Public Risk July 2019 by Moire Marketing Partners

PUBLISHED BY THE PUBLIC RISK MANAGEMENT ASSOCIATION JULY 2019

The Curse of Confidentiality:

How what you don’ t share can hurt you PAGE 6

ALSO IN THIS ISSUE

WHEN NATURAL DISASTERS BECOME BIGGER, SO DO THE CHALLENGES FOR WORKERS’ COMP PAGE 10

SHORE UP THE HOME HEALTH STAFFING SHORTAGE WITH A DEEP BENCH OF EXPERTISE

PAGE 16

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NOT IF, BUT HOW

The Public Risk Management Association promotes effective risk management in the public interest as an essential component of public administration.

JULY 2019 | Volume 35, No. 6 | www.primacentral.org

CONTENTS

PRESIDENT Scott J. Kramer, MBA, ARM County Administrator Autauga County Commission Prattville, AL PAST PRESIDENT Jani J. Jennings, ARM Risk Manager City of Bellevue Bellevue, NE PRESIDENT-ELECT Sheri D. Swain Director, Enterprise Risk Management Maricopa County Community College Tempe, AZ DIRECTORS Forestine W. Carroll Manager of Risk Management Memphis Housing Authority Memphis, TN Lori J. Gray, RMPE Risk Manager County of Prince William Woodbridge, VA

The Curse of Confidentiality:

HOW WHAT YOU DON’T SHARE CAN HURT YOU By Anne Hernandez and Jacquelyn Miller

JamiAnn N. Hannah, RMPE Risk Manager City of Gallatin Gallatin, TN Laurie T. Kemper Sr. Risk Management Consultant City/County Insurance Services Salem, OR Michael S. Payne, ARM, HEM Risk Manager City of Fresno Fresno, CA Melissa R. Steger, MPA Asst. Dir., WCI & Unemployment Ins. University of Texas System Austin, TX NON-VOTING DIRECTOR Jennifer Ackerman, CAE Chief Executive Officer Public Risk Management Association Alexandria, VA EDITOR Teal Griffey, MBA Manager of Marketing and Communications 703.253.1262 • tgriffey@primacentral.org ADVERTISING Teal Griffey, MBA 703.253.1262 • tgriffey@primacentral.org

When Natural Disasters Become Bigger, So Do the Challenges for Workers’ Comp By Lisa Anne Bickford

IN EVERY ISSUE

Shore up the Home Health Staffing Shortage with a Deep Bench of Expertise By Bob Smith

Public Risk is published 10 times per year by the Public Risk Management Association, 700 S. Washington St., #218, Alexandria, VA 22314 tel: 703.528.7701 • fax: 703.739.0200 email: info@primacentral.org • Web site: www.primacentral.org Opinions and ideas expressed are not necessarily representative of the policies of PRIMA. Subscription rate: $140 per year. Back issue copies for members available for $7 each ($13 each for non-PRIMA members). All back issues are subject to availability. Apply to the editor for permission to reprint any part of the magazine. POSTMASTER: Send address changes to PRIMA, 700 S. Washington St., #218, Alexandria, VA 22314. Copyright 2019 Public Risk Management Association

| 4 NEWS BRIEFS | 19 ADVERTISER INDEX

JULY 2019 | PUBLIC RISK

BIG IDEAS. SMALL SETTING. PRIMA INSTITUTE The Industry’s Premier Risk Management Educational Program

October 21–25, 2019 • San Diego, CA PRIMA INSTITUTE 2019 (PI 19) is an innovative educational symposium comprised of fundamental risk management curriculum, outstanding faculty, and excellent networking opportunities. PI 19 is aimed at new and seasoned risk management professionals who want to learn more about emerging trends and best practices.

Registration Now Open: institute.primacentral.org

PRIMA INSTITUTE

The Industry’s Premier Risk Management Training Program

MESSAGE FROM PRIMA PRESIDENT SCOTT J. KRAMER, MBA, ARM

o become an effective risk manager, one of the most important goals is to establish a solid reputation for your department. Reputational risk is a threat or danger to the good name or standing, in this case, of your risk management department. Reputational risk is comparable to contingent liability risks, for example, the result of a court case, and the duration could last a long time. The entire risk management department must be continuously aware that daily decisions can have a positive or negative impact on the department. In the past risk managers focused on avoiding risks at all costs, which can be viewed as negative or non-productive. Our profession has since matured past this by working with senior leadership through enterprise risk management to recognize issues early and determine the best way to move forward in alleviating the risk. As an effective reputational leader, you need to establish relationships and policies that others perceive as value-added. Your department’s reputational brand begins with becoming knowledgeable in your field. You can earn the respect of your peers, department heads, managers, brokers, third-party administrators, management, and fellow employees based on your passion for what you do. Also, your department’s policies and procedures must be clearly defined and exhibiting transparency with decisions. TACKLE REPUTATIONAL RISK BY: Make reputational risk an integral part of your entity’s strategy and planning Clearly define your entity’s reputational weaknesses and strengths, while workshopping potential scenarios that could damage

“

To assist in becoming a reputation leader, PRIMA provides many opportunities to increase your knowledge, as well as providing an established network of peers you can contact when a challenge arises.

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Risk Management and Reputational Risk

public perception, and plan contingencies accordingly. Involve your employees at various levels to gain a broader perspective of such risks and how to negate them. Set reasonable standards Don’t set expectations or make guarantees that you or your entity can’t keep. Ensure promises of work are in keeping with what can be actually accomplished. Processes should be standardized, and employees provided with reasonable time, budgeting, and other resources needed to complete projects or every-day work at the expected level. Stay positive and timely Through emails, social media, customer service, and more, entities have every opportunity to provide good publicity for themselves. The more positive publicity your entity garners the better defense it has against reputational risks. Ensure the entity maintains transparency and customers are kept informed should an issue arise to lessen any fallout damage.

