Division of Federal Employees' Compensation (DFEC)

Table of Contents

 

Fiscal Year 2021

Circular

Subject

FECA Circular No. 21-01

Medical Management Application

FECA Circular No. 21-02

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

FECA Circular No. 21-03

Dual Benefits - FERS Cost of Living Adjustments

FECA Circular No. 21-04

Bill Pay – Requests for Durable Medical Equipment (DME)

FECA Circular No. 21-05

Healthcare Common Procedure Coding System Code (HCPCS) P9020 Bill Payment Restrictions

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Fiscal Year 2020

Circular

Subject

FECA Circular No. 20-01

Pharmacy Kit Maximum Quantity Restrictions

FECA Circular No. 20-02

Claims Examiner Query Link (CE-LinQ)

FECA Circular No. 20-03

Current Interest Rates for Prompt Payment Bills and Debt Collection

FECA Circular No. 20-04

Dual Benefits - FERS Cost of Living Adjustments

FECA Circular No. 20-05

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

FECA Circular No. 20-06

Current Interest Rates for Prompt Payment Bills and Debt Collection

FECA Circular No. 20-07

Mailing Address Change

FECA Circular No. 20-08

Elimination of Jurisdictional Boundaries

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Fiscal Year 2019

Circular

Subject

FECA Circular No. 19-01

Filling Non-maintenance Medications

FECA Circular No. 19-02

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

FECA Circular No. 19-03

Dual Benefits - FERS Cost of Living Adjustments

FECA Circular No. 19-04

FECA Pharmacy Benefits Management System

FECA Circular No. 19-05

FDA Medical Devices

FECA Circular No. 19-06

Online method for debtors to make payments to the OWCP Division of Federal Employees' Compensation (DFEC)

FECA Circular No. 19-07

Current Procedural Terminology Code (CPT) 99070 Bill Payment Restrictions

FECA Circular No. 19-08

Current Interest Rates for Prompt Payment Bills and Debt Collection

FECA Circular No. 19-09

Prescription and non-prescription or over-the-counter (OTC) drugs

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Fiscal Year 2018

Circular

Subject

FECA Circular No. 18-01

Application of the Department of Labor's (DOL) Suspension and Debarment Procedures to Medical Provider Payments under the Federal Employees' Compensation Act (FECA)

FECA Circular No. 18-02

Dual Benefits - FERS Cost of Living Adjustments

FECA Circular No. 18-03

Current Interest Rates for Prompt Payment Bills and Debt Collection

FECA Circular No. 18-04

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

FECA Circular No. 18-05

Medication "Convenience" Kits and Combination Medications

FECA Circular No. 18-06

Physician Dispensed Medication (Billing for Unspecified "J Codes")

FECA Circular No. 18-07

Employees' Compensation and Management Portal (ECOMP) Disability Management Interface (DMI)

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Fiscal Year 2017

Circular

Subject

FECA Circular No. 17-01

Dual Benefits - FERS Cost of Living Adjustments

FECA Circular No. 17-02

Current Interest Rates for Prompt Payment Bills and Debt Collection

FECA Circular No. 17-03

OFFICE OF INSPECTOR GENERAL (OIG) INVESTIGATIONS PERTAINING TO FEDERAL EMPLOYEES' COMPENSATION ACT (FECA) CLAIMANT AND MEDICAL PROVIDER FRAUD

FECA Circular No. 17-04

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

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Fiscal Year 2016

Circular

Subject

FECA Circular No. 16-01

ICD-10 TRANSITION

FECA Circular No. 16-02

Current Interest Rates for Prompt Payment Bills and Debt Collection

FECA Circular No. 16-03

Federal Occupational Health (FOH) – District Medical Advisors (DMAs)

FECA Circular No. 16-04

Reimbursement Rates Payable for the Use of Privately Owned Automobiles Necessary to Secure Medical Examination and Treatment.

FECA Circular No. 16-05

Current Interest Rates for Prompt Payment Bills and Debt Collection

FECA Circular No. 16-06

Electronic Document Approval Process (ELAPP)

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Fiscal Year 2015

Circular

Subject

FECA Circular No. 15-01

Outpatient Prospective Payment System

FECA Circular No. 15-02

SSA Contacts for FERS Dual Benefits

FECA Circular No. 15-03

Dual Benefits - FERS Cost of Living Adjustments

FECA Circular No. 15-04

Current Interest Rates for Prompt Payment Bills and Debt Collection

FECA Circular No. 15-05

Reimbursement Rates Payable for the Use of Privately Owned Automobiles Necessary to Secure Medical Examination and Treatment.

FECA Circular No. 15-06

Labor for America (LFA)

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Fiscal Year 2014

Circular

Subject

FECA Circular No. 14-01

Current Interest Rates for Prompt Payment Bills and Debt Collection

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Fiscal Year 2013

Circular

Subject

FECA Circular No. 13-01

Dual Benefits - FERS Cost of Living Adjustments

FECA Circular No. 13-02

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

FECA Circular No. 13-03

Employees' Compensation and Management Portal (ECOMP)

FECA Circular No. 13-04

Current Interest Rates for Prompt Payment Bills and Debt Collection

FECA Circular No. 13-05

Offsets as the result of the receipt of lump-sum incentive payments made by the United States Postal Service

FECA Circular No. 13-06

Employees' Compensation and Management Portal (ECOMP) Agency Reviewer Imaging (ARi)

FECA Circular No. 13-07

Improper Document Submissions

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Fiscal Year 2012

Circular

Subject

FECA Circular No. 12-01

Dual Benefits - FERS Cost of Living Adjustments

FECA Circular No. 12-02

Agency Query System (AQS) Access for Agency Employees, Contractors and Inspector General Offices

FECA Circular No. 12-03

Current Interest Rates for Prompt Payment Bills and Debt Collection

FECA Circular No. 12-04

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

FECA Circular No. 12-05

Insurance Deductions

FECA Circular No. 12-06

Bill Payment Practices and Restrictions

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Fiscal Year 2011

Circular

Subject

FECA Circular No. 11-01

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

FECA Circular No. 11-02

Dual Benefits - FERS Cost of Living Adjustments

FECA Circular No. 11-03

Current Interest Rates for Prompt Payment Bills and Debt Collection

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Fiscal Year 2010

Circular

Subject

FECA Circular No. 10-01

Guidance for claims filed as a result of the 2010 Decennial Census

FECA Circular No. 10-02

Current Interest Rates for Prompt Payment Bills and Debt Collection

FECA Circular No. 10-03

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

FECA Circular No. 10-04

Dual Benefits - FERS Cost of Living Adjustments

FECA Circular No. 10-05

Early disability management in 2010 Decennial Census claims

FECA Circular No. 10-06

Overpayments in cases where lesser impairment is established after a schedule award has been paid for greater impairment

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Fiscal Year 2009

Circular

Subject

FECA Circular No. 09-01

Current Interest Rates for Prompt Payment Bills and Debt Collect

FECA Circular No. 09-02

Dual Benefits - FERS Cost of Living Adjustments

FECA Circular No. 09-03

Fees for Representatives' Services - Contingency Fees

FECA Circular No. 09-04

Health Benefits Insurance and Life Insurance - General Guidance

FECA Circular No. 09-05

Release of Documents from Federal Employees' Compensation (FECA) Files

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Fiscal Year 2008

Circular

Subject

FECA Circular No. 08-01

Debt Collection – Classification of Aged Delinquent Debts as Currently Not Collectable (CNC)

FECA Circular No. 08-02

Dual Benefits - FERS Cost of Living Adjustments

FECA Circular No. 08-03

Current Interest Rates for Prompt Payment Bills and Debt Collection

FECA Circular No. 08-04

DFEC Protocol Statement- OIG Audits, Evaluations, And Investigations

FECA Circular No. 08-05

Current Interest Rates for Prompt Payment Bills and Debt Collection

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Fiscal Year 2007

Circular

Subject

FECA Circular No. 07-01

Dual Benefits - FERS

FECA Circular No. 07-02

Current Interest Rates for Prompt Payment Bills and Debt Collection

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Fiscal Year 2006

Circular

Subject

FECA Circular No. 06-01

Dual Benefits - FERS Cost of Living Adjustments

FECA Circular No. 06-02

Fiscal - Current Interest Rates for Prompt Payment Bills And Debt Collection

FECA Circular No. 06-03

Loss of Wage Earning Capacity Calculations Under Performance Based Alternative Pay Systems

FECA Circular No. 06-04

Case Management and Coding of Beryllium Claims

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Fiscal Year 2005

Circular

Subject

FECA Circular No. 05-01

Dual Benefits - FERS COLA

FECA Circular No. 05-02

Fiscal - Current Interest Rates for Prompt Payment Bills and Debt Collection

FECA Circular No. 05-03

Adjudication of Claims - Claims Related to Beryllium Exposure

FECA Circular No. 05-04

Bill Pay – Revised Form CA-16

FECA Circular No. 05-05

Due Process - Revised Appeal Rights

FECA Circular No. 05-06

Imaged FECA Cases to Be Provided in Portable Document Format (PDF) on CD-ROM

FECA Circular No. 05-07

Dual Benefits - FERS

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Fiscal Year 2004

Circular

Subject

FECA Circular No. 04-01

Forms - Electronic Submission

FECA Circular No. 04-02

Current Interest Rates for Prompt Payment Bills and Debt Collection

FECA Circular No. 04-03

DUAL BENEFITS - FERS COLA

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Fiscal Year 2003

Circular

Subject

FECA Circular No. 03-01

DUAL BENEFITS - FERS COLA

FECA Circular No. 03-02

SELECTED ECAB DECISIONS FOR JANUARY – MARCH, 2002

FECA Circular No. 03-03

SELECTED ECAB DECISIONS FOR JULY - SEPTEMBER, 2001

FECA Circular No. 03-04

Current Interest Rates for Prompt Payment Bills and Debt Collection

FECA Circular No. 03-05

SELECTED ECAB DECISIONS FOR OCTOBER – DECEMBER, 2001

FECA Circular No. 03-07

Forms – Appeal Rights

FECA Circular No. 03-08

Forms Correspondence - Deletion of Letters

FECA Circular No. 03-09

Selected ECAB Decisions for July - September, 2002

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Fiscal Year 2002

Circular

Subject

FECA Circular No. 02-01

DUAL BENEFITS - FERS COLA

FECA Circular No. 02-02

FECA Circular 02-02 (not published)

FECA Circular No. 02-03

SELECTED ECAB DECISIONS FOR OCTOBER – DECEMBER, 2000

FECA Circular No. 02-04

SUBJECT: SELECTED ECAB DECISIONS FOR JANUARY - MARCH, 2001

FECA Circular No. 02-05

SUBJECT: SELECTED ECAB DECISIONS FOR APRIL - JUNE, 2001

FECA Circular No. 02-06

Current Interest Rates for Prompt Payment Bills and Debt Collection

FECA Circular No. 02-07

Current Interest Rates for Prompt Payment Bills and Debt Collection

FECA Circular No. 02-08

Statement of Accepted Facts (SOAF)

FECA Circular No. 02-09

Code changes for the Departments of the Air Force, Army, Defense, Health and Human Services, Navy, State, Treasury, and Veterans Affairs, and Other Establishments, Case Management Users' Manual, Appendix 4-7

FECA Circular No. 02-10

Code changes for the Departments of Labor, Transportation, and Veterans Affairs, Case Management Users' Manual, Appendix 4-7

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Fiscal Year 2001

Circular

Subject

FECA Circular No. 01-01

DUAL BENEFITS - FERS COLA

FECA Circular No. 01-02

Current Interest Rates for Prompt Payment Bills and Debt Collection

FECA Circular No. 01-03

Code changes for the Departments of Agriculture, Defense, Justice, Labor, State, and Veterans Affairs, and the Federal Judiciary and the U.S. Postal Service, Case Management Users' Manual, Appendix 4-7

FECA Circular No. 01-04

Selected ECAB Decisions for April – June 2000

FECA Circular No. 01-05

Selected ECAB Decisions for July - September, 2000

FECA Circular No. 01-06

Current Interest Rates for Prompt Payment Bills and Debt Collection

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Fiscal Year 2000

Circular

Subject

FECA Circular No. 00-01

Folio VIEWS Job Aid

FECA Circular No. 00-02

Representative Fee Petitions (12/99A)

FECA Circular No. 00-03

Dual Benefits – FERS COLA (11/99B)

FECA Circular No. 00-04

Selected ECAB Decisions for April - June, 1999 (11/99B)

FECA Circular No. 00-06

Current Interest Rates for Prompt Payment Bills and Debt Collection (02/00A)

FECA Circular No. 00-07

Code changes for the Departments of the Army, Defense, Labor, State, Transportation, and Veterans Affairs, and the U.S. Postal Service and Other Establishments, Case Management Users' Manual, Appendix 4-7 (03/00A)

FECA Circular No. 00-08

Referee Evaluations--Claims of Bias (03/00B)

FECA Circular No. 00-09

Compensation Payments--2000 Census (04/00A)

FECA Circular No. 00-10

Selected ECAB desisions for July - September 1999

FECA Circular No. 00-11

Selected ECAB desisions for October - December, 1999

FECA Circular No. 00-12

Current Interest Rates for Prompt Payment Bills and Debt Collection (08/00B)

FECA Circular No. 00-13

Dual Benefits – Authorization and Earnings Information from Social Security Administration (09/00A)

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Fiscal Year 1999

Circular

Subject

FECA Circular No. 99-01

Reconsiderations - Correct Appeal Rights (10/98B)

FECA Circular No. 99-02

Dual Benefits - FERS COLA (11/98B)

FECA Circular No. 99-03

Loss of Wage Earning Capacity - USPS and Reassignment to Part Time Flexible Positions (11/98B)

FECA Circular No. 99-04

New Regulations Governing Claims under the FECA (01/99A)

FECA Circular No. 99-05

Selected ECAB Decisions for April - June, 1997 (01/99B)

FECA Circular No. 99-06

Selected ECAB Decisions for July - September, 1997 (01/99B)

FECA Circular No. 99-07

Code changes for the Departments of the Air Force, Army, Defense, Transportation, Treasury, and Veterans Affairs, and the U.S. Postal Service and the Federal Judiciary, Case Management Users' Manual, Appendix 4-7 (01/99A)

FECA Circular No. 99-08

Current Interest Rates for Prompt Payment Bills and Debt Collection (02/99A)

FECA Circular No. 99-09

Selected ECAB Decisions for January-March, 1998 (04/99A)

FECA Circular No. 99-10

Seclected ECAB Decisions for April-June, 1998 (04/99A)

FECA Circular No. 99-11

Selected ECAB Decisions for July-September, 1998 (04/99B)

FECA Circular No. 99-12

Revised CA-7 (04/99B)

FECA Circular No. 99-13

Current Interest Rates for Prompt Payment Bills and Debt Collection (08/99A)

FECA Circular No. 99-14

Loss of Wage Earning Capacity--Actual Earnings from Temporary Positions (08/99B)

FECA Circular No. 99-15

Selected ECAB Decisions for October - December 1998 (09/99A)

FECA Circular No. 99-16

Revised Form CA-1 (09/99A)

FECA Circular No. 99-17

Selected ECAB Decisions for January - March, 1999 (09/99A)

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Circular

Subject

Fiscal Year 1998

FECA Circular No. 98-01

Selected ECAB Decisions for January - March, 1997 (02/98A)

FECA Circular No. 98-02

Revised Forms CA-1, CA-2, CA-5, CA-5b, CA-6, CA-7, and CA-20, CA-8, and CA-20a, CA-16, and CA-17 (11/97A)

FECA Circular No. 98-03

Dual Benefits - FERS (11/97A)

FECA Circular No. 98-04

Code Changes for the Departments of Agriculture, Defense, Navy, Transportation, Treasury, and Veterans Affairs, and the General Services Administration, National Aeronautics and Space Administration, and Other Establishments, Case Management Users' Manual, Appendix 4-7 (11/97A)

FECA Circular No. 98-05

Dual Benefits - FERS COLA (11/97A)

FECA Circular No. 98-06

Selected ECAB Decisions for October - December, 1996 (11/97B)

FECA Circular No. 98-07

Current Interest Rates for Prompt Payment Bills and Debt Collection (01/98A)

FECA Circular No. 98-08

Revised Forms - CA-16 and CA-17 (02/98)

FECA Circular No. 98-09

Current Interest Rates for Prompt Payment Bills and Debt Collection (07/98B)

FECA Circular No. 98-10

Pay Rates: Inclusion of Extra Pay Authorized Under the FLSA (08/98A)

FECA Circular No. 98-11

Bill Payment/BPS - Procedure Code Modifiers (10/98A)

FECA Circular No. 98-12

Selected ECAB Decisions for October - December, 1997 (10/98A)

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Fiscal Year 1997

Circular

Subject

FECA Circular No. 97-01

ADP--Access to OWCP Material on the World Wide Web

FECA Circular No. 97-02

Cost of Living Increase to SSA Benefits in FERS Cases

FECA Circular No. 97-03

Selected ECAB Decisions for July - September, 1996

FECA Circular No. 97-04

Current Interest Rates for Prompt Payment Bills and Debt Collection

FECA Circular No. 97-05

Code Changes (0297A)

FECA Circular No. 97-06

Bill Pay--OWCP Liability for Sales Taxes - (0797B)

FECA Circular No. 97-07

Current Interest Rates for Prompt Payment Bills and Debt Collection-(0797B)

FECA Circular No. 97-08

Comp Pay--ACPS Reports (07/97A)

FECA Circular No. 97-09

Revised Forms OWCP-5a, OWCP-5b, OWCP-5c(August 25, 1997)

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Fiscal Year 1996

Circular

Subject

FECA Circular No. 96-01

Selected ECAB Decisions for April Through June 1995

FECA Circular No. 96-02

Increases in the Reimbursement Rate for OWCP Contract Field Nurses

FECA Circular No. 96-03

Current Interest Rates for Prompt Payment Bills and Debt Collection

FECA Circular No. 96-04

Selected ECAB Decisions for October - December 1995

FECA Circular No. 96-05

Selected ECAB Decisions for July - September 1995

FECA Circular No. 96-06

Current Interest Rates for Prompt Payment Bills

FECA Circular No. 96-07

Computation of Compensation for Rural Letter Carriers (09/96A)

FECA Circular No. 96-08

Selected ECAB Decisions for April - June 1996 (09/96B)


 

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FECA CIRCULAR NO. 21-01

December 14, 2020

Subject: Medical Management Application

Background: The Medical Management Application (MMA) in the Integrated Federal Employees' Compensation System (iFECS) allows program users access to a database of Board-certified specialist physicians in order to schedule impartial referee examinations (IME) under the Federal Employees' Compensation Act (FECA). An IME under 5 U.S.C. 8123 of FECA is used where there is a conflict in medical evidence between a claimant's physician and a physician for the Office of Workers' Compensation Programs (OWCP) such as a District Medical Advisor or a second opinion physician. MMA contains an automatic and strict rotational scheduling feature, provides for consistent rotation among physicians and records the information needed to document the IME selection.

If a physician in the rotation cannot or will not schedule an examination, he or she must be bypassed in the "Schedule Appointments" application in iFECS so that the next physician in the rotation can be considered for IME scheduling.

If a physician will not accept DOL or OWCP cases for medical examinations, the physician's record in the "Physicians" application in iFECS should be updated so that the physician no longer appears in the rotation in the "Schedule Appointments" application.1

The FECA program staff reported repeated issues with the scheduling of IME examinations, creating a significant administrative burden on the program and potential delay in scheduling referee examinations. For that reason, a comprehensive review of data in the MMA was undertaken. That review revealed that while many physicians have been repeatedly bypassed by medical scheduling staff due to their unwillingness to accept DOL or OWCP cases, they were not removed from the referee rotation.

Applicability: Appropriate National Office and Office personnel.

