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|Legislative & Regulatory Issues|
WCA Defends DCs' Right to Treat Lower Extremities
Several insurers are intentionally misinterpreting and misusing Chapter 81 of the DWD Treatment Guidelines in a manner that is inconsistent with the WI Worker's Compensation Act. In response, WCA issued a letter to DWD regarding improper denials of reimbursement for care received by chiropractors who have treated a patient's lower extremities.
DWD responded to WCA in a letter that affirms WCA's stance on this issue. According to DWD, "There is no statutory authority allowing the use of the Treatment Guidelines for Utilization of Treatment Reviews to deny payment." Therefore, "Any action by an insurance carrier or self-insured employer to deny payment solely based on ch. DWD 81 of the Wisconsin Administrative Code, cannot be enforced or upheld under the Wisconsin Worker's Compensation Act." These major insurers cannot cite and/or misuse this statute in order to dictate care provided by licensed Doctors of Chiropractic.
Not only has DWD affirmed WCA's stance on this issue, but it has also taken positive action to deter such future misuses of WI statutes by insurance companies. The Department has updated the language on its website regarding the purpose and statutory use of ch. DWD 81. In addition, DWD has issued a memo for medical providers to use to remind interested parties about the appropriate use of ch. DWD 81.
If Inappropriately Denied Reimbursement under Chapter DWD 81
WCA encourages you to thoroughly review case denials related to treating lower extremities that you've received based on the Treatment Guidelines. If you feel you are being denied payment because an insurer or self-insured employer inappropriately used the Treatment Guidelines to refuse to pay for treatment, WCA recommends the following actions:
*Dispute/resolve this inappropriate denial directly with the insurance company. We encourage you to use the following sample template appeal letter:
*If you are unable to resolve the issue with the insurance company, you must file a dispute with the Wisconsin Department of Workforce Development using the following form:
WCA is Protecting Against Proposed Medical Fee Schedules in Worker's Compensation
The Worker’s Compensation Advisory Council (WCAC) has once again proposed a bill that would institute government rate setting for medical providers who treat injured workers under Worker’s Compensation. Wisconsin Manufacturers & Commerce (WMC) instigated this push to impose a fee schedule in Worker’s Comp, ignoring the superior, cost-effective health care injured workers in Wisconsin receive.
WCA is part of a coalition serving as liaisons to WCAC that is against government-mandated price fixing for Worker's Comp. This coalition of four groups has issued a joint letter to Wisconsin Senate Labor and Regulatory Reform Chair Sen. Stephen Nass and Assembly Labor Chair Rep. Bob Kulp, specifically requesting that these committee chairs not introduce or hold hearings on WCAC’s proposed bill.
The Coalition has also issued a press release highlighting the fact that Wisconsin ranks first in the nation in health Care Quality and has the lowest Worker’s Comp cost in the Midwest.
WCA Advocating for DCs' Ability to Perform Sports Physicals
If a school requires a student to have a physical examination to participate in youth sports, families across Wisconsin should have the choice to select a Doctor of Chiropractic to perform sports physicals for student athletes. The Wisconsin State Assembly passed Assembly Bill 260 in June 2017. This bill allows for parental choice by requiring Wisconsin schools to accept a physical examination completed by a Doctor of Chiropractic who holds a certificate in health or physical examinations, in the same manner that the school accepts a physical exam completed by a licensed physician.
As the bill heads to the Wisconsin State Senate, WCA President Dr. Gene Yellen-Shiring has authored an Op-Ed in support of AB260. WCA will continue to advocate for the reality that citizens of Wisconsin deserve the choice to receive thorough physical examinations from licensed and qualified doctors of chiropractic medicine.
WCA's Efforts to Protect Chiropractic Benefits
WCA is working to protect chiropractic benefits for state and local government employees.
The Group Insurance Board, (GIB), an 11 member board under the Wisconsin Department of Employee Trust Funds (ETF), has been tasked with exploring the cost/benefit of converting state and local government employees from the current fully insurance health care model to self insurance in an effort to save money. Bids are due this month at GIB from health insurers and third part administrators interested in managing a self insurance health plan for state and local government employees.
This move is being questioned by the Wisconsin Chiropractic Association in a letter from WCA Executive Director John Murray. “We are very concerned that the move to self insurance will reduce or outright eliminate access to chiropractic care,” said Murray.
“We are seeking to clarify the intent of the GIB and protect equal access to chiropractic care."