Utilize PRIMA Resources To assist in becoming a reputation leader, PRIMA provides many opportunities to increase your knowledge, as well as providing an established network of peers you can contact when a challenge arises. June’s Annual Conference included specific sessions on reputational risks, such as “6 Reasons Organizational Risk Management Works.” PRIMA also has a two-day Enterprise Risk Management Training Program that offers in-house instruction to create an organizational culture that proactively manages risk. These sessions have helped me hone my skills and protect my reputation! Sincerely,

Scott J. Kramer, MBA, ARM PRIMA President 2019–2020 County Administrator Autauga County Commission Prattville, AL

JULY 2019 | PUBLIC RISK

NEWS BRIEFS

NEWS Briefs

IN DEFINING CONSENT, THERE’S A GAP BETWEEN THE LAW, CULTURE NEW YORK — It may sound simple: You either consent to sexual activity or you don’t.

conversations about this in political discourse, and yet you have many states that are not there yet.”

But just what constitutes an expression of consent is a hotly debated topic in the justice system and in society at large. And while there’s been a gradual cultural trend, especially on university campuses, toward a standard of “affirmative consent”—otherwise known as “yes means yes” rather than “no means no”—the laws on sexual assault have not similarly evolved.

To help states arrive at a more consistent definition, an organization called the American Law Institute is working on updating the sexual assault laws in its 1962 Model Penal Code, proposals used as models for measures in state legislatures. A definition of consent took the body of judges, lawyers and academics about five years to work out. An early, simple affirmative consent standard was deemed to be “too far from cultural norms,” and a compromise definition was ultimately approved. The proposed sex assault laws are likely to be voted on in May 2020.

“There’s a definite lag between what’s happening culturally and what’s happening in criminal law,” says Deborah Tuerkheimer, a law professor at Northwestern University who has written extensively about the topic. “I haven’t seen the (hash) MeToo movement usher in a wave of criminal law reform. Maybe that’s to come, but I haven’t seen it.” There is no uniform legal definition of consent. That’s because sexual assault laws, of which consent is often a key component, vary widely state by state. Only a handful of states, among them California, Florida and Wisconsin, have an affirmative consent standard on the books, according to the anti-sexual violence organization RAINN. Far more than that—about half of all states—don’t define consent at all in their sex assault laws. Many of these states use force, rather than lack of consent, as a standard for deciding whether an assault occurred. Tuerkheimer sees that as “a huge problem.” “It certainly doesn’t track the widespread consensus around what constitutes sexual assault,” she says, noting that not all assault cases involve strong physical force, including assaults by someone the victim knows or assaults resulting from a power imbalance. “Consent has become the dividing line in most of our

PUBLIC RISK | JULY 2019

Consent has become a front-burner issue in the Me Too era, which since late 2017 has shone a light on sexual assault and harassment in an unprecedented way. But it’s been a crucial issue on college campuses—often a laboratory for social change—for decades. In 1990, students at Antioch College in Ohio were subject to nationwide ridicule when they introduced an extensive affirmative consent policy. It hardly seems controversial now, but news anchors traveled to the campus and delivered snarky reports, predicting that kissing itself would be outlawed. “Saturday Night Live” mocked the policy with a skit about a game show called “Is It Date Rape?” with actress Shannon Doherty playing a contestant majoring in “victimization studies”—who hit a buzzer to say “date rape!” of every social scenario presented to her. The New York Times weighed in with an editorial, saying adolescents will always make mistakes “but legislating kisses won’t save them from themselves.” The reaction shut down further movement toward such policies—for a while. But in recent

years, campus activists have refocused on consent amid rising concern over sexual assaults at U.S. colleges and universities. President Barack Obama’s administration put pressure on universities, even threatening to withhold federal funding from schools that didn’t have an affirmative consent standard in their campus codes. California and New York now legally require colleges and universities to use the standard, and affirmative consent is present in a number of college campus codes, though precise numbers are hard to come by. Will it become the new norm? “We’re definitely moving in that direction,” says B. Ever Hanna, campus policy manager at the organization End Rape On Campus. “The question is: How quickly?” Hanna’s group has come up with five key requirements for an affirmative consent definition, which include “a voluntary, affirmative, conscious, agreement” that can be revoked any time during an encounter. Also, a previous relationship does not imply consent, force or coercion cannot be used to get consent, and crucially, a person incapacitated by drugs or alcohol is incapable of giving consent. But as important as specific policies are, the issue is far more complex than any code or law can capture, says Peggy Orenstein, who has written frequently about consent and is the author of the book “Girls and Sex.” Orenstein says she meets many young people today who may understand the concept but have trouble applying it to their own behavior. “I feel sometimes that consent can become a catchall, when it shouldn’t be,” Orenstein says. “Consent only tells you if it was legal. There is so much more that we need to be talking about.”

CHILDHOOD ASTHMA: A LINGERING EFFECT OF REDLINING New research shows that disparities in housing contribute to disparities in one of the most common chronic diseases afflicting children. In the 1930s, a New Deal agency produced notorious maps to signal the credit worthiness of neighborhoods for mortgage lenders looking to refinance homes. These redlining maps color-coded predominantly African American neighborhoods as “hazardous,” indicating a high credit risk. Decades later, the “hazardous” warnings appear to be literally true. A new study finds that people who live in historically redlined neighborhoods are more than twice as likely as others to go to the emergency room for asthma. The new research from the University of California, Berkeley, and the University of California, San Francisco, links decades of residential segregation to new findings of environmental racism. Disparities in housing contribute to disparities in the morbidity of asthma—one of the most common chronic diseases afflicting children.

The study examined historic redlining maps produced by the government-sponsored Home Owners’ Loan Corporation for eight cities in California (San Francisco, San Jose, Oakland, Sacramento, Stockton, Fresno, Los Angeles, and San Diego). Researchers led by Anthony Nardone, a medical student from the universities’ Joint Medical Program, compared the risk ratings with the number of emergency room visits for asthma for corresponding census tracts. Residents of redlined “high-risk” neighborhoods were 2.4 times more likely to go to the ER for asthma than residents of green “low-risk” areas. Left: HOLC redlining maps for San Francisco and Oakland. Right: Emergency room visits for asthma complaints per 10,000 residents per census tract. (Anthony Nardone/University of California, Berkeley) Historically redlined neighborhoods also exhibited much higher amounts of diesel particulate matter in the air, according to the study. The researchers compared air quality ratings for each census tract in these eight California cities using a state data mapping tool.