Reference: 5 U.S.C. 8123, Federal Employees' Compensation Act (FECA) Procedure Manual Chapter 3-0500, OWCP Directed Medical Examinations

Action:

  1. A significant number of physicians in MMA have been regularly bypassed because they will not accept any Department of Labor (DOL) cases, will not do IMEs, will not accept workers' compensation cases, or are not willing to perform examinations for OWCP.
  2. It is burdensome for OWCP to continue to contact these physicians as they appear in the rotation. These contacts result in delays in IME impartial referee medical examination scheduling and slows claims processing. OWCP removed from the MMA those physicians whose offices have reported to OWCP their unwillingness to perform referee medical examinations.
  3. Physicians bypassed for other reasons, such as those that have relocated from the address indicated in MMA, will not be removed through this process.

Disposition: This Bulletin should be retained until incorporated into the FECA Procedure Manual.


1 FECA Procedure Manual 3-0500.6.

 

Antonio Rios
Director for
Division of Federal Employees', Longshore and Harbor Workers' Compensation

Distribution: All FECA Staff

 

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FECA CIRCULAR NO. 21-02

February 18, 2021

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, 2021, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile DECREASED to 56 cents per mile per U.S. General Services Administration (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 FECA Program personnel.

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

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

The following is a list of the historical mileage rates used to reimburse claimant travel:

Dates

Cents per mile

01/01/2021 to Present

56.0 cents per mile

01/01/2020 to 12/31/2020

57.5 cents per mile

01/01/2019 - 12/31/2019

58.0 cents per mile

01/01/2018 - 12/31/2018

54.5 cents per mile

01/01/2017 - 12/31/2017

53.5 cents per mile

01/01/2016 - 12/31/2016

54.0 cents per mile

01/01/2015 - 12/31/2015

57.5 cents per mile

01/01/2014 - 12/31/2014

56.0 cents per mile

01/01/2013 - 12/31/2013

56.5 cents per mile

04/17/2012 - 12/31/2012

55.5 cents per mile

01/01/2011 - 04/16/2012

51.0 cents per mile

01/01/2010 - 12/31/2010

50.0 cents per mile

01/01/2009 - 12/31/2009

55.0 cents per mile

08/01/2008 - 12/31/2008

58.5 cents per mile

03/19/2008 - 07/31/2008

50.5 cents per mile

02/01/2007 - 03/18/2008

48.5 cents per mile

01/01/2006 - 01/31/2007

44.5 cents per mile

09/01/2005 - 12/31/2005

48.5 cents per mile

02/04/2005 - 08/31/2005

40.5 cents per mile

01/01/2004 - 02/03/2005

37.5 cents per mile

01/01/2003 - 12/31/2003

36.0 cents per mile

01/21/2002 - 12/31/2002

36.5 cents per mile

01/22/2001 - 01/20/2002

34.5 cents per mile

01/14/2000 - 01/21/2001

32.5 cents per mile

04/01/1999 - 01/13/2000

31.0 cents per mile

09/08/1998 - 03/31/1999

32.5 cents per mile

06/07/1996 - 09/07/1998

31.0 cents per mile

01/01/1995 - 06/06/1996

30.0 cents per mile

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

 

Antonio Rios
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Distribution: All FECA Program Staff

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FECA CIRCULAR NO. 21-03

February 18, 2021

Subject: Dual Benefits - FERS Cost of Living Adjustments

Background: Effective December 1, 2020, benefits issued by the Social Security Administration (SSA) were increased by 1.3%. Therefore, the amount of the Federal Employees’ Retirement System (FERS) Dual Benefits deduction needed to be increased by the same amount, to ensure the dollar-for-dollar offset required by 5 U.S.C. 8116 (d) (2) of the Federal Employees’ Compensation Act remains current.

Applicability: Appropriate FECA Program personnel.

Action: This adjustment was made from the National Office for all cases that were correctly entered into the integrated Federal Compensation System (iFECS). The adjustment was effective on the periodic roll cycle beginning December 06, 2020.

The historical SSA cost of living adjustments are as follows:

Dates

Cost of living adjustment

12/01/2020 – 11/30/2021

1.3%

12/01/2019 - 11/30/2020

1.6%

12/01/2018 - 11/30/2019

2.8%

12/01/2017 - 11/30/2018

2.0%

12/01/2016 - 11/30/2017

0.3%

12/01/2015 - 11/30/2016

0.0%

12/01/2014 - 11/30/2015

1.7%

12/01/2013 - 11/30/2014

1.5%

12/01/2012 - 11/30/2013

1.7%

12/01/2011 - 11/30/2012

3.6%

12/01/2010 - 11/30/2011

0.0%

12/01/2009 - 11/30/2010

0.0%

12/01/2008 - 11/30/2009

5.8%

12/01/2007 - 11/30/2008

2.3%

12/01/2006 - 11/30/2007

3.3%

12/01/2005 - 11/30/2006

4.1%

12/01/2004 - 11/30/2005

2.7%

12/01/2003 - 11/30/2004

2.1%

12/01/2002 - 11/30/2003

1.4%

12/01/2001 - 11/30/2002

2.6%

12/01/2000 - 11/30/2001

3.5%

12/01/1999 - 11/30/2000

2.4%

12/01/1998 - 11/30/1999

1.3%

12/01/1997 - 11/30/1998

2.1%

12/01/1996 - 11/30/1997

2.9%

12/01/1995 - 11/30/1996

2.6%

12/01/1994 - 11/30/1995

2.8%

 

Antonio Rios
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Distribution: All FECA Program Staff

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FECA CIRCULAR NO. 21-04

April 14, 2021

Subject: Bill Pay – Requests for Durable Medical Equipment (DME)

Purpose: This circular is being issued to document authorization and pricing procedures for Durable Medical Equipment (DME) that went into effect on April 27, 2020.

The FECA program has been using these pricing procedures since April 27, 2020 and continues to do so.

Authority: Under the Federal Employees’ Compensation Act (FECA), the 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) authorizes OWCP's FECA program to set limitations and require pre-authorization for medical services and supplies where deemed necessary.

The below protocols supersede the rental vs. purchase procedures outlined in the FECA Procedure Manual, 2-810-17; the need to demonstrate medical necessity for DME is unchanged.

Action: In accordance with the discretion granted to DOL and delegated to OWCP, the FECA program updated its policy regarding medical authorization and bill pay procedures related to DME.

  1. Effective April 27, 2020, authorization requests for durable medical equipment are now examined to determine whether there was a previous authorization for the same provider, claimant, procedure code and rental (RR) modifier for past 365 days based on the “To Date” received on the authorization request.

  2. Authorization requests for DME rental up to 90 days will be processed as usual, depending upon the nature of the DME requested and the associated level of authorization.

  3. If the 90 day DME rental period is not exhausted, but the authorized dollars for the rental are exhausted, then another DME Authorization for rental or purchase must be requested.

  4. If the cumulative days of the DME rental request exceeds 90 days then the request will be considered level 3 and thus assigned to the claims examiner for review. The claims examiner should consider the purchase price of the DME and if the original authorization was for rental only, a new DME authorization request for purchase should be requested to authorize the remaining unused purchase amount.

Antonio Rios
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Distribution: All FECA Program Staff

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FECA CIRCULAR NO. 21-05

September 10, 2021

SUBJECT: Healthcare Common Procedure Coding System Code (HCPCS) P9020 Bill Payment Restrictions

PURPOSE: To provide notification of new DFEC policy with respect to payment for HCPCS code P9020, Platelet Rich Plasm, Each Unit

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. See 20 C.F.R. 10.800-826.

BACKGROUND: The American Medical Association provides the following definition of HCPCS code P9020:

“Platelet Rich Plasma, Each Unit”

The use of this code allows medical providers to bill for the intravenous infusion of platelet rich plasma for the treatment of thrombocytopenia and other blood defects. This code should not be used to describe the injection of platelet rich plasma into a specific site as a means of treating musculoskeletal injuries and/or joint conditions.

The Office of Workers' Compensation Programs (OWCP) Division of Federal Employees', Longshore and Harbor Workers’ Compensation is committed to the safety of its claimants and the reduction of fraud, waste and abuse. As part of this mission, OWCP analyzed medical billing practices for HCPCS code P9020 and determined that this code could be potentially used for purposes inconsistent with the HCPCS description.

AUTHORITY: 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) authorizes OWCP's FECA program to set limitations and require pre-authorization for medical services and supplies where deemed necessary.

ACTION: In accordance with the discretion granted to DOL and delegated to OWCP, the FECA program is updating its policy regarding reimbursement of HCPCS code P9020.

  1. Effective September 18, 2021, DFEC will only recognize HCPCS code P9020 as a valid code if rendered and billed by Inpatient and Outpatient facilities. Services rendered by a provider in-office and billed with HCPCS code P9020 will not be reimbursable.

This policy is effective September 18, 2021. All bills received on and after this date will be subject to this policy.

 

ANTONIO RIOS
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Distribution: All FECA Program Staff

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FECA CIRCULAR NO. 20-01

October 17, 2019

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

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FECA CIRCULAR NO. 20-02

December 10, 2019

Subject: Claims Examiner Query Link (CE-LinQ)

Purpose: This Circular is being issued to announce the new iFECS-ECOMP communication system. This iFECS-ECOMP communication system is named CE-LinQ. CE-LinQ is a new subsystem process for the OWCP/DFEC claims staff to submit letters to employing agencies via an automated process that connects iFECS with ECOMP in a bidirectional process. It leverages existing ECOMP electronic agency dashboards and lines of communication to facilitate information exchanges between the OWCP/DFEC claims staff and employing agency personnel. CE-LinQ ensures fast and secure communications to assist in claims processing.

Background: ECOMP was released to the public on November 2, 2011, and can be accessed directly at the following url: https://www.ecomp.dol.gov. The site originally contained two different types of functionality – electronic submission of documents and electronic submission of FECA claim forms. See FECA Circular 13-03, Employees' Compensation and Management Portal (ECOMP), for more detail on those features. Effective April 9, 2013, ECOMP was enhanced to allow designated ECOMP Agency Reviewers (AR) the ability to view imaged documents for cases assigned to their agency. See FECA Circular 13-06, Employees' Compensation and Management Portal (ECOMP) Agency Reviewer Imaging (ARi), for more detail on the additional features. Effective August 3, 2018, ECOMP was further enhanced with the implementation of the Disability Management Interface (DMI). See FECA Circular 18-07, Employees' Compensation and Management Portal (ECOMP) Disability Management Interface (DMI), for more detail on those features.

Effective December 10, 2019, the new iFECS-ECOMP communication system (called CE-LinQ) was released. CE-LinQ leverages a fully electronic method to pass correspondence back and forth between iFECS and ECOMP. As a result, requests for information will no longer be reliant on the speed of traditional paper mail processes. CE-LinQ will also allow data to be transferred back and forth between iFECS and ECOMP 24 hours per day, thus speeding up communications. With CE-LinQ, obtaining information from employing agencies will become faster and more efficient, allowing the OWCP to render speedier entitlement decisions, and make quicker benefit payments to the injured workers.

Actions:

  1. The OWCP DFEC claims staff will continue to send employing agencies requests for information via Correspondence Library letters, as usual. When claims staff send letters using CE-LinQ, a task linked to each specific letter is generated and will appear in the new ECOMP agency dashboard created specifically for CE-LinQ tasks.
     
  2. The following documents indexed with select Subject Descriptions are examples of documents that may be sent via CE-LinQ:
     
    • Compensation Claim Development;
    • Controversion/COP/CA1038;
    • Initial Development;
    • Job Offers/Return to Work;
    • Pay Rate/Payment;
    • Reconsideration; and
    • Recurrence Development.









































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  3. Employing agency responders will then be able to utilize the ECOMP CE-LinQ feature to generate a response document, plus upload attachments (if needed). Responses will appear in iFECS Imaging as ECOMP generated new mail.

 

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution:All DFEC Staff

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FECA CIRCULAR NO. 20-03

January 27, 2020

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

PROMPT PAYMENT INTEREST RATES

Dates

Percentage

07/1/19 - 12/31/19

2⅝%

01/1/19 - 06/30/19

3⅝%

07/1/18 - 12/31/18

3½%

01/1/18 - 06/30/18

2⅝%

07/1/17 - 12/31/17

2⅜%

01/1/17 - 06/30/17

2½%

07/1/16 - 12/31/16

1⅞%

01/1/16 - 06/30/16

2½%

07/1/15 - 12/31/15

2⅜%

01/1/15 - 12/31/15

2⅛%

07/1/14 - 12/31/14

2.0%

01/1/14 - 12/31/14

2⅛%

07/1/13 - 12/31/13

1¾%

01/1/13 - 12/31/13

1⅜%

07/1/12 - 12/31/12

1¾%

01/1/12 - 12/31/12

2.0%

07/1/11 - 12/31/11

2½%

01/1/11 - 06/30/11

2⅝%

01/1/10 - 12/31/10

2⅝%

01/1/10 - 12/31/10

3¼%

PROMPT PAYMENT INTEREST RATES

Dates

Percentage

Dates

Percentage

07/1/09 - 12/31/09

4⅞%

07/1/99 - 12/31/99

6½%

01/1/09 - 06/30/09

5⅝%

01/1/99 - 06/30/99

5.0%

07/1/08 - 12/31/08

5⅛%

07/1/98 - 12/31/98

6.0%

01/1/08 - 06/30/08

4¾%

01/1/98 - 06/30/98

6¼%

07/1/07 - 12/31/07

5¾%

07/1/97 - 12/31/97

6¾%

01/1/07 - 06/30/07

5¼%

01/1/97 - 06/30/97

6⅜%

07/1/06 - 12/31/06

5¾%

07/1/96 - 12/31/96

7.0%

01/1/06 - 06/30/06

5⅛%

01/1/96 - 06/30/96

5⅞%

07/1/05 - 12/31/05

4½%

07/1/95 - 12/31/95

6⅜%

01/1/05 - 06/30/05

4¼%

01/1/95 - 06/30/95

8⅛%

07/1/04 - 12/31/04

4½%

07/1/94 - 12/31/94

7.0%

01/1/04 - 06/30/04

4.0%

01/1/94 - 06/30/94

5½%

07/1/03 - 12/31/03

3⅛%

07/1/93 - 12/31/93

5⅝%

01/1/03 - 06/30/03

4¼%

01/1/93 - 06/30/93

6½%

07/1/02 - 12/31/02

5¼%

07/1/92 - 12/31/92

7.0%

01/1/02 - 06/30/02

5½%

01/1/92 - 06/30/92

6⅞%

07/1/01 - 12/31/01

5⅞%

07/1/91 - 12/31/91

8½%

01/1/01 - 06/30/01

6⅜%

01/1/91 - 06/30/91

8⅜%

07/1/00 - 12/31/00

7¼%

07/1/90 - 12/31/90

9.0%

01/1/00 - 06/30/00

6¾%

01/1/90 - 06/30/90

8½%

       

01/1/89 - 06/30/89

9¾%

07/1/86 - 12/31/86

8½%

07/1/88 - 12/31/88

9¼%

01/1/86 - 06/30/86

9¾%

01/1/88 - 06/30/88

9⅜%

07/1/85 - 12/31/85

10⅜%

07/1/87 - 12/31/87

8⅞%

01/1/85 - 06/30/85

12⅛%

01/1/87 - 06/30/87

7⅝%

   

ATTACHMENT TO FECA CIRCULAR NO. 20-03

DEBT MANAGEMENT INTEREST RATES

 

Dates

Percentages

01/01/20 - 12/31/20

2%

01/1/19 - 12/31/19

1%

01/1/18 - 12/31/18

1%

01/1/17 - 12/31/17

1%

01/1/16 - 12/31/16

1%

01/1/15 - 12/31/15

1%

01/1/14 - 12/31/14

1%

01/1/13 - 12/31/13

1%

01/1/12 - 12/31/12

1%

01/1/11 - 12/31/11

1%

01/1/10 - 12/31/10

1%

   

01/1/09 - 12/31/09

3%

07/1/08 - 12/31/08

3%

01/1/08 - 06/30/08

5%

01/1/07 - 12/31/07

4%

07/1/06 - 12/31/06

4%

01/1/06 - 06/30/06

2%

01/1/05 - 12/31/05

1%

   

01/1/04 - 12/31/04

1%

01/1/03 - 12/31/03

2%

07/1/02 - 12/31/02

3%

01/1/02 - 06/30/02

5%

01/1/01 - 12/31/01

6%

01/1/00 - 12/31/00

5%

   

01/1/99 - 12/31/99

5%

01/1/98 - 12/31/98

5%

01/1/97 - 12/31/97

5%

01/1/96 - 12/31/96

5%

07/1/95 - 12/31/95

5%

01/1/95 - 06/30/95

3%

   

01/1/94 - 12/31/94

3%

01/1/93 - 12/31/93

4%

01/1/92 - 12/31/92

6%

01/1/91 - 12/31/91

8%

01/1/90 - 12/31/90

9%

   

01/1/89 - 12/31/89

7%

01/1/88 - 12/31/88

6%

01/1/87 - 12/31/87

7%

01/1/86 - 12/31/86

8%

01/1/85 - 12/31/85

9%

Prior to 01/01/84

Not Applicable

 

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FECA CIRCULAR NO. 20-04

January 27, 2020

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.

The historical SSA cost of living adjustments are as follows:

Dates

Cost of living adjustment

Dates

Cost of living adjustment

12/01/2019 - 11/30/2020

1.6%

12/01/1999 - 11/30/2000

2.4%

12/01/2018 - 11/30/2019

2.8%

12/01/1998 - 11/30/1999

1.3%

12/01/2017 - 11/30/2018

2.0%

12/01/1997 - 11/30/1998

2.1%

12/01/2016 - 11/30/2017

0.3%

12/01/1996 - 11/30/1997

2.9%

12/01/2015 - 11/30/2016

0.0%

12/01/1995 - 11/30/1996

2.6%

12/01/2014 - 11/30/2015

1.7%

12/01/1994 - 11/30/1995

2.8%

12/01/2013 - 11/30/2014

1.5%

 

 

12/01/2012 - 11/30/2013

1.7%

   

12/01/2011 - 11/30/2012

3.6%

   

12/01/2010 - 11/30/2011

0.0%

   

12/01/2009 - 11/30/2010

0.0%

   

12/01/2008 - 11/30/2009

5.8%

   

12/01/2007 - 11/30/2008

2.3%

   

12/01/2006 - 11/30/2007

3.3%

   

12/01/2005 - 11/30/2006

4.1%

   

12/01/2004 - 11/30/2005

2.7%

   

12/01/2003 - 11/30/2004

2.1%

   

12/01/2002 - 11/30/2003

1.4%

   

12/01/2001 - 11/30/2002

2.6%

   

12/01/2000 - 11/30/2001

3.5%

   

 

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff

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FECA CIRCULAR NO. 20-05

January 27, 2020

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.

