Michigan Department of Labor and Economic Opportunity  
Workers’ Disability Compensation Agency  
Meeting Date: October 30, 2019  
Time: 1:30 p.m.  
Workers’ Disability Compensation Agency  
2501 Woodlake Circle  
Okemos, Michigan  
Members Present:  
Members Absent:  
Gordon White, Chair; Jayson Chizick; Patrick Harrington; Paul  
Kauffman; Katie Mason; Gina Otterbein, PT; Holly Secord; Kurt Titze,  
William Borch; Shannon Gedert; Barry Leshman, D.O.; Sharon  
Meadows; George Metropoulos, MD; Steven Pollok;  
WCA Representatives: Mark Long, Director  
Dave Campbell, Manager RR&R Division  
Kris Kloc, Medical Claims Analyst  
Beth VanElls  
Guests Present:  
See attached list  
Gordon White called the meeting to order at 1:32 p.m.  
Gordon White asked for additions or corrections to the minutes of the October 17, 2018  
and May 15, 2019 meetings, and there was not any provided. There being none, a  
motion was made by Paul Kauffman and seconded by Pat Harrington to accept the  
minutes as written. Motion passed.  
Dave Campbell provided an update on Rule Set 2019-027 LR. Due to the  
administration change, procedural issues have arisen which have delayed the  
movement of the rule set. Rule changes will include all the proposed changes from the  
May meeting except for the source code documents. Since it is so close to 2020, it  
would be best wait on those changes and incorporate the 2020 source document  
changes next year.  
Health Care Services Advisory Committee  
October 30, 2019  
Page 2  
Mark explained executive order 2019-13 effective August 12, 2019 moves the now  
named WorkersDisability Compensation Agency to the Department of Labor and  
Economic Opportunity along with several other LARA bureaus. The Board of  
Magistrates and WorkersDisability Compensation Appeals Commission are now under  
the Agency umbrella. Unemployment and workerscompensation appeals were split  
into separate appellate bodies. Luke McMurray is the chair of the Board of Magistrates  
and Daryl Royal is the chair of the Appeals Commission. The rules for these entities  
need to be moved to separate rules from the MAHS rule set. Mark provided additional  
information on the rule promulgation process related to these administration changes.  
Ground Ambulance  
Kris Kloc explained that ground ambulance reimbursement is currently by report,  
meaning reimbursement is based on the providers usual and customary charge or a  
reasonable amount, whichever is the less. They have noticed an increase in filings of  
104-B forms from ground ambulance entities, with a wide range of reimbursement  
practices among carriers. Carriers have been reimbursing on average around 200% of  
Medicare. Would this necessitate a fee schedule or is this not an issue? Katie Mason  
indicated that Ford reimburses 100% of billed charges and has been doing so since  
approximately 1993. Paul Kauffman indicated that AF Group pays the 80th percentile of  
Fair Health database amounts, which translates to about 175-200% above Medicare.  
There was discussion regarding the definition of Fair Health. Per the current Health  
Care Services Rules, air ambulance service is reimbursed at 140% above Medicare.  
For consistency sake, Paul thought similar rules would be appropriate for ground  
ambulance reimbursement. Mark indicated it would be appropriate to research other  
state practices and draft a rule set that can be included with the current ruleset. This  
will be brought back to the committee if deemed appropriate.  
Optometry Billing Practices  
Jeff Towns, Executive Director, of the Michigan Optometric Association (MOA)  
introduced his colleagues: Grant Williams, MOA Legal Counsel; Dr. Lynette Burgess,  
Dr. Elizabeth Becker and Dr. Anthony Sesto. Mr. Williams explained the interpretation  
of optometry rules by some carriers has changed recently, even though the rules did not  
change related to optometry reimbursement. The MOA is proposing changes to Rule  
208 to remove the current limitations on codes an optometrist may utilize for billing  
purposes. Current rule language only allows optometrists to bill codes in the 92000  
series and excludes other services within an optometristsscope of practice, which may  
limit access to care. Billing for extraction and rehabilitation services needs to be  
allowed and the practice of optometry not limited to codes in the 92000 series.  
Health Care Services Advisory Committee  
October 30, 2019  
Page 3  
Dr. Becker provided a presentation on low vision treatment which relates to adaptability  
to every-day tasks associated with eye disease or trauma. This treatment does not fall  
within the 92000 series of codes. These are specialized services that general  
optometry does not handle. There are only a few providers that deal with this specialty.  
Dr. Burgess handles the rehabilitation aspect of optometry related to traumatic brain  
injury. This area of eyecare deals with visual processing where there are not issues  
related to the health of the eye, but rather how the information is processed by the  
brain. She also prescribes therapeutic lenses for treatment of this condition. Dr.  
Burgess receives referrals from many other areas of practice because of her specialized  
expertise. Other medical providers in other specialties do not offer this type of  
treatment. This particular area of medicine has developed over the last 20 years and  
the current rules and fee schedule do not account for these advances in treatment. For  
prior workerscompensation claims, Dr. Burgess always provided documentation to  
support the treatment and the procedures were approved and paid by insurance  
carriers. The recent rule interpretation change by some carriers has led to patients not  
receiving necessary treatment due to lack of reimbursable billing codes.  
The proposed changes remove reference to specific codes from Rule 208(4) to not limit  
treatment and inserts language “that most accurately reflect the services rendered  
including those for rehabilitative care and extraction.Mr. Williams feels this will resolve  
the majority of billing issues. Additionally, he requested scope of practice for  
rehabilitative services under MCL 333.17401 and R338.301 be included in Rule 208(5).  
Mr. Williams presented the optometry scope of practice as it existed in 1992 and  
outlined the subsequent changes to the scope of practice since 1992. He pointed out  
that the requested rule changes would be in compliance with Section 315 of the Act,  
which limits reimbursement for optometry to the definition of the practice of optometry  
under the public health code as of May 20, 1992.  
Paul Kauffman indicated AF Group would be willing to pay for this treatment if is  
beneficial, but he would like medical research that documents the effectiveness. He  
indicated he will reach out to AF Group specialists for further discussion. Discussion  
ensued about removal of foreign objects from the eye and an optometrists inability to  
treat because of absence of billing framework for their profession.  
Jason Chizick expressed concern that the rule changes may be too general and  
possibly invite more denials by insurance companies because of the lack of specificity.  
Should we include something more detailed to reduce denials?  
Mark is open to making a rule change in some form to bring the codes up-to-date with  
current treatment. This subject, along with ground ambulance payment, will be  
discussed at the next meeting.  
Proposed Meeting Dates  
Dave presented proposed 2020 meeting dates. The next meeting will be in February.  
Mark reiterated the requirement that we meet two times per year.  
Health Care Services Advisory Committee  
October 30, 2019  
Page 4  
The meeting was adjourned at 2:35 p.m.  
February 12, 2020  
with modifications indicated.  
Gordon White, Chair