Last year, the researchers at the U.S. Environmental Protection Agency’s National Center for Environmental Assessment concluded that people of color are far more likely to breathe polluted air than their white counterparts. Majority-black neighborhoods are more likely to be located near sources of pollution, according to a study that examined living patterns at “national, state, and county scales.” Racial segregation is linked to disparities in education, safety, and wealth. The persistence of these effects over many decades—the Fair Housing Act banning discrimination in lending was passed more than 50 years ago—leads to generational gaps in outcomes. But this new research shows that segregation means more than opportunities deferred or denied. Environmental racism is a present danger for communities of color. As a chronic disease that affects more children than adults, asthma is an especially pernicious symptom of racial segregation—a threat to health and wellbeing, but also an impediment to growth, education, and development.

STATE LOWERS DEGREE REQUIREMENTS FOR CHILD WELFARE CASE WORKERS The move in Oregon comes amid concerns about workforce diversity and recruiting and retaining employees. Child welfare case workers in Oregon will only be required to have an associate degree, instead of a bachelor’s degree, under a bill Gov. Kate Brown has signed into law. The legislation calls for people with associate degrees to get additional training or certifications determined by the state’s Department of Human Services in order to become case workers. Oregon’s child welfare director, Marilyn Jones, had urged lawmakers to relax the degree requirements. In doing so, she said workforce diversity was a leading concern, but also noted difficulties with recruiting and retaining employees. “We want to honor life experience and continue to build a diverse workforce that is inclusive across language, race, class and culture,” Jones told

members of a House committee earlier this year, according to a written copy of her testimony. “In order to build a more culturally and linguistically responsive workforce, DHS needs the appropriate discretion to value and recruit individuals with lived experience,” she added. Case workers in positions affected by the change conduct child abuse investigations and make determinations regarding whether children need to be placed in protective custody.

“Research evidence on the viability of the child welfare workforce clearly supports the desirability of more education and training,” they said in a letter. They cited reports suggesting workforce shortages and turnover are due to poor working conditions, not educational barriers. And they said they were interested in partnering with the state to look at options apart from the bill, including state-funded higher ed programs, increased training and licensure requirements for certain staff, and higher pay.

An audit Oregon’s secretary of state released last year describes the child welfare system as “critically understaffed.” It adds that “turnover and overtime are high, and an inexperienced workforce is taking on heavy caseloads, increasing the risks of child endangerment.”

An initial version of the legislation would have eliminated all degree requirements for case workers, leaving it up to the Department of Human Services to set minimum qualifications for the positions. The bill was amended last month to include the associate degree provision.

The directors of social work educational programs in Oregon, along with the state’s chapter of the National Association of Social Workers, were among those who voiced concerns about the legislation changing degree requirements for case workers.

The legislation enjoyed broad support in both chambers of the Oregon legislature. It passed the House in April on a 57-1 vote. The Senate approved it earlier this month on a 24-4 vote. Brown, a Democrat, signed the legislation into law.

JULY 2019 | PUBLIC RISK

The Curse of Confidentiality: How what you don’ t share can hurt you

Maintaining confidentiality is critical, but failing to share appropriate information with the right people can lead to increased workers’ compensation costs and delayed claim resolutions BY ANNE HERNANDEZ AND JACQUELYN MILLER

PUBLIC RISK | JULY 2019

MPLOYERS AND CLAIMS ADMINISTRATORS HAVE A GREAT DEAL OF INFORMATION AVAILABLE TO THEM AT ALL TIMES—and it’s information that can often impact a workers’ compensation claim,

either negatively or positively. Knowing when and what information to share is critical to the accurate administration and defense of claims.

Hopefully, those of us in the workers’ compensation field have a genuine appreciation for maintaining confidentiality throughout a workers’ compensation claim. We all know you shouldn’t discuss claim specifics with friends or family or—even if you’ve got “the best story ever” regarding a specific claim— at the office holiday party. Common sense, right? So when is the appropriate time to share? There are certain instances where an employer, claims administrator, defense attorney or even a treating doctor have critical information regarding a claim that needs to be shared…with the right party.

So when is the appropriate time to share?

ongoing need for medical care, residual disability and the relationship of the injury to benefits claimed. When a case is litigated, a defense attorney is assigned; he or she needs specific information to resolve the disputes involved in the claim. That information may come from the employer, claims administrator, physician(s) or even the injured worker.

Employer • Claims Administrator Defense Attorney

THE RISKS OF UNDER-SHARING.

WHAT EACH PARTY NEEDS TO KNOW. Each person involved in the claim needs information for a variety of reasons:

An employer is looking for information regarding the employee’s ability to return to work. What work restrictions might they may have? Will those restrictions be permanent or temporary? Will the employee be off work for an extended period of time? The claims administrator’s responsibility is to gather information to determine accurate and timely benefits. He or she will be looking for information on return to work,

Let’s take a look at a few examples of how under-sharing information, or failing to provide needed information, can impact a claim.

Delayed information about a new injury. An employee has been telling his coworkers about his “major crash” while water skiing last weekend. “Man, it was something! I’m lucky I walked away!” The following week, the same employee files a workers’ compensation claim for an unwitnessed knee injury that happened as he was walking up some stairs at the office. While seeking treatment at the designated occupational clinic, he made no mention of the earlier water skiing accident. Without knowledge of the previous incident, his knee injury is considered minor; with no compensable time loss, the injury is accepted and benefits are paid.