The following is a list of the historical mileage rates used to reimburse claimant travel:

Dates

Cents per mile

01/01/1995 - 06/06/1996

30.0 cents per mile

06/07/1996 - 09/07/1998

31.0 cents per mile

09/08/1998 - 03/31/1999

32.5 cents per mile

04/01/1999 - 01/13/2000

31.0 cents per mile

 

 

01/14/2000 - 01/21/2001

32.5 cents per mile

01/22/2001 - 01/20/2002

34.5 cents per mile

01/21/2002 - 12/31/2002

36.5 cents per mile

01/01/2003 - 12/31/2003

36.0 cents per mile

01/01/2004 - 02/03/2005

37.5 cents per mile

02/04/2005 - 08/31/2005

40.5 cents per mile

09/01/2005 - 12/31/2005

48.5 cents per mile

01/01/2006 - 01/31/2007

44.5 cents per mile

02/01/2007 - 03/18/2008

48.5 cents per mile

03/19/2008 - 07/31/2008

50.5 cents per mile

08/01/2008 - 12/31/2008

58.5 cents per mile

01/01/2009 - 12/31/2009

55.0 cents per mile

 

 

01/01/2010 - 12/31/2010

50.0 cents per mile

01/01/2011 - 04/16/2012

51.0 cents per mile

04/17/2012 - 12/31/2012

55.5 cents per mile

01/01/2013 - 12/31/2013

56.5 cents per mile

01/01/2014 - 12/31/2014

56.0 cents per mile

01/01/2015 - 12/31/2015

57.5 cents per mile

01/01/2016 - 12/31/2016

54.0 cents per mile

01/01/2017 - 12/31/2017

53.5 cents per mile

01/01/2018 - 12/31/2018

54.5 cents per mile

01/01/2019 - 12/31/2019

58.0 cents per mile

01/01/2020 to Present

57.5 cents per mile

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

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FECA CIRCULAR NO. 20-06

July 29, 2020

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

PROMPT PAYMENT INTEREST RATES

Dates

Percentage

07/1/20 - 12/31/20

1⅛%

01/1/20 - 06/30/20

2⅛%

07/1/19 - 12/31/19

2⅝%

01/1/19 - 06/30/19

3⅝%

07/1/18 - 12/31/18

3½%

01/1/18 - 06/30/18

2⅝%

07/1/17 - 12/31/17

2⅜%

01/1/17 - 06/30/17

2½%

07/1/16 - 12/31/16

1⅞%

01/1/16 - 06/30/16

2½%

07/1/15 - 12/31/15

2⅜%

01/1/15 - 12/31/15

2⅛%

07/1/14 - 12/31/14

2.0%

01/1/14 - 12/31/14

2⅛%

07/1/13 - 12/31/13

1¾%

01/1/13 - 12/31/13

1⅜%

07/1/12 - 12/31/12

1¾%

01/1/12 - 12/31/12

2.0%

07/1/11 - 12/31/11

2½%

01/1/11 - 06/30/11

2⅝%

01/1/10 - 12/31/10

2⅝%

01/1/10 - 12/31/10

3¼%

PROMPT PAYMENT INTEREST RATES

Dates

Percentage

Dates

Percentage

07/1/09 - 12/31/09

4⅞%

07/1/99 - 12/31/99

6½%

01/1/09 - 06/30/09

5⅝%

01/1/99 - 06/30/99

5.0%

07/1/08 - 12/31/08

5⅛%

07/1/98 - 12/31/98

6.0%

01/1/08 - 06/30/08

4¾%

01/1/98 - 06/30/98

6¼%

07/1/07 - 12/31/07

5¾%

07/1/97 - 12/31/97

6¾%

01/1/07 - 06/30/07

5¼%

01/1/97 - 06/30/97

6⅜%

07/1/06 - 12/31/06

5¾%

07/1/96 - 12/31/96

7.0%

01/1/06 - 06/30/06

5⅛%

01/1/96 - 06/30/96

5⅞%

07/1/05 - 12/31/05

4½%

07/1/95 - 12/31/95

6⅜%

01/1/05 - 06/30/05

4¼%

01/1/95 - 06/30/95

8⅛%

07/1/04 - 12/31/04

4½%

07/1/94 - 12/31/94

7.0%

01/1/04 - 06/30/04

4.0%

01/1/94 - 06/30/94

5½%

07/1/03 - 12/31/03

3⅛%

07/1/93 - 12/31/93

5⅝%

01/1/03 - 06/30/03

4¼%

01/1/93 - 06/30/93

6½%

07/1/02 - 12/31/02

5¼%

07/1/92 - 12/31/92

7.0%

01/1/02 - 06/30/02

5½%

01/1/92 - 06/30/92

6⅞%

07/1/01 - 12/31/01

5⅞%

07/1/91 - 12/31/91

8½%

01/1/01 - 06/30/01

6⅜%

01/1/91 - 06/30/91

8⅜%

07/1/00 - 12/31/00

7¼%

07/1/90 - 12/31/90

9.0%

01/1/00 - 06/30/00

6¾%

01/1/90 - 06/30/90

8½%

       

01/1/89 - 06/30/89

9¾%

07/1/86 - 12/31/86

8½%

07/1/88 - 12/31/88

9¼%

01/1/86 - 06/30/86

9¾%

01/1/88 - 06/30/88

9⅜%

07/1/85 - 12/31/85

10⅜%

07/1/87 - 12/31/87

8⅞%

01/1/85 - 06/30/85

12⅛%

01/1/87 - 06/30/87

7⅝%

   

ATTACHMENT TO FECA CIRCULAR NO. 20-06

DEBT MANAGEMENT INTEREST RATES

 

Dates

Percentages

01/1/20 - 12/31/20

2%

01/1/19 - 12/31/19

1%

01/1/18 - 12/31/18

1%

01/1/17 - 12/31/17

1%

01/1/16 - 12/31/16

1%

01/1/15 - 12/31/15

1%

01/1/14 - 12/31/14

1%

01/1/13 - 12/31/13

1%

01/1/12 - 12/31/12

1%

01/1/11 - 12/31/11

1%

01/1/10 - 12/31/10

1%

   

01/1/09 - 12/31/09

3%

07/1/08 - 12/31/08

3%

01/1/08 - 06/30/08

5%

01/1/07 - 12/31/07

4%

07/1/06 - 12/31/06

4%

01/1/06 - 06/30/06

2%

01/1/05 - 12/31/05

1%

   

01/1/04 - 12/31/04

1%

01/1/03 - 12/31/03

2%

07/1/02 - 12/31/02

3%

01/1/02 - 06/30/02

5%

01/1/01 - 12/31/01

6%

01/1/00 - 12/31/00

5%

   

01/1/99 - 12/31/99

5%

01/1/98 - 12/31/98

5%

01/1/97 - 12/31/97

5%

01/1/96 - 12/31/96

5%

07/1/95 - 12/31/95

5%

01/1/95 - 06/30/95

3%

   

01/1/94 - 12/31/94

3%

01/1/93 - 12/31/93

4%

01/1/92 - 12/31/92

6%

01/1/91 - 12/31/91

8%

01/1/90 - 12/31/90

9%

   

01/1/89 - 12/31/89

7%

01/1/88 - 12/31/88

6%

01/1/87 - 12/31/87

7%

01/1/86 - 12/31/86

8%

01/1/85 - 12/31/85

9%

Prior to 01/01/84

Not Applicable

 

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FECA CIRCULAR NO. 20-07

July 29, 2020

SUBJECT: Mailing Address Change

On April 27, 2020, Division of Federal Employees' Compensation (DFEC) changed its mailing addresses from PO Boxes in London, KY to ones in San Antonio, TX. The change was a result of the start of operations for the new medical bill pay contractor, Client Network Services, Inc. (CNSI). Effective July 24, 2020, the mailing addresses were changed back to PO Boxes in London, KY.

General Case Correspondence

Previous

U.S. Department of Labor
OWCP/DFEC
P.O. Box 34090
San Antonio, TX 78265

Current

U.S. Department of Labor
OWCP/DFEC
PO Box 8311
London, KY 40742-8311

Medical Bills and Claimant Reimbursements:

Previous

U.S. Department of Labor
OWCP/DFEC
P.O. Box 34450
San Antonio, TX 78265

Current

U.S. Department of Labor
OWCP/DFEC
PO Box 8300
London, KY 40742-8300

Provider Enrollments:

Previous

Provider Enrollment
Department of Labor - OWCP
P. O. Box 34690
San Antonio, TX 78265

Current

Provider Enrollment
Department of Labor - OWCP
PO Box 8312
London, KY 40742-8312

All OWCP forms with the San Antonio addresses will be updated with the London, KY addresses. Mail sent to the addresses in San Antonio will be forwarded to London, KY through September 30, 2020.

 

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff

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FECA CIRCULAR NO. 20-08

September 25, 2020

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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FECA CIRCULAR NO. 19-01

December 14, 2018

Subject: Filling Non-maintenance Medications

Purpose: This circular is being issued to document the policies regarding filling non-maintenance medications for the treatment of work-related injuries or illnesses.

Background: Under the 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) authorizes OWCP's FECA program to set limitations and require pre-authorization for medical services and supplies where deemed necessary.

In accordance with the discretion granted to DOL and delegated to OWCP, in May, 2017 OWCP's Division of Federal Employees' Compensation (DFEC) instituted a new policy for filling non-maintenance medications for work-related illnesses or injuries.

Actions: With respect to non-maintenance medications, the policy limits the dispensing of such medications to 30 day increments. Additionally, refills cannot be obtained until 75% of the prescription timeline has passed. Maintenance medications (such as those used to treat chronic conditions like high blood pressure and asthma) are not subject to these limitations.

Physicians seeking to have the 30 day/75% fill requirement waived for non-maintenance drugs should submit a written request directly to the responsible DFEC district office because there is no method of requesting an exception through the Web Bill Processing Portal. Waiver of the fill requirements for non-maintenance drugs will be authorized on an exception basis only based on approval of the OWCP Chief Medical Officer or his/her designee.

 

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff

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FECA CIRCULAR NO. 19-02

January 2, 2019

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, 2019, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile INCREASED to 58.0 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 5, Benefit Payments, 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.

The following is a list of the historical mileage rates used to reimburse claimant travel:

Dates

Cents per mile

01/01/1995 - 06/06/1996

30.0 cents per mile

06/07/1996 - 09/07/1998

31.0 cents per mile

09/08/1998 - 03/31/1999

32.5 cents per mile

04/01/1999 - 01/13/2000

31.0 cents per mile

 

 

01/14/2000 - 01/21/2001

32.5 cents per mile

01/22/2001 - 01/20/2002

34.5 cents per mile

01/21/2002 - 12/31/2002

36.5 cents per mile

01/01/2003 - 12/31/2003

36.0 cents per mile

01/01/2004 - 02/03/2005

37.5 cents per mile

02/04/2005 - 08/31/2005

40.5 cents per mile

09/01/2005 - 12/31/2005

48.5 cents per mile

01/01/2006 - 01/31/2007

44.5 cents per mile

02/01/2007 - 03/18/2008

48.5 cents per mile

03/19/2008 - 07/31/2008

50.5 cents per mile

08/01/2008 - 12/31/2008

58.5 cents per mile

01/01/2009 - 12/31/2009

55.0 cents per mile

 

 

01/01/2010 - 12/31/2010

50.0 cents per mile

01/01/2011 - 04/16/2012

51.0 cents per mile

04/17/2012 - 12/31/2012

55.5 cents per mile

01/01/2013 - 12/31/2013

56.5 cents per mile

01/01/2014 - 12/31/2014

56.0 cents per mile

01/01/2015 - 12/31/2015

57.5 cents per mile

01/01/2016 - 12/31/2016

54.0 cents per mile

01/01/2017 - 12/31/2017

53.5 cents per mile

01/01/2018 - 12/31/2018

54.5 cents per mile

01/01/2019 - Present

58.0 cents per mile

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff

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FECA CIRCULAR NO. 19-03

January 2, 2019

Subject: Dual Benefits - FERS Cost of Living Adjustments

Background: Effective December 1, 2018, benefits issued by the Social Security Administration (SSA) will be increased by 2.8%. 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.

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 iFECS Compensation program. The adjustment will be effective with the periodic roll cycle beginning December 09, 2018. There will be no adjustment or overpayment declared for the period of December 1, 2018 through December 8, 2018.

The historical SSA cost of living adjustments are as follows:

Dates

Cost of living adjustment

Dates

Cost of living adjustment

12/01/2018 - 11/30/2019

2.8%

12/01/1999 - 11/30/2000

2.4%

12/01/2017 - 11/30/2018

2.0%

12/01/1998 - 11/30/1999

1.3%

12/01/2016 - 11/30/2017

0.3%

12/01/1997 - 11/30/1998

2.1%

12/01/2015 - 11/30/2016

0.0%

12/01/1996 - 11/30/1997

2.9%

12/01/2014 - 11/30/2015

1.7%

12/01/1995 - 11/30/1996

2.6%

12/01/2013 - 11/30/2014

1.5%

12/01/1994 - 11/30/1995

2.8%

12/01/2012 - 11/30/2013

1.7%

   

12/01/2011 - 11/30/2012

3.6%

   

12/01/2010 - 11/30/2011

0.0%

   

12/01/2009 - 11/30/2010

0.0%

   

12/01/2008 - 11/30/2009

5.8%

   

12/01/2007 - 11/30/2008

2.3%

   

12/01/2006 - 11/30/2007

3.3%

   

12/01/2005 - 11/30/2006

4.1%

   

12/01/2004 - 11/30/2005

2.7%

   

12/01/2003 - 11/30/2004

2.1%

   

12/01/2002 - 11/30/2003

1.4%

   

12/01/2001 - 11/30/2002

2.6%

   

12/01/2000 - 11/30/2001

3.5%

   

 

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff

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FECA CIRCULAR NO. 19-04

January 4, 2019

Subject: FECA Pharmacy Benefits Management System

Purpose: To announce the implementation of the Office of Workers' Compensation's (OWCP) Division of Federal Employees' Compensation's (DFEC) Pharmacy Benefits Management System (PBM).

Background: Pharmacy benefit managers are third-party administrators (TPA) of prescription drug programs for commercial health plans, self-insured employer plans, Federal and State government employee health plans, etc. PBMs are primarily responsible for developing and maintaining formularies which include an approved listing of prescriptions, contracting with pharmacies to increase enrollment, negotiating discounts and rebates with drug manufacturers and processing and paying prescription drug claims.

Pursuant to 5 U.S.C. 8103 and 20 C.F.R. 10.809, OWCP DFEC has contracted with First Script to serve as DFEC's PBM for claimants covered under the Federal Employees' Compensation Act (FECA). DFEC's PBM will be responsible for pharmaceutical transactions including but not limited to implementation of OWCP DFEC eligibility determinations and pricing for pharmaceutical drugs provided to FECA claimants. All DFEC claimants will be required to use the PBM for prescribed medication; otherwise, payment of drugs will not be authorized at the pharmacy. The PBM will pay network pharmacies directly and then seek reimbursement for those payments via submission of a payment file to DFEC's Bill Pay System (BPS). Since the PBM is responsible for both ensuring eligibility and pricing for pharmaceutical transactions, the BPS will be limited to processing electronic payment files from the PBM and reimbursing the PBM only.

DFEC's PBM will also offer an optional Durable Medical Equipment (DME) and diagnostic testing component.

Actions: PBM implementation will be accomplished in a phased approach. In order to receive pharmacy benefits, injured workers must present their new pharmacy cards to a participating pharmacy along with prescriptions for their accepted, work-related condition(s). A listing of participating pharmacies can be found on the internet at www.feca-pbm.dol.gov. Further assistance in locating or verifying a participating pharmacy or transferring a prescription can be obtained by contacting First Script at 1-877-344-3811.

  1. First Script/FECA pharmacy cards and welcome letters will be mailed to FECA claimant in multiple groupings. Due to urgent safety concerns, welcome packets will first be mailed on January 3, 2019, to claimants who have been prescribed opioids with daily dosages exceeding the 90 MED (Morphine Equivalent Dose).

    All Pharmacy cards will include a Bank Identification Number (BIN), the date the cards become effective, a PBM toll-free number for information, as well as claimant-specific information.
     
  2. Additional phases are estimated to be deployed over the next several months of Fiscal Year 2019, and will include (1) pharmacy cards and welcome packets to all FECA claimants and (2) development and implementation of a user interface for pharmacy authorization transmittals, coordination with DFEC's existing central bill processing contractor and implementation of an interactive website. Subsequent FECA Circulars containing the details of those phases will be issued once those phases are ready for deployment.
     
  3. Additional information and updates will be posted on the DFEC website and provided to the DFEC subscriber list found on the DFEC website.

 

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff

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FECA CIRCULAR NO. 19-05

February 22, 2019

SUBJECT: FDA Medical Devices

PURPOSE: To provide notification of new DFEC policy with respect to payment for certain medical devices.

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 Bulletins 17-01 and 17-03; and FECA Circular 18-05. 21 U.S.C. §§ 321, 351-360n-1; 21 C.F.R. Parts 800-1299

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 Bulletin 17-01 (issued October 14, 2016) implemented new controls for the authorization of compounded medications.

FECA Bulletin 17-03 (March 22, 2017) implemented a new policy that herbal supplements would only be authorized on an exception basis.

FECA Circular 18-05 (issued February 14, 2018) implemented an exception-based policy pertaining to convenience kits and certain other combination medications. Authorization and payment for specified National Drug Codes (NDCs) now automatically denies when: 1. the Division of Federal Employees' Compensation (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 2. The primary use is for a condition not normally caused by a workers' compensation injury. With that circular, DFEC published on its website an initial list of 49 NDCs that were set to deny based on these criteria. Since publication, DFEC has continued to use data analytics to identify other NDCs that fit these criteria and add them to the list. The current list now stands at over 140 NDCs.

Since Circular 18-05 was published, DFEC has identified a new trend in the dispensing of specific prescription medical devices (that are billed with NDCs), which may have emerged as a possible substitute for the prior practice of compounding and prescription medication kits and combination medications.

A medical device is defined within the Food Drug & Cosmetic Act as "...an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including a component part, or accessory which is: recognized in the official National Formulary, or the United States Pharmacopoeia, or any supplement to them, intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals, or intended to affect the structure or any function of the body of man or other animals, and which does not achieve any of its primary intended purposes through chemical action within or on the body of man or other animals and which is not dependent upon being metabolized for the achievement of any of its primary intended purposes." See, Is The Product A Medical Device?

Medical devices distributed in the United States are subject to general controls, and may also be subject to premarketing and other special controls. See, Overview of Device Regulation.

General Controls include:

  1. Establishment Registration by manufacturers, distributors, repackagers and re-labelers,
  2. Medical Device Listing with FDA of devices to be marketed,
  3. Manufacturing the devices in accordance with Good Manufacturing Practices,
  4. Labeling requirements, such as name and place of business of the manufacturer, intended use, and adequate directions for use, See generally 21 C.F.R. 801, 21 C.F.R. 809,
  5. Medical Device Reporting of adverse events as identified by the user, manufacturer and/or distributor of the medical device.

Pre-marketing controls are device and classification specific. Pre-marketing controls for a medical device include Pre-Market Approval (PMA) for certain high risk devices or Pre-Market Notification 510(k) for devices not requiring PMA. Post marketing controls include Device Listing, Medical Device Reporting (MDR), Establishment Registration and Quality System Compliance Inspection.

Like convenience kits, the cost of some of these medical devices can be extremely high and, in some instances, there may be FDA determined safe and commercially available alternatives available at a lower cost.

For example, KamDoy Skin Emulsion is a topical skin care emulsion that is indicated to manage and relieve the burning and itching experienced with various types of dermatoses. It contains the following ingredients: deionized water, copolymer, vegetable oils from African palms, lidocaine HCl (less than 1%), and silver nanoparticles (as a preservative). There are over the counter and/or prescription alternatives for the ingredients in this type of product.

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 medical devices that fit the description above.

ACTION:

  1. DFEC will apply the same basic criteria used for the review of convenience kits.

    Authorization and payment will automatically deny when:
    1. DFEC has determined that the items in the medical device can typically be obtained separately and/or at a lower cost and there is a reasonable commercially available alternative or substitute; or
    2. The primary use is for a condition not normally caused by a workers' compensation injury.
       
  2. For ease of use and ready reference, DFEC will use the same Denial List for medical devices that it uses for updates based on Circular 18-05.
  3. DFEC will continuously and regularly review and evaluate medical devices that fit this criteria in accordance with the above policy and set the corresponding NDC to deny. As this evaluation process progresses, additional non-payable medical devices will be added to the denial list. The list can be found in its entirety, with effective dates, on DFEC's website: DFEC List of National Drug Codes (NDCs) That Will Deny.

    Medical Devices Being Added to the NDC Denial List with the Publication of this Circular:
Medical Devices

NDC

Device Name

15455956601

KamDoy Skin Emulsion Spray

70350261501

Sil-K Pad

69336080204

Silivex Pad

72057000101

Atopaderm Cream

70569002602

Synerderm Skin Emulsion

35781250003

Astero Lidocaine Gel

69336083530

Lidotrex Wound Gel

42546071005

PruMyx

51224045010

Nivatopic Plus

  1. Providers are expected to review this list prior to dispensing to determine if the device will be covered for payment. DFEC will also place notice regarding this new policy on the DFEC Web Bill Processing website.

