Lance's Corner

WCB Launches Latest Online Enhancements

Apr 22, 2025

Per the notice below, the New York State Workers' Compensation Board (WCB) has launched its latest online enhancements including health care provider prior authorization improvements and filing actions by legal counsel.

Request for Further Action by Legal Counsel               Issue 6

RFA-1LC

The Board implemented the mandatory online eForm for the electronic Request for Further Action by Legal Counsel (Form RFA-1LC) on December 13, 2024.  This eForm represents another milestone in the OnBoard modernization program, which is transforming the Board from a paper-based system into an efficient and transparent electronic system to expeditiously deliver quality services to stakeholders.  The new RFA-1LC eForm has embedded workflow process improvements that have already enabled the Board to schedule requested hearings about 30% faster than just eight months ago.  The RFA-1LC eForm allows the Board to receive requests and route them accurately within seconds so they can receive an appropriate response, resolution, or hearing date.  Prior to the new eForm, it took up to 10 days for the Board to scan the form into eCase, manually review the information, and route the request to appropriate personnel for action.  Moreover, approximately 20% of these requests were returned for being incomplete, something that cannot happen with the new eForm.  The Board expects to gain even more efficiencies as attorneys become more familiar with the eForm submission requirements and we continue to evaluate potential enhancements to the RFA-1LC eForm to further improve Board processing and response.

Actions outside of the eForm’s scope

The Board’s website contains information to help guide attorneys with the eForm submission process (see the RFA webpage and FAQs).  Please note that an RFA-1LC eForm is not required on requests that already result in an automated Board action, such as Stipulations and Section 32 waiver agreements.  If timely action has not been taken on these documents that are already in the case file, follow up by submitting an online Claims inquiry.  For issues that do not result in an automated Board action and the request reason is not on the RFA-1LC eForm, attorney correspondence may be submitted.  For example, correspondence may be submitted to request a decision to memorialize findings not in dispute.

When to use the eForm for PARs

The Board has noticed frequent incorrect RFA-1LC eForm submissions requesting review of prior authorization requests (PARs).  Only certain PAR denials are eligible to be submitted for review via the RFA-1LC eForm, and these will be displayed for selection on the eForm.  Please note the following PAR denials for which the RFA-1LC eForm can be submitted:
  • Denial for administrative or no jurisdiction reasons – all PAR types except Medication.
  • Denial for IME scheduling related reasons – only MTG Variance, MTG Special Services, and Non-MTG Over $1,000 PARs.
  • Partial grant for medical reasons – only MTG Variance, MTG Special Services, and Non-MTG Over $1,000 PARs.
  • Denial for medical reasons – only MTG Variance and MTG Special Services PARs.  Please note examiner action is automatically triggered on Non-MTG Over $1,000 PARs denied for medical reasons.  An RFA-1LC eForm is not required to request review.
  • Denial for Level 3/MDO response – only Medication, Durable Medical Equipment, MTG Variance, and MTG Special Services PARs.
Please note that health care providers can request a Level 3 Medical Director’s Office (MDO) review for specific PAR types through OnBoard: Limited Release.  If an RFA-1LC eForm is filed before an MDO decision is issued, the denial will be resolved through Adjudication and an MDO decision will not be issued.

Questions?

If you have any questions regarding the guidance in this issue of Efficiency Enhancements, please write to: outreach@wcb.ny.gov.

USDOL Issues Comprehensive Employer Guidance on Long COVID

The United States Department of Labor (USDOL) has issued a comprehensive set of resources that can be accessed below for employers on dealing with Long COVID.

Supporting Employees with Long COVID: A Guide for Employers

The “Supporting Employees with Long COVID” guide from the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) and Job Accommodation Network (JAN) addresses the basics of Long COVID, including its intersection with mental health, and common workplace supports for different symptoms.  It also explores employers’ responsibilities to provide reasonable accommodations and answers frequently asked questions about Long COVID and employment, including inquiries related to telework and leave.

Download the guide

Accommodation and Compliance: Long COVID

The Long COVID Accommodation and Compliance webpage from the USDOL-funded Job Accommodation Network (JAN) helps employers and employees understand strategies for supporting workers with Long COVID.  Topics include Long COVID in the context of disability under the Americans with Disabilities Act (ADA), specific accommodation ideas based on limitations or work-related functions, common situations and solutions, and questions to consider when identifying effective accommodations for employees with Long COVID.  Find this and other Long COVID resources from JAN, below:

Long COVID, Disability and Underserved Communities: Recommendations for Employers

The research-to-practice brief “Long COVID, Disability and Underserved Communities” synthesizes an extensive review of documents, literature and data sources, conducted by the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) on the impact of Long COVID on employment, with a focus on demographic differences.  It also outlines recommended actions organizations can take to create a supportive and inclusive workplace culture for people with Long COVID, especially those with disabilities who belong to other historically underserved groups.

