Government Affairs

Leading the industry and setting standards—in compliance

PMSI’s Government Affairs team is at the forefront of guiding policies that protect the interests of the workers’ compensation industry, our clients and injured workers. Over the years, PMSI has cultivated long-term relationships with state government agencies, regulatory officials and key legislators—allowing for regular communication about pending regulation/legislation—and the opportunity to effect meaningful change for the industry.

Managing today’s workload and complying with current workers’ compensation legislation is challenging enough without having to constantly monitor looming regulations or dramatic industry changes. Nearly all workers’ compensation law is governed by the states, which means change can come from 50 different directions. At PMSI, we help shape policy decisions at the state and national levels as well as within industry trade associations—policies that can drive beneficial change for all parties—from the injured worker to payors to states.

The goal of PMSI’s Government Affairs team is to protect interests of key stakeholders, which is accomplished by quickly communicating any developments or changes to help keep our clients compliant. PMSI maintains a strong and active regulatory presence and keeps a constant pulse on legislative developments in all 50 states. Our Government Affairs team has extensive experience in managing workers’ compensation and pharmacy-related regulation and legislation and is dedicated to staying informed and involved to keep our clients informed and prepared. PMSI’s team continues to interact and participate in developments on issues such as state reporting, eBilling, and average wholesale price (AWP) issues as it relates to fee schedules and treatment guidelines. In California, Texas and other states our team continues to work with various state agencies as states enhance existing and develop pending eBilling regulations. In Florida and Oregon, our team was instrumental in working with state agencies to influence development of their state medical data reporting requirements. And, in Texas, PMSI continues to participate directly with the Division of Workers’ Compensation on development of their closed pharmacy formulary.

PMSI also actively participates in industry groups such as the National Council on Compensation Insurance (NCCI), the International Association of Industrial Accident Boards & Commissions (IAIABC) and the National Council of Prescription Drug Programs (NCPDP) to help develop policies, standards and best practices for the workers’ compensation industry. Not only does our team interact with state agencies on development efforts, they direct compliance efforts internally and are available to assist our clients in better understanding regulatory/legislative impacts.

PMSI has worked to advance the workers’ compensation industry through:

• State Reporting – PMSI was among the first companies in both Florida and Texas—and the first in California—to be approved for electronic filing. This team works with clients to apply leading technology to automate state reporting and ensure compliance with state laws. PMSI’s team is also on the front line in communicating with and developing processes necessary for NCCI’s 2010 Medical Data Call Project.

• Universal Paper/Electronic Claim Form for Workers’ Compensation – The Government Affairs team continues to work with NCPDP and major stakeholders such as pharmacy chains, retailers and group health organizations to finalize a workers’ compensation-specific universal workers’ compensation pharmacy billing form, for use and standardization in numerous jurisdictions.

• eBilling Development – PMSI’s Government Affairs and Information Technology teams are active participants with NCPDP and IAIABC as they work to finalize a National Standard/Guidelines on eBilling, a guidebook to be used by states when adopting eBilling regulations, and continue to work closely with states such as California, Minnesota and Texas to roll out their eBilling requirements.

• Formulary Development – One of PMSI’s pharmacy experts is working closely with the Texas Division of Workers’ Compensation to provide insight and recommendations as the agency develops effective formularies to bring savings, efficacy and safety into the workers’ compensation pharmacy marketplace.

PMSI’s internal operations are aware of, and maintain compliance with new regulations such as changes to fee schedules, billing dates, and controlled-substance restrictions. PMSI ensures injured workers receive the medications, services and products they need—and both providers and payors remain compliant with applicable workers’ compensation requirements.

PMSI’s Government Affairs team publishes regular and special Government Affairs Alerts to distribute important compliance information for our clients and customers. PMSI is also an active participant of CompPharma, a consortium of Pharmacy Benefit Managers working together to create and advocate for new solutions to control the cost of pharmacy in workers’ compensation. CompPharma members identify and prioritize industry-wide problems and develop and deliver solutions—this forum provides PMSI a platform to work in concert with other solution providers to gain a greater voice in advocating at the regulatory and legislative levels for sound policies and changes in governmental regulation that better the industry. PMSI keeps a close pulse on the industry from a regulatory and legislative perspective and is the go-to source for our clients on industry matters.