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