NYS Workers’ Compensation System BPR Implementation NY PRIMA September 18, 2014

2 Agenda Introductions/ Welcome BPR Project Recap Next Steps Wrap-Up/ Questions

WHY DO A BPR? Injured Workers 4

Some Key WC System BPR Goals Improve timely first payment of indemnity benefits Faster delivery of appropriate medical care Improve the process for reporting medical treatment Reduce the administrative burden on medical providers and other stakeholders Reduce reliance on paper forms 5

BPR Planning Phase Recap & Highlights As-Is Assessment To- - Be Assessment BPR Implementation Communication, Change Management and Information Planning 6 September 2013December 2013 March 2014 June 2014 WE ARE HERE Sept. 2014

System Participant Outreach Injured Workers Over 65+ in-person outreach sessions conducted Met with over 600+ participants Four Injured Worker Days Over 8,000 injured workers surveys received Six Focus Groups developed One Cross Functional Advisory committee developed 7

To-Be Recommendation Themes Redefine Role of the Board in the System Protecting the Rights of Injured Workers & Employers  Increase Board’s Education, Communications and Outreach Function  Reinstate System Oversight and Compliance  Monitor and Enforce Timely First Payment of Benefits… Management and Availability of Quality Medical Care  Improve Access to Medical Care for Injured Workers  Monitor and Enforce Timely Payment of Medical Bills  Create a Flexible and Appropriate Fee Schedule… Technology  Implement Appropriate Technology Tools to Enhance Workers’ Compensation System  Create a System Participant Portal for Medical Issues and Claims Information 8

BPR Initial Implementation Initiatives 9 Medical Portal Payor Compliance Quality Medical Care Initiatives

Technology Solution Overview

Medical Portal Medical Provider Submission of: Request for treatment authorization (C-4AUTH) MTG variance (MG-2) MTG optional prior approval for treatment (MG-1) Medical Bills Medical Reports 12 Carrier Response to Medical Provider Submissions Self-Service Portal Next Steps: Work with Vendor to gather Business & Stakeholder Requirements this fall Identify Technology Solution Board monitoring and enforcement

Payor Compliance 13 Performance Standards: Timely FROI/SROI Timely payment of medical bills % of controverted cases Timeliness of controversy Timely payment of first indemnity Next Steps: √ Created Monitoring Unit √ Partner with Department of Financial Services Collaborate with payor community on proper metrics this fall eClaims/Data Warehouse

Quality Medical Care Initiatives In effort to increase access to quality care: Adopt a predictable and standardized method of pricing medical goods and services Adopt robust and well-known billing rules for providers based on a national standard Reduce disparities between workers’ compensation medical practice administration and general health practice administration Implement evidence-based Non-Acute Pain MTG In Progress Fall 2014 April 2015 Medical Fee Schedule Implementation Implement Non-Acute Pain Guidelines Development of final fee schedule & methodology for maintenance 14 Summer 2014 Fee Schedule Public Discussion Fee Schedule Public Comment Winter 2014