Exception Basis Note: DFEC policy on considering exceptions for specified medical devices as described in this Circular and on the list will follow that set forth in FECA Bulletin 17-03. This means that the medical devices on DFEC's denial list can only be approved on a District Director exception basis when a claimant's treating physician acquires pre-authorization by submitting rationalized medical evidence to the claims examiner that explains why the authorization of the medical device is medically necessary and cost effective, fully explaining why the commercially available alternative is not suitable for this condition for this particular claimant. In the event that the exception is denied, a formal decision will be issued to the claimant upon request.

 

ANTONIO RIOS
Director for
Federal Employees' Compensation

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

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FECA CIRCULAR NO. 19-06

April 26, 2019

Subject: Online method for debtors to make payments to the OWCP Division of Federal Employees' Compensation (DFEC).

Background: 20 CFR § 10.441(b) provides that when an overpayment of compensation under 5 U.S.C. § 8129 of the Federal Employees' Compensation Act has been made to an individual who is not entitled to further payments, the individual shall refund to the Office of Workers' Compensation (OWCP) the amount of the overpayment as soon as the error is discovered or his or her attention is called to the same.

The overpayment is subject to the provisions of The Federal Claims Collection Act, 31 U.S.C. § 3701, et seq., as amended by the Debt Collection Act of 1982 and the Debt Collection Improvement Act of 1996 (DCIA), and may be reported to the Internal Revenue Service as income. If the individual fails to make such refund, the OWCP DFEC may recover the same through any available means, including offset of salary, annuity benefits, or other Federal payments, including tax refunds as authorized by the Tax Refund Offset Program, or referral of the debt to a collection agency or to the Department of Justice.

Previously, if DFEC could not recover an overpayment from continuing compensation or through similar, alternative means, the debtor was required to submit a payer check by mail.

Applicability: Appropriate National Office and District Office personnel.

Reference: Chapter 6-0500, Debt Liquidation, Part 6, Debt Management, Federal (FECA) Procedure Manual.

Action:

  1. Debtors now have the opportunity to make payments directly from their bank accounts or using a debit card via an online form on pay.gov, a program of the U.S. Treasury, Bureau of the Fiscal Service.
     
  2. The form requires the DFEC debt number, case number, debtor name, street address and payment amount in order to be processed.
     
  3. Payments will be posted to the account via the debt management application in the integrated Federal Employees' Compensation System (iFECS).

Disposition: This circular should be retained until incorporated into Chapter 6-0500, Debt Liquidation, of the FECA Procedure Manual.

 

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff

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FECA CIRCULAR NO. 19-07

May 14, 2019

SUBJECT: Current Procedural Terminology Code (CPT) 99070 Bill Payment Restrictions

PURPOSE: To provide notification of new DFEC policy with respect to payment for CPT code 99070, Supplies and Materials

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. See 20 C.F.R. 10.800-826, FECA Bulletins 17-01 and 17-03.

BACKGROUND:
FECA Circular 12-06 outlined that if providers billed a National Drug Code (NDC) in conjunction with CPT code 99070, the NDC would be evaluated to determine payment based on the same criteria as those billed with unlisted HCPCS "J" codes (J3490, J8499, J8999 and J9999).

FECA Bulletin 17-01 implemented new controls for the authorization of compounded medications.

FECA Bulletin, 17-03 implemented a new policy that herbal supplements would only be authorized on an exception basis.

FECA Bulletin 17-07 implemented new controls for the authorization of opioid medications.

FECA Circular 18-05 implemented a new exception-based policy pertaining to payment of convenience kits and certain other combination medications.

FECA Circular 18-06 implemented a new exception-based policy pertaining to payment of physician dispensed medications billed under Unspecified Healthcare Common Procedure Coding System (HCPCS) "J Codes".

FECA Circular 19-05 implemented a new exception based policy pertaining to payment of prescription medical devices.

The American Medical Association provides the following definition of CPT code 99070:

"Supplies and materials (except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided)"

The use of this code allows medical providers to bill for supplies and material, such as prescription medications, that are not usually included as part of the medical service.

Current FECA policy for CPT code 99070 restricts the usage from durable medical equipment providers and establishes a maximum allowable reimbursement amount up to $125.00. However, since the controls for physician dispensed medications were implemented in FECA Circular 18-06, the Division of Federal Employees' Compensation (DFEC) has identified a trend in the dispensing of medication in physician offices using CPT code 99070.

Similar to the concerns outlined in FECA Circular 18-06, physician dispensing in this manner can present a safety concern as it presents obstacles for both a physician and pharmacist to identify harmful drug interactions when multiple physicians are treating a patient. The cost of physician dispensed medications can be significantly higher than those dispensed at a pharmacy when billing under 99070, and billing medication in this manner allows such submissions to bypass controls that DFEC has implemented. There may also be situations where the prescription of certain medications can be incentivized, potentially impacting physician judgment on medical necessity and the medication quantity prescribed.

The practice of dispensing medications in this manner inhibits DFEC from effectively administering program controls relating to safety, cost and medical necessity. It circumvents opioid controls as outlined in FECA Bulletin 17-07 and adversely impacts program controls on compound medications (FECA Bulletin 17-01) and implementation of the DFEC list of not covered national drug codes (Circulars 18-05 and 19-05).

In addition, as code 99070 is designed to be billed in combination with other medical services, there may be situations where it is used to unbundle services that are considered a component of the rendered service in an effort to increase reimbursable amounts.

Currently code 99070 is not considered a reimbursable code for the Office of Workers' Compensation Programs', Division of Energy Employees Occupational Illness Compensation or the Center for Medicare Services. For reimbursement of covered supplies and materials, an appropriate Level II HCPCS code must be submitted.

AUTHORITY: 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) authorizes OWCP's FECA program to set limitations and require pre-authorization for medical services and supplies where deemed necessary.

ACTION: In accordance with the discretion granted to DOL and delegated to OWCP, DFEC is updating its policy regarding reimbursement of CPT code 99070.

  1. Effective June 1, 2019, DFEC will no longer recognize CPT code 99070 as a valid reimbursable code.
     
  2. For reimbursement of covered supplies, materials, and medication, an appropriate Level II HCPCS code must be submitted.
     
  3. DFEC will rely on the guidance set forth in FECA Circular 18-06 to determine whether medication dispensed and billed with one of the six unspecified codes will be authorized and paid. If the medication dispensed is indeed a drug, "that ordinarily cannot be self-administered", DFEC will authorize and pay for the medication without further claims development in accordance with 20 C.F.R. 10.800-826.
     
  4. This policy is effective June 1, 2019. All bills received on and after this date will be subject to this policy.

 

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff

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FECA CIRCULAR NO. 19-08

July 26, 2019

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

The interest rate to be assessed for the prompt payment bills is 2.625 percent for the period of July 1, 2019 through December 31, 2019. This new rate has been updated in the Central Bill Payment system tables. The rate was changed from 3.625 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 1.0 percent for the period of January 1, 2019 through December 31, 2019. This rate remains unchanged 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. 19-08

PROMPT PAYMENT INTEREST RATES

Dates

Percentage

07/1/19 - 12/31/19

2⅝%

01/1/19 - 06/30/19

3⅝%

07/1/18 - 12/31/18

3½%

01/1/18 - 06/30/18

2⅝%

07/1/17 - 12/31/17

2⅜%

01/1/17 - 06/30/17

2½%

07/1/16 - 12/31/16

1⅞%

01/1/16 - 06/30/16

2½%

07/1/15 - 12/31/15

2⅜%

01/1/15 - 12/31/15

2⅛%

07/1/14 - 12/31/14

2.0%

01/1/14 - 12/31/14

2⅛%

07/1/13 - 12/31/13

1¾%

01/1/13 - 12/31/13

1⅜%

07/1/12 - 12/31/12

1¾%

01/1/12 - 12/31/12

2.0%

07/1/11 - 12/31/11

2½%

01/1/11 - 06/30/11

2⅝%

01/1/10 - 12/31/10

2⅝%

01/1/10 - 12/31/10

3¼%

PROMPT PAYMENT INTEREST RATES

Dates

Percentage

Dates

Percentage

07/1/09 - 12/31/09

4⅞%

07/1/99 - 12/31/99

6½%

01/1/09 - 06/30/09

5⅝%

01/1/99 - 06/30/99

5.0%

07/1/08 - 12/31/08

5⅛%

07/1/98 - 12/31/98

6.0%

01/1/08 - 06/30/08

4¾%

01/1/98 - 06/30/98

6¼%

07/1/07 - 12/31/07

5¾%

07/1/97 - 12/31/97

6¾%

01/1/07 - 06/30/07

5¼%

01/1/97 - 06/30/97

6⅜%

07/1/06 - 12/31/06

5¾%

07/1/96 - 12/31/96

7.0%

01/1/06 - 06/30/06

5⅛%

01/1/96 - 06/30/96

5⅞%

07/1/05 - 12/31/05

4½%

07/1/95 - 12/31/95

6⅜%

01/1/05 - 06/30/05

4¼%

01/1/95 - 06/30/95

8⅛%

07/1/04 - 12/31/04

4½%

07/1/94 - 12/31/94

7.0%

01/1/04 - 06/30/04

4.0%

01/1/94 - 06/30/94

5½%

07/1/03 - 12/31/03

3⅛%

07/1/93 - 12/31/93

5⅝%

01/1/03 - 06/30/03

4¼%

01/1/93 - 06/30/93

6½%

07/1/02 - 12/31/02

5¼%

07/1/92 - 12/31/92

7.0%

01/1/02 - 06/30/02

5½%

01/1/92 - 06/30/92

6⅞%

07/1/01 - 12/31/01

5⅞%

07/1/91 - 12/31/91

8½%

01/1/01 - 06/30/01

6⅜%

01/1/91 - 06/30/91

8⅜%

07/1/00 - 12/31/00

7¼%

07/1/90 - 12/31/90

9.0%

01/1/00 - 06/30/00

6¾%

01/1/90 - 06/30/90

8½%

       

01/1/89 - 06/30/89

9¾%

07/1/86 - 12/31/86

8½%

07/1/88 - 12/31/88

9¼%

01/1/86 - 06/30/86

9¾%

01/1/88 - 06/30/88

9⅜%

07/1/85 - 12/31/85

10⅜%

07/1/87 - 12/31/87

8⅞%

01/1/85 - 06/30/85

12⅛%

01/1/87 - 06/30/87

7⅝%

   

ATTACHMENT TO FECA CIRCULAR NO. 19-08

DEBT MANAGEMENT INTEREST RATES

 

Dates

Percentages

01/1/19 - 12/31/19

1.0%

01/1/18 - 12/31/18

1.0%

01/1/17 - 12/31/17

1.0%

01/1/16 - 12/31/16

1.0%

01/1/15 - 12/31/15

1.0%

01/1/14 - 12/31/14

1.0%

01/1/13 - 12/31/13

1.0%

01/1/12 - 12/31/12

1.0%

01/1/11 - 12/31/11

1.0%

01/1/10 - 12/31/10

1.0%

   

01/1/09 - 12/31/09

3.0%

07/1/08 - 12/31/08

3.0%

01/1/08 - 06/30/08

5.0%

01/1/07 - 12/31/07

4.0%

07/1/06 - 12/31/06

4.0%

01/1/06 - 06/30/06

2.0%

01/1/05 - 12/31/05

1.0%

   

01/1/04 - 12/31/04

1.0%

01/1/03 - 12/31/03

2.0%

07/1/02 - 12/31/02

3.0%

01/1/02 - 06/30/02

5.0%

01/1/01 - 12/31/01

6.0%

01/1/00 - 12/31/00

5.0%

   

01/1/99 - 12/31/99

5.0%

01/1/98 - 12/31/98

5.0%

01/1/97 - 12/31/97

5.0%

01/1/96 - 12/31/96

5.0%

07/1/95 - 12/31/95

5.0%

01/1/95 - 06/30/95

3.0%

   

01/1/94 - 12/31/94

3.0%

01/1/93 - 12/31/93

4.0%

01/1/92 - 12/31/92

6.0%

01/1/91 - 12/31/91

8.0%

01/1/90 - 12/31/90

9.0%

   

01/1/89 - 12/31/89

7.0%

01/1/88 - 12/31/88

6.0%

01/1/87 - 12/31/87

7.0%

01/1/86 - 12/31/86

8.0%

01/1/85 - 12/31/85

9.0%

Prior to 01/01/84

Not Applicable

 

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FECA CIRCULAR NO. 19-09

September 11, 2019

SUBJECT: Prescription and non-prescription or over-the-counter (OTC) drugs

PURPOSE: To provide notification of new DFEC policy with respect to payment for non-prescription or over-the-counter (OTC) drugs instead of certain prescription drugs.

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 and 19-05.

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 Bulletin 17-01 (issued October 14, 2016) implemented new controls for the authorization of compounded medications.

FECA Bulletin 17-03 (March 22, 2017) implemented a new policy that herbal supplements would only be authorized on an exception basis.

FECA Circular 18-05 (issued February 14, 2018) implemented an exception-based policy pertaining to convenience kits and certain other combination medications. Authorization and payment for specified National Drug Codes (NDCs) now automatically denies when:
1. OWCP's Division of Federal Employees' Compensation (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
2. The primary use is for a condition not normally caused by a workers' compensation injury.
For FECA Circular 18-05, DFEC published on its website an initial list of 49 NDCs that were set to deny based on these criteria. Since publication, DFEC has continued to use data analytics to identify other NDCs that fit these criteria and add them to the list.

FECA Circular 19-05 (issued February 22, 2019) implemented an exception-based policy pertaining to the dispensing of specific prescription medical devices (that are billed with NDCs), which has emerged as a possible substitute for the prior practice of compounding and prescription medication kits and combination medications.

DFEC has identified a similar trend in the dispensing of medications via prescription-only when nonprescription or over-the-counter (OTC) drugs are commercially available.

When originally enacted, the Federal Food, Drug, and Cosmetic Act of 1938 did not make a distinction between prescription and OTC drugs. In 1951 the Durham-Humphrey amendments to the act set up criteria to differentiate between these two classifications of drugs. Prescription drugs were recognized as any drug that cannot be used safely without professional supervision and therefore can only be dispensed only by prescription. OTC drugs were recognized as any drugs which are safe and effective for use by the general public without seeking treatment by a health professional. A separate process was later implemented by the U.S. Food and Drug Administration (FDA) which provided a path for the reclassification of drugs from prescription to OTC status which is referred to as an "Rx to OTC switch".1

Non-prescription or OTC drugs are generally less expensive than prescription alternatives according to the FDA, and in July 2018, the FDA released draft guidance detailing innovative approaches that could lead to the approval of a wider range of non-prescription drug products. (U. S. Food and Drug Administration Saving Money On Prescription Drugs and Innovative Approaches for Nonprescription Drug Products)

Like convenience kits and prescription medical devices, the cost of certain prescription drugs can be extremely high and, in some instances, there may be safe and commercially available alternative OTC drugs at a lower cost.

For example, Omeprazole/Sodium Bicarbonate 20/1100 mg capsules are available both by prescription and OTC. The OTC version of this drug is the same dosage while being commercially available at a substantially lower cost.

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. Authorization and payment will automatically deny when DFEC has determined that the prescribed drug(s) has a medically reasonable alternative that is available OTC at a lower cost.
     
  2. For ease of use and ready reference, DFEC will use the same Denial List that it uses for updates based on Circular 18-05.
     
  3. DFEC will continuously and regularly review and evaluate drugs that fit this criteria in accordance with the above policy and set the corresponding NDC to deny. As this evaluation process progresses, additional non-payable drugs will be added to the denial list. The list can be found in its entirety, with effective dates, on DFEC's website.
     
    Prescription Drugs With OTC Alternatives Being Added to the NDC Denial List with the Publication of this Circular:

    NDC

    Drug Name

    71399242003

    Omeprazole/Sodium Bicarbonate 20/1100 mg capsule

    13107011530

    Omeprazole-Sodium Bicarbonate Oral Capsule 20-1100 MG

    27241002931

    Omeprazole-Sodium Bicarbonate Oral Packet 20-1680 MG

    27241002962

    Omeprazole-Sodium Bicarbonate Oral Packet 20-1680 MG

    49884026811

    Omeprazole-Sodium Bicarbonate Oral Packet 20-1680 MG

    49884026852

    Omeprazole-Sodium Bicarbonate Oral Packet 20-1680 MG

    55111036330

    Omeprazole-Sodium Bicarbonate Oral Capsule 20-1100 MG

    68682099030

    Omeprazole-Sodium Bicarbonate Oral Packet 20-1680 MG

    69367019530

    Omeprazole-Sodium Bicarbonate Oral Capsule 20-1100 MG

    69665011530

    OmePPi Oral Capsule 20-1100 MG

    16714050801

    Omeprazole-Sodium Bicarbonate Oral Capsule 20-1100 MG

    68382050106

    Omeprazole-Sodium Bicarbonate Oral Capsule 20-1100 MG

    69097091302

    Omeprazole-Sodium Bicarbonate Oral Capsule 20-1100 MG

    68012005230

    Zegerid Oral Packet 20-1680 MG

    68012010230

    Zegerid Oral Capsule 20-1100 MG

    60505082901

    Fluticasone propionate nasal spray

    65162025310

    Ranitidine HCl 150 mg tablet


     
  4. Providers are expected to review this list prior to dispensing to determine if the drugs will be covered for payment. DFEC will also place notice regarding this new policy on the DFEC Web Bill Processing website.
     
  5. Claimants whose pharmacy will not dispense a specific drug as it is not covered for payment based on the above criteria are expected to discuss with their physician the available OTC options. Reimbursement for expenses associated with these OTC drug options can be claimed by use of form OWCP-915, Claim for Medical Reimbursement.

Exception Basis Note: DFEC policy on considering exceptions for specified drugs as described in this Circular and on the list will follow that set forth in FECA Bulletin 17-03. This means that the prescription drugs on DFEC's denial list can only be approved on a District Director exception basis when a claimant's treating physician acquires pre-authorization by submitting rationalized medical evidence to the claims examiner that explains why the authorization of the prescription drug is medically necessary and cost effective, fully explaining why the commercially available alternative is not suitable for this condition for this particular claimant. In the event that the exception is denied, a formal decision will be issued to the claimant upon request.

ANTONIO A. RIOS
Director for Federal Employees' Compensation

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

1See generally Federal Food, Drug, and Cosmetic Act Amendments (Durham-Humphrey amendments), Pub.L.No.82-215, 65 Stat. 648 (1951); 21 U.S.C. Chapter 9 § 301 et seq

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FECA CIRCULAR NO. 18-01

November 29, 2017

SUBJECT: Application of the Department of Labor’s (DOL) Suspension and Debarment Procedures to Medical Provider Payments under the Federal Employees’ Compensation Act (FECA)

Background: On August 10, 2011, the Division of Federal Employees’ Compensation (DFEC) issued FECA Bulletin 11-08, Exclusion of Providers, which outlines the steps required to exclude a provider under 20 CFR 10.815-10.826. Section 10.816 provides that DFEC will automatically exclude a provider that has been convicted under any criminal statute of fraudulent activities in connection with any Federal or State program for which payments are made to providers for similar medical, surgical or hospital services, appliances or supplies; or a provider that has been excluded or suspended, or has resigned in lieu of exclusion of suspension, from participation in any such Federal or State program. Sections 10.817-824 provide administrative procedures for exclusion of a provider that has engaged in activities enumerated in section 10.815(c)-(j). These procedures include review by DOL’s Office of Inspector General (OIG), a proposed decision and final decision and, if requested, a hearing before an Administrative Law Judge (ALJ). Nothing in this circular affects DFEC’s provider exclusion procedures under 20 CFR 10.815-10.826.

This circular provides notice that the Department of Labor has instituted nonprocurement suspension and debarment procedures that DFEC has determined will apply to medical providers providing medical services and supplies under FECA. This DOL nonprocurement suspension/debarment process is separate from the FECA regulatory provider exclusion process under 20 CFR 10.815-10.826.

Under DOL’s nonprocurement suspension and debarment procedures, the Department’s OIG can refer a provider to DOL’s Suspension and Debarment Official (SDO) when (1) there is reasonable belief indicating the provider has engaged in fraudulent billing practices, (2) a provider has been criminally indicted with defrauding the FECA program (suspension referral), and/or (3) a provider has been convicted criminally of defrauding the FECA program (debarment referral). The SDO is the ultimate decision-making authority as to whether DOL will take nonprocurement suspension and/or debarment actions against a provider.

