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About Northwest labor press. (Portland , Ore.) 1987-current | View Entire Issue (Nov. 7, 2008)
NOV. 7, 2008 :NWLP 11/5/08 10:05 AM Page 10 Workers’ comp division files proposed rules on medical fees to care providers Proposal would prohibit PPO contracts with providers, but allow providers to offer discounts SALEM — A flap over how much insurance companies pay health care providers for treating injured workers in Oregon may soon be over. Health care providers (doctors, physical therapists and others) began disputing the amounts some insurance companies were reimbursing them for treating injured workers. Insurance companies argued that they were paying health care providers the amounts spelled out in their pre- ferred provider organization (PPO) contracts. PPOs are popular in the pri- vate sector because in exchange for discounted fees, the network directs patients to their practices. In the no-fault workers’ comp sys- tem, insurers are suppose to pay med- ical bills in one of three ways: At the provider’s normal fee; at the amount set by law under the Oregon medical fee schedule (if it is less than the nor- mal fee); or at the rate contracted with a provider enrolled in a state-certified managed care organization (MCO). MCO rates typically are lower than both the medical fee schedule and the provider’s normal rate. MCOs were al- lowed into Oregon’s workers’ comp system as part of a controversial major overhaul in 1990. The state regulates MCOs (all four of them) to ensure that injured workers are getting good care. PPOs are not regulated. In an attempt to settle the medical fee dispute, Oregon’s Workers’ Com- pensation Division initially ruled that the PPO rates should not have been applied, and ordered the insurers to pay the difference between the PPO discount and the state-mandated fee schedule. That prompted one of the nation’s largest PPOs — Coventry Health Care of Maryland — to threaten to quit doing business in Oregon. Subsequently, the Workers’ Comp Division issued a temporary emer- gency order that then allowed insur- ance companies to use PPO rates in workers’ comp cases. The emergency order angered health care providers, who said they would quit taking injured workers as patients if paid the lower rates. Stuck in the middle of the contro- versy were injured workers. Organized labor stepped in on their behalf. Union officials were outraged that the emergency order came with little or no input from them or from man- agement — the two key players in the workers’ comp system. “This ruling is not in anyone’s in- terest — not the state’s, not the em- ployer’s, and certainly not the injured worker’s,” said State Rep. Brad Witt, a union rep for United Food and Com- mercial Workers Local 555 who had already begun preparing legislation to have the emergency order overturned. After studying the issue and receiv- ing feedback from a variety of parties, the Workers’Comp Division developed the new proposed rules to replace the emergency rules. Specifically, the new proposed rules do the following: • Disallow fee discounts for medical services that are part of contracts be- tween providers and PPOs. • Allow providers to enter into fee discount agreements if they choose. • Sets requirements for those fee dis- count agreements, including the follow- ing: 1. The agreement must be directly Ridgeline Montessori employees reaffirm AFT representation EUGENE—Teachers and staff at Ridgeline Montessori Public Charter School again chose the American Fed- eration of Teachers (AFT) as their union representative in mail ballots counted Oct. 29. The election was conducted by the Oregon Employment Relations Board (ERB). A majority of employees previously chose AFT by signing authorization cards, but the employer refused to rec- ognize them. Oregon’s “card check” law allows union representation without an elec- tion if a majority of eligible bargaining unit employees sign union authoriza- tion cards. Under this law, even if the criteria are met, employees can still re- quest that the ERB hold an election if 30 