JULY 2019 | PUBLIC RISK

THE CURSE OF CONFIDENTIALIT Y: HOW WHAT YOU DON’T SHARE CAN HURT YOU

Some time later, the employee’s personal treating physician recommends a total knee replacement and the employee is claiming compensable time loss relating back to the minor, accepted knee injury. Only now do his coworkers report the water skiing information to their supervisor. In this case, a delay in reporting important information regarding recent activity resulted in a claim being accepted for an injury which may not have been work-related. The delay eliminated the value of a timely and reasonable investigation in to injury causation. What should happen? The employer should actively collect any relevant information from coworkers whenever an unwitnessed injury occurs. A supervisor should check in with the worksite at the time of injury for helpful information; employees will often answer direct questions, but not offer information unless specifically asked. This information should be immediately provided to the claims administrator before any decisions of compensability are made. Return-to-work information. An HR director plans to return an employee to work at full duty on June 1st, but hasn’t shared that plan with others involved in the claim. The employee is back to work for two weeks before the claims administrator is notified. In this case, under-sharing information could lead to an overpayment of benefits. Additional risks include increased claims costs for additional care if the employee has not yet been medically released to work and her recovery is delayed, or a delayed claim resolution if the overpayment is disputed. What should happen? Employers should communicate with the claims administrator when they begin planning an injured employee’s return to work, to ensure a safe and appropriate return to work and to determine any change to benefits. Questionable employee activity. The Police Chief receives an email asking for donations for a charity run in which one of her officers is competing. The email explains the officer has been training for the past few months, and is very excited about the run! The Chief agrees it’s a great charity and donates $50. The same employee has been medically disabled from

PUBLIC RISK | JULY 2019

working for the last three months due to an ankle injury; she has been restricted from running, but no information regarding the upcoming charity run is provided to the claims administrator. In this case, not sharing information could lead to benefits being overpaid to an employee who can be returned to work. What should happen? When an employer receives information indicating an injured worker may be involved in an activity beyond their work restrictions, he or she should contact the claims administrator and provide as much information as possible to evaluate and investigate the situation. Notice of representation. A Public Works department supervisor receives a legal notice of representation regarding a workers’ compensation claim; he files the notice in his desk and forgets about it. Six months later, the city receives a Hearing notice regarding this claim and forwards it to the claims administrator. In this case, the under-sharing risks might involve increased claims costs for legal representation and defense, or from potential claim liability for failure to evaluate the claim and provide or deny benefits in a timely way. What should happen? Notice of a claim from any source should be shared with the claims administrator immediately. There are specific timelines in place to accept or deny benefits; a failure to abide by these timelines may result in a claim being accepted that could have been successfully disputed. Employment agreements. An employer provides salary continuation benefits to certain staff. When an employee was temporarily disabled, her salary continued but no one notified the claims administrator. Salary continued at the same time disability benefits were paid from the claims file, resulting in an overpayment.

adjuster any time salary is continued. Providing the claims administrator with information regarding the salary continuation program in advance of claims may prevent overpayment of benefits when claims occur.

COMMUNICATION IS KEY.

For many employers, workers’ compensation is just another task on their list; it may or may not be part of their everyday work. We’ve reviewed some basic instances where under-sharing may lead to risk— now, let’s take a look at how we can mitigate it. Establish clear communication expectations between the employer representative and the claims adjuster. If workers’ compensation responsibilities are transferred to a new person or department, make sure they know who handles the workers’ compensation claims and how to reach them. Unsure what information to share? The best bet is to call the adjuster and have a discussion. Communication between the employer and the defense attorney should involve the claims adjuster. Litigation management doesn’t happen in a vacuum and the claims adjuster cannot manage the workers’ compensation case without this communication. At every step in the life of a claim, sharing the correct, appropriate information is critical. Remember: As part of the workers’ compensation team, your contribution and communication is key to a successful claim!

Communication is key to a successful claim

In this case, there is a risk of increased litigation costs should the issue of reimbursement become a dispute. Other risks include an overpayment of benefits, or delayed claim resolution due to ongoing litigation.

Jacquelyn Miller is a Senior Advisor in Workers’ Compensation with York.

What should happen? Upon reporting the claim, the employer should notify the claims

Anne Hernandez is a Senior Partner with Mullen & Filippi.

PRIMA would like to sincerely thank all our sponsors for their generosity and enterprising

spirit, as without their financial support the PRIMA 2019 Annual Conference would not have been possible. From PRIMA staff to conference attendees, we toast our sponsors and look forward to future endeavors!

Jennifer Ackerman, CAE Chief Executive Officer

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JULY 2019 | PUBLIC RISK

WHEN

NATURAL DISASTERS BECOME BIGGER, SO DO THE CHALLENGES FOR WORKERSâ&#x20AC;&#x2122; COMP BY LISA ANNE BICKFORD

PUBLIC RISK | JULY 2019

N JUST THE PAST FEW YEARS, natural disasters generated startling headlines and produced enormous challenges, including for workers’ compensation systems. In 2017, colossal hurricanes lashed the coasts

of Florida, Puerto Rico, and Texas before scraping across enormous inland areas. The following year, the

deadliest U.S. wildfire in a century1 swept across Northern California, leveling an area the size of Chicago.

Already in 2019, a patchwork of Midwestern levies has strained and sometimes failed to hold back rivers swollen by snowmelt and copious rain. If the assaults seem more intense these days, that’s because they often are. More than ever, proper disaster planning is necessary to ensure workers’ comp systems are able to rebound from catastrophe. In dollars—an admittedly inadequate yardstick relative to the human toll involved—many of the most recent disasters have been among the worst recorded. The eight years with the most billion-dollar disasters in the U.S. all occurred in the past decade, according to the National Oceanographic and Atmospheric Administration. Recent events lay out the story: Hurricanes FIGURE I

Harvey and Maria were the second- and thirdmost expensive2 hurricanes to strike the U.S. (Irma, which also hit in 2017, was fifth.) And California’s Camp Fire was the most expensive natural disaster in the world last year.3 Figure I identifies the 16 disasters that topped $1 billion in damages in 2017. Scientists and government forecasters warn we can expect more extreme events. These could add to the challenges workers’ comp regulators have long faced from more run-of-the-mill disasters. To better prepare for all types of disasters, the workers’ comp industry, regulators and clinicians will need to construct more robust backup plans, more resilient systems and more flexible rules for emergencies. They’ll also

need to further prepare for surges in claims. There are pockets of welcome news on this front. Some states, pressed into action by experience, are fortifying their regulatory safeguards. In Florida, regulators are taking steps to prepare for events that could compromise workers. The Sunshine State’s 8,400 miles of coastline, flat topography and porous limestone foundation leave it susceptible to rising seas, storm surges and sinkholes. In response, Florida devised a regulatory mechanism that kicks in automatically when the governor’s office declares an emergency. Florida’s Office of Insurance Regulation is then able to issue certain administrative orders without delay. This ready-made response consists of two parts: • Property/casualty provisions: These address topics such as non-renewals, rate hikes and cancellations within 90 days of a catastrophic natural disaster. These rules are focused on the property/casualty market. • Pharmacy-related provisions: These include measures that suspend “refill-too-soon” flags that can arise when a patient seeks to replace a medication that might have been left behind, lost or ruined in a natural disaster. These measures affect all lines of insurance that provide pharmacy-related services, including workers’ compensation.

