Office of Workers’ Compensation Programs Division of ... · 15/02/2018 · Office of Workers’...
Transcript of Office of Workers’ Compensation Programs Division of ... · 15/02/2018 · Office of Workers’...
Office of Workers’ Compensation Programs
Division of Federal Employees’ Compensation Interagency
MeetingFebruary 15, 2018
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
Antonio A. Rios
Director,Division of Federal
Employees’ Compensation
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
Case Create Trends
100,000
110,000
120,000
130,000
140,000
150,000
160,000
170,000
180,000
190,000
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016
Cases Created
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
Periodic Roll Trends
4000042000440004600048000500005200054000560005800060000
Number ofCases Paid onthe Periodic Roll
PRM Units Implemented
New Policies • Nurse@ 2 weeks of TTD • 2nd Op Exams @ 12 months of TTD
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
Chargeback Trends 2007 - 2017
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Billi
ons
MedicalCompensationTotal
Drop in Comp CostsCorresponds with Drop in PR
Universe
2015 Rise in Compounds 2016-2017 Drop in Compounds
Costs
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
We’re Listening…New ECOMP Document Upload Categories such as:
Job Offer Rejections or Non-Responses Case Copy/Document Request Employer’s Claim Challenge Compensation Question
Averages Inquiries per Month Increased by 85%
Average Response Time Decreased by 30%
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
0
1000
2000
3000
4000
5000
6000
7000
8000
FY2017FY2018 thru Jan 31
Average Inquiries per Month
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
0
5
10
15
20
25
FY2017FY2018 thru Jan 31
Average Days to Respond
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
• Pharmacy Benefit Manager (PBM) Pause any PBM contract renewals/awards Consult with DOL OWCP before doing so
• End to End Case Management• Opioid Policy Implementation • Expanding Program Integrity• Collaborative Case Management o Disability Management Interface (DMI)
Continuing to Improve Efficiencies
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
Disability Management Interface (DMI)
No RTW after Job Found Suitable
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
Disability Management Interface (DMI)
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
Disability Management Interface (DMI)
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
Disability Management Interface (DMI)
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
Disability Management Interface (DMI)
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
Disability Management Interface (DMI)
Letter shell is populated with text
entered in DMI
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
Disability Management Interface (DMI)
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
Disability Management Interface (DMI)To use DMI, a Federal Agency must:
– Have a completed ECOMP MOU on file with DOL and demonstrate a current forms filing status in the system
– Contact DOL’s Branch of Technical Assistance to request access
– Review and agree to the DMI Rules of Behavior
– Complete DMI training
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
Julia A. Tritz
Deputy Director,Division of Federal
Employees’ Compensation
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
• Opioid Policy Development • CE Identity Update• End to End District Office
Changes
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
Jennifer Valdivieso
Deputy Director,Division of Federal
Employees’ Compensation
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
• Four Units: Jacksonville, Seattle, New Orleans, Chicago
• Medical Benefit Examiner vs.Responsible Claims Examiner
• Cases Assigned by SSN
Prescription Management Units
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
• Identification of Risky Opioid Providers/Prescriberso High Volumeo High Morphine Equivalent
Dose (MED) • Predictive Analytics and Risk Metrics
Program Integrity
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
FECA CIRCULAR 18-05, issued February 14, 2018
Payment will be denied if the items in the kit/medication:• can typically be obtained separately and/or at a lower cost,• there is a reasonable alternative or substitute, or • the primary use is for a condition not normally not caused by a
workers’ compensation injury.
Initial denial list has 49 different NDCs
Medication Kits and Combination Medications
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
FECA CIRCULAR NO. 17-03: Office of Inspector General (OIG) Investigations Pertaining to Federal Employees’ Compensation Act (FECA) Claimant and Medical Provider Fraud
FECA BULLETIN NO. 17–04: Investigations related to Federal Employees’ Compensation Act (FECA) Claimant Fraud
FECA BULLETIN NO. 17-05: Investigations related to Federal Employees’ Compensation Act (FECA) Medical Fraud
Available at https://www.dol.gov/owcp/dfec/
Fraud Protocols
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
Tara N. Jones
Chief,Branch of Technical
Assistance
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
Where do I sign up?
Disability Management Interface (DMI)
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
• Contact DFEC’s Branch of Technical Assistance (BTA)
• Complete Training• In person/WebEx, facilitated by BTA• Agency must request cases through ARI in advance• During training will work on actual claims
• Agree to Rules of Behavior
Disability Management Interface (DMI) – Gaining Access
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
• Non-negotiables: • Complete and accurate information• No duplicates• Upload requested information• System abuse
Disability Management Interface (DMI) – Rules of Behavior
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
• Requesting suitability on temporary job offers:• See 20 CFR §10.500, 5 U.S.C. 8106(c)(2)
• Requesting medical at unreasonable intervals:• See 20 CFR §10.501
• Failing to provide useful data in requested fields of the application
Disability Management Interface (DMI) – Non-Compliance Examples
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
• Review and Monitor submissions• Non Compliance will result in:
• Suspension and/or Termination• Individual or Departmental
Disability Management Interface (DMI) – Auditing
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
• WEEDS Page Limit Increased to 7 (from 6) • PR Schedule for 2018 Posted Online• CQS:
• 3,196 accounts since September 2017• 1% reported registration issues
• Forms: CA-7/16/17/20 and OWCP5a/b/c
General Updates
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
• Register for Listserv• Notify Us of Staffing Changes That Affect
User Accounts• CHEP 2018 Announcement
General Updates
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
Julia K. Hearthway
Director,Office of Workers’
Compensation Programs
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
FECA Legislative Reform
• Included in President’s FY2019 Budget• Subject to Interagency Clearance
U.S. Department of LaborOffice of Workers’ Compensation Programs
Division of Federal Employees’ Compensation
President’s 2019 Budget and FECA ReformFECA Provisions
Simplifying Benefits Single rate of compensation*
Retirement conversion benefit*Improving Program IntegrityPrevent retroactive election of OPM and FECA benefits
Suspend payments to indicted medical providersModernizing Program Administration Waiting periodFuneral benefitDisfigurementTotal Proposed Cost or Savings $885M
*Applicable to new injuries post-enactment