percent of the bargaining unit sup- ports having an election. This was the case at Ridgeline Montessori. PAGE 10 “Employees at Ridgeline demon- strated their desire to form a union in September when a majority designated the union with signed authorization cards,” said Mark Schwebke, president of AFT-Oregon. “This vote reaffirms the wishes of Ridgeline staff and proves as well that the card-check process accurately conveys the will of the workers.” Some 87 percent of eligible em- ployees participated in the mail ballot election. Nearly two-thirds voted for AFT representation. Teachers and staff at Ridgeline, which serves over 220 students in grades K-8, formed the Eugene Char- ter School Professionals to represent them, which is the newest of 20 locals in AFT-Oregon, an affiliate of the AFL-CIO. between the provider and the insurer or self-insured employer and must only apply to workers’ compensation. 2. The agreement must be in a stan- dard format and registered with the Workers’ Compensation Division. 3. The maximum discount allowed is 10 percent below the medical fee schedule. 4. Either party may terminate the agreement by providing 30 days writ- ten notice. 5. Continue to allow discounts to providers as part of managed care or- ganization (MCO) contracts. 6. Continue to allow network dis- counts for durable medical equipment, ambulatory surgical centers, hospitals (excluding rural hospitals), and pre- scription drugs. Bob Shiprack, executive director of the Oregon State Building and Con- struction Trades Council and co-chair of the Management-Labor Advisory Council on Workers’ Compensation, said he is satisfied with the proposal. “It makes clear what you can and cannot do. It’s like we thought it was before the emergency order was im- plemented,” he said. Public hearings on the proposed rules are scheduled for Nov. 20 at 5 p.m. and Nov. 24, at 1:30 p.m. at the Labor and Industries Building in Salem, and the public is invited to submit written testimony on the rules through Nov. 26. To read the proposed rules, go to: http://wcd.oregon.gov/policy/rules/rule s.html#proprules. Once the division reviews the pub- lic testimony, it will file the final ver- sion of the rules, which will take effect Jan. 1, 2009. For more information or to comment on the rules: Contact Fred Bruyns at 503-947-7717; fax: 503-947-7581; e- mail: fred.h.bruyns@state.or.us BARGAIN COUNTER E E FR Free classified ads to subscribers DEADLINE: Friday prior to publication Published 1st and 3rd Fridays Now accepting e-mails Send to: Michael492@comcast.net Mail to: NWLP, PO Box 13150, Portland OR 97213 (Please include union affiliation) • 15-20 words • No commercial or business ads • 1 ad per issue • All lower case (NO CAPITAL LETTERS, PLEASE) • Ads MUST include area code or they will not be published Automotive ’87 VW CABRIOLET, 115k miles, nice, $1900; ’90 Mercedes 420 SEL, needs work, $1,500. 503 231-1208 ’84 FIREBIRD 305, V8, PB, PS, PW, PDL, tilt , AC, cruise control. 503 777-2730 ’04 NISSAN FRONTIER XE, short bed, AC, new tires, 50k, hitch, custom rack, $15,500. 360 687-4830 ’90 F150 4x4, 5.0 auto, full size reg cab, $1,500 OBO. 503 231-1208 (Bob) 454 CHEV BLOCK, crank, rebuilt heads and new parts to build a long block, $750 (may trade for guns) 503 658-6108 '79 FORD VAN, built 460 under 30k miles, trans rebuilt, tinted windows, custom wheels and tires, puller, $2,500 OBO. 541- 729-4734 STUDDED SNOW TIRES, two 165SR 13, on Hyundai wheels; one 175/70 SR13 non-stud on aluminum Hyundai wheel. 503-285-2439 ’00 HONDA ACCORD Coupe EX, 4cyl, 5spd, pdl, pw, cc, mnrf, alarm, 6-disc changer, 1 owner, non-smk, 41,600 mi, $10,700. 503 777-6568 Housing ROCKAWAY BEACH house, 3 bed, 2 bath, sleeps 10, great amenities, minutes to beach or shops. 503 355-2136 or 503 709-6018 SNOWMOBILE, ride ATV’s at Rock Creek reservoir, 2 bed, 1 bath. 541 544-3499 LINCOLN CITY, nice 2-level beach house, 2bd,2ba. $350/wk, 175/wkend. 541-399- 6650 or 503-351-1408 UNIONHOUSE looking to share housing with clean and sober brothers. 353 SE GOT BENEFITS? 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