1. SC Workers’ Compensation Commission SC Hospital Association Managed Care Directors October 9, 2012

2. System Overview Perspective South Carolina Workers’ Compensation Commission

3. General Information Organization Budget Statistical Information System Cost, Premiums Paid, Taxes Paid Current Issues/Ongoing Efforts South Carolina Workers’ Compensation Commission

4. Organization Commissioners - 7 South Carolina Workers’ Compensation Commission

5. Commissioners T. Scott Beck Chairman Term Expires June 30, 2014 Susan S. Barden Term Expires June 30, 2016 Andrea C. Roche Term Expires June 30, 2012 Avery B. Wilkerson, Jr. Term Expires June 30, 2014 Derrick L. Williams Term Expires June 30, 2014 Gene McCaskill Term Expires June 30, 2018 Melody L. James Term Expires June 30, 2014 South Carolina Workers’ Compensation Commission

6. Organization Executive Director Administration Claims Judicial Information Technology Insurance and Medical Services South Carolina Workers’ Compensation Commission

7. FTE’s 54 employees 64 approved FTEs (81 in 2001) South Carolina Workers’ Compensation Commission

8. Annual Budget $4.99 million (FY12-13) General Fund $1.7 million Earmarked Funds $ 3.2 million South Carolina Workers’ Compensation Commission

9. Claim Review Process Injured Worker Files Claim –Minor Medical No lost time Medical Cost < $ 2,500 –Form 12 A Submitted to Commission Coverage determined South Carolina Workers’ Compensation Commission

10. Hearing Process Informal Conference Single Commissioner Appeal - Full Commission Appeal - Court System Circuit Court (Pre 2007) Court of Appeals (Post 2007) South Carolina Workers’ Compensation Commission

11. Statistical Abstract

12. Accidents Filed FY 2007 – 2012 South Carolina Workers’ Compensation Commission

13. Informal Conferences Assigned & Conducted FY 2006-2012 South Carolina Workers’ Compensation Commission

14. Hearings Assigned & Conducted FY 2006-2012 South Carolina Workers’ Compensation Commission

15. Appeals to Commission FY2006-12

16. South Carolina Workers’ Compensation Commission Appeals to Higher Court FY06-FY12

17. South Carolina Workers’ Compensation Commission Compensation & Medical Cost FY2008-12 ($ millions)

18. South Carolina Workers’ Compensation Commission Compensation by Category FY2008-FY12 (millions)

19. Work Comp Premiums ( millions ) FY11 FY12 Commercial Market CY 2011 $ 540.3$ 576.5 Self Insurance FY 2012 $ 215.8 $ 210.9 State Accident Fund FY 2012 $ 86.7$ 69.2 Total$ 842.8$ 856.3 South Carolina Workers’ Compensation Commission

20. Work Comp Premium Taxes ( millions ) FY11 FY12 Commercial Market $ 11,424,000 $ 14,407,303 Self Insurance FY 2011 $ 4,775,811$ 4,663,681 Total $16,199,811$ 19,070,984 South Carolina Workers’ Compensation Commission

21. Statutory Changes & Regulatory Changes

22. Statutory H 3111 Impacts Physicians Fee Schedule Service providers may appeal to ALJ 10% change in fee schedule Governor Signed June 7, 2012 South Carolina Workers’ Compensation Commission

23. Regulations Mediation 67-1801 Oral Argument 67-706 South Carolina Workers’ Compensation Commission

24. Mediation 67-1801 Admitted Cases 42-9-10 & 42-9-30 Occupational diseases Third party lien reduction Contested death Mental/mental injury Concurrent jurisdiction Federal Longshore and Harbor Workers Comp Act Multiple employees with same employer admitted or not South Carolina Workers’ Compensation Commission

25. Oral Argument Regulation 67-706 Require parties to be present 30 minutes before appellate hearing South Carolina Workers’ Compensation Commission

26. Ongoing Efforts Transparency Communication Emails to Stakeholders Update Website South Carolina Workers’ Compensation Commission

27. Ongoing Efforts Stakeholder Advisory Committees Fee Schedules Surgical Implantable Devices Commuted Values South Carolina Workers’ Compensation Commission

28. Cost Control Fee Schedules Improved Processes Filing Claims Scheduling Hearings South Carolina Workers’ Compensation Commission

29. Physician’s Fee Schedule Medicare based 2010 RBRVS – Conversion Factor $50 South Carolina Workers’ Compensation Commission

30. Inpatient Fee Schedule Ambulatory Surgery Fee Schedule Medicare plus 40% South Carolina Workers’ Compensation Commission

31. Pharmacy Fee Schedule Adopted Advisory Committee Repackaged pharmaceuticals Physicians may dispense MAP based on original NDC Surgical Implantable Devices Advisory Committee South Carolina Workers’ Compensation Commission

32. Information Technology Electronic Filing Proof of Coverage – Notice of cancellation Notices/Orders Informal Conference Process Adjusters Roundtable South Carolina Workers’ Compensation Commission

33. NCCI Rate Filing SC Vocational Rehabilitation Department Claimant Referrals South Carolina Workers’ Compensation Commission

34. Medical Services Payment Dispute Resolution Process SC Code of Laws - Section 42-9-360(d) Payment to an authorized health care provider for services shall be made in a timely manner but no later than thirty days from the date the authorized health care provider tenders request for payment to the employer's representative, unless the commission has received a request to review the medical bill. South Carolina Workers’ Compensation Commission

35. Medical Services Payment Dispute Resolution Process http://www.wcc.sc.gov/insurance/Pages/MedicalProvidersPay mentDispute.aspx http://www.wcc.sc.gov/insurance/Pages/MedicalProvidersPay mentDispute.aspx South Carolina Workers’ Compensation Commission

36. How can we serve you better? System…. Processes….. South Carolina Workers’ Compensation Commission

37. Contact Gary M. Cannon gcannon@wcc.sc.gov (803) 737-5744 www.wcc.sc.gov South Carolina Workers’ Compensation Commission

38. THANK YOU South Carolina Workers’ Compensation Commission