Read the brief

Long COVID and Disability Accommodations in the Workplace

The policy brief “Long COVID and Disability Accommodations in the Workplace” explores Long COVID’s impact on the workforce and provides examples of policy actions different states are taking to help affected people remain at work or return when ready.  It was developed by the National Conference of State Legislatures (NCSL) as part of its involvement in USDOL’s State Exchange on Employment and Disability (SEED) initiative.

Download the policy brief

Understanding and Addressing the Workplace Challenges Related to Long COVID

The report “Understanding and Addressing the Workplace Challenges Related to Long COVID” summarizes key themes and takeaways from an ePolicyWorks national online dialogue through which members of the public were invited to share their experiences and insights regarding workplace challenges posed by Long COVID.  The dialogue took place during summer 2022 and was hosted by USDOL and its agencies in collaboration with the Centers for Disease Control and Prevention and the U.S. Surgeon General.

Download the report

Working with Long COVID

The USDOL-published “Working with Long COVID” fact sheet shares strategies for supporting workers with Long COVID, including accommodations for common symptoms and resources for further guidance and assistance with specific situations.

Download the fact sheet

COVID-19: Long-Term Symptoms

This USDOL motion graphic informs workers with Long COVID that they may be entitled to temporary or long-term supports to help them stay on the job or return to work when ready, and shares where they can find related assistance.

Watch the motion graphic

A Personal Story of Long COVID and Disability Disclosure

In the podcast “A Personal Story of Long COVID and Disability Disclosure,” Pam Bingham, senior program manager for Intuit’s Diversity, Equity and Inclusion in Tech team, shares her personal experience of navigating Long COVID symptoms at work.  The segment was produced by the USDOL-funded Partnership on Employment and Accessible Technology (PEAT) as part of its ongoing “Future of Work” podcast series.

Listen to the podcast

HHS OIG Issues Annual Report on State MFCUs

Per the notice below, the Office of the Inspector General (OIG) of the United States Department of Health and Human Services (HHS) has issued its annual report on the performance of state Medicaid Fraud Control Units (MFCUs).

Medicaid Fraud Control Units Fiscal Year 2023 Annual Report (OEI-09-24-00200) 

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. OIG is the Federal agency that oversees and annually approves federal funding for MFCUs through a recertification process. This new report analyzed the statistical data on annual case outcomes—such as convictions, civil settlements and judgments, and recoveries—that the 53 MFCUs submitted for Fiscal Year 2023.  New York data is as follows:

Outcomes

  • Investigations1 - 556
  • Indicted/Charged - 9
  • Convictions - 8
  • Civil Settlements/Judgments - 28
  • Recoveries2 - $73,204,518

Resources

  • MFCU Expenditures3 - $55,964,293
  • Staff on Board4 - 257

1Investigations are defined as the total number of open investigations at the end of the fiscal year.

2Recoveries are defined as the amount of money that defendants are required to pay as a result of a settlement, judgment, or prefiling settlement in criminal and civil cases and may not reflect actual collections.  Recoveries may involve cases that include participation by other Federal and State agencies.

3MFCU and Medicaid Expenditures include both State and Federal expenditures.

4Staff on Board is defined as the total number of staff employed by the Unit at the end of the fiscal year.

Read the Full Report

View the Statistical Chart

Engage with the Interactive Map

GAO Issues Report on Medicaid Managed Care Service Denials and Appeal Outcomes

The United States Government Accountability Office (GAO) has issued a report on federal use of state data on Medicaid managed care service denials and appeal outcomes.  GAO found that federal oversight is limited because it doesn't require states to report on Medicaid managed care service denials or appeal outcomes and there has not been much progress on plans to analyze and make the data publicly available.  To read the GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the first link below.  To read GAO highlights of the report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the second link below.
https://www.gao.gov/assets/d24106627.pdf  (GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes)
https://www.gao.gov/assets/d24106627_high.pdf  (GAO highlights on federal use of state data on Medicaid managed care service denials and appeal outcomes)

CMS Issues Latest Medicare Regulatory Activities Update

The Centers for Medicare and Medicaid Services (CMS) has issued its latest update on its regulatory activities in the Medicare program.  While dentistry is only minimally connected to the Medicare program, Medicare drives the majority of health care policies and insurance reimbursement policies throughout the country.  Therefore, it always pays to keep a close eye on what CMS is doing in Medicare.  To read the latest CMS update on its regulatory activities in Medicare, use the link below.
https://www.cms.gov/training-education/medicare-learning-network/newsletter/2024-03-14-mlnc