IN TEXAS, A STEPPED-UP RESPONSE TO AN UNPRECEDENTED STORM

Texas, for its part, put in place temporary rules following the havoc that Hurricane

JULY 2019 | PUBLIC RISK

WHEN NATURAL DISASTERS BECOME BIGGER, SO DO THE CHALLENGES FOR WORKERS’ COMP

The takeaway is clear: Disasters happen. They’re nothing new. What is perhaps new is an increase in the frequency and severity of natural disasters. If these occur more often and with greater consequence, workers’ comp systems will face more challenges bouncing back. Thoughtful planning will become ever more critical to ensuring systems set up to safeguard and help workers can continue to do so following a major disruption… The risks to injured workers following a disaster can be great. Failing to prepare for calamity only makes those risks greater. Harvey delivered in late August 2017. The way in which Harvey unfolded—by stalling over land and dumping rain—illustrates the way in which many scientists believe storms themselves are starting to evolve. A warmer planet can supercharge hurricanes because heat is fuel for storms.4 And because warmer air holds more moisture, hurricanes can now vacuum up more water over the ocean and deposit more of it over land.5 On top of that, more people are living along coasts and in areas susceptible to flooding.6 It all adds up to heightened risk, according to federal forecasters. The U.S. Government Accountability Office, the investigative arm of Congress, projects rising seas and more frequent and intense storms could add $13 billion to $23 billion in annual flooding costs for U.S. coastal communities by the middle of the century.7 The U.S. Geological Survey ranked Harvey the nation’s largest rain event in scope and rainfall totals since such recordkeeping began in the 1880s.8 The storm’s destruction fanned out from the Gulf of Mexico deep into the second-most populous state. More than 122,000 people required rescuing; more than 210,000 homes were lost. Injured workers also suffered. Even the Texas Department of Insurance (TDI), which oversees the state’s workers’ comp program, was not impervious to Harvey’s toll. Field offices endured flooding, forcing some to close. Doctors and other providers saw facilities destroyed and medical records lost. Closed courts meant that dockets piled up. Hundreds of first responders filed claims. And communication disruptions, from downed phone lines to interrupted mail service, added to the challenges. Regulators took far-reaching steps so injured workers could continue to obtain care.

PUBLIC RISK | JULY 2019

TDI had to provide answers to the injured workers, medical providers, attorneys, claims administration organizations and others who turned to the agency. TDI issued a benchmark regulatory response highlighting emergency measures that remained in effect until January 2018. These included: • Requiring carriers to continue benefit delivery in affected counties • Waiving penalties/restrictions for emergency and non-emergency care with non-networked providers and payment for those services • Extending deadlines for medical examinations • Authorizing payments to pharmacies for up to a 90-day supply of prescriptions regardless of the most recent refill date • Providing for expedited change-ofaddress processing • Temporarily suspending a number of regulatory cutoff points, including claim notification and filing deadlines, medical billing deadlines, medical and income benefit payment deadlines.

DISASTERS DIFFER BUT THE NEED FOR PREPARATION IS A CONSTANT

The hurricanes that ravaged parts of the U.S. in 2017 gave way to disasters of a different sort in the summer and fall of 2018 when wildfires ripped across broad swaths of the West. The strongest wildfires in California history became emblematic. The notorious Camp Fire killed more than 80 people in November 2018; the fatalities surpassed the combined toll from the state’s previous worst three fires. The inferno destroyed more than 18,000 structures—more than the combined loss from the seven next most destructive fires.9 As with the 2017

hurricanes, government officials declared states of emergency. Health care leaders, clinicians and administrators also jumped into response mode, even as many fled their homes and workplaces. The disruptions wrought by flood and flame, as well as other calamities, offer warnings for how profound the consequences of disasters can be for injured workers and those who care for them. These events underscore the need for proper disaster-recovery planning in workers’ compensation, which can be overlooked given its small size compared with group health. Too few states have adopted specific operational and regulatory plans relating to how workers’ compensation systems would respond to a disaster. Texas offers instructive insights into how to minimize disruptions. As part of its efforts to respond to Hurricane Harvey, TDI took several important steps. These included sending staff to disaster-recovery centers and other sites to answer questions and provide information about how to contact insurers and reschedule appointments. The agency extended the hours of its customerservice hotline and also gave staff time off to volunteer for the cleanup. TDI coordinated efforts with other government agencies including the Federal Emergency Management Agency and the Occupational Safety and Health Administration.

Jurisdictions beyond Texas could devise similar frameworks for how they would respond in an emergency. Perhaps the most basic function would be to act as a conduit for communication, including among injured workers, medical providers and claims handlers. Likewise, communication with local, state and federal agencies is critical. State workers’ compensation regulators, in particular, are well positioned to assist in this role as it relates to injured workers. Payers and claims administrators also have a role. Most pressing is to ensure injured workers continue to receive medical care and benefit checks. Larger payers or third-party administrators (TPAs) often can reroute claims-handling to offices outside of disaster zones. Redundant systems and business-continuity plans can hasten recovery. Thanks to improved technology, payers often can make changes to claim information (such as updating the system to reflect a temporary mailing address) without incurring delays that can impede delivery of benefits. Similarly, facilitating waivers that lift restrictions on prescription replacements and out-ofnetwork treatments can allow injured workers to obtain care when disasters disrupt access to network treating providers or facilities. As in Texas, a governor’s disaster proclamation can be used to automatically suspend certain deadlines and requirements stemming from state regulations. Payers can work to clear away time-bound obstacles by adjusting their own operations and by working with vendor partners to do the same. Taking such steps can prevent injured workers and providers, who likely are already traumatized by a disaster, from enduring unnecessary bureaucratic blows.

