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States continue with PTSD and presumption coverage raising concerns over future impact

June 24, 2020 · Optum Workers' Comp and Auto No-fault

Prior to the untimely COVID-19 outbreak, Post-Traumatic Stress Disorder (PTSD) and Presumption coverage for first responders was a popular topic in the 2020 legislative season.  In 2019, numerous states adopted policies to expand and/or create new coverage, or approve treating conditions previously not considered compensable, and that trend spilled over into 2020.

In early 2020, legislative efforts continued to evaluate expansion of coverage to treat PTSD for first responders. PTSD, a mental health condition often triggered by a traumatic event or continued exposure to high levels of stress or traumatic events, is gaining interest in the first responder community. Police officers, firefighters and paramedics are often exposed to high stress level situations or traumatic events during the course of their employment.  

States add PTSD coverage

While many state legislative sessions were cut short due to COVID-19, over 18 states filed or debated legislation to provide PTSD coverage for first responders, with several states passing final legislation making PTSD a covered condition. Minnesota, Virginia, Washington and Wyoming enacted policies to either modify the existing list of covered conditions for first responders or add a new definition or coverage of PTSD as a work-related injury or illness compensable under existing state workers’ comp laws.  In all, 24 states have enacted PTSD policies or policy changes since 2018.

New type of care creates future uncertainties for employers and payers

Although, first responders welcome attention on PTSD and expanded work comp-related coverage, some in state and municipal governments remain concerned about future costs for expanded coverage. While treatment of PTSD is sorely needed, addition of PTSD coverage for this select group of state/municipal employees introduces a new arena of care less focused on physical treatment, the traditional type of workers’ comp care, and more focused on mental health treatment. 

Clinical perspective

PTSD can cause dramatic and devastating effects, and the most beneficial treatment involves a fully-developed and multidisciplinary approach. Medications (most commonly antidepressants) and psychological therapy or counseling, such as cognitive behavioral therapy, are often required. As with other complex medical conditions, it is important to remember the key is providing a synergistic course of treatment that keeps the injured worker at the center of the claim.

Policy makers continue the debate

As states expand or include PTSD as a compensable condition, Optum urges clients who provide coverage for first responders to learn more about the condition, as well as the treatments and various medications which are commonly utilized to treat PTSD.

Optum creates Behavioral Health Supplemental Formulary

To provide exceptional service if a behavioral health condition is the primary injury (i.e., PTSD) or secondary to an injury (i.e., depression), Optum has developed the Behavioral Health Supplemental Formulary, which may be applied for individuals who have experienced an emotionally-traumatic event and/or suffered a behavioral health condition as the result of an injury or accident. The Behavioral Health Supplemental Formulary is effective July 1, 2020 and is a supplement to, not a replacement of, a claimant’s current formulary. It is intended to provide added coverage of select medications, in addition to a claimant’s assigned formulary, for up to six months, or longer if needed.

Follow Optum Workers’ Comp for the latest updates

As many state legislative sessions were cut short in 2020, we expect 2021 to be an active year for PTSD and presumption, specifically presumptions related to COVID-19, as well as other public policy developments. 

Should you have questions on this or any other policy, please contact our Public Policy and Regulatory Affairs team at OWCApolicymatters@optum.com


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