If the SDO issues a Notice of Suspension, the provider may not receive payments for services provided on or after the date of the notice during the period of the suspension. The provider has an opportunity to respond to the notice of suspension but the payments cease immediately upon the notice. Suspensions generally are for a period of 12 months but may extend to 18 months.

If the SDO issues a Proposed Notice of Debarment, the provider has an opportunity to respond. If a Final Notice of Debarment is ultimately issued, the provider may not receive payments for services on or after the date of the notice during the period of debarment, which begins on the date the final notice is issued. The period of debarment is generally for a period of 3 years but may extend to five years based on the seriousness of the causes upon which debarment was based.

Since SDO decisions may be issued prior to conviction and serve to immediately halt payments to providers suspected to be acting in a fraudulent manner, DFEC is issuing procedures to make clear it will stop payments to medical providers based on either a notice of suspension or final debarment determination taken by the SDO.

Legal Authority: Discretionary suspensions and debarments are governed by two regulatory schemes - one for procurement (located in the Federal Acquisition Regulation, or FAR, at 48 C.F.R. Subpart 9.4) and one for nonprocurement (2 C.F.R. Part 180). A nonprocurement suspension or debarment applies to "covered transactions," which are defined in the nonprocurement rules common to all federal agencies (called the "NCR" or "common rule") and further defined in agency-specific regulations or policies. See 2 C.F.R. 180.210, 180.215, 180.970; see also Executive Order 12549, 51 Fed. Reg. 6370 (Feb. 18, 1986); Executive Order 12689, 54 Fed. Reg. 34131 (Aug. 15, 1989).

Under the nonprocurement common rule, a "covered transaction" is "any transaction, regardless of type (except procurement contracts), including but not limited to "grants, cooperative agreements, scholarships, fellowships, contracts of assistance, loans, loan guarantees, subsidies, insurances, payments for specified uses, and donation agreements." 2 C.F.R. 180.970. Covered transactions do not include "benefit[s] to an individual as a personal entitlement ..." but do include "benefits received in an individual’s business capacity." 2 C.F.R. 180.215(b).

DOL has determined that payments made to medical providers are considered a "covered transaction" under the nonprocurement common rule framework. FECA medical benefit payments are almost always made directly to the medical provider for providing medical services and supplies in his/her business capacity as a doctor, pharmacy, etc. and not as a benefit to which the medical provider is personally entitled.

DFEC has concluded that DOL’s nonprocurement suspension and debarment regulations shall be applied to medical providers providing medical services and supplies to FECA claimants.

References: 2 C.F.R. Part 180.

Purpose: To inform the affected parties of the effect of a decision issued by the DOL SDO on FECA providers and payments to such providers.

Applicability: Medical providers for FECA claimants, DOL SDO, OASAM, DOL OIG; Employing Agency personnel and OIG offices, all National Office staff and District Office claims personnel.

Actions:

  1. If the DOL SDO receives a recommendation for suspension or debarment for a FECA medical provider from DOL OIG , DFEC will be provided with a copy of the referral. DFEC will update its records accordingly but no further action will be taken.
  2. When the DOL SDO makes an initial determination to issue a notice of proposed suspension or debarment on the matter, DFEC shall be notified.
  3. If the DOL SDO chooses to take no action on the matter, DFEC will update its records accordingly and take no further action as it relates to this process.
  4. If the DOL SDO issues a Notice of Suspension, DFEC will issue a notice to the provider indicating that payment for services provided on and after the date of the SDO’s notice will be suspended. Upon a final determination by the SDO, DFEC will issue a notice to the provider that payment for services provided will not be made for the period outlined in the SDO’s Final Determination of Suspension.
  5. If the DOL SDO issues an initial Notice of Debarment, DFEC will update its records accordingly but no further action will be taken until a final notice is issued. If a Final Notice of Debarment is then issued, DFEC will issue a notice to the provider indicating that payment will not be made for services provided on and after the date of the debarment decision for the period outlined in the SDO’s Final Determination of Debarment. DOL’s SDO will update the System for Award Management (SAM) to include the names of the provider under the list of suspended or debarred entities.
  6. Since suspension and debarment applies only to those services that are provided after the date of the applicable notice or decision, DFEC will suspend/cease payments made after the effective date of the notice of suspension or final debarment decision. DFEC will pay for services which occurred prior to that effective date even if the request for payment comes after the effective date of the suspension notice or debarment decision.
  7. To stop payments to the provider, DFEC will notify its central bill processing vendor to place the provider "on review." This action will stop payments from being made, and any incoming bills will be placed into a queue. DFEC’s National Office Bill Payment Specialist, or designee, will monitor that provider’s bill queue and authorize payment for bills for dates of service prior to the effective date of the suspension notice /debarment decision, if otherwise payable for the accepted work-related conditions in that case.
  8. If the DOL SDO issues a decision that rescinds or alters its determination, DFEC will notify the provider accordingly and process unpaid bills, if needed.
  9. DFEC will publish on its website a listing of providers that have been suspended or debarred, with the effective date and applicable periods. If an injured worker is currently receiving treatment from such a provider, a change will be authorized if requested.

 

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff

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FECA CIRCULAR NO. 18-02

January 2, 2018

SUBJECT: Dual Benefits - FERS Cost of Living Adjustments

Background: Effective December 1, 2017, benefits issued by the Social Security Administration (SSA) will be increased by 2.0%. 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.

This adjustment will be made from the National Office for all cases that were correctly entered into the iFECS Compensation program. The adjustment will be effective with the periodic roll cycle beginning December 10, 2017. There will be no adjustment or overpayment declared for the period of December 1, 2017 through December 9, 2017.

The historical SSA cost of living adjustments are as follows:

Dates

Cost of living adjustment

Dates

Cost of living adjustment

12/01/2017 - 11/30/2018

2.0%

12/01/1999 - 11/30/2000

2.4%

12/01/2016 - 11/30/2017

0.3%

12/01/1998 - 11/30/1999

1.3%

12/01/2015 - 11/30/2016

0.0%

12/01/1997 - 11/30/1998

2.1%

12/01/2014 - 11/30/2015

1.7%

12/01/1996 - 11/30/1997

2.9%

12/01/2013 - 11/30/2014

1.5%

12/01/1995 - 11/30/1996

2.6%

12/01/2012 - 11/30/2013

1.7%

12/01/1994 - 11/30/1995

2.8%

12/01/2011 - 11/30/2012

3.6%

   
       

12/01/2010 - 11/30/2011

0.0%

   

12/01/2009 - 11/30/2010

0.0%

   

12/01/2008 - 11/30/2009

5.8%

   

12/01/2007 - 11/30/2008

2.3%

   

12/01/2006 - 11/30/2007

3.3%

   

12/01/2005 - 11/30/2006

4.1%

   

12/01/2004 - 11/30/2005

2.7%

   

12/01/2003 - 11/30/2004

2.1%

   

12/01/2002 - 11/30/2003

1.4%

   

12/01/2001 - 11/30/2002

2.6%

   

12/01/2000 - 11/30/2001

3.5%

   

 

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff

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FECA CIRCULAR NO. 18-03

January 2, 2018

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

The interest rate to be assessed for the prompt payment bills is 2.63 percent for the period of January 1, 2018 through June 30, 2018. This new rate has been updated in the Central Bill Payment system tables.

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 1.0 percent for the period of January 1, 2018 through December 31, 2018. This rate remains unchanged in the iFECS system tables.

Ordinarily, the rate of interest charged on debts due the U.S. Government is only changed in January, and is effective for the entire year. However, the rate may be changed in July if there is a difference in the Current Value of Funds (CVF) interest rate of more than two percent. The rate will be reviewed on July 1, 2018 to determine if the Treasury has changed the rate.

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 Pay Interest Rates Debt Management Interest Rates

Distribution: All DFEC Staff


PROMPT PAYMENT INTEREST RATES

Dates

Percentage

01/1/18 - 06/30/18

2⅝%

07/1/17 - 12/31/17

2⅜%

01/1/17 - 06/30/17

2½%

07/1/16 - 12/31/16

1⅞%

01/1/16 - 06/30/16

2½%

07/1/15 - 12/31/15

2⅜%

01/1/15 - 12/31/15

2⅛%

07/1/14 - 12/31/14

2.0%

01/1/14 - 12/31/14

2⅛%

07/1/13 - 12/31/13

1¾%

01/1/13 - 12/31/13

1⅜%

07/1/12 - 12/31/12

1¾%

01/1/12 - 12/31/12

2.0%

07/1/11 - 12/31/11

2½%

01/1/11 - 06/30/11

2⅝%

01/1/10 - 12/31/10

2⅝%

01/1/10 - 12/31/10

3¼%

PROMPT PAYMENT INTEREST RATES

Dates

Percentage

Dates

Percentage

07/1/09 - 12/31/09

4⅞%

07/1/99 - 12/31/99

6½%

01/1/09 - 06/30/09

5⅝%

01/1/99 - 06/30/99

5.0%

07/1/08 - 12/31/08

5⅛%

07/1/98 - 12/31/98

6.0%

01/1/08 - 06/30/08

4¾%

01/1/98 - 06/30/98

6¼%

07/1/07 - 12/31/07

5¾%

07/1/97 - 12/31/97

6¾%

01/1/07 - 06/30/07

5¼%

01/1/97 - 06/30/97

6⅜%

07/1/06 - 12/31/06

5¾%

07/1/96 - 12/31/96

7.0%

01/1/06 - 06/30/06

5⅛%

01/1/96 - 06/30/96

5⅞%

07/1/05 - 12/31/05

4½%

07/1/95 - 12/31/95

6⅜%

01/1/05 - 06/30/05

4¼%

01/1/95 - 06/30/95

8⅛%

07/1/04 - 12/31/04

4½%

07/1/94 - 12/31/94

7.0%

01/1/04 - 06/30/04

4.0%

01/1/94 - 06/30/94

5½%

07/1/03 - 12/31/03

3⅛%

07/1/93 - 12/31/93

5⅝%

01/1/03 - 06/30/03

4¼%

01/1/93 - 06/30/93

6½%

07/1/02 - 12/31/02

5¼%

07/1/92 - 12/31/92

7.0%

01/1/02 - 06/30/02

5½%

01/1/92 - 06/30/92

6⅞%

07/1/01 - 12/31/01

5⅞%

07/1/91 - 12/31/91

8½%

01/1/01 - 06/30/01

6⅜%

01/1/91 - 06/30/91

8⅜%

07/1/00 - 12/31/00

7¼%

07/1/90 - 12/31/90

9.0%

01/1/00 - 06/30/00

6¾%

01/1/90 - 06/30/90

8½%

       

01/1/89 - 06/30/89

9¾%

07/1/86 - 12/31/86

8½%

07/1/88 - 12/31/88

9¼%

01/1/86 - 06/30/86

9¾%

01/1/88 - 06/30/88

9⅜%

07/1/85 - 12/31/85

10⅜%

07/1/87 - 12/31/87

8⅞%

01/1/85 - 06/30/85

12⅛%

01/1/87 - 06/30/87

7⅝%

   

ATTACHMENT TO FECA CIRCULAR NO. 18-03

DEBT MANAGEMENT INTEREST RATES

 

Dates

Percentages

01/1/18 - 12/31/18

1.0%

01/1/17 - 12/31/17

1.0%

01/1/16 - 12/31/16

1.0%

01/1/15 - 12/31/15

1.0%

01/1/14 - 12/31/14

1.0%

01/1/13 - 12/31/13

1.0%

01/1/12 - 12/31/12

1.0%

01/1/11 - 12/31/11

1.0%

01/1/10 - 12/31/10

1.0%

   

01/1/09 - 12/31/09

3.0%

07/1/08 - 12/31/08

3.0%

01/1/08 - 06/30/08

5.0%

01/1/07 - 12/31/07

4.0%

07/1/06 - 12/31/06

4.0%

01/1/06 - 06/30/06

2.0%

01/1/05 - 12/31/05

1.0%

   

01/1/04 - 12/31/04

1.0%

01/1/03 - 12/31/03

2.0%

07/1/02 - 12/31/02

3.0%

01/1/02 - 06/30/02

5.0%

01/1/01 - 12/31/01

6.0%

01/1/00 - 12/31/00

5.0%

   

01/1/99 - 12/31/99

5.0%

01/1/98 - 12/31/98

5.0%

01/1/97 - 12/31/97

5.0%

01/1/96 - 12/31/96

5.0%

07/1/95 - 12/31/95

5.0%

01/1/95 - 06/30/95

3.0%

   

01/1/94 - 12/31/94

3.0%

01/1/93 - 12/31/93

4.0%

01/1/92 - 12/31/92

6.0%

01/1/91 - 12/31/91

8.0%

01/1/90 - 12/31/90

9.0%

   

01/1/89 - 12/31/89

7.0%

01/1/88 - 12/31/88

6.0%

01/1/87 - 12/31/87

7.0%

01/1/86 - 12/31/86

8.0%

01/1/85 - 12/31/85

9.0%

Prior to 01/01/84

Not Applicable

 

ATTACHMENT TO FECA CIRCULAR NO. 18-03

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FECA CIRCULAR NO. 18-04

January 2, 2018

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, 2018, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile INCREASED to 54.5 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 5, Benefit Payments, 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.

The following is a list of the historical mileage rates used to reimburse claimant travel:

Dates

Cents per mile

01/01/1995 - 06/06/1996

30.0 cents per mile

06/07/1996 - 09/07/1998

31.0 cents per mile

09/08/1998 - 03/31/1999

32.5 cents per mile

04/01/1999 - 01/13/2000

31.0 cents per mile

 

 

01/14/2000 - 01/21/2001

32.5 cents per mile

01/22/2001 - 01/20/2002

34.5 cents per mile

01/21/2002 - 12/31/2002

36.5 cents per mile

01/01/2003 - 12/31/2003

36.0 cents per mile

01/01/2004 - 02/03/2005

37.5 cents per mile

02/04/2005 - 08/31/2005

40.5 cents per mile

09/01/2005 - 12/31/2005

48.5 cents per mile

01/01/2006 - 01/31/2007

44.5 cents per mile

02/01/2007 - 03/18/2008

48.5 cents per mile

03/19/2008 - 07/31/2008

50.5 cents per mile

08/01/2008 - 12/31/2008

58.5 cents per mile

01/01/2009 - 12/31/2009

55.0 cents per mile

 

 

01/01/2010 - 12/31/2010

50.0 cents per mile

01/01/2011 - 04/16/2012

51.0 cents per mile

04/17/2012 - 12/31/2012

55.5 cents per mile

01/01/2013 - 12/31/2013

56.5 cents per mile

01/01/2014 - 12/31/2014

56.0 cents per mile

01/01/2015 - 12/31/2015

57.5 cents per mile

01/01/2016 - 12/31/2016

54.0 cents per mile

01/01/2017 - 12/31/2017

53.5 cents per mile

01/01/2018 to Present

54.5 cents per mile

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

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FECA CIRCULAR NO. 18-05

February 14, 2018

SUBJECT: Medication "Convenience" Kits and Combination Medications

PURPOSE: To provide notification of new DFEC policy with respect to payment for certain medications and 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. See 20 C.F.R. 10.800-826, FECA Bulletins 17-01 and 17-03.

Medical compounding is the process of combining or altering two or more drugs or their ingredients to create a hybrid that is tailored to the specific need of a patient. Compounding is normally done by licensed pharmacists with the oversight of the states' boards of pharmacy or by licensed physicians. With FECA Bulletin 17-01, a new DFEC policy was instituted for the authorization of compounded products, and how to manage cases where a claimant is receiving such compound medications. With FECA Bulletin, 17-03, a new policy was issued that herbal supplements would only be authorized on an exception basis.

Since Bulletin 17-01 was published, the Division of Federal Employees' Compensation (DFEC) has identified a new trend in the dispensing of medication kits, which may have emerged as a possible substitute for traditional compounding. While most compounded medications are mixed together by a pharmacist, some medication kits appear to be packaged solely for convenience. These "convenience kits" include multiple medications or items that are used together or mixed by the patient at home. There are several varieties of kits available. A typical compounding convenience kit might contain a base chemical and one or more pre-measured active ingredients that are to be mixed by the patient by following packaged instructions.

While compounded drugs use multiple billing codes for multiple ingredients, these kits typically have just one National Drug Code (NDC) number registered to them. This has allowed such convenience kits to be approved and paid for regardless of the cost of the kit's individual components and not in accordance with DFEC's Letter of Medical Necessity (LMN) process. Similarly, there are combination medications that in effect may meet the technical definition of a compound drug. Although they combine two drugs, they are assigned a single NDC number and thus also cannot be processed through the LMN process.

The cost of certain convenience kits and combination medications is extremely high and in many instances, there are safe and commercially available alternative NDCs available at a lower cost.

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) authorizes OWCP's FECA program to set limitations and require pre-authorization for medical services and supplies where deemed necessary.

In accordance with the discretion granted to DOL and delegated to OWCP, DFEC is instituting a new exception-based policy pertaining to payment of convenience kits and certain other combination medications. Authorization and payment will automatically deny when:

  1. 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
  2. The primary use is for a condition not normally caused by a workers' compensation injury.

For example, the combination medication kit Dermacinrx Zrm Pak (NDC 59088080500) contains a patch and a cream. These items (Lidocaine 5% patch and Dimethicone 5% cream) can be obtained separately and at lower cost, so this is one of the NDCs on DFEC's denial list.

This trend has also been observed for other combination medications, such as Duexis (NDC 75987001003), which is a combination of Ibuprofen and Famotidine, both of which can be obtained separately and at a lower cost. Therefore, this medication is also being placed on DFEC's denial list.

DFEC's initial list of denied NDCs contains 49 different NDCs. An informational copy of this initial list is attached to this Circular. Please note that DFEC will continuously and regularly review and evaluate NDCs in accordance with the above policy and set the corresponding NDC to deny. As this evaluation process progresses, additional listings of non-payable medications (such as convenience kits and combination medications) will be made available on DFEC's website at https://www.dol.gov/owcp/dfec/. Providers are expected to review this list prior to dispensing to determine if the NDC will be covered for payment. DFEC will also place notice regarding this new policy on the DFEC Web Bill Processing website at https://owcpmed.dol.gov.

Exception Basis Note: DFEC policy on considering exceptions for DFEC specified NDCs for convenience kits and combination medications will follow that set forth in FECA Bulletin 17-03. The convenience kits and combination medications for DFEC specified NDCs can only be approved on a District Director exception basis when a claimant's treating physician acquires pre-authorization by submitting rationalized medical evidence that explains why the authorization of the convenience kit/combination medication is medically necessary and cost effective, fully explaining why the commercially available alternative is not suitable for this condition for this particular claimant.

