2020 FECA Circulars Archive

Attention: This circular has been superseded and is inactive.

SUBJECT: Pharmacy Kit Maximum Quantity Restrictions

PURPOSE: To provide notification of an updated DFEC policy with respect to payment of maximum quantities for certain prescription kits

REFERENCES: 5 U.S.C. § 8103; 5 U.S.C. § 8124 (a)(2); 5 U.S.C. § 8128; 5 U.S.C. § 8145; 5 U.S.C § 8149; 20 C.F.R. 10.800-826; FECA Procedure Manual 3-400-3-a. FECA Bulletins 17-01 and 17-03; FECA Circulars 18-05.

BACKGROUND:

Under the Federal Employees' Compensation Act (FECA), the Department of Labor's (DOL) Office of Workers' Compensation Programs (OWCP) may provide to an employee injured while in the performance of duty, the services, appliances, and supplies prescribed or recommended by a qualified physician, which OWCP considers "likely to cure, give relief, reduce the degree or the period of disability, or aid in lessening the amount of the monthly compensation." See 5 U.S.C. 8103. The Act and its implementing regulations at 20 C.F.R. Part 10, Subpart I (20 C.F.R. 10.800) authorize OWCP's FECA program to set limitations and require pre-authorization for medical services and supplies where deemed necessary, including the issuance of an exception-based policy.

FECA Circular 18-05 (issued February 14, 2018) implemented an exception-based policy pertaining to convenience kits and certain other combination medications. Under this Circular, authorization and payment for specified National Drug Codes (NDCs) will automatically deny when DFEC has determined that the items in the kit/medication can typically be obtained separately and/or at a lower cost and there is a reasonable commercially available alternative or substitute; or the primary use is for a condition not normally caused by a workers' compensation injury.

DFEC has identified another trend in the dispensing of prescription kits in which providers are billing an incorrect and inflated number of "units" for pharmacy claims resulting in overpayments. According to the National Council for Prescription Drug Programs (NCPDP) Billing Unit Standard, kits are designed with the intent to be dispensed and billed as a unit of "each" versus a "gram" or "milliliter". If the recommended maximum unit quantity to be dispensed for a particular kit is two, but the pharmacy bills for the total number of actual grams in the kit, such as 60 grams, this would result in an overpayment.

In accordance with the discretion granted to DOL and delegated to OWCP, DFEC is instituting a new exception-based policy pertaining to payment of certain drugs that fit the description above.

ACTION:

1. DFEC will continue to review all pharmacy kits and medications for inclusion into the NDC deny list (FECA Bulletin 18-05). There is no change to our current NDC denial list protocols.
2. DFEC will utilize a drug information compendia to identify NDCs that are considered to be kits.
3. A unit quantity restriction will be implemented for any kit not suitable for the NDC deny list. This will be done retroactively for kits not yet approved for the NDC list.
4. DFEC will apply maximum dosage restrictions based on recommendations from the U.S. Food and Drug Administration, the medical literature, or from the best available evidence for all kits determined to be payable.

Please note that DFEC will continuously and regularly review and evaluate Kit NDCs in accordance with the above policies and set the corresponding NDC to deny or be subject to maximum quantity restrictions.

Exception Basis Note: DFEC policy on considering exceptions for maximum quantities of DFEC specified Kit NDCs will follow that set forth in FECA Bulletin 17-03 and FECA Circular 18-05. Allowance for more than the DFEC maximum quantity can only be approved on a District Director exception basis when a claimant's treating physician acquires pre-authorization by submitting rationalized medical evidence explaining why the authorization of that quantity is medically necessary.

ANTONIO RIOS
Director for Federal Employees' Compensation

Distribution: All DFEC Staff, OWCP Branch of Medical Standards and Rehabilitation

Back to Top of FECA Circular No. 20-01

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Attention: This circular has been superseded and is inactive.

SUBJECT: Current Interest Rates for Prompt Payment Bills and Debt Collection

The interest rate to be assessed for the prompt payment bills is 2.125 percent for the period of January 1, 2020 through June 30, 2020. This new rate has been updated in the Central Bill Payment system tables. The rate was changed from 2.625 percent because there was a difference in the Current Value of Funds (CVF) interest rate of more than two percent.

The rate for assessing interest charges on debts due the government remains unchanged again this year. The interest rate for assessing interest charges on debts due the government is 2.0 percent for the period of January 1, 2020 through December 31, 2020. The rate has been updated in the iFECS system tables.

Attached to this Circular is an updated listing of both the Prompt Payment and Debt Management interest rates from January 1, 1985 through the current date.

ANTONIO RIOS
Director for
Federal Employees' Compensation

Attachment: Prompt Payment Interest Rates
Debt Management Interest Rates

Distribution: All DFEC Staff

ATTACHMENT TO FECA CIRCULAR NO. 20-03

ATTACHMENT TO FECA CIRCULAR NO. 20-03

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Attention: This circular has been superseded and is inactive.

Subject: Dual Benefits - FERS Cost of Living Adjustments

Background: Effective December 1, 2019, benefits issued by the Social Security Administration (SSA) will be increased by 1.6%. This requires the amount of the Federal Employees' Retirement System (FERS) Dual Benefits deduction to be increased by the same amount, to ensure the dollar-for-dollar offset remains current.p>

Applicability: Appropriate National Office and District Office personnel.