COORDINATED EFFORTS SHOULD OCCUR BEFORE AN EVENT UNFOLDS

A number of other claims-handling considerations can be relevant. For example, adjusters from other states might be called upon to work through a surge in claim volume. In such cases, payers and TPAs must ensure that out-of-state adjusters are sufficiently trained and vetted. Those adjusters must be properly licensed for the jurisdiction. Failing to use licensed adjusters can give rise to a host of legal and other complica-

tions. Similar issues could emerge when out-of-state medical personnel step in to take on a recovery effort. Emergency licenses might be required and could be issued as needed. Workers’ comp systems vary in their regulatory readiness to respond to disasters. Some states have assembled detailed regulatory steps for what to do in an emergency while other states have not put forth formal plans. In some cases, states have drafted disaster preparedness manuals or business-continuity plans. Other states have done both. Even the most robust protocols will require regular updating. And key players must be kept aware of the tasks and roles they are designated to undertake. Organizations that operate nationwide such as the International Association of Industrial Accident Boards and Commissions (IAIABC) could facilitate development of model regulations and legislation. Efforts to craft sample frameworks might benefit from coordination among groups like the National Council of Insurance Legislators (NCOIL) or the National Insurance Commission (NIC). By working together, these organizations could offer states a unified approach that would clarify what to expect and how to respond when coping with a disaster.

LEGAL AND UNDERWRITING CONCERNS CAN POSE UNIQUE RISKS

A number of legal and underwriting considerations could come into play in the wake of a disaster as well. Court dockets may be delayed and venues could change. Numerous issues also might arise relating to jurisdiction. These might involve conflicting laws among states or exterritorial provisions. There can also be hurdles involving workers’ comp coverage for those who arrive in a disaster zone from out of state. For example, a roofing contractor from Georgia might become injured after traveling to Florida to help repair homes following a hurricane. Or a worker might fall or inhale toxic fumes when attempting to clean up from a fire. This could mean a worker is taking on job responsibilities that are outside her traditional role. Doing so could trigger a temporary reclassification from, for example, “clerical” to “janitorial” if a worker’s job

responsibilities change substantially to take on more risk.10 Depending on the size and nature of the disaster, it might be necessary to obtain advice from legal counsel experienced in handling these types of issues.

DOING THE WORK OF PLANNING NOW CAN SPEED THE RECOVERY LATER

JULY 2019 | PUBLIC RISK

CONGRATULATIONS TO PRIMAâ&#x20AC;&#x2122;S 2019 PUBLIC RISK MANAGER OF THE YEAR James Curbeam, CPCU, ARM, AIC, MBA! Risk Manager for the Las Vegas Valley Water District and Southern Nevada Water Authority We had many qualified candidates for PRIMAâ&#x20AC;&#x2122;s Public Risk Manager of the Year award, but James stood out by helping found the American Association of Water Distribution & Management, which formed as a Thought Leadership Lab (TTL) for the public water system space. The TTL shares best practices, engages in joint research, discusses emerging trends, identifies actionable innovation, and serves as an effective bridge with insurers and affiliated stakeholders. James also recently transitioned a $4 billion domestic property insurance program to a direct underwriting relationship saving an immediate $250,000 for the Las Vegas Valley Water District! James is currently serving as a board member for the PRIMA Nevada Chapter. Thank you so much to James for applying, and we welcome him to take his place among our other fantastic Risk Manager of the Year alumni. Thank you to AON, who sponsors our Public Risk Manager of the Year award!

Further your public sector risk management education without leaving the office! This Webinar series features top presenters delivering risk knowledge to your desktop!

PRIMA’S 2019 RISK MANAGEMENT

WEBINAR SERIES PRIMA WEBINARS ARE FREE FOR MEMBERS! Visit www.primacentral.org today to register for individual Webinars or for the entire program!

J U LY 17 | 1 2 : 0 0 P M – 1 : 3 0 P M E ST CULTIVATING A SAFETY CULTURE SPEAKERS: Marilyn L. Rivers, CPCU, ARM, AIC, Director – Risk and Safety/City Safety and Compliance Officer, City of Saratoga Springs, NY Daniel Hurley, CSP, ARM-P, Risk Manager, City of Chesapeake, VA DESCRIPTION: Risk professionals are often called the “tip of the spear” within their organization with regard to developing and marrying the relationships between risk and safety. It’s a difficult role that requires ongoing education, training and an understanding of the dynamics of our global safety culture in the context of our local environments. This webinar is designed to provide discussion points to ensure your employees and team members recognize the value of the health and safety of their personal and professional human habits. Life is as cyclical as our risk management wheel. Topics of discussion include how to engage your people and instill within them the importance of their participation and support of creating a safety culture within your organization and community. AT T E N D E E TA K E AWAYS :  Determine the parameters of relationship building for safety programming within your entity  Understand what perseverance may be needed to earn the respect of your local leaders  Learn techniques to embrace resiliency and consensus in developing and mitigating emerging safety issues  Understand the dynamics of the relationship between risk, political intrigue and safety

For more information, or to register, visit primacentral.org/webinars.

SHORE UP THE

HOME

HEALTH STAFFING SHORTAGE WITH A DEEP BENCH OF EXPERTISE BY BOB SMITH

PUBLIC RISK | JULY 2019

HEN EMPLOYEES SUSTAIN COMPLEX, SEVERE OR CATASTROPHIC INJURIES, THEY MAY

REQUIRE HOME HEALTH SERVICES. Today, there are significant challenges facing home health, which could affect our industry’s ability to meet the home care needs of injured employees.

We must be aware of these issues and be prepared with strategies to minimize resulting risks.