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff

Denied NDCs

Effective Date of Denial

NDC

Name

02/28/2018

45861010801

ACTIVE-PAC KIT

02/28/2018

69677004002

CAPXIB KIT

02/28/2018

69677004003

CAPXIB KIT

02/28/2018

59088035100

DERMACINRX CINLONE-I CPI KIT

02/28/2018

59088039100

DERMACINRX CLORHEXACIN KIT

02/28/2018

59088081000

DERMACINRX EMPRICAINE KIT

02/28/2018

59088034300

DERMACINRX LEXITRAL PHARMAPAK

02/28/2018

59088080700

DERMACINRX PHN PAK

02/28/2018

59088087300

DERMACINRX PRIZOPAK KIT

02/28/2018

59088033600

DERMACINRX SILAPAK

02/28/2018

59088036700

DERMACINRX SILAPAK

02/28/2018

59088036300

DERMACINRX SILAZONE PHARMAPAK

02/28/2018

59088035300

DERMACINRX SURGICAL PHARMAPAK

02/28/2018

59088080500

DERMACINRX ZRM PAK

02/28/2018

69329033500

DERMASILKRX DICLOPAK

02/28/2018

69329025001

DERMASILKRX SDS PAK

02/28/2018

69329029001

DERMAWERX SDS PAK

02/28/2018

69329027001

DERMAWERX SURGICAL PLUS PAK

02/28/2018

69621039300

DERMAZONE 0.1% KIT

02/28/2018

69621080500

DERMAZYL KIT

02/28/2018

69621081400

DICLO GEL 1%-XRYLIX SHEET KIT

02/28/2018

69336082701

DICLOZOR KIT

02/28/2018

75987001003

DUEXIS

02/28/2018

59088084600

ELLZIA PAK

02/28/2018

59088009300

INFLAMMACIN KIT

02/28/2018

70350520001

INFLAMMA-K KIT

02/28/2018

45861001705

LENZAPATCH 4-1% patch

02/28/2018

69336082501

LIDOPRIL 2.5%-2.5% CREAM-DRESS

02/28/2018

69336082601

LIDOPRIL XR 2.5-2.5% CRM-DRESS

02/28/2018

69176014000

LIDO-PRILO CAINE PACK

02/28/2018

69621081100

LIDOTRANS 5 PAK

02/28/2018

69677006002

LIDOXIB KIT

02/28/2018

69677006003

LIDOXIB KIT

02/28/2018

69665061001

LIPROZONEPAK 2.5-2.5% CRM-DRSS

02/28/2018

59088008300

MIGRANOW KIT

02/28/2018

75987004005

PENNSAID 2% solution

02/28/2018

59088039300

SILAZONE-II KIT

02/28/2018

69677006302

SMARTRX GABAKIT

02/28/2018

69677006902

SMARTRX GABA-V KIT

02/28/2018

69621081200

TICALAST NASAL SPRAY KIT

02/28/2018

59088039200

TICANASE KIT

02/28/2018

69621039200

TICASPRAY KIT

02/28/2018

69621039400

TRI-SILA TOPICAL KIT

02/28/2018

69621034300

XELITRAL PACK

02/28/2018

69621009300

XENAFLAMM KIT

02/28/2018

70350521801

XILAPAK KIT

02/28/2018

69621082200

XRYLIDERM 5% KIT

02/28/2018

59088036500

XRYLIX 1.5% KIT

02/28/2018

69621082100

ZEYOCAINE 5% KIT

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FECA CIRCULAR NO. 18-06

May 18, 2018

SUBJECT: Physician Dispensed Medication (Billing for Unspecified "J Codes")

PURPOSE: To provide notification of new DFEC policy with respect to payment for Unspecified Healthcare Common Procedure Coding System (HCPCS) "J Codes"

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. See 20 C.F.R. 10.800-826, FECA Bulletins 17-01 and 17-03, 17-07 and FECA Circulars 12-06 and 18-05.

BACKGROUND:

FECA Circular 12-06 outlined that providers submitting bills for payment of medications dispensed in the office using Healthcare Common Procedure Coding System (HCPCS) "J" codes J3490, J8499, J8999, and/or J9999 were required to also submit a National Drug Code (NDC) and the day's supply.

FECA Bulletin 17-01 implemented new controls for the authorization of compounded medications.

FECA Bulletin, 17-03 implemented a new policy that herbal supplements would only be authorized on an exception basis.

FECA Bulletin 17-07 implemented new controls for the authorization of opioid medications.

FECA Circular 18-05 implemented a new exception-based policy pertaining to payment of convenience kits and certain other combination medications.

This circular implements additional controls on physician dispensed medications as explained below. Since the controls for pharmacy dispensed medications were implemented, the Division of Federal Employees’ Compensation (DFEC) has identified a new trend in the dispensing of medication in physician offices. Medication dispensed in this manner is typically billed using HCPCS codes, specifically "J codes". In the HCPCS manual, a "J code" is described as follows:

"J codes include drugs that ordinarily cannot be self-administered, chemotherapy drugs, immunosuppressive drugs, inhalation solutions, and other miscellaneous drugs and solutions."

Physician dispensing can present a safety concern as it presents obstacles for both a physician and pharmacist to identify harmful drug interactions when multiple physicians are treating a patient.

The cost of the physician dispensed medications can be significantly higher than those dispensed at a pharmacy, and billing medication in this manner allows such submissions to bypass controls that DFEC has implemented. There may also be situations where the prescription of certain medications can be incentivized, potentially impacting physician judgment on medical necessity and medication quantity prescribed.

Specifically, the practice of dispensing medications in this manner inhibits DFEC from effectively administering program controls relating to safety, cost and medical necessity. It circumvents opioid controls as outlined in FECA Bulletin 17-07 and adversely impacts program controls on compound medications as outlined in FECA Bulletin 17-01.

AUTHORITY: 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) authorizes OWCP's FECA program to set limitations and require pre-authorization for medical services and supplies where deemed necessary.

ACTION: In accordance with the discretion granted to DOL and delegated to OWCP, DFEC is updating its policy regarding Physician Dispensed Medication, specifically as it relates to unspecified "J codes."

  1. DFEC will continue to authorize and pay for specific "J codes" (not subject to the limitations listed in #2 below) if properly administered and billed in accordance with 20 C.F.R. 10.800-826. Examples of such J Codes include J0878 - Injection, daptomycin, 1 mg, or J2278 - Injection, ziconotide, 1 mcg.
     
  2. Expanding on the guidance in FECA Circular 12-06, all bills for the following unspecified "J codes" must be submitted with an NDC and the day's supply and are subject to prior authorization by claims staff:
     
    • J3490 - Drugs unclassified
    • J3590 - Unclassified biologics
    • J7999 - Compounded drug, not otherwise classified
    • J8999 - Prescription drug, oral, chemotherapeutic, NOS
    • J9999 - Not otherwise classified, antineoplastic drugs
    • J8499 - Prescription drug, oral, nonchemotherapeutic, NOS1
       
  3. DFEC will rely on the specific definition of a HCPCS "J code" to determine whether medication dispensed and billed with one of the six unspecified codes in #2 will be authorized and paid. If the medication dispensed is indeed a drug, "that ordinarily cannot be self-administered," (see 3a) DFEC will authorize and pay for the medication without further claims development in accordance with 20 C.F.R. 10.800-826.
     
    1. Examples of medications that ordinarily cannot be self-administered and would instead be administered by a physician in the physician’s office, that cannot be billed with a specific "J code", and in turn would be considered payable by DFEC if billed with one of the six unspecified codes in #2 above, include the following:
       
      • Enalaprilat 1.25MG/ 1ML (NDC 10019009504), Famotidine 10MG/ 1ML (NDC 10019004602), Glycopyrrolate 0.2MG/ 1ML (NDC 10019001663) and Flumazenil 0.1MG/ 1ML (NDC 36000014810)
         
    2. Examples of medications that ordinarily can be self-administered, would not need to be administered by a physician and could be obtained in a pharmacy setting, and in turn would NOT generally be considered payable by DFEC if billed with one of the six unspecified codes in #2 above, include the following:
       
      • Ointments and Lotions, such as LidoPro Ointment (NDC 53225102201), Relador Pak w/Occlusive Dressing (NDC 69166010590), Baclofen Topical Cream (NDC 76420093101) and New Terocin lotion (NDC 50488112901)
         
      • Patches, such as Terocin Patch -Menthol (NDC 50488100101), LidoPro Patch (NDC 53225102301), Lidocaine Patch (NDC 59088039654, 59088039682) and Lidozen patches (NDC 63187091730)
         
      • Combination Medication Kits, such as Livixil Pak (NDC 15455950401), NuTriaRX CreamPak (NDC 70859000201), NuDiclo SoluPak (NDC 70859000301) and NuDiclo TabPak (70859000401)
         
      • Oral Medications, such as Tramadol Hydrochloride capsule (NDC 69467100101), Cyclobenzaprine Hydrochloride tablet (NDC 69420100101), Omeprazole capsule (NDC 68462023110), and Morphine Sulfate tablet (NDC 00406833001).
         
  4. Prior authorizations for the medications described in 3a may be requested by utilizing the Unspecified J Code Authorization Request, which is available on the DFEC Web Bill Processing website at https://owcpmed.dol.gov. Prior Authorization requests should be faxed with supporting medical documentation to the number provided on the website. All fields are required and must be completed. Incomplete requests cannot be processed and will be returned.

    DFEC will review the request and case file documentation to determine whether to authorize the requested medication. Specifically, DFEC will review whether the prescribing physician has provided medical rationale regarding why the medication is necessary for the claimant's accepted work related condition. In some instances, DFEC may request additional medical justification from the physician and may undertake additional medical development concerning the medical necessity of requested medication. In the event a medication authorization is denied, a claimant may upon request receive a formal decision with appeal rights.
     
  5. This policy is effective June 1, 2018. All bills received on and after this date will be subject to this policy.
-----

1J8499 may also be permitted upon review in very limited situations such as after-hours emergency visits, house calls, or in rural areas where access to pharmacy is limited.

 

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff

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FECA CIRCULAR NO. 18-07

Issued: August 3, 2018

SUBJECT: Employees' Compensation and Management Portal (ECOMP) Disability Management Interface (DMI)

Purpose: To announce a new component of ECOMP that allows Agency Reviewers to submit specific requests for claims actions related to disability management directly into the Office of Workers' Compensation (OWCP) case.

Background: ECOMP was released to the public on November 2, 2011 and can be accessed directly at the following url: https://www.ecomp.dol.gov. The site originally contained two different types of functionality – electronic submission of documents and electronic submission of Federal Employees' Compensation Act (FECA) claim forms. See FECA Circular 13-03, Employees' Compensation and Management Portal (ECOMP), for more detail on those features. Effective April 9, 2013, ECOMP was enhanced to allow designated ECOMP Agency Reviewers (AR) the ability to view imaged documents for cases assigned to their agency. See FECA Circular 13-06, Employees' Compensation and Management Portal (ECOMP) Agency Reviewer Imaging (ARi), for more detail on the additional features.

Effective August 3, 2018, ECOMP was further enhanced with the implementation of DMI. DMI is a new feature that will allow ARs to request the Claims Examiner (CE) to take claims action on a particular claim. DMI will promote more efficient management of long-term total disability cases by highlighting pending job offers1; identifying an absence of medical evidence supporting disability; by reporting information on an injured workers' work status; and by requesting certain case management actions. Only ARs who have been granted access to use ARi by their respective agencies will have the ability to use DMI. An agency's access to use DMI will be granted by DFEC after receiving the necessary training, and the agency's ECOMP Agency Maintenance User will manage access to DMI for individual ARs.

If information or a request is submitted using DMI, it should not be submitted via mail, fax or ECOMP WEEDs. Submission via DMI replaces these other methods of submission.

Actions: The following options will initially be available for an AR to submit through DMI:

  • Request Updated Medical Evidence
  • Report Job Offer Refusal
  • No Return to Work after Job Found Suitable
  • No Return to Work after 15 Day Letter
  • No Response to Prior DMI Request

When one of the above options is selected, an interface will be displayed where the AR will enter pertinent information surrounding the request. Because the information provided may be relied on to provide the factual basis for a CE determination, it is essential that the AR ensure the entries are factually correct and any applicable documents are uploaded.2

The information provided by the AR will then be transmitted to the CE.

The CE may generate a letter to the injured worker or the employing agency (i.e. making a suitability finding, requesting medical evidence, etc.), which will be populated with the information that the AR submitted via DMI. While the CE will confirm that information provided by the AR conforms to evidence contained in the case record prior to releasing any correspondence. It is crucial that the AR confirm the accuracy of the information provided via DMI, and ensure that any corresponding evidence, such as a copy of a job offer (with all required documentation), has been uploaded to the file.

Additional options for ARs to report information or request actions via DMI may be added to ECOMP in the future.

-----

1 While it is anticipated that DMI will primarily be used for job offers of suitable employment for which sanctions under 5 U.S.C. 8106 are available, temporary assignment offers made pursuant to 20 CFR 10.500 and FECA Procedure Manual 2-814-9 may also be submitted through DMI.

2 DMI access may be suspended if repeat incidents of providing inaccurate or inappropriate information are noted. ARs should be aware for that certain employees (such as those with more serious conditions and those over age 65) OWCP may in its discretion require less frequent documentation. See generally 20 C.F.R. 10.501.

 

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff; Employing Agencies

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FECA CIRCULAR NO. 17-01

February 3, 2017

SUBJECT: Dual Benefits - FERS Cost of Living Adjustments

Effective December 1, 2016, benefits issued by the Social Security Administration (SSA) will be increased by 0.3%. 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.

This adjustment will be made from the National Office for all cases that were correctly entered into the iFECS Compensation program. The adjustment will be effective with the periodic roll cycle beginning December 11, 2016. There will be no adjustment or overpayment declared for the period of December 1, 2016 through December 10, 2016.

The historical SSA cost of living adjustments are as follows:

Dates

Percentages

Dates

Percentages

12/01/2016 - 11/30/2017

0.30%

12/01/1999 - 11/30/2000

2.40%

12/01/2015 - 11/30/2016

0.00%

12/01/1998 - 11/30/1999

1.30%

12/01/2014 - 11/30/2015

1.70%

12/01/1997 - 11/30/1998

2.10%

12/01/2013 - 11/30/2014

1.50%

12/01/1996 - 11/30/1997

2.90%

12/01/2012 - 11/30/2013

1.70%

12/01/1995 - 11/30/1996

2.60%

12/01/2011 - 11/30/2012

3.60%

12/01/1994 - 11/30/1995

2.80%

 

 

 

 

 

 

 

 

12/01/2010 - 11/30/2011

0.00%

 

 

12/01/2009 - 11/30/2010

0.00%

 

 

12/01/2008 - 11/30/2009

5.80%

 

 

12/01/2007 - 11/30/2008

2.30%

 

 

12/01/2006 - 11/30/2007

3.30%

 

 

12/01/2005 - 11/30/2006

4.10%

 

 

12/01/2004 - 11/30/2005

2.70%

 

 

12/01/2003 - 11/30/2004

2.10%

 

 

12/01/2002 - 11/30/2003

1.40%

 

 

12/01/2001 - 11/30/2002

2.60%

 

 

12/01/2000 - 11/30/2001

3.50%

 

 

 

 

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff

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FECA CIRCULAR NO. 17-02

February 3, 2017

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

The interest rate to be assessed for the prompt payment bills is 2.5 percent for the period of January 1, 2017 through June 30, 2017. This new rate has been updated in the Central Bill Payment system tables.

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 1.0 percent for the period of January 1, 2017 through December 31, 2017. This rate remains unchanged in the iFECS system tables.

Ordinarily, the rate of interest charged on debts due the U.S. Government is only changed in January, and is effective for the entire year. However, the rate may be changed in July if there is a difference in the Current Value of Funds (CVF) interest rate of more than two percent. The rate will be reviewed on July 1, 2017 to determine if the Treasury has changed the rate.

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

Distribution: All DFEC Staff

 

PROMPT PAYMENT INTEREST RATES

 

Dates

Percentages

01/1/17 - 06/30/17

2½%

07/1/16 - 12/31/16

1⅞%

01/1/16 - 06/30/16

2½%

07/1/15 - 12/31/15

2⅜%

01/1/15 - 12/31/15

2⅛%

07/1/14 - 12/31/14

2.0%

01/1/14 - 12/31/14

2⅛%

07/1/13 - 12/31/13

1¾%

01/1/13 - 12/31/13

1⅜%

07/1/12 - 12/31/12

1¾%

01/1/12 - 12/31/12

2.0%

07/1/11 - 12/31/11

2½%

01/1/11 - 06/30/11

2⅝%

01/1/10 - 12/31/10

2⅝%

01/1/10 - 12/31/10

3¼%

PROMPT PAYMENT INTEREST RATES

Dates

Percentages

Dates

Percentages

07/1/09 - 12/31/09

4⅞%

07/1/99 - 12/31/99

6½%

01/1/09 - 06/30/09

5⅝ %

01/1/99 - 06/30/99

5.0%

07/1/08 - 12/31/08

5⅛%

07/1/98 - 12/31/98

6.0%

01/1/08 - 06/30/08

4¾%

01/1/98 - 06/30/98

6¼%

07/1/07 - 12/31/07

5¾%

07/1/97 - 12/31/97

6¾%

01/1/07 - 06/30/07

5¼%

01/1/97 - 06/30/97

6⅜%

07/1/06 - 12/31/06

5¾%

07/1/96 - 12/31/96

7.0%

01/1/06 - 06/30/06

5⅛%

01/1/96 - 06/30/96

5⅞%

07/1/05 - 12/31/05

4½%

07/1/95 - 12/31/95

6⅜%

01/1/05 - 06/30/05

4¼%

01/1/95 - 06/30/95

8⅛%

07/1/04 - 12/31/04

4½%

07/1/94 - 12/31/94

7.0%

01/1/04 - 06/30/04

4.0%

01/1/94 - 06/30/94

5½%

07/1/03 - 12/31/03

3⅛%

07/1/93 - 12/31/93

5⅝%

01/1/03 - 06/30/03

4¼%

01/1/93 - 06/30/93

6½%

07/1/02 - 12/31/02

5¼%

07/1/92 - 12/31/92

7.0%

01/1/02 - 06/30/02

5½%

01/1/92 - 06/30/92

6⅞%

07/1/01 - 12/31/01

5⅞%

07/1/91 - 12/31/91

8½%

01/1/01 - 06/30/01

6⅜%

01/1/91 - 06/30/91

8⅜%

07/1/00 - 12/31/00

7¼%

07/1/90 - 12/31/90

9.0%

01/1/00 - 06/30/00

6¾%

01/1/90 - 06/30/90

8½%

PROMPT PAYMENT INTEREST RATES

Dates

Percentages

Dates

Percentages

01/1/89 - 06/30/89

9¾%

07/1/86 - 12/31/86

8½%

07/1/88 - 12/31/88

9¼%

01/1/86 - 06/30/86

9¾%

01/1/88 - 06/30/88

9⅜%

07/1/85 - 12/31/85

10⅜%

07/1/87 - 12/31/87

8⅞%

01/1/85 - 06/30/85

12⅛%

01/1/87 - 06/30/87

7⅝%

 

 

 

 

 

 

 

ATTACHMENT TO FECA CIRCULAR NO. 17-02

DEBT MANAGEMENT INTEREST RATES

 

Dates

Percentages

01/1/17 - 12/31/17

1%

01/1/16 - 12/31/16

1%

01/1/15 - 12/31/15

1%

01/1/14 - 12/31/14

1%

01/1/13 - 12/31/13

1%

01/1/12 - 12/31/12

1%

01/1/11 - 12/31/11

1%

1/1/10 - 12/31/10

1%

 

 

1/1/09 - 12/31/09

3%

7/1/08 - 12/31/08

3%

1/1/08 - 6/30/08

5%

1/1/07 - 12/31/07

4%

7/1/06 - 12/31/06

4%

1/1/06 - 12/31/06

2%

1/1/05 - 12/31/05

1%

   

1/1/04 - 12/31/04

1%

1/1/03 - 12/31/03

2%

7/1/02 - 12/31/02

3%

1/1/02 - 06/30/02

5%

1/1/01 - 12/31/01

6%

1/1/00 - 12/31/00

5%

 

 

1/1/99 - 12/31/99

5%

1/1/98 - 12/31/98

5%

1/1/97 - 12/31/97

5%

1/1/96 - 12/31/96

5%

7/1/95 - 12/31/95

5%

1/1/95 - 06/30/95

3%

 

 

1/1/94 - 12/31/94

3%

1/1/93 - 12/31/93

4%

1/1/92 - 12/31/92

6%

1/1/91 - 12/31/91

8%

1/1/90 - 12/31/90

9%

   

1/1/89 - 12/31/89

7%

1/1/88 - 12/31/88

6%

1/1/87 - 12/31/87

7%

1/1/86 - 12/31/86

8%

1/1/85 - 12/31/85

9%

 

 

Prior to 01/01/84

Not applicable

 

ATTACHMENT TO FECA CIRCULAR NO. 17-02

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FECA CIRCULAR NO. 17-03

SUBJECT: OFFICE OF INSPECTOR GENERAL (OIG) INVESTIGATIONS PERTAINING TO FEDERAL EMPLOYEES' COMPENSATION ACT (FECA) CLAIMANT AND MEDICAL PROVIDER FRAUD

PURPOSE: TO ESTABLISH COMMUNICATION PROTOCOLS BETWEEN THE OIG COMMUNITY AND THE DIVISION OF FEDERAL EMPLOYEES' COMPENSATION (DFEC)

ISSUE DATE: MAY 8, 2017


I. BACKGROUND: Federal agencies' increased awareness of the monies spent on workplace injuries under the Federal Employees' Compensation Act (FECA) has prompted agencies and their respective Offices of Inspector General (OIG) to look for ways to reduce costs and return more people to work as well as to prevent and detect fraud. Consequently, DFEC is receiving an increasing number of requests for information from the OIG community as they perform audits, inspections and investigations. The Office of Workers' Compensation Programs (OWCP) Division of Federal Employees' Compensation (DFEC) is committed to working with the OIG to reduce waste, fraud and abuse. To do so effectively, DFEC must coordinate with the OIG on projects to respond to requests while remaining focused on DFEC's core mission of providing benefits to injured federal employees. DFEC is instituting a consistent process to support these requests in a manner that preserves program resources, improves timeframes for providing information/data and avoids duplication of effort.

