Transcription
Office of Workers’Compensation ProgramsDivision of Federal Employees’Compensation InteragencyMeetingFebruary 15, 2018
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationAntonio A. RiosDirector,Division of FederalEmployees’ Compensation
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ Compensation190,000180,000170,000Case Create TrendsCases 00,0001990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationPeriodic Roll Trends60000 PRM 0440004200040000New Policies Nurse@ 2 weeks of TTD2nd Op Exams @ 12 months of TTDNumber ofCases Paid onthe Periodic Roll
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationBillionsChargeback Trends 2007 - 20173.503.00Drop in Comp CostsCorresponds with Drop in 0.500.002015 Rise in Compounds2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 20172016-2017 Dropin CompoundsCosts
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationWe’re Listening New ECOMP Document Upload Categories such as: Job Offer Rejections or Non-ResponsesCase Copy/Document RequestEmployer’s Claim ChallengeCompensation QuestionAverages Inquiries perMonth Increased by 85%Average Response TimeDecreased by 30%
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationAverage Inquiries per Month800070006000500040003000200010000FY2017FY2018 thru Jan 31
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationAverage Days to Respond2520151050FY2017FY2018 thru Jan 31
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationContinuing to Improve Efficiencies Pharmacy Benefit Manager (PBM) Pause any PBM contract renewals/awards Consult with DOL OWCP before doing so End to End Case ManagementOpioid Policy ImplementationExpanding Program IntegrityCollaborative Case Managemento Disability Management Interface (DMI)
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationDisability Management Interface (DMI)No RTW after Job Found Suitable
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationDisability Management Interface (DMI)
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationDisability Management Interface (DMI)
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationDisability Management Interface (DMI)
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationDisability Management Interface (DMI)
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationDisability Management Interface (DMI)Letter shell ispopulated with textentered in DMI
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationDisability Management Interface (DMI)
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationDisability Management Interface (DMI)To use DMI, a Federal Agency must:– Have a completed ECOMP MOU on file withDOL and demonstrate a current forms filingstatus in the system– Contact DOL’s Branch of Technical Assistanceto request access– Review and agree to the DMI Rules ofBehavior– Complete DMI training
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationJulia A. TritzDeputy Director,Division of FederalEmployees’ Compensation
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ Compensation Opioid Policy Development CE Identity Update End to End District OfficeChanges
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationJennifer ValdiviesoDeputy Director,Division of FederalEmployees’ Compensation
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationPrescription Management Units Four Units: Jacksonville, Seattle,New Orleans, Chicago Medical Benefit Examiner vs.Responsible Claims Examiner Cases Assigned by SSN
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationProgram Integrity Identification of Risky OpioidProviders/Prescriberso High Volumeo High Morphine EquivalentDose (MED) Predictive Analytics and Risk Metrics
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ Compensation
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ Compensation
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationMedication Kits andCombination MedicationsFECA CIRCULAR 18-05, issued February 14, 2018Payment 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 aworkers’ compensation injury.Initial denial list has 49 different NDCs
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ Compensation
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationFraud ProtocolsFECA CIRCULAR NO. 17-03: Office of Inspector General (OIG)Investigations Pertaining to Federal Employees’ CompensationAct (FECA) Claimant and Medical Provider FraudFECA BULLETIN NO. 17–04: Investigations related to FederalEmployees’ Compensation Act (FECA) Claimant FraudFECA BULLETIN NO. 17-05: Investigations related to FederalEmployees’ Compensation Act (FECA) Medical FraudAvailable at https://www.dol.gov/owcp/dfec/
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationTara N. JonesChief,Branch of TechnicalAssistance
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationDisability Management Interface(DMI)Where do I sign up?
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationDisability Management Interface(DMI) – Gaining Access Contact DFEC’s Branch of Technical Assistance(BTA)Complete Training In person/WebEx, facilitated by BTAAgency must request cases through ARI in advanceDuring training will work on actual claimsAgree to Rules of Behavior
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationDisability Management Interface(DMI) – Rules of Behavior Non-negotiables: Complete and accurate information No duplicates Upload requested information System abuse
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationDisability Management Interface(DMI) – Non-Compliance Examples 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 requestedfields of the application
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationDisability Management Interface(DMI) – Auditing Review and Monitor submissions Non Compliance will result in: Suspension and/or Termination Individual or Departmental
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationGeneral Updates WEEDS Page Limit Increased to 7 (from 6) PR Schedule for 2018 Posted Online CQS: 3,196 accounts since September 20171% reported registration issues Forms: CA-7/16/17/20 and OWCP5a/b/c
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationGeneral Updates Register for Listserv Notify Us of Staffing Changes That AffectUser Accounts CHEP 2018 Announcement
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationJulia K. HearthwayDirector,Office of Workers’Compensation Programs
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationFECA Legislative Reform Included in President’s FY2019 Budget Subject to Interagency Clearance
U.S. Department of LaborOffice of Workers’ Compensation ProgramsDivision of Federal Employees’ CompensationPresident’s 2019 Budget and FECA ReformSimplifying BenefitsFECA ProvisionsSingle rate of compensation*Retirement conversion benefit*Improving Program IntegrityPrevent retroactive election of OPM and FECA benefitsSuspend payments to indicted medical providersModernizing Program AdministrationWaiting periodFuneral benefitDisfigurementTotal Proposed Cost or Savings 885M*Applicable to new injuries post-enactment
DOL and demonstrate a current forms filing status in the system - Contact DOL's Branch of Technical Assistance to request access . CQS: 3,196 accounts since September 2017 1% reported registration issues Forms: CA-7/16/17/20 and OWCP5a/b/c General Updates.
