Staying on top of PTSD legislation: How Optum helps

Recently, PTSD coverage has been a central topic for legislators seeking to expand workers’ compensation laws, particularly to cover first responders and other select groups of mostly municipal employees. Most states have adopted some form of PTSD-related coverage policy, and almost every state has at least formally considered legislation addressing workers’ compensation coverage for PTSD.

As PTSD coverage continues to expand — not only to new states, but also to new employment types and other mental health conditions — the focus of new laws or proposed legislation in some states has expanded beyond on-the-scene first responders to 911 dispatchers, hospital workers, teachers, and other types of mostly municipal employees.

Many states last year considered new or expanded PTSD and mental health coverage in workers’ compensation, with some enacting new legislation in the end.

One of the more dramatic examples of expansion last year came with Connecticut Senate Bill 913, which extended coverage for PTSD to all employees.

This year, Oklahoma is another notable example. An Oklahoma bill expanding mental health coverage for first responders was signed on May 8. The bill, Senate Bill 1457, exempts certain first responders from the requirement in the state workers’ compensation law that a mental injury or illness is not compensable unless caused by a physical injury (this exemption previously only applied to violent crime victims). This will open up coverage to “mental-mental” claims for eligible first responders. SB 1457 also states that the employer must provide reasonable and necessary medical treatment (subject to the workers’ comp medical fee schedule) for no more than one year, and the employer would not be responsible for prescription medications in excess of $10,000.

The Minnesota Department of Labor and Industry (DLI) is also currently in the process of conducting a study to identify systemic or regulatory changes to improve the experience and outcomes of employees with work-related PTSD. This study was required by legislation signed in 2023. The DLI hosted two virtual informational meetings in April of this year to update stakeholders about the scope and status of the study.

Included within the thousands of pieces of legislation the Optum PPRA team has been tracking this year are several bills seeking to expand coverage for PTSD. While some have failed, we’re currently tracking around a dozen such bills still pending in 2024.

With the expansion of PTSD coverage, there is increased debate among stakeholders regarding whether this is a positive or negative trend, and the downstream consequences of expansion. The expansion of PTSD and mental health coverage in workers’ compensation is also a concern for regulators charged with implementing statutes enacted by state legislators.  One recent example was the Florida Division of Workers’ Compensation rule-making efforts to greater define “injuries that qualify as grievous bodily harm of a nature that shocks the conscience” after the passage of Senate Bill 376 in 2018.

The Optum Public Policy & Regulatory Affairs team continually reviews the public policy landscape. As we track regulations and legislation in each state, we provide early notification and education regarding new developments and changes to support our clients and stakeholders in remaining informed, prepared, and compliant.