II. DFEC ROLES AND RESPONSIBILITIES: To help facilitate the exchange of information, DFEC has established a National Office Fraud Liaison, a District Office Fraud Liaison for each District Office and a Program Integrity Unit.

A. National Office Fraud Liaison - This DFEC employee serves as the Point of Contact (POC) for OIGs who have an active criminal or civil investigation on either claimants or medical providers. The role of the National Office Fraud Liaison is to assist in the coordination and tracking of all of DFEC's activities pertaining to ongoing fraud investigations, provide a level of consistency in the way DFEC supports investigations, and act as the POC for the District Office Fraud Liaisons.

B. District Office Fraud Liaison - Each District Office has a designated POC for OIG requests relating to suspected fraud of claimants or a medical provider whose services are limited to the jurisdiction of a single District Office. The role of the District Office Fraud Liaison is to assist OIGs with obtaining data from DFEC records, to include provider enrollment forms, limited copies of bills and reports on a provider's billing activity which can be generated locally. This individual also provides OIGs with guidance on FECA administration and program rules/regulations; coordinates oversight of non-criminal investigative memoranda; evaluates loss to the government calculation requests and provides testimony as appropriate.

C. Program Integrity Unit - In addition to the designated POCs, DFEC has established a Program Integrity Unit which provides an internal mechanism for DFEC to analyze claims data, including medical provider data, and make referrals to the OIG based on those findings.

III. DFEC CONTACTS FOR OIG: To facilitate, centralize and coordinate all communications between OIGs and DFEC staff, DFEC has created email addresses where all OIG communications should be directed, depending on the type of request and/or the status of a potential or active investigation.

DFEC CONTACTS FOR OIG

Type of Request and/or Status of Investigation

Email Address

Provider Data/Record Requests – services within the jurisdiction of one District Office

FECA_Provider_Fraud_Local_Record_Request@dol.gov

Provider Data/Record Requests – services that are cross regional or nation-wide

FECA_Provider_ Fraud_National_Record_Request@dol.gov

Provider Investigations - includes all phases of the investigation (initial submission, testimony, conviction/plea, etc.)

FECA_Provider_Investigation@dol.gov 

Claimant Data/Record Requests - records/documents pertaining to a claimant

FECA_Claimant_Fraud_Record_Request@dol.gov

Claimant Investigations - non-prosecutorial Investigative Memoranda

FECA_Claimant_Investigation@dol.gov 

Claimant Prosecution - includes loss to the government calculations, testimony requests, convictions/pleas, etc.

FECA_Claimant_Fraud_Prosecution@dol.gov

 

If physical evidence such as photos or videos is part of the investigation (which occurs primarily with claimant investigations), it should be submitted to the District Office with jurisdiction of the case at the time the investigative report is submitted to the email address above. It should be submitted to the attention of the District Director, and it should be in a Windows Media Player compatible format.

The above email addresses are intended for use by the OIG community. If other agency and/or compensation personnel suspect fraud, they are encouraged to follow their agency procedures for reporting fraud and may contact their agency OIG for guidance.

Note: Suspected fraud can also be reported directly to the DOL OIG via the OIG Hotline available at the following website: http://www.oig.dol.gov/hotlinecontact.htm Alternatively, fraud can be reported jointly to the DOL OIG and OWCP/DFEC at the following addresses: Office of Inspector General, U.S. Department of Labor, 200 Constitution Avenue, N.W., Room S-5506, Washington, D.C. 20210 and National Office Fraud Liaison - OWCP/DFEC, U.S. Department of Labor, 200 Constitution Ave., NW, Room S-3229, Washington, DC 20210.

IV. OIG EMAIL SUBMISSION PROTOCOLS: In accordance with Office of Workers' Compensation Program (OWCP) policy, all requests submitted to any of the above email addresses from non-DOL OIG should be secured since the communication occurs outside the DOL network and therefore security of the transmission is not secured. Email sent between OWCP and DOL-OIG through the DOL network is considered secure and document encryption is unnecessary.

A. DOL OIG Submissions - Attachments should not be encrypted.

Claimant Submissions

  • The subject line of the email should be the request type, e.g. Claimant Record Request, Claimant Investigation, etc.
  • The DFEC case number and the claimant's name should be included in the body of the email message, but not in the subject line.

Provider Submissions

  • The subject line of the email should be the request type, e.g. Provider Record Request, Provider Investigation, Provider Testimony Request, etc.
  • The full name of the Provider(s) and EIN(s) should be included in the body of the email.

B. Non-DOL OIG Submissions - Attachments must be encrypted.

Claimant Submissions

  • The subject line of the email should be the request type, e.g. Claimant Record Request, Claimant Investigation, etc.
  • No reference to the complete SSN, claimant's name or other protected PII should be made in any part of the email message. The DFEC case number and the claimant's initials should be the only identifying piece of information in the email submission, and those items should be in the body of the email message.

Provider Submissions

  • The subject line of the email should be the request type, e.g. Provider Record Request, Provider Investigation, Provider Testimony Request, etc.
  • The full name of the Provider(s) and EIN should be included in the body of the email.

Attachments – All attachments should be encrypted with the following password protection format: Requesting Agent's first and last initials (capitalized), followed by the 2 character numeric month, date and year of the date the request is being transmitted via email, without hyphens, i.e. FLMMDDYY.

V. GUIDELINES AND RESTRICTIONS FOR OIG:

A. Privacy Act - All OWCP records relating to claims for benefits, including copies of such records maintained by an employer, are considered confidential and may not be released, inspected, copied or otherwise disclosed except as provided in the Freedom of Information Act (5 U.S.C. § 552) and the Privacy Act of 1974 (5 U.S.C. § 552a). OWCP information is available to be used by employing agencies, including agency OIG, only for purposes consistent with the routine uses in OWCP's system of records for FECA information, DOL/GOVT-1.

B. Contact with Physicians - Such interaction whether by personal visit or telephone by OIG agents in the context of an investigation may occur. As OIG are independent and separate from the employing agency, such contact does not violate 20 C.F.R. 10.506.

C. Agency Audits and Requests for Information - An agency OIG is permitted to audit/review only its own agency's processes. In accordance with the Privacy Act, the only data that could be made available would pertain solely to the requesting agency's cases. Because agency OIG is permitted to audit its own agency's processes, much of the information necessary for official investigative purposes is contained in the weekly, monthly and quarterly extracts provided to each agency's injury compensation management office. The weekly extracts contain case management, bill payment and compensation payment detail data; monthly extracts contain new case-create data; quarterly extracts contain agency chargeback data. DFEC will not duplicate its efforts to reproduce these data runs. The agency OIG should refer to their agency's injury compensation management program coordinator for information related to this data. If an agency audit requires data that is not routinely sent by OWCP to the employer, the agency OIG should provide a brief outline of what is needed, and such requests should be coordinated with that agency OIG's National Office. The OIG should also notify the DOL OIG Assistant Inspector General for Audit (AIGA) of the planned work.

VI. PROVIDER CASES: Examples of provider fraud include, but are not limited to, billing for services not rendered, up coding, unbundling billing codes, and anti-kickback violations. Providers may also be subject to civil prosecution under the False Claims Act or the Program Fraud Civil Remedies Act for submitting false claims.

Since an agency OIG only has a right to data on medical providers as it relates to their own injured employees, coordination with DOL OIG may be required to help ensure that all data is evaluated. In some instances, medical providers are treating injured workers from multiple agencies; therefore, failing to include DOL OIG may unnecessarily limit the scope of investigation and potential prosecution. In situations where DOL OIG has not been actively involved in an investigation or action, program data concerning other agencies may be provided to the prosecuting attorney or to agency OIG at the prosecutor's written request.

A. Provider Data/Record Requests - OIG may request the following kinds of provider documentation: provider utilization reports, provider enrollment documents, billing information and/or remittance vouchers. If the services of the provider(s) fall within the jurisdiction of a single district office, the OIG should submit any request for data or records to the "FECA Provider Fraud Local Record Request" email address identified in Section III. If the services of the provider(s) fall within the jurisdiction of multiple district offices, the OIG should submit any request for data or records to the "FECA Provider Fraud National Record Request" email address identified in Section III. If the scope of the practice is not known, the request should be submitted to the "FECA Provider Fraud National Record Request" email address.

B. Provider Investigations/Prosecution – If the OIG identifies a specific trend or concern for which investigation and/or prosecution is being undertaken, the OIG should submit an Investigation Initiation Memorandum to the "FECA Provider Investigation" email address identified in Section III.

1. The Investigation Initiation Memorandum should include as much information as possible with respect to the identity of the provider entity(s) and tax ID(s), the nature of the allegations or scheme, and any other relevant information to include the status of the investigation and prosecutorial action (if any). If the provider/practice in question is operating in different geographical locations, different names or numerous EINS, all available information is necessary for each location/practice, and if there is any indication of a wider operation, that information should also be included.

Should a criminal or civil case against a medical provider be accepted for prosecution and an indictment has been obtained, the OIG must outline the criminal charges and enclose the relevant and/or releasable court documents. In instances where special requests are also provided to DFEC with regard to the provider's ongoing practice and billing, DFEC will require written confirmation from the prosecutor on the specified course of action. (If DFEC Testimony is required, reference Section VIII of this Circular.)

2. DFEC Actions -

  • If the Investigation Initiation Memorandum is received directly from the DOL OIG, DOL OIG will also include a recommendation regarding whether DFEC should pursue administrative actions, such as administrative review of the provider's bills. DFEC 's actions will be guided and informed by that recommendation.
  • If the Investigation Initiation Memorandum is received from a non-DOL OIG, DFEC will forward the memorandum to DOL OIG for a preliminary review. After consideration of the non-DOL OIG position and status of the investigation, DOL OIG will provide a response regarding whether DFEC may pursue administrative actions, such as administrative review of the provider's bills, and DFEC's actions will be guided and informed by that recommendation.

3. Status Updates - DOL OIG and non-DOL OIG are expected to update DFEC accordingly if the status of the investigation and/or prosecution changes.

VII. CLAIMANT CASES: Agency OIG investigate fraud cases involving their own agency employees/former employees. The DOL OIG role may be limited unless the claimant in question is a Department of Labor employee. Examples of single case fraud include, but are not limited to falsifying an injury, failure to report earnings, and fraudulently claimed reimbursements for medical care and travel expenses.

A. Claimant Record Requests - During the course of the investigation, it may be necessary for the OIG to review case records. The OIG may submit a request for data or records to the "FECA Claimant Fraud Record Request" email address identified in Section III; however, in order to provide case documents in the most efficient and timely manner possible, DFEC is now allowing the OIG to use the Employees' Compensation and Management Portal (ECOMP) Agency Reviewer Imaging (ARi) application which allows the user to view (and print) a defined set of imaged documents within a case (see FECA Circular 13-06). If the agency OIG requires a complete copy of a case record, the request should be submitted to the email address identified above so that it may be provided on encrypted CD if the case is fully imaged.

ECOMP ARi for OIG

  • Each OIG must sign a Memorandum of Understanding that sets out a description of the system and rules of conduct for system access, data use and retention.
  • Each OIG agent must be authorized access by the Agency OIG Administrator. To obtain access to ECOMP ARi, agents should contact that designated individual.
  • DOL OIG has access to all cases; agency OIG have access only to cases within the assigned agency.
  • Once an account has been created, the OIG agent may access a case based on an investigation into a potential violation of law; the agent will be required to acknowledge that he/she is accessing the case file consistent with the routine use in DOL/GOVT-1.
  • Unlike the Agency Reviewers in ECOMP ARi, these acknowledgment statements will not be placed in the individual case records (see FECA Circular 13-06, Section E). Instead, case access and the document downloads are recorded via an internal tracking mechanism from which reports can be created at a later date.

B. Claimant Investigations (non-prosecutorial cases) - The OIG should submit any documentation of an investigation that does not result in a criminal prosecution as an investigative memoranda (IM) to the "FECA Claimant Investigations" email address identified in Section III. Any documentation of an investigation that does not result in a criminal prosecution received by DFEC will be placed in the case file and used for case management actions in accordance with DFEC procedures. A designated individual will review each IM to determine if the investigation establishes inconsistencies or calls into question the validity of the medical evidence, the severity of the employment injury or the reported work restrictions or whether it establishes unreported work activity, and then take action accordingly. The OIG should be aware that documentation of misrepresentation of physical disability by the claimant does not result in immediate termination of compensation.

C. Claimant Investigations (potential prosecution) - Should the case be accepted for prosecution by a federal or state prosecutor, a loss to the government or statement on materiality may be requested. DFEC bears the responsibility for calculating the financial loss to the government.

Calculation of Loss to the Government:

  1. Submission - When requesting a loss to the government calculation, the OIGs should submit a memorandum requesting a loss calculation to the "FECA Claimant Fraud Prosecution" email address identified in Section III. The request and accompanying evidence will not be placed in the DFEC case record until the investigation is completed. However, a decision cannot be rendered that considers the evidence until all relevant documents are included in the case record.
  2. Loss Request Memorandum Requirements - The request should include a summary of the following (with all supportive documentation):
    1. the date range(s) in question,
    2. the claimant's employment and/or earnings activities
    3. the actual dollar amount earned or the approximate number of hours worked per day/week during the CA-1032 or CA-7 period(s),
    4. the status of any criminal prosecution,
    5. a date by which the loss calculation is needed, and
    6. the "current" salary for the date of injury position as of the first date of unreported earnings [since the loss calculation is based on a loss of wage earning capacity utilizing the Shadrick formula (see FECA PM 2-0815.4.b.)].
  3. Actual Earnings Not Available - In those cases where actual earnings are unavailable, the evidence submitted should support that the claimant was performing employment activities for a specific number of hours per day or week for the duration of the period(s) in question. In these cases, the description of employment activity performed should be as detailed as possible so that the most comparable hourly wage may be constructed by DFEC. That wage is then multiplied by the number of hours the claimant worked, as established by the evidence, and used as the constructed weekly wage in the Shadrick formula.
  4. Evidence Determined to be Insufficient - If the information provided in the request is insufficient to allow for a loss calculation, DFEC will contact the OIG and request clarification or assistance in identifying and obtaining any missing data points.
  5. DFEC Calculation - Once all of the information is received, the District Office POC and/or other designee will calculate the loss. This is accomplished by calculating the gross amount that the claimant would have been entitled to in accordance with the Shadrick formula had he or she truthfully reported earnings/work activity and deducting that from the amount of gross compensation actually paid. The difference represents the loss to the government. Once completed, all calculations must be certified by the National Office. Upon certification, the National Office Fraud Liaison or designee will authorize the release of the loss calculation to the requesting party.
  6. Processing Time - The necessary lead time to certify a loss calculation is dependent upon the accuracy and comprehensiveness of the supporting documentation and whether such loss is based on actual or constructed earnings. Generally, after the District Office Fraud Liaison has calculated the loss and submitted it to the National Office Fraud Liaison up to 2 weeks may be necessary to certify the calculation. It is recommended that all requests for calculation of loss to the government be submitted as early as possible.
  7. Concurrent Dissimilar Employment and Passive Income - There are instances where unreported earnings can result in no loss to the government. If the fraud investigation is based on failure to report earnings from a position that the claimant held on the date of injury, and the concurrent employment was dissimilar to their government position, then those earnings cannot be used to reduce compensation. While the behavior itself may be determined to be fraudulent and such earnings are required to be reported on the CA-1032 under the regulations, the fact that those earnings could not have been included in the pay rate for compensation purposes means that the government would have paid total disability regardless and the financial loss may be zero. Similarly, if the income is more properly characterized as income from passive investment in a business, this income cannot be the basis of a loss of wage-earning capacity determination.
  8. Grand Jury Protection - If evidence is shielded by grand jury protection, the OIG agent should contact the District Office Fraud Liaison and National Office Fraud Liaison simultaneously to appropriately identify those individuals who should be granted access to the necessary information.

D. Claimant Conviction or Guilty Plea - Upon conviction or a guilty plea entered in open court, notice should be sent to the "FECA Claimant Prosecution" email address identified in Section III.

  1. The request should include a memorandum outlining the disposition of the criminal proceeding and relevant court documentation that the guilty verdict or plea was accepted by a judge in open court. Should a victim impact statement be required, this should be included in the request. Any funds for restitution imposed by the court should be directed to DFEC for processing. Restitution payments will be credited to the agency's chargeback bill once received by DFEC.
  2. The District Office Fraud Liaison will see that compensation benefits are terminated in accordance with 5 U.S.C. 8148 and all other appropriate case actions are completed. (See 20 CFR §§10.16, 10.17).
  3. It is particularly important in the case of state prosecutions that the charging documents, information/indictment clearly identify the charge as involving FECA fraud in order to form the basis of termination of compensation under 5 U.S.C. 8148 (a).
  4. In cases of claimant incarceration in a State or Federal jail, prison, penal institution or other correctional facility due to a State or Federal felony conviction that would trigger the provisions of 5 U.S.C. 8148 (b), notification of such should be provided in an Investigative Memorandum and submitted in accordance with Section VII B (above).

VIII. DFEC Testimony – As much advance notice as possible is required to allow for the time necessary to process the request for testimony in any claimant or provider fraud case.

  1. Federal Court Cases - When requesting the testimony of a DFEC official the issuance of a subpoena is not required, however, advance notice of the date and place of the proceedings are essential.
  2. State Court Cases - Cases brought in state court do require the issuance of a subpoena and participation is subject to the Department of Labor's Touhy Regulations. 29 C.F.R. 2.20-2.24. The prosecutor (in collaboration with the OIG agent) should submit a request and include a written description of the expected testimony. In accordance with the Touhy Regulations, the Deputy Solicitor of Labor must preapprove participation in the proceeding before the state.
  3. Requests for testimony in a provider fraud case should be submitted to the "FECA Provider Investigation" email address identified in Section III.
  4. Requests for testimony in a claimant fraud case should be submitted to the "FECA Claimant Fraud Prosecution" email address identified in Section III.

IX. OWCP Actions: All requests submitted to any of the email addresses identified above will be tracked by DFEC upon receipt. The OIG originator will receive email acknowledgement that the request has been received. DFEC will also provide notification that the report/request is being acted upon or is completed in accordance with FECA Bulletins 17-04 and/or 17-05.

 

ANTONIO A. RIOS
Director for
Federal Employees' Compensation

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FECA CIRCULAR NO. 17-04

September 26, 2017

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, 2017, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile REDUCED to 53.5 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 5, Benefit Payments, 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.

