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The Compliance Corner

—August 18, 2016
The Compliance Corner

By Michele Hibbert-Iacobacci, OHCC, CCSP Vice President, Information Management & Support, Casualty Solutions Group

Medical Marijuana

Prescription protocols for medical marijuana are changing monthly due to new studies promoting use and regulatory bodies that allow the prescription of medical marijuana in their states. Medical marijuana, sometimes referred to as “Medical Jane,” has been used for medical purposes since 1550 BC in ancient Egypt to treat inflammation. It took thousands of years to actually be able to prescribe medical marijuana legally in the United States for the same ailment. In modern history, the Food and Drug Administration (FDA) has been the gate keeper for whether drug use be permitted in the United States. Marijuana was categorized with other illegal drugs like opium and morphine since the early 1990’s. By 1970, marijuana was a “Schedule I” drug and was considered to have no medical use.

In November 1991, the very first proposition called on the state of California and the California Medical Association to “restore hemp medical preparations to the list of available medicines in California, and not to penalize physicians for prescribing hemp preparations for medical purposes. The vote passed overwhelmingly with nearly 80% in favor. The state of California legalized medical marijuana in 1996” (, 2016). In addition to the District of Columbia, medical marijuana is currently legal in the following U.S. states: Alaska, Arizona, California, Colorado, Connecticut, DC, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont and Washington. Nearly all other states have propositions on the books for legalizing medical marijuana.

There is a large difference between the legalization of medical marijuana and the coverage of the drug under insurance policies. Aside from the workers’ compensation cases in Minnesota and New Mexico (Lewis v. Am. Gen. Media), there has not been a broad acceptance by payors. This is a legal matter left to interpretation by policy and regulations. Today the FDA has not approved marijuana for medical use and it is still classified under the same umbrella with heroin, LSD and Ecstasy as a Schedule I drug. The latest move to change the drug class was in March 2015, when the CARERS Act was introduced to the Senate proposing to reclassify marijuana to Schedule II, recognizing the “accepted medical use.” Schedule II drugs are those that can be potentially addictive like oxycodone.

On June 2, 2016, the Property Casualty Insurers Association of America (PCI) issued a statement expressing their approval of the House Action on the Marijuana-Impaired Driving Study.

Excerpt from National Highway Transportation and Safety Association:

“PCI applauds the House Appropriations Committee for including language in its THUD report that directs the National Highway Traffic Safety Administration (NHTSA), along with the National Institute on Drug Abuse and other related agencies, to conduct a study of marijuana-impaired driving,” (PCI, 2016).

This commentary is on the heels of a review by PCI and NHTSA examining the use of marijuana and distracted driving leading to higher claim frequency (NHTSA, 2016).

Click Here To View The Full Statement.

How regulations for casualty evolve will take time. The use of medical marijuana, even if compensated routinely, will still have challenges. Employers will need to evaluate patients who are prescribed medical marijuana for on-the-job liabilities and determine the new norm of distracted driving, with driving under the influence as a cause for the rise in claim frequency.

Telemedicine: New Innovations In The Old Program

Telemedicine is the method of delivering health care electronically through applications like smart phones, email, and skype. Telemedicine started over 40 years ago with the intention of enabling health care providers, mainly hospitals, to provide services to patients in remote areas.

The concept expanded as a means to provide more affordable services and better quality care by health care providers after The Affordable Care Act was introduced in 2012, mandating health insurance coverage for all Americans. This legislation introduced many new-comers to the healthcare system that otherwise may have never been provided health services. Over 30 million people with coverage were added into the healthcare system during this time, with the threat of not enough providers to service those insured.

It is estimated that the United States currently holds roughly 200 telemedicine networks, providing connection to over 3,000 sites. A variety of services including consultations, medical education modules, vitals monitoring and meetings with primary care providers are examples of the offerings made available through telemedicine.

Timing is critical when it comes to delivering emergency services for some medical conditions. With timing being an influential role, it makes sense that telemedicine continues to think about how to develop quality clinical services and improve innovation. One example of innovation used in the telemedicine realm is “telestroke” services, which have the ability to send information to neurologists from rural facilities to assist identifying the sources of strokes in patients. Initial studies in Canada have shown a 92% decrease in the transferring of patients to more expensive facilities, thus making the care more affordable. What you won’t see in telemedicine are chiropractic manipulations and other hands-on care, but instead, the planning and care coordination efforts as it relates to these specific providers.

The Institute for Healthcare Consumerism (IHC) has been reporting on “wait times” and the impact of adding more patients into the system for several years. For example, in San Diego, the average wait time for a provider appointment is 20.2 days, and 27 days in Philadelphia. These long wait times can impact a patient’s health and the use of telemedicine can be invaluable in providing quality of care in these instances. When a patient suffers a severe injury as in a motor vehicle accident, they go to the emergency room. The CDC (spell CDC out) has reported that nearly 80% of adults are going to the emergency room because of a lack of alternative health care resources, ultimately impacting the people that really need to be treated in the Emergency Room setting. Telemedicine could serve as a solution in these cases.

The challenge we face in the Property and Casualty (P&C) industry is delineating the necessity for telemedicine, and positioning the benefit of including it as an “add on” to services already rendered. The intent of telemedicine is to provide quality and affordable care, not to create another line item on the provider bill for payment. For telemedicine Professional Services claims, services are to use the appropriate CPT or HCPCS code along with the modifier GT (via interactive audio and video telecommunications systems).

Imagine a $50 telemedicine bill on a claim replacing the average $1,000 or more emergency room bill. It certainly makes it a compelling alternative for the future. The market assessments are not bad either, with reporting in January 2016 a potential market for telemedicine valued over $45 billion by 2021.

Opt-Out: Hurry Up and Wait

Opt-Out in the workers’ compensation world is 2016’s buzz for deregulation of payment for workers’ compensation claims at the state level. Opt-Out is an alternate compensation model for the injured worker whereby employers choose to “opt-out” of state regulated systems. It has been promoted in some states like Oklahoma and Texas. Although not a new concept, new interests among both advocates and non-supporters have been brought to the horizon, including different proposed models.

Last May, the International Association of Industrial Accident Boards and Commissions (IAIABC) published an analysis of the treatment of occupational injuries and illnesses under state workers’ compensation systems and Opt-Out programs adopted in Oklahoma and proposed in South Carolina and Tennessee. The study sought to address key questions outlined below:

  • What part of workers' compensation law is the employer renouncing by opting out?
  • What are the conditions, or regulatory requirements, that the state places on Opt-out employers?
  • What regulatory monitoring and enforcement system should govern Opt-out benefit plan compliance?
Click Here To View The Study.

The latter half of May was met with the US Department of Labor investigating Opt-Out programs due to the interest in the state of Washington. The main concern was the oversight component and whether the injured worker would be harmed. All in all, the consistency in application of plans has been one of the major findings in Oklahoma and whether or not employers will offer plans equal to or greater than what the employee had previously.


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