AIA Seeks Exemption for Workers’ Comp Managed Care Programs

June 6, 2001

The American Insurance Association (AIA) is calling on the Massachusetts Legislature’s Joint Health Care Committee to approve an AIA-filed bill (HB 3310) to exempt workers’ compensation programs from new managed care regulations.

Testifying before the Joint Health Committee, Donald Baldini, AIA assistant vice president, northeast region, stated that Regulation 211 CMR 52.00 came about as a result of legislation passed aimed at managed care health insurers in 2000. He said the inclusion of workers’ comp programs under this regulation at best creates confusion as to the standards that should apply, and at worst, will cause workers’ comp insurers to abandon a heretofore successful, problem-free option for co-coordinating the return to work of injured employees.

Provider networks in the workers’ comp context were first authorized in the Reform Act of 1991. As of 1999, the Division of Insurance reported that there were 54 networks involving 3,037 employers across the state. Since 1991 these networks have been approved and licensed by the Division of Insurance. After licensure, the delivery of medical care to injured workers by the networks is subject to Department of Industrial Accidents (DIA) oversight. The networks must comply with requirements which include utilization review programs, use of DIA-developed treatment protocols, bill paying standards, and dispute resolution mechanisms, including impartial medical examiners and administrative judges.

nsurer judgments regarding medical care can be overridden, and there are enalties for failure to conform to the statutory and regulatory requirements.

The program created by the 1991 law is strictly voluntary for injured workers. After an initial visit, injured workers cannot be required to use the managed care network.

The bill is sponsored Rep. Harriet L. Stanley (D-West Newbury), the House Chair of the Joint Health Care Committee.

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