On January 4, 2017, as part of the wave of federal regulations filed late in the administration, the US DOL Office of Workers Compensation Programs released substantive rules for comment with respect to the payment of Black Lung medical benefits. The regulations generally set a new national method of determining approved medical reimbursement amounts. The changes in determination of medical reimbursement are based on Medicare fee schedules instead of internally derived reimbursement rates, resulting in significant changes for providers and payers on a state by state basis. The regulation release may be accessed athttps://www.gpo.gov/fdsys/pkg/FR-2017-01-04/pdf/2016-31382.pdf
Proposes National Methodology for Medical and Prescription Drug Payment and Reimbursement
Specifically, the Department proposes to replace current § 725.706(c) with proposed §§ 725.707–725.717, which adopt payment formulas and procedures to determine the rates at which various medical services and treatments will be paid by the Trust Fund, as well as the rates at which OWCP will seek reimbursement from operators for medical benefits paid on an interim basis used by the other three workers’ compensation programs that OWCP administers. Such payment formulas were first developed and adopted for use in claims under the Federal Employees’ Compensation Act, 5 U.S.C. 8101 et seq., in 1986. See 51 FR 8276– 82 (Mar. 10, 1986). Subsequently, similar formulas were adopted for claims under the Longshore Act in 1995 and for claims under the Energy Employees Occupational Illness Compensation Program Act, 42 U.S.C. 7384 et seq., in 2001. See 60 FR 51347– 48 (Oct. 2, 1995); 66 FR 28957–59, 79– 80 (May 25, 2001).
The payment formulas the Department proposes to adopt for claims under the BLBA (and those it already utilizes under the other OWCP programs) are derived from the payment formulas that CMS uses to determine payments for medical services and treatments under the Medicare program.
The proposed formulas encompass locality-based payment rates for physician services and medical equipment (see proposed § 725.708), as well as for outpatient and inpatient medical services (see proposed §§ 725.710 and 725.711, respectively).
The Department also proposes, consistent with existing practice and similar to the other OWCP programs, to adopt a single national formula for the payment of prescription-drug costs. See proposed § 725.709.
Finally, the Department proposes to adopt specific procedures for providers to enroll with OWCP for authorization to submit medical bills for payment, and for miners to request reimbursement for covered medical expenses and transportation costs. See proposed §§ 725.714–725.717.
Written comments must be received by March 6, 2017, identified by RIN number 1240–AA11, by any of the following methods.
- Federal eRulemaking Portal: http://www.regulations.gov. Follow the instructions on the Web site for submitting comments.
- Facsimile: (202) 693–1395 (this is not a toll-free number). Only comments of ten or fewer pages, including a FAX cover sheet and attachments, if any, will be accepted by FAX.
- Regular Mail or Hand Delivery/ Courier: Submit comments on paper to the Division of Coal Mine Workers’ Compensation, Office of Workers’ Compensation Programs, U.S. Department of Labor, Suite C–3520, 200 Constitution Avenue NW., Washington, DC 20210.
The Department’s receipt of U.S. mail may be significantly delayed due to security procedures. You must take this into consideration when preparing to meet the deadline for submitting comments.
Instructions: All submissions received must include the agency name and the Regulatory Information Number (RIN) for this rulemaking. All comments received will be posted without change to http://www.regulations.gov, including any personal information provided.
Docket: For access to the docket to read background documents or comments received, go to http:// www.regulations.gov.