It’s Almost July 1st, Remind Me Again: What Do I Have to Do?

As July 1st approaches, licensed Vermont workers' compensation adjusters need to:

Adjust the COLA

Any worker who has been receiving temporary total or temporary partial disability compensation for 26 or more weeks is entitled to a COLA. The new maximum for those injuries arising after June 30, 1986 is $1,166.00.  The new maximum for injuries prior to that date is $777.00.  The minimum in all cases is $389.00. The new Form 28(FY14) and the Form 28A(FY14) are now available and may be downloaded from the Vermont Department of Labor website located at: http://labor.vermont.gov/Default.aspx?tabid=170. 

Determine If Medicaid Has Paid Bills

Insurers must take reasonable steps to discover whether the Department of Vermont Health Access has paid medical bills associated with workers’ compensation claims. 33 V.S.A. §1910 (b)(2). The State of Vermont Human Service Agency has a lien against the insurer for monies paid for medical expenses on behalf of a person who has an injury, illness or disease and the person initiates a claim against an insurer for that injury, illness or disease. The Department has noted that “the claim file should contain documentation (electronic, recorded language, typed or handwritten) to support the insurer's actions.”  The procedure sets forth that reasonable steps to determine the existence of such a lien include: (1) Asking the claimant or claimant’s representative at the beginning of the process by telephone, letter or electronic mail if he or she was a Medicaid recipient at the time of the injury.  If the answer is yes then the insurer should contact the Department of Vermont Health Access and refrain from payment until the lien is determined.  If the answer is no then the insurer must continue to review bills to determine if there is evidence that the Department of Vermont Health Access has paid bills on the claimant’s behalf and if so the insurer should determine the amount of the lien.  If not the insurer may proceed to resolve the claim; (2) An insurer may contact the Department of Vermont Health Access at any time to determine if a lien exists by contacting  the Department at: DVHATPLTeam@state.vt.us; by telephone at 802-879-5646; or by fax at 802-879-5959. The outreach document prepared by the Department of Vermont Health Access is located here: http://dvha.vermont.gov/budget-legislative/insurer-procedure-medicaid-liens.pdf

Vermont Insurers Must Determine Existence of Medicaid Liens Starting July 1, 2013

 

Effective July 1, 2013, insurers shall take reasonable steps to discover whether the Department of Vermont Health Access has paid medical bills associated with workers’ compensation claims. 33 V.S.A. §1910 (b)(2). The legislation provides that the State of Vermont Human Service Agency has a lien against the insurer for monies paid for medical expenses on behalf of a person who has an injury, illness or disease and the person initiates a claim against an insurer for that injury, illness or disease. Additionally the legislation provides that “Payment to the recipient instead of the agency does not discharge the insurer from payment of the agency’s claim.” 33 V.S.A. §1910 (b)(2).  The statute is: http://www.leg.state.vt.us/statutes/fullsection.cfm?Title=33&Chapter=019&Section=01910

 

The Department of Vermont Health Access has written a memorandum on the insurer procedure for determining the existence of Medicaid Liens.  Most importantly the Department has noted that “the claim file should contain documentation (electronic, recorded language, typed or handwritten) to support the insurer's actions.”  The procedure sets forth that reasonable steps to determine the existence of such a lien include: (1) Asking the claimant or claimant’s representative at the beginning of the process by telephone, letter or electronic mail if he or she was a Medicaid recipient at the time of the injury.  If the answer is yes then the insurer should contact the Department of Vermont Health Access and refrain from payment until the lien is determined.  If the answer is no then the insurer must continue to review bills to determine if there is evidence that the Department of Vermont Health Access has paid bills on the claimant’s behalf and if so the insurer should determine the amount of the lien.  If not the insurer may proceed to resolve the claim; (2) An insurer may contact the Department of Vermont Health Access at any time to determine if a lien exists by contacting  the Department at: DVHATPLTeam@state.vt.us; by telephone at 802-879-5646; or by fax at 802-879-5959. The memorandum indicates that the insurer should document the claim files as to when and who was contacted at DVHA.  The memorandum concludes that if a lien exists the insurer must ensure reimbursement out of settlement proceeds by the claimant, the claimant’s representative, the insurer, or by naming Department of Vermont Health Access on monies paid to the claimant.  Then the claim may be closed and documentation of these actions protects the insurer from claims of bad faith or duplicate payment to the Department or the claimant.

The outreach document prepared by the Department of Vermont Health Access is located here: http://dvha.vermont.gov/budget-legislative/insurer-procedure-medicaid-liens.pdf