RELEASE – TRANSMISSION OF REVISED MATERIAL TO BE INCORPORATED INTO THE FEDERAL (EEOICPA) PROCEDURE MANUAL: CHAPTER 2-0100 INTRODUCTION, CHAPTER 2-0200 RESOURCE CENTERS, CHAPTER 2-0300 INITIAL DEVELOPMENT, CHAPTER 2-0500 COVERED EMPLOYMENT, CHAPTER 2-0600 SEC STATUS, CHAPTER 2-0700 TOXIC SUBSTANCE EXPOSURE, CHAPTER 2-0800 WEIGHING MEDICAL EVIDENCE, CHAPTER 2-0900 CANCER AND RADIATION, CHAPTER 2-1500 CONSEQUENTIAL ILNNESSES, CHAPTER 3-0100 INTRODUCTION, CHAPTER 3-0200 MEDICAL BILL PROCESS, AND CHAPTER 3-0300 ANCILLARY MEDICAL SERVICES.

EEOICPA TRANSMITTAL NO.10-07                January, 2010

EXPLANATION OF MATERIAL TRANSMITTED:

These twelve chapters are transmitted for placement in the new Unified Procedure Manual(PM) binder.  These chapters consist of the consolidation of updated information and guidance as it pertains to the Program’s administration of Parts B and E of the EEOICPA.  This is the final transmittal accompanying the release of the Unified Procedure Manual.  All prior released chapters should now be associated with this publication in the Unified binder to serve as the official DEEOIC Procedure Manual, and all older Part B and E versions should be discarded.

New chapter 2-0100 replaces Part E chapter E-100.

New chapter 2-0200 replaces Part E chapter E-400.

• Chapter 2-0200 establishes guidelines for Resource Center use of ECMS, and provides guidance for Resource Center outreach to solicit impairment claims.

New chapter 2-0300 replaces Part B chapter 2-0100 and Part E chapter E-300.

• Chapter 2-0300 discusses the role of the Resource Centers in gathering claimant information for initial development, and establishes procedures for developing the claims of terminally ill claimants.

New chapter 2-0500 replaces Part B chapter 2-0400 and Part E chapter E-400.

• Chapter 2-0500 consolidates previous guidance for obtaining employment verification from four separate lists into a unified resource for employment verification known as the Employment Process Overview Document.  Chapter 2-0500 also incorporates procedures from the following:

• Bulletin 02-18: Use of ORISE database.

• Bulletin 03-21: Coverage of Uniformed Members of the military.

• Bulletin 03-26: Government Agency Employment.

• Bulletin 03-27: Establishing covered subcontractor employment.

• Bulletin 03-28: EEOICPA coverage of the citizens of the Marshall Islands.

• Bulletin 06-09: Center to Protect Workers' Rights (CPWR) and its predecessor of the same name Bulletin number 04-09.

• Bulletin 09-02: Subcontractor database for verification of contractual relationship at covered facilities.

• Bulletin 09-10: Processing Social Security Administration Form SSA-581.

New chapter 2-0600 replaces parts of Part B chapter 2-0500 and 2-0600.

• Chapter 2-0600 incorporates existing procedures for handling SEC claims. This includes a listing of the specified cancers, instructions on calculating 250 work days, and roles of the claims staff including Branch of Policy, Regulations and Procedures in handling SEC claims.

New chapter 2-0700 replaces parts of Part E chapter E-400.

• Chapter 2-0700 includes information about the Site Exposure Matrices (SEM), and qualifies that under no circumstances is a claim for benefits denied solely due to a lack of information contained in SEM.

New chapter 2-0800 replaces Part B chapter 2-0300 and parts of Part E chapter E-500.

• Chapter 2-0800 has been revised to include an exhibit of a Statement of Accepted Facts (SOAF) and includes the general requirements for a proper Statement of Accepted Facts.  The Chapter also instructs claim staff to use ACS web portal to select a second opinion physician.

• Chapter 2-0800 includes revised ECMS coding to ensure prompt payment of medical bills from District Medical Consultants (DMC), second and referee physicians. This chapter includes an exhibit of approved ICD-9 codes and corresponding Procedure Codes, and has revised the Medical Consultant Referral Form to include more medical specialties.

New chapter 2-0900 replaces Part B chapter 2-0600.

· The revision of PM Chapter 2-0900 includes guidance on establishing causation for cancer under Part E.

• The chapter also explains how a case “pended” or “pulled” by NIOSH during the dose reconstruction affects the dose reconstruction process and the procedures to resolve a case in “pulled” status.  

• Chapter 2-0900 includes detailed explanations of when rework of dose reconstruction is required and provides specific examples.

• Chapter 2-0900 includes procedures for requesting a rework of dose reconstruction.

New chapter 2-1500 replaces Part B chapter 2-1000.

• Chapter 2-1500 clarifies the circumstances by which an illness will become compensable as a consequential illness of an accepted condition.

New chapter 3-0100 contains entirely new material.

New chapter 3-0200 replaces parts of Part B chapter 3-0100.

• Chapter 3-0200 consolidates guidance on payment for non-standard medical treatments and explains the procedure for approving organ transplants, and experimental medical procedures, among others.

New chapter 3-0300 replaces parts of Part B chapter 3-0100.

• Chapter 3-0300 incorporates guidance relating to approval of in-home health care services for claimants requiring such services.

Rachel P. Leiton 

Director, Division of

Energy Employees Occupational Illness Compensation

FILING INSTRUCTIONS:

File this transmittal behind EEOICPA Transmittal 10-06 in the front of the new Unified Federal (EEOICPA) Procedure Manual.

Distribution:  List No. 3:  All DEEOIC Employees

List No. 6:  Regional Directors, District Directors, Assistant District Directors, National Office Staff, and Resource Center Staff.