Action: This adjustment will be made from the National Office for all cases that were correctly entered into the integrated Federal Compensation System (iFECS). The adjustment will be effective with the periodic roll cycle beginning December 08, 2019.

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff

Back to Top of FECA Circular No. 20-04

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Attention: This circular has been superseded and is inactive.

Subject: Bill Pay - Revision in the Reimbursement Rates Payable for the Use of Privately Owned Automobiles Necessary to Secure Medical Examination and Treatment.

Background: Effective January 1, 2020, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile DECREASED to 57.5 cents per mile by GSA. No restriction is made as to the number of miles that can be traveled. As in the past, determination has been made to apply the applicable rate to disabled FECA beneficiaries traveling to secure necessary medical examination and treatment.

Applicability: Appropriate National Office and District Office personnel.

Reference: Chapter 5-0204, Principles of Bill Adjudication, Part 8, Travel, Federal (FECA) Procedure Manual and 5 USC 8103.

Action: The Central Bill Pay (CBP) facility has updated their system to reflect the new rates. Since there is no action required at the District Office level, the rates are being provided for informational purposes only.

Disposition: This Bulletin should be retained in Chapter 5-0204, Principles of Bill Adjudication, Federal (FECA) Procedure Manual.

Antonio Rios
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff

Back to Top of FECA Circular No. 20-05

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Attention: This circular has been superseded and is inactive.

SUBJECT: Current Interest Rates for Prompt Payment Bills and Debt Collection

The interest rate to be assessed for the prompt payment bills is 1.125 percent for the period of July 1, 2020 through December 31, 2020. This new rate has been updated in the Central Bill Payment system tables. The rate was changed from 2.125 percent because there was a difference in the Current Value of Funds (CVF) interest rate of more than two percent.

The rate for assessing interest charges on debts due the government was changed this year effective January 1, 2020. The interest rate for assessing interest charges on debts due the government is 2.0 percent for the period of January 1, 2020 through December 31, 2020.

Attached to this Circular is an updated listing of both the Prompt Payment and Debt Management interest rates from January 1, 1985 through the current date.

ANTONIO RIOS
Director for
Federal Employees' Compensation

Attachment: Prompt Payment Interest Rates
Debt Management Interest Rates

Distribution: All DFEC Staff

ATTACHMENT TO FECA CIRCULAR NO. 20-06

ATTACHMENT TO FECA CIRCULAR NO. 20-06

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Attention: This circular has been superseded and is inactive.

Subject: Elimination of Jurisdictional Boundaries

Purpose: This Circular is to announce that the Office of Workers' Compensation Programs' (OWCP) Division of Federal Employees', Longshore and Harbor Workers' Compensation (DFELHWC) will eliminate jurisdictional boundaries in the Federal Employees' Compensation Act (FECA) Program and cease geographic-based jurisdictional case assignments. In addition, the Senior Claims Examiner position will be retired and a new position, the Quality Assurance and Mentoring Examiner (QAM), will be introduced.

Background: Historically, the Program has created and assigned cases across FECA's 12 District Offices based on geographical jurisdiction rules. Case creation and assignment was governed by the claimant's home address.

However, in recent years, the Office of Workers' Compensation Programs (OWCP) has progressively moved from a regional and geographic based structure to a more centralized and cohesive organization. Operations and policies have been realigned to build seamless lines of communication, eliminating barriers and distinctions between the national office and the field offices. Many positions previously located in field offices have also been realigned. Staff Nurse and Rehabilitation Specialists are now under the Branch of Regulations and Procedures, Fiscal Officers and Medical Coding Specialists are now under the Branch of Fiscal Operations and Customer Service Representatives are now under the Branch of Technical Assistance.

Further, effective August 2020, the Divisions of Federal Employees' Compensation and Longshore and Harbor Workers' Compensation merged to create a single Division (DFELHWC).

Action: In continuation of this national focus, case assignments in the FECA Program will no longer follow previous geographic jurisdictional rules. Instead, claims examiners will now handle cases based on a rotational assignment model regardless of the claimant's geographic location. Special jurisdiction cases, such as those handled by the Special Claims Unit and the cases for employees of the Department of Labor, will remain an exception and will be handled centrally by a dedicated group of claims examiners.

Also, effective September 28, 2020 newly created FECA cases that do not require a special designation and will begin with the prefix "55." Further information on case prefixes and special designations and jurisdictions can be found in FECA Procedure Manual 1-0200, Jurisdiction.

These changes will allow equitable distribution of cases among FECA Claims Examiners and optimize consistent case processing across the country. Further, this reorganization will afford the FECA Program increased flexibility in the hiring process as well as provide the Program with greater agility to respond to unanticipated events.

Lastly, the position of Senior Claims Examiner will be retired and a new position, the QAM, created. Historically, Senior Claims Examiners have been utilized differently with many engaged in more routine Claims Examiner duties. The new role will focus primarily on helping ensure the quality of Claims Examiner work as well as mentoring and developing staff.

ANTONIO RIOS
Director for
Federal Employees, Longshore and Harbor Workers' Compensation

Distribution: All FECA Program Staff

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