A key issue is the shortage of nursing professionals across health care in general and a shortage of home health aides in particular. There are an estimated 2 million home health workers across the U.S.1 These caregivers looked after 7.6 million in-home clients in 2007—and this number could rise to 28 million by 2030.2 This is because the elderly and disabled populations are growing, particularly with aging baby boomers. As a result, the U.S. may need as many as one million new home health aides by 2026.3 Home health aides work under the direction of nursing or medical staff, and they’re responsible for a myriad of tasks, including bathing, measuring vital statistics such as blood pressure, administering oral medications, managing incontinence, moving non-ambulatory patients to avoid bed sores, assisting in personal hygiene, grooming, dressing and feeding patients, as well as performing light housekeeping tasks. It’s no wonder they’re considered the heroes of home care.

While in-home nursing professionals maintain relevant licenses, home health aides often undergo mandatory training and certification. Both professionals are often employed by home health and home care agencies (“agencies”)—of which there are well over 17,700 in the U.S.4 In the near future, the pace of demand for home health workers will likely exceed supply. The expected workforce shortage will hit 446,300 workers by 2025, according to Mercer.5

MEETING THE NEEDS OF INJURED EMPLOYEES

While staffing shortages persist and grow, meeting the home health needs of injured employees continues to be a complex, multi-faceted process. An injured employee’s home is a private, intimate setting. Injured employees—as well as family members—want to feel comfortable with the caregivers they invite into this space.

JULY 2019 | PUBLIC RISK

SHORE UP THE HOME HEALTH STAFFING SHORTAGE WITH A DEEP BENCH OF EXPERTISE

and facilitate total home and care needs in a comprehensive plan, which may include durable medical equipment, supplies, transportation, and home or vehicle modifications. If possible, they will also speak to the injured employee and family members to assess social, lifestyle, and environmental factors that can affect the match: Does the family have pets, such as cats and dogs, to which a caregiver might be allergic? Is there a preference for a male or female caregiver? Are there other critical issues or preferences? In other words, a wise coordinator will make sure there’s a medical and personality match.

Injured employees may be struggling with a difficult transition—going from function and independence in performing work and daily activities—to now living with a disability and requiring ongoing care and personal assistance. As a result, they need compassionate, caring health professionals, who are also highly skilled and experienced in caring for those who have experienced a severe or life-altering injury. WHAT A QUALITY ANCILLARY SERVICE PROVIDER CAN OFFER Today, claims adjusters already have a full plate of responsibilities, so they need to be able to hand off the home care coordination process. If an injured employee is to be discharged from a hospital or facility, the adjuster or nurse case manager will immediately notify the ancillary service provider to make its home care coordinators aware of the impending date, so they can set up services in a timely fashion. The first order of business is to match the injured employee’s medical needs to the appropriate skill level required—whether that’s a registered nurse (RN), licensed vocational nurse (LVN), licensed practical nurse (LPN), certified nurse assistant (CNA) or home health aide (HHA). If necessary, home care coordinators will speak to the treating physician or nurse case manager to get clarification on patient needs. They will actually assess

PUBLIC RISK | JULY 2019

Some states allow injured employees to hire family members to provide in-home supportive services. It’s important that a home health professional be able to fit into the overall family, home and caregiver-team dynamic. Over time, the ancillary service provider may consult with the treating physician and nurse case manager to see if the caregiver skill level can be reduced—perhaps from a nurse to a home health aide—which can help save significant costs, especially over the life of a claim requiring 24/7 care.

ENSURING QUALITY, CONSISTENT HOME CARE SERVICES

In light of staffing shortages, a big part of quality is ensuring that cases are staffed and home care professionals show up—or that a process is in place to substitute staff if a caregiver calls in sick or requires personal time-off. If no-shows occur at the last minute, family members may not be

available to fill in, and injured employees could be left without the medical care and personal assistance they require. In addition, constant switching of home health staff could disrupt continuity of care, and ongoing turnover could result in patient dissatisfaction. To proactively nip such issues in the bud, organizations should partner with a quality ancillary service provider that has a broad national network of home health and home care agencies. This provider will usually collaborate with several agencies in a region to make sure it can cover all of its cases. The ancillary service provider will also ensure that agencies it works with have a track record of dependability and consistency, and policies in place requiring staff to provide early notification if they must miss work—otherwise, they could jeopardize the health and safety of injured employees. Across its many agency partnerships, an ancillary service provider will have access to a deep bench of expert home health professionals, which will enable it to proactively substitute and replace caregivers as needed. Due to the volume of business and favorable terms it provides agency partners, it’s able to obtain prioritized handling of its cases. In the end, organizations can avoid the scenario where a claims adjuster receives a frantic call from a family saying a nurse or home health aide has not shown up. Instead, gaps and disruptions in home care are avoided. Bob Smith is the CEO of Priority Care Solutions (PCS), a division of Genex Services. FOOTNOTES 1 Kardish, Chris, “Are Home Health Workers Worth More Than Babysitters?” Tribune Regional News, March 1, 2015. 2 Baron, Sherry, “Protecting Home Health Care Workers: A Challenge to Pandemic Influenza Preparedness Planning,” American Journal of Public Health, 2009. 3 Rolf, David, “Life on the Homecare Front,” American Society on Aging, Spring 2016. 4 Baron, Sherry, “Protecting Home Health Care Workers: A Challenge to Pandemic Influenza Preparedness Planning,” American Journal of Public Health, 2009. 5 Baxter, Amy, “Where the Home Health Aide Shortage Will Hit Hardest by 2025,” Home Health Care News, May 6, 2018.

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HAS YOUR ENTITY LAUNCHED A SUCCESSFUL PROGRAM? An innovative solution to a common problem? A money-saving idea that kept a program under-budget? Each month, Public Risk features articles from practitioners like you. Share your successes with your colleagues by writing for Public Risk magazine! For more information, or to submit an article, contact Teal Griffey at tgriffey@primacentral.org or 703.253.1262.

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CALENDAR OF EVENTS PRIMA’s calendar of events is current at time of publication. For the most up-to-date schedule, visit www.primacentral.org.

