Sharing perspectives leads to greater understanding and fuels innovation. The ​Optum Insights ​blog is where we share our perspective and challenge preconceptions to clear a new path forward

  • Texas governor signs opioid control legislation

    | Jun 21, 2019
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    Pain Management, Pharmacy, Government Affairs, Opioids
    A new Texas law to curb opioid abuse includes prescribing restrictions for opioid treatment of acute pain. Effective September 1, 2019, when prescribing for treatment of acute pain, a provider may not prescribe opioids for more than a 10-day supply or refill an opioid.

  • Michigan enacts auto no-fault insurance reform to combat high costs

    • Optum
    | Jun 20, 2019
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    Government Affairs, Auto No-Fault
    Michigan’s governor has signed two bills to help curb high costs in the state’s no-fault auto insurance system. The legislation addresses numerous challenges, including several that impact the services Optum Workers’ Comp and Auto No-fault (OWCA) provides to clients. Most of the reforms go into effect in 2020 or 2021.

  • Colorado doctors can now recommend medical marijuana as opioid alternative

    | Jun 13, 2019
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    Clinical Intervention, Clinical, Opioids, Government Affairs, Medical Marijuana
    The Colorado legislature has passed a law permitting physicians to recommend marijuana in lieu of opioids to treat certain disabling medical conditions. Senate Bill 13, gives providers greater leeway in discussing pain treatment options with their patients and is scheduled to take effect August 2, 2019.

  • Oklahoma enacts workers’ compensation reform bill

    • OWCA
    | Jun 10, 2019
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    Workers' Compensation, Government Affairs
    Oklahoma has enacted a workers’ comp reform bill that requires the Workers’ Compensation Commission (WCC) to update the medical fee schedule ― which hasn’t been updated since 2012. House Bill 2367 outlines a new process requiring the WCC to update the fee schedule by 2020 and every two years, thereafter.

  • New York adopts final version of its workers’ compensation drug formulary

    • Optum for Workers' Compensation
    | Jun 06, 2019
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    Workers' Compensation, Workers Comp, New York, formulary, Government Affairs
    After more than two years of rule-making activity, meetings with stakeholders and review of stakeholder comments, the New York Workers’ Compensation Board (WCB) is ready to move forward with implementation of their formulary.

  • Minnesota enacts opioid prescribing limits

    • Optum for Workers' Compensation
    | Jun 03, 2019
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    Workers' Compensation, Opioids, Pain Management, Government Affairs, Clinical
    Minnesota has enacted legislation to address the opioid epidemic that includes opioid prescription and dispensing limitations for acute pain and initial prescriptions. The new policy expands upon prior narrower limitations. These new limitations take effect August 1, 2019.

  • Is it just me or are we all thinking the same thing? Is this the beginning of mandatory MSAs in liability, no-fault, work comp claims?

    • Optum for Workers' Compensation
    | May 16, 2019
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    Workers' Compensation, MSA, Medicare Insights

    April 22, 2019 
    by Rafael Gonzalez, Esq.

    Late in 2018, our federal government announced in 2019 that it intends to regulate how and when to take Medicare’s future interests into account.

    Time may be up on “MSA not necessary” assumption
    You have heard it a million times: Medicare Set Asides (MSA) are not required. You have been told again and again, there is no law that requires submission of MSAs to the Centers for Medicare and Medicaid Services (CMS) for review and approval. Well, both of these statements may come to an abrupt end if, as announced, the federal government produces Code of Federal Regulations (CFR) to ensure that beneficiaries and payers meet future medical obligations under the Medicare Secondary Payer Act (MSP).

    Non-submit MSAs—likely triggering new regulations
    Involved in the MSP program since 1983, I had a feeling this moment was coming. And, as the industry’s appetite for non-submit MSAs has grown, I began to write and speak publicly about the potential that such behavior would, in fact, encourage or push the federal government into mandatory regulatory mode.

    Federal actions foretell changes ahead
    The latest announcement by the Executive Office of the President and the expected efforts HHS/CMS will undertake in 2019 and beyond certainly seem to indicate this will be the beginning of a new course for payers as well as current and anticipated Medicare beneficiaries. These federal actions may mandate the creation of MSAs in auto, liability, no-fault, and work comp claims, and possibly require submission of such MSAs to CMS for review and approval.

    No legal requirement to produce or submit MSAs, but…
    As we have learned since 2001, a current/potential Medicare beneficiary may, but is not legally required to, consider Medicare’s future interests by putting together an MSA and seeking CMS approval of the proposed MSA amount. The primary benefit for doing so has been the certainty of CMS reviewing and approving the proposed amount with respect to the sum that must be appropriately exhausted before Medicare becomes the primary payer for future claim related medical expenses.

    How we got here
    When the Medicare program was enacted in 1965, Medicare was the primary payer for all services, with the exception of those covered and payable by workers’ compensation. In 1980, Congress enacted the first of a series of provisions.....

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