Promising Practices in Providing Workers’ Compensation The New Mexico Experience November 1, 2007...

Promising Practices

in Providing Workers’ Compensation

The New Mexico Experience

November 1, 2007

Patrick L. Lopez, J.D.Former General Counsel

Aging and Long-Term Services Department

How about a Legislative Mandate?

New Mexico 2006 Regular Session

House Memorial 25Some Highlights


“A MEMORIAL

REQUESTING THE INSURANCE DIVISION OF THE PUBLIC REGULATION COMMISSION TO

CONVENE A TASK FORCE TO STUDY WAYS TO REDUCE WORKERS’ COMPENSATION PREMIUMS

FOR NONPROFIT AGENCIES PROVIDING HEALTH AND HUMAN SERVICES.”


“WHEREAS, workers’ compensation premiums for nonprofit agencies providing health and human services have dramatically increased in recent years, resulting in financial hardship for these agencies; and


WHEREAS, agencies providing health and human services may be assigned to the workers’ compensation assigned-risk pool with significantly higher costs, further jeopardizing fiscal solvency for these agencies; and


WHEREAS, independent contractors may have been erroneously classified as agency employees, resulting in increased premiums;


NOW, THEREFORE, BE IT RESOLVED BY THE HOUSE OF REPRESENTATIVES OF THE STATE OF NEW MEXICO that the insurance division of the public regulation commission be requested to convene a task force to study ways to reduce workers’ compensation premiums for nonprofit agencies providing health and human services; and


BE IT FURTHER RESOLVED that a copy of this memorial be sent to the insurance division of the public regulation commission.”

Identify the State Players

New Mexico

• The Public Regulation Commission– Department of Insurance

• Workers’ Compensation Division

Involve the Public Sector

Major Insurance Underwriters

New Mexico Mutual

Find a Good Agent

The Code

NATIONAL COUNCIL ON COMPENSATION INSURANCE, INC. 01-NM-2007ITEM 01-NM-2007–REVISIONS TO BASIC MANUAL CLASSIFICATIONS FOR

DOMESTIC SERVICE WORKERS

EXHIBIT 1BASIC MANUAL – 2001 EDITION

NEW MEXICO SPECIAL CLASSIFICATIONS

0918 DOMESTIC SERVICE WORKERS – INSIDE – PHYSICAL ASSISTANCE – CONSUMER DIRECTED PROGRAMSCode 0918 applies to those domestic workers, however named, engaged in providing physical assistance in the activities of daily living to an elderly, convalescent, acutely or chronically ill, or physically or mentally disabled person who is, or whose representative is, their common law employer.

Identify the Roadblocks

New Mexico

National Council for Compensation Insurance (NCCI)

Frightened Actuaries

Identify the Roadblocks – Codes you don’t want

Examples of duties assigned to Domestic Codes 0908 or 0913: no physical assistance allowed

• General or light housekeeping• Washing and drying laundry• Meal preparation with no feeding allowed• Shopping• Accompanying the individual while traveling to community

activities, the library, fitness center, self-advocacy meeting, and community events

• Companionship and social interactions• No professional designation such as RN, CNA, etc.

Identify the Roadblocks – Codes you don’t want

Examples of duties assigned to Home Health Care Code 8835: physically assisting a household member with:

• Walking or using prescribed equipment• Taking medications prescribed by a physician that

otherwise would be self-administered• Bathing, personal hygiene, dressing, or grooming• Meal preparation, eating (including tube feeding and

special nutritional/dietary needs) and cleanup• Transferring in and out of bed• Performing range-of-motion exercises• Health-related needs• All employees with professional designations

The Policy

New Mexico

• $3.09 per $100.00 of payrollClass code 0918 Domestic Service Workers – Inside – Physical Assistance – Consumer Directed Programs

The Policy

New Mexico

• Account Name: Mi Via Home and Community-Based Services

The Policy

New MexicoGeneral Amendatory Endorsement

NCCI CODE:STATE CODE: NM(30)

It is agreed that PPL is recognized as the Financial Management Agent (FMA) for the Mi Via Home and Community-Based Services Waiver (MV HCBSW) program and is assigned all rights, duties and responsibilities in regard to this policy as authorized by 8.314.6.10 NMAC-N, 12-1-06.

The Policy

New Mexico

Named Insured Endorsement

ALL PARTICIPANTS APPROVED FOR MV HCBSW PER 8.314.6 NMAC-N, 12-1-06. FMA TO MAINTAIN DOCUMENTATION AND RECORDS.

Applause

Promising Practices in Providing Workers’ Compensation The New Mexico Experience November 1, 2007...

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