Minnesota Natural Health Legal Reform Project

Workers' Compensation

We Support the Repeal of 2008 language in the Workers' Compensation Law

In the 2008 Worker’s Compensation Bill, a provision was included which prohibits the payment of services rendered to injured workers by unlicensed healthcare providers in Minnesota.  This provision is found in Minnesota Statute 176.135, subd 1b.  This change in 2008 has been presented by the Minnesota Department of Labor and Industry (DOLI) as a "reform".  However, they have not shown any evidence that there was any abuse of the system.  In short, this "reform" is a solution looking for a problem. 

 As consumers of unlicensed health care in Minnesota, we support the repeal of this provision.

There are many points to be made regarding this provision. They are listed below:

·         Interferes with Insurance Companies:  This prohibition has unintended consequences.  It ties the hands of the insurance companies unnecessarily.  If a cutting edge insurance company decided that it was more effective to cover the natural therapies, they would be unable to do so.  A company which self insures for Workers Compensation would also be unable to do so—this is perhaps a more likely scenario.  This is not up to the state to decide.  The state should not erect artificial restrictions that inhibit innovation by the Workers Compensation insurance companies. 

·         A Claim Can Be Refused:
  Repealing this part of the statute in no way requires that the Worker’s Compensation Insurance companies cover services by 146A practitioners. As always, they can refuse a claim. 

·         Precedence in Minnesota Law:
  There is a precedence in Minnesota Law of reimbursing unlicensed therapies.  If you get an approval by a physician or chiropractor, No-Fault Auto Insurance covers these therapies on a reimbursement basis.  Although we are not asking for this to be included in the Worker’s Compensation law, it apparently is working elsewhere in Minnesota. 

·         Unlicensed = Legal in Minnesota:  Statute 146A does make the practice of natural therapies by unlicensed providers legal in Minnesota.

·         What do Minnesotans want?  This is a major step backwards in health care for Minnesotans.  It is very clearly NOT what the citizens of this state are looking for.  Statute 146A passed in 2000 with only one dissenting vote in the Minnesota Senate and very few dissenting votes in the House.  This strong support in the legislature was due to strong grass roots support from the members’ constituents. Citizens from all over Minnesota worked very hard to encourage the passage of MN Stat 146A. People are supportive of the law and are using natural medicine because they see positive results.  Minnesotans want to be able to choose their health care practitioners, both Western Medicine and Complementary and Alternative practitioners. 

·         Why Health Practitioners are Licensed:  MN Statute 214.002 lists a number of questions which must be answered before a modality which is seeking licensure can be licensed.  The 146A practitioners couldn’t be licensed if they wanted to.  Licensure is about protecting from harm.  MD’s are licensed because pharmaceuticals and surgery have a high risk of harm.  What 146A practitioners do is considered so safe, it doesn’t need licensing.  By creating Statute 214.002, the legislature decided that they were not in the business of “assuring” consumers, but in the business of protecting consumers.  The public does not need unnecessary protection from 146A practitioners.

·         Qualifications to Practice:  Statute 146A requires practitioners to give each client a Bill of Rights.  It includes all the training the practitioner has that is relevant to the natural care practice, and other things that are required by law.  Most people do and should ask about the background of any practitioner before scheduling an appointment.  Buyer beware applies even to licensed practitioners.  We’ve all had a doctor we haven’t thought was particularly talented, but doesn’t mean he or she should not be practicing, but maybe just appeals to a different sort of person.  Experience has shown that there are some MD’s that are more effective than others—indeed the Workers Compensation program wants to do a pilot project using the more effective MD’s.  But they are all licensed.  It is true with any profession.  Some people are better than others at what they do.  The less effective ones won’t be in business as long.  It is also important to note that 146A practitioners are and always have been covered by fraud laws in Minnesota. 

·         No Scope of Practice: 
One concern raised is that since there is no scope of practice and no training or educational requirements named in statute for unlicensed practitioners, anyone could say they have a practitioner/client relationship and agree to split money.  This is highly unlikely.  A licensed physician will still be required to verify and diagnose the injury and an independent medical examination is required to debunk fraudulent claims. There are also laws which prohibit such fraudulent behavior.  From the Minnesota DOLI website:  “Any person who, with intent to defraud, receives workers’ compensation benefits to which the person is not entitled by knowingly misrepresenting, misstating, or failing to disclose any material fact is guilty of theft and shall be sentenced pursuant to section 609.52, subdivision 3.”  In other words, they will be charged with theft and prosecuted to the full extent of the law. 

A quick look at health insurance fraud laws in general show that having a license and a standard of care has not completely prevented any such person from engaging in fraud.  Some of the more common health insurance fraud acts include:
  1. Billing health insurance companies for expensive treatments, tests or equipment patients never had or never received
  2. Double- or triple-billing health insurers for the same treatments
  3. Giving health care recipients unnecessary, dangerous, or life-threatening treatments
  4. Stealing medical information and using it to bill health insurance companies for phantom treatments
We were unable to locate any information about such fraud committed by unlicensed practitioners.  If someone wants to commit fraud, a medical license and scope of practice clearly aren’t going to stop them from doing so.  Creating public policy based on a worst case scenario, for which there is no evidence it has ever occurred in the past limits the ability of injured workers to get the help they need and stifles the creativity of the work comp insurance companies. 

·         No Benefits to 146A practitioners:  Most 146A practitioners do not see work comp clients.  There is usually not even an expectation by the consumers of natural therapies that their natural therapies will be reimbursed.  Changing this law will not provide any additional income for practitioners.  It is a net zero cost for the State of Minnesota.  It isn’t a budget buster in any way for any body concerned. 

·         The “Exemption”:
  The department has said that there is an exemption to this if the practitioner is under the supervision of a licensed practitioner.  This isn’t in law, it is a rule 5221.0700 subp.3.  It refers to ancillary medical workers who aren’t licensed but for whom their services need to be billed. The way licensing laws are set up in Minnesota, it is nearly impossible for a licensed person to hire an unlicensed, 146A practitioner.  Since it isn’t in their scope of practice or standard of care to practice natural modalities, they set themselves up for an investigation by the medical board if they make such referrals.  Additionally, the lack of legal ability to practice natural therapies leads to inadequate experience or expertise to provide knowledgeable oversight to the 146A practitioner.  So this exemption is really pointless and impractical. 

·         Cost of Natural Therapies:  The cost of natural therapies is generally MUCH less than the western medicine therapies, and often equally or  more effective.  So it would actually SAVE money rather than cost money. 

Therefore, MNHLRP supports the REPEAL of Minnesota Statute 176.135, subd 1b.