

    ``I'll grant you, there are some warts on this thing,'' Rep. Dennis Baxley, R-Ocala, told his colleagues on the House floor. ``But we have to take action.''

    With the big-ticket changes, the National Council on Compensation Insurance estimated the bill would cleave some $400 million in costs per year, or 12.5 percent, from Florida's workers' compensation system. Savings would reach 16.5 percent in the construction industry, where much of the antifraud measures are focused.

    Those savings are supposed to be reflected in the rates employers will pay for Workers' Compensation insurance. But the reform bill doesn't mandate a rate rollback.

    Can insurers be trusted to request that their rates be cut by those percentages this fall?

    NCCI has stated it plans to submit a filing ``to reflect the estimated savings in this bill.''

    Mary Ann Stiles, who represents Associated Industries, suggested that with more time, NCCI may find even more savings. ``I expect [rates] will come down substantially more than NCCI said,'' she said. ``I think it's 20 percent.''

    And if the formal rate request doesn't reflect the figures bandied about in the Legislature?

    ``I don't know exactly what happens,'' said Sen. Charlie Clary, R-Destin, one of the Senate sponsors of the reform bill. ``We have asked for a rate filing to reflect what NCCI said we would see in savings. We'll just have to wait and see what comes out of that.''

    FairCare Falls

    In May 2002, with complaints about Florida's system mounting, Bush created the Governor's Commission on Workers' Compensation Reform, charging it with evaluating the system and making policy recommendations. The commission met eight times across the state, taking testimony from stakeholders and evaluating reform proposals.

    Its final report and recommendations surfaced as a Senate bill this session.

    At its core was what came to be dubbed ``FairCare,'' an integrated system that attempted to blow up existing Workers' Compensation law and address its dysfunctions: lack of consensus on medical care authorization and decisions; inconsistent, out-of-whack reimbursement to medical providers; a dispute-resolution system that breeds conflict; an indemnity system based on impairment ratings rather than ability to work; and other woes.

    The end product of the commission's nine months of work never saw the light of day.

    ``It is unfortunate that they [legislators] had an opportunity to create substantive change, and instead chose again to tweak existing pieces of the system,'' said Jerry Fogel, a consultant to the governor's commission and main author of its reform proposal.

    Fogel says some of those ``tweaks'' in the bill that passed - elimination of the Social Security standard for permanent total disability, adjusting reimbursement rates for medical providers - were necessary. But he's disappointed lawmakers didn't tackle an overall, substantive, top-to-bottom fix.

    Clary, one of the sponsors of the legislation that passed in lieu of FairCare, said senators were uncomfortable with what they felt was such radical reform. It seemed ``very expensive, also extremely problematic,'' he said.

    Fogel's frustration is evident as he describes the commission's nine months of effort and the year that he and like- minded colleagues put in behind the scenes forging what they considered meaningful reform.

    ``My initial response to this is, `What a colossal waste,' '' Fogel said.

    He offered two explanations for the brush-off of FairCare: ``There needed to be a real sense of will and leadership,'' he said. ``Two, vested interests ruled the day.''

    Open, Then Closed

    Florida is one of six states in which regulators set Workers' Compensation insurance rates based on an all-encompassing request by an insurers' group. That group, NCCI, compiles data from its member insurance companies, including their benefit payouts, underwriting costs and other expenses, and expected profits, and files for a rate increase or decrease as it deems necessary.

    There was a movement this year to open up the system to greater competition. Proponents said competitive rate- making would expose the existing system as a virtual racket for insurance companies, which mark up underwriting, expenses and profits to gain rate hikes from Florida employers.

    Clary, one of the Workers' Compensation point men in the Senate, met with representatives of competitive systems in Kentucky, Missouri and California and came away impressed. At a news conference during the legislative session, he said he would sponsor a bill that would be the vehicle for reform of the rate-making process in Florida.

    But when Workers' Compensation hit the Senate floor, Clary's bill had disappeared.

    ``I think it was maybe a little premature,'' Clary said. ``They [lawmakers] just were not ready, or at least the majority wasn't ready, to wholeheartedly embrace that concept. We felt that we needed to have a Workers' Compensation bill, and we needed to get one out this year, so we ended up taking a little different direction than I wanted to.''

    The reform bill that passed includes, at Clary's insistence, the creation of a legislative committee that will study the merits of requiring each Workers' Compensation insurer to individually submit its expense and profit portion of the rate it wants to charge, while relying on NCCI for the base rate, the amount the insurers overall expect to pay out in benefits.

    ``The one thing we do know is that the majority of states approach Workers' Compensation in a completely different way than we do, and they don't appear to have anywhere near the problems we do,'' Clary said. ``I think this lays the groundwork for a systematic look at other states and the potential to change the system to something other than these rifle-shots of finding ways to save money.''

    Back For More?

    He was joking, but Rep. Henriquez, who sat on the House Workers' Compensation reform committee at the beginning of the legislative session, may have had a better grasp on the Legislature's role in workers' compensation reform than he let on.

    ``Remember about three- fourths of the way through `Groundhog Day,' how Bill Murray looked?'' he said at that meeting. Then, gazing at the lobbyists and others crowding the hearing room to pitch their angles, the Tampa Democrat quoted a line from that movie: ``I've been here before.''

    Henriquez and his colleagues could be back to revisit the subject, say those dissatisfied with this year's reform bill.

    While Fogel, the FairCare consultant, repeats that the Legislature made several important revisions, he warns, ``The very things they said were broken with the system, they didn't fix. As a result, I think they're going to be back here in a year or two screaming their heads off for another fix.''

    As always, the volatile Workers' Compensation issue is a war of words.

    Stiles, the Associated Industries representative, says she understands why lawmakers are uncomfortable with some aspects of the bill. ``But those of us who do this for a living, we are here to tell them that they are saving money. They are. You cannot not save money with this bill.''

    The evidence of that will come with the upcoming rate filing and with the next few annual requests by the insurance group. Many will be watching.

    Reporter Jerome R. Stockfisch can be reached at (813) 259-7850.

    This story can be found at:

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