PRIMA ANNUAL CONFERENCES June 14–17, 2020 PRIMA 2020 Annual Conference Nashville, TN Gaylord Opryland June 13–16, 2021 PRIMA 2021 Annual Conference Milwaukee, WI Wisconsin Center June 5–8, 2022 PRIMA 2022 Annual Conference San Antonio, Texas Henry B. Gonzalez Convention Center

PRIMA INSTITUTE October 21–25, 2019 San Diego, CA

ISO 31000 TRAINING November 13–14, 2019 New Orleans, LA

PRIMA WEBINARS July 17 Cultivating a Safety Culture August 21 Avoiding Liability: Early and Regular Communication with Your Legal Team September 25 Steps to Developing a Risk Appetite Framework October 16 Integrating ERM with the Strategic Planning Process

Keep up with what’s happening at PRIMA and connect with your risk management peers! Visit us at www.facebook.com/primacentral.

November 20 Improving Safety in Government by Changing Driving Behavior December 11 What Your Attorney REALLY Wants from Risk Management

JULY 2019 | PUBLIC RISK

PRIMA’S 2019 ANNUAL CONFERENCE

BY TEAL GRIFFEY, MBA

RIMA’S ANNUAL CONFERENCE, or #PRIMAac19 for those in the know, was packed with education, networking, and fun! The Gaylord Palms Resort in Orlando provided a stunning backdrop to this year’s conference, which kicked off on Sunday, June 9.

There were too many extraordinary conference moments to name them all, so please enjoy our #PRIMAac19 top ten list! ➓ Annual Fun Run/Walk It’s always great to get an early start to Wednesday morning by doing some good and getting exercise while doing it! All 2019 Fun Run proceeds went to the Celebration Foundation, which provides various community services such as concert series, food programs, community area building, scholarships, and more. Event sponsored by Euclid Public Sector. ➒ Business Exchange The newly reimagined Business Exchange gave attendees better access to exhibitors and daily raffle drawings. Did everyone get their free PRIMA t-shirt? Attendees enjoyed lunch in the Business Exchange this year, and the new networking pavilion, sponsored by Berkley Public Entity and TRISTAR, featured a live musician, cornhole sets, Connect-4, and more games for attendee enjoyment.

active shooters, and more, the new Crisis Resilience Learning Lab, sponsored by Arthur J. Gallagher, marked another first for PRIMA and further education opportunities for our attendees. ➏ Welcome Reception What a great way to say hello to everyone! Held in the stunning Emerald Bay Plaza of the Gaylord Resort, this year’s welcome reception featured an ice-bar (yes, a literal bar made of ice) serving martini’s while our attendees served up conversation and networking. Sponsored by Munich RE. ➎ Camp Fire Chats This year we offered Camp Fire chats on Sunday, allowing attendees to get a jump start on their education and we’re proud to report they were a well-attended success! We’ll be offering them next year as well, so don’t miss them!

➑ Cram Sessions These 30-minute sessions were delightful as they quickly gave essential information. Whether attendees were learning about new K-9 policies, how to lie with statistics, or election protections, it was the perfect opportunity to gain knowledge in a short space of time.

➍ House of Blues, Signature Social Event If you thought the Welcome Reception was rocking, then PRIMA’s Signature Social Event would have knocked your socks off! We all enjoyed dancing, or at least tapping our feet, to the Mo-town sounds of the band “O-Town Mo-Town,” at the hip House of Blues. Sponsored by Genesis.

➐ Crisis Resilience Learning Lab With education sessions and product demo’s specific to threat assessments, violent assailants,

➌ Keynote Sessions Our keynote speakers were out in force for our Annual Conference! Margaret Spence kicked off

PUBLIC RISK | JULY 2019

the conference Monday morning with a focus on talent retention and leadership development while Tuesday’s keynote put diversity front and center with speaker Mauricio Velasquez. Both sessions sponsored by Travelers. On Wednesday, we ended the conference with a fascinating Keynote Lunch & Learn. Three panelists from disaster and police backgrounds presented on disaster planning, workplace violence, and police de-escalation with a Q&A portion afterward. It was a great way to cap off all the education at the Annual Conference. ➋ PRIMA Awards It’s always a pleasure to reward the hard-working public risk management professionals that do so much for our industry. The prestigious Public Risk Manager of the Year award, sponsored by AON, was awarded to James Curbeam, Risk Manager of the Las Vegas Valley Water District. Other achievement award winners include Prince William County, Broward County, and Minnesota Counties Intergovernmental Trust, while Texas won our Chapter Recognition award. Great job, everyone! ➊ Education Sessions It’s no secret that PRIMA’s Annual Conference is the only nation-wide public risk conference, and with over a decade of annual meetings under our belt, we’ve honed PRIMA’s education sessions to only the best, most timely, and indispensable to the public risk industry. Sessions covered employee benefits, enterprise risk management, pools, risk and benefits financing, insurance, risk control and safety, schools, and more. PRIMA is proud to report that we had another fantastic year of education sessions and speakers. We can’t wait to do this again next year! See you in Nashville!

ENTERPRI

R M

EMENT AG

SK MAN I R E S

Evaluate Educate Elevate Create an Organizational Culture that Proactively Manages Risk ATTEND PRIMA’S 2019 ENTERPRISE RISK MANAGEMENT TRAINING!

NEXT TRAINING November 13–14, 2019 Hyatt Regency New Orleans

Visit primacentral.org/ermtraining to register today!

BIG IDEAS. SMALL SETTING. PRIMA INSTITUTE The Industry’s Premier Risk Management Educational Program • October 21–25, 2019 • San Diego, CA

F E AT U R E D E D U C AT I O N S E S S I O N S : • Cram Session: RFP Do’s and Don’ts • Telematics • Risk Management for Public Fleet Operations • Police Action: Media Portrayal, Law, & Reality • Understanding Loss Control • Mental Illness and Crisis De-escalation

• Impact of Legalized Marijuana in the Workplace • ERM Workshop: Tools You Can Use Today • Newly Elected or Appointed Officials: Understanding the Consequences of Risk • Smart Cities and the Infrastructure Revolution

R E G I S T R AT I O N F O R ENTIRE PROGRAM* Before August 31 Member*

$895

Non-Member

$1,395

*A la carte pricing also available.

Registration Now Open: institute.primacentral.org