The following is a list of the historical mileage rates used to reimburse claimant travel:

The following is a list of the historical mileage rates used to reimburse claimant travel

Dates

Cents per mile

01/01/1995 – 06/06/1996

30.0 cents per mile

06/07/1996 – 09/07/1998

31.0 cents per mile

09/08/1998 – 03/31/1999

32.5 cents per mile

04/01/1999 – 01/13/2000

31.0 cents per mile

 

 

01/14/2000 – 01/21/2001

32.5 cents per mile

01/22/2001 – 01/20/2002

34.5 cents per mile

01/21/2002 – 12/31/2002

36.5 cents per mile

01/01/2003 – 12/31/2003

36.0 cents per mile

01/01/2004 – 02/03/2005

37.5 cents per mile

02/04/2005 – 08/31/2005

40.5 cents per mile

09/01/2005 – 12/31/2005

48.5 cents per mile

01/01/2006 – 01/31/2007

44.5 cents per mile

02/01/2007 – 03/18/2008

48.5 cents per mile

03/19/2008 – 07/31/2008

50.5 cents per mile

08/01/2008 – 12/31/2008

58.5 cents per mile

01/01/2009 – 12/31/2009

55.0 cents per mile

 

 

01/01/2010 – 12/31/2010

50.0 cents per mile

01/01/2011 – 04/16/2012

51.0 cents per mile

04/17/2012 – 12/31/2012

55.5 cents per mile

01/01/2013 – 12/31/2013

56.5 cents per mile

01/01/2014 – 12/31/2014

56.0 cents per mile

01/01/2015 – 12/31/2015

57.5 cents per mile

01/01/2016 – 12/31/2016

54.0 cents per mile

01/01/2017 to Present

53.5 cents per mile

 

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

 

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FECA CIRCULAR NO. 16-06

July 18, 2016

SUBJECT: Electronic Document Approval Process (ELAPP)

PURPOSE: To announce the use of electronic signatures for the FECA program

The Office of Workers' Compensation Programs' Division of Federal Employees' Compensation (DFEC) routinely responds to a myriad of written inquiries. Claims staff also issue written correspondence when developing and adjudicating a claim, and when terminating, reducing or suspending entitlement following case acceptance.

DFEC previously issued guidance on specific correspondence that must bear a signature prior to release.1

However, a signature need not be a wet signature. To that end, DFEC has created an Electronic Document Approval Process (ELAPP) which creates a signing record incorporating an approval process confirming that the signature is legally binding and valid.

The ELAPP process requires any member of the DFEC claims staff choosing to sign a document electronically to certify as follows:

I agree that my electronic signature is the legally binding equivalent to my handwritten signature and that my electronic signature has the same validity and meaning as my handwritten signature.

Once agreed upon, the electronic signature generated in ELAPP produces a QR code. This code contains the following information, verifying the document was signed by the corresponding DFEC staff member:

  • Case Number
  • Date
  • Name of DFEC Staff Member
  • Staff Member Signature ID

The QR code appears on the bottom left hand side of each page of any applicable letter, and can be read by any QR Code reader.

Documents requiring multiple signatures display multiple QR codes on the bottom left hand side of each page. Each QR code represents the electronic signature of one DFEC Staff Member.

ELAPP signatures are tracked in the DFEC IT databases.


1FECA Bulletin 16-01 (Issued October 13, 2015).

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff, OWCP

 

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FECA CIRCULAR NO. 16-05

March 30, 2016

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

The interest rate to be assessed for the prompt payment bills is 2.5 percent for the period of January 1, 2016 through June 30, 2016. This new rate has been updated in the Central Bill Payment system tables.

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 1.0 percent for the period of January 1, 2016 through December 31, 2016. This rate remains unchanged in the iFECS system tables.

Ordinarily, the rate of interest charged on debts due the U.S. Government is only changed in January, and is effective for the entire year. However, the rate may be changed in July if there is a difference in the Current Value of Funds (CVF) interest rate of more than two percent. The rate will be reviewed on July 1, 2016 to determine if the Treasury has changed the rate.

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.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Attachments: Prompt Payment Interest Rates
Debt Management Interest Rates

Distribution: All DFEC Staff

 

PROMPT PAYMENT INTEREST RATES

Dates

Percentages

01/1/16 - 06/30/16

2½%

07/1/15 - 12/31/15

2⅜%

01/1/15 - 12/31/15

2⅛%

07/1/14 - 12/31/14

2.0%

01/1/14 - 12/31/14

2⅛%

07/1/13 - 12/31/13

1¾%

01/1/13 - 12/31/13

1⅜%

07/1/12 - 12/31/12

1¾%

01/1/12 - 12/31/12

2.0%

07/1/11 - 12/31/11

2½%

01/1/11 - 06/30/11

2⅝%

01/1/10 - 12/31/10

2⅝%

01/1/10 - 12/31/10

3¼%

PROMPT PAYMENT INTEREST RATES

Dates

Percentages

Dates

Percentages

07/1/09 - 12/31/09

4⅞%

07/1/99 - 12/31/99

6½%

01/1/09 - 06/30/09

5⅝ %

01/1/99 - 06/30/99

5.0%

07/1/08 - 12/31/08

5⅛%

07/1/98 - 12/31/98

6.0%

01/1/08 - 06/30/08

4¾%

01/1/98 - 06/30/98

6¼%

07/1/07 - 12/31/07

5¾%

07/1/97 - 12/31/97

6¾%

01/1/07 - 06/30/07

5¼%

01/1/97 - 06/30/97

6⅜%

07/1/06 - 12/31/06

5¾%

07/1/96 - 12/31/96

7.0%

01/1/06 - 06/30/06

5⅛%

01/1/96 - 06/30/96

5⅞%

07/1/05 - 12/31/05

4½%

07/1/95 - 12/31/95

6⅜%

01/1/05 - 06/30/05

4¼%

01/1/95 - 06/30/95

8⅛%

07/1/04 - 12/31/04

4½%

07/1/94 - 12/31/94

7.0%

01/1/04 - 06/30/04

4.0%

01/1/94 - 06/30/94

5½%

07/1/03 - 12/31/03

3⅛%

07/1/93 - 12/31/93

5⅝%

01/1/03 - 06/30/03

4¼%

01/1/93 - 06/30/93

6½%

07/1/02 - 12/31/02

5¼%

07/1/92 - 12/31/92

7.0%

01/1/02 - 06/30/02

5½%

01/1/92 - 06/30/92

6⅞%

07/1/01 - 12/31/01

5⅞%

07/1/91 - 12/31/91

8½%

01/1/01 - 06/30/01

6⅜%

01/1/91 - 06/30/91

8⅜%

07/1/00 - 12/31/00

7¼%

07/1/90 - 12/31/90

9.0%

01/1/00 - 06/30/00

6¾%

01/1/90 - 06/30/90

8½%

PROMPT PAYMENT INTEREST RATES

Dates

Percentages

Dates

Percentages

01/1/89 - 06/30/89

9¾%

07/1/86 - 12/31/86

8½%

07/1/88 - 12/31/88

9¼%

01/1/86 - 06/30/86

9¾%

01/1/88 - 06/30/88

9⅜%

07/1/85 - 12/31/85

10⅜%

07/1/87 - 12/31/87

8⅞%

01/1/85 - 06/30/85

12⅛%

01/1/87 - 06/30/87

7⅝%

 

 

 

 

 

 

 

ATTACHMENT TO FECA CIRCULAR NO. 16-05

 

DEBT MANAGEMENT INTEREST RATES

Dates

Percentages

01/1/16 - 12/31/16

1%

01/1/15 - 12/31/15

1%

01/1/14 - 12/31/14

1%

01/1/13 - 12/31/13

1%

01/1/12 - 12/31/12

1%

01/1/11 - 12/31/11

1%

1/1/10 - 12/31/10

1%

 

 

1/1/09 - 12/31/09

3%

7/1/08 - 12/31/08

3%

1/1/08 - 6/30/08

5%

1/1/07 - 12/31/07

4%

7/1/06 - 12/31/06

4%

1/1/06 - 12/31/06

2%

1/1/05 - 12/31/05

1%

   

1/1/04 - 12/31/04

1%

1/1/03 - 12/31/03

2%

7/1/02 - 12/31/02

3%

1/1/02 - 06/30/02

5%

1/1/01 - 12/31/01

6%

1/1/00 - 12/31/00

5%

 

 

1/1/99 - 12/31/99

5%

1/1/98 - 12/31/98

5%

1/1/97 - 12/31/97

5%

1/1/96 - 12/31/96

5%

7/1/95 - 12/31/95

5%

1/1/95 - 06/30/95

3%

 

 

1/1/94 - 12/31/94

3%

1/1/93 - 12/31/93

4%

1/1/92 - 12/31/92

6%

1/1/91 - 12/31/91

8%

1/1/90 - 12/31/90

9%

   

1/1/89 - 12/31/89

7%

1/1/88 - 12/31/88

6%

1/1/87 - 12/31/87

7%

1/1/86 - 12/31/86

8%

1/1/85 - 12/31/85

9%

 

 

Prior to 01/01/84

Not applicable

 

ATTACHMENT TO FECA CIRCULAR NO. 16-05

 

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FECA CIRCULAR NO. 16-04

February 1, 2016

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

Effective January 1, 2016, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile has been REDUCED to 54 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.

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.

Attached to this Circular is an updated listing of mileage reimbursement rates from January 1, 1995 through the current date.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Attachment: Private Automobile Mileage Reimbursement Rates

Distribution: All DFEC Staff

 

ATTACHMENT TO FECA CIRCULAR NO. 16 – 04

PRIVATE AUTOMOBILE MILEAGE REIMBURSEMENT RATES

Dates

Cents per mile

01/01/1995 – 06/06/1996

30.0 cents per mile

06/07/1996 – 09/07/1998

31.0 cents per mile

09/08/1998 – 03/31/1999

32.5 cents per mile

04/01/1999 – 01/13/2000

31.0 cents per mile

 

 

01/14/2000 – 01/21/2001

32.5 cents per mile

01/22/2001 – 01/20/2002

34.5 cents per mile

01/21/2002 – 12/31/2002

36.5 cents per mile

01/01/2003 – 12/31/2003

36.0 cents per mile

01/01/2004 – 02/03/2005

37.5 cents per mile

02/04/2005 – 08/31/2005

40.5 cents per mile

09/01/2005 – 12/31/2005

48.5 cents per mile

01/01/2006 – 01/31/2007

44.5 cents per mile

02/01/2007 – 03/18/2008

48.5 cents per mile

03/19/2008 – 07/31/2008

50.5 cents per mile

08/01/2008 – 12/31/2008

58.5 cents per mile

01/01/2009 – 12/31/2009

55.0 cents per mile

 

 

01/01/2010 – 12/31/2010

50.0 cents per mile

01/01/2011 – 04/16/2012

51.0 cents per mile

04/17/2012 – 12/31/2012

55.5 cents per mile

01/01/2013 – 12/31/2013

56.5 cents per mile

01/01/2014 – 12/31/2014

56.0 cents per mile

01/01/2015 – 12/31/2015

57.5 cents per mile

01/01/2016 to Present

54.0 cents per mile

 

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FECA CIRCULAR NO. 16-03

January 15, 2016

SUBJECT: Federal Occupational Health (FOH) – District Medical Advisors (DMAs)

PURPOSE: To announce the transition to the nationwide FOH-DMA Interagency Agreement

The Office of Workers' Compensation Programs' Division of Federal Employees' Compensation (DFEC) uses physicians called District Medical Advisors1 (DMA) to perform medical evaluations of case files under the Federal Employees' Compensation Act. DMAs have historically been hired to provide services through each District Office, generally through the use of a Memorandum of Agreement.

DMA medical evaluations are performed for a variety of purposes. When Claims Examiners (CEs) need assistance with interpretation of medical reports or need review of the appropriateness of a medical authorization (such as surgery), the DMA can be asked to provide an opinion to assist the CE with medical management. DMAs also provide written opinions assessing and/or calculating the percentage of permanent impairment in accordance with the American Medical Association's (AMA) Guides to the Evaluation of Permanent Impairment. See FECA Procedure Manual 2-600-3; 2-808-6; 3-200-4; 3-600-3; 3-700-3.

Effective November 16, 2015, the Department of Health and Human Services' Federal Occupational Health Service (FOH) will be providing DMA services for all 12 District Offices through an interagency agreement with DFEC. See 5 U.S.C. 7901 and 42 U.S.C. 231. FOH will provide a network/cadre of active, current Board-certified and licensed physicians and/or specialists to deliver the DFEC District Offices with DMA medical evaluations/services in accordance with established DFEC policies and procedures. DMA reviews will be classified into three categories: (1) Impairment Rating, (2) Medical/Surgical Review, and (3) Death Claim Review. Reviews will also be designated as routine (for more basic issues) or as complex (for those requiring a more extensive review). Cases can also be designated for Expedited Review, when a quicker response is needed.

There has been no change to DFEC policy with regards to the case file circumstances that necessitate a DMA referral nor any change regarding the services provided.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff, OWCP


1DMAs are referred to as Office medical advisors in the decisions of the Employees' Compensation Appeals Board.

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FECA CIRCULAR NO. 16-02

October 13, 2015

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

The interest rate to be assessed for the prompt payment bills is 2.375 percent for the period of July 1, 2015 through December 31, 2015. This new rate has been updated in the Central Bill Payment system tables.

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 1.0 percent for the period of January 1, 2015 through December 31, 2015. This new rate has been updated in the iFECS system tables.

Ordinarily, the rate of interest charged on debts due the U.S. Government is only changed in January, and is effective for the entire year. However, the rate may be changed in July if there is a difference in the Current Value of Funds (CVF) interest rate of more than two percent. The rate will be reviewed on July 1, 2015 to determine if the Treasury has changed the rate.

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.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Attachments: Prompt Payment Interest Rates
Debt Management Interest Rates

 

Distribution: List No. 2--Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, Staff Nurses and Fiscal Personnel)

 

ATTACHMENT TO FECA CIRCULAR NO. 16-02

PROMPT PAYMENT INTEREST RATES

Dates

Percentages

07/1/15 - 12/31/15
01/1/15 - 06/30/15
07/1/14 - 12/31/14
01/1/14 - 12/31/14
07/1/13 - 12/31/13
01/1/13 - 12/31/13
07/1/12 - 12/31/12
01/1/12 - 12/31/12
07/1/11 - 12/31/11
01/1/11 - 06/30/11
01/1/10 - 12/31/10
01/1/10 - 12/31/10

2 ⅜ %
2 ⅛ %
2.0 %
2 ⅛ %
1 ¾ %
1 ⅜ %
1 ¾ %
2.0 %
2 ½ %
2 ⅝ %
2 ⅝ %
3 ¼ %

PROMPT PAYMENT INTEREST RATES

Dates

Percentages

Dates

Percentages

07/1/09 - 12/31/09
01/1/09 - 06/30/09
07/1/08 - 12/31/08
01/1/08 - 06/30/08
07/1/07 - 12/31/07
01/1/07 - 06/30/07
07/1/06 - 12/31/06
01/1/06 - 06/30/06
07/1/05 - 12/31/05
01/1/05 - 06/30/05
07/1/04 - 12/31/04
01/1/04 - 06/30/04
07/1/03 - 12/31/03
01/1/03 - 06/30/03
07/1/02 - 12/31/02
01/1/02 - 06/30/02
07/1/01 - 12/31/01
01/1/01 - 06/30/01
07/1/00 - 12/31/00
01/1/00 - 06/30/00

4 ⅞ %
5 ⅝ %
5 ⅛ %
4 ¾ %
5 ¾ %
5 ¼ %
5 ¾ %
5 ⅛ %
4 ½ %
4 ¼ %
4 ½ %
4.0 %
3 ⅛ %
4 ¼ %
5 ¼ %
5 ½ %
5 ⅞ %
6 ⅜ %
7 ¼ %
6 ¾ %

07/1/99 - 12/31/99
01/1/99 - 06/30/99
07/1/98 - 12/31/98
01/1/98 - 06/30/98
07/1/97 - 12/31/97
01/1/97 - 06/30/97
07/1/96 - 12/31/96
01/1/96 - 06/30/96
07/1/95 - 12/31/95
01/1/95 - 06/30/95
07/1/94 - 12/31/94
01/1/94 - 06/30/94
07/1/93 - 12/31/93
01/1/93 - 06/30/93
07/1/92 - 12/31/92
01/1/92 - 06/30/92
07/1/91 - 12/31/91
01/1/91 - 06/30/91
07/1/90 - 12/31/90
01/1/90 - 06/30/90

6 ½ %
5.0 %
6.0 %
6 ¼ %
6 ¾ %
6 ⅜ %
7.0 %
5 ⅞ %
6 ⅜ %
8 ⅛ %
7.0 %
5 ½ %
5 ⅝ %
6 ½ %
7.0 %
6 ⅞ %
8 ½ %
8 ⅜ %
9.0 %
8 ½ %

PROMPT PAYMENT INTEREST RATES

Dates

Percentages

Dates

Percentages

01/1/89 - 06/30/89
07/1/88 - 12/31/88
01/1/88 - 06/30/88
07/1/87 - 12/31/87
01/1/87 - 06/30/87

9 ¾ %
9 ¼ %
9 ⅜ %
8 ⅞ %
7 ⅝ %

07/1/86 - 12/31/86
01/1/86 - 06/30/86
07/1/85 - 12/31/85
01/1/85 - 06/30/85

8 ½ %
9 ¾ %
10 ⅜ %
12 ⅛ %

 

ATTACHMENT TO FECA CIRCULAR NO. 16 - 02

DEBT MANAGEMENT INTEREST RATES

Dates

Percentages

01/1/15 - 12/31/15

1 %

01/1/14 - 12/31/14

1%

01/1/13 - 12/31/13

1%

01/1/12 - 12/31/12

1%

01/1/11 - 12/31/11

1%

1/1/10 - 12/31/10

1%

 

 

1/1/09 - 12/31/09

3%

7/1/08 - 12/31/08

3%

1/1/08 - 6/30/08

5%

1/1/07 - 12/31/07

4%

7/1/06 - 12/31/06

4%

1/1/06 - 12/31/06

2%

1/1/05 - 12/31/05

1%

   

1/1/04 - 12/31/04

1%

1/1/03 - 12/31/03

2%

7/1/02 - 12/31/02

3%

1/1/02 - 06/30/02

5%

1/1/01 - 12/31/01

6%

1/1/00 - 12/31/00

5%

 

 

1/1/99 - 12/31/99

5%

1/1/98 - 12/31/98

5%

1/1/97 - 12/31/97

5%

1/1/96 - 12/31/96

5%

7/1/95 - 12/31/95

5%

1/1/95 - 06/30/95

3%

 

 

1/1/94 - 12/31/94

3%

1/1/93 - 12/31/93

4%

1/1/92 - 12/31/92

6%

1/1/91 - 12/31/91

8%

1/1/90 - 12/31/90

9%

   

1/1/89 - 12/31/89

7%

1/1/88 - 12/31/88

6%

1/1/87 - 12/31/87

7%

1/1/86 - 12/31/86

8%

1/1/85 - 12/31/85

9%

 

 

Prior to 01/01/84

Not applicable

 

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FECA CIRCULAR NO. 16-01

October 6, 2015

SUBJECT: ICD-10 TRANSITION

On October 1, 2015, the Office of Workers' Compensation Programs' Division of Federal Employees' Compensation (DFEC) will transition to the new International Classification of Diseases (ICD), Tenth Revision and Clinical Modification (ICD-10-CM) Coding System. The ICD is used to standardize codes for medical conditions and is the standard diagnostic tool for epidemiology, health management and clinical purposes.

The U.S. Department of Health and Human Services (HHS) issued a Final Rule finalizing October 1, 2015, as the compliance date for health care providers, health plans and health care clearinghouses to transition from ICD-9 to ICD-10, the tenth revision of the ICD. The transition to ICD-10 is coordinated by the HHS Centers for Medicare & Medicaid Services (CMS) and is mandatory across the country, including for DFEC. For all claims filed on or after October 1, 2015, the ICD-10 is the operative code for decisions, correspondence, and development.

ICD-9 had not been updated in more than 35 years and contained outdated and obsolete terminology. The new ICD-10 system consists of more than 68,000 codes, compared to approximately 13,000 ICD-9 codes. ICD-10 incorporates greater specificity and clinical detail.

1. ICD-10 differs from ICD-9 in its organization and structure, code composition and level of detail. ICD-9 codes consisted of three to five characters. In ICD-10, codes will consist of three to seven characters. The first digit is alphabetical and all letters are used except for U. The second and third digits are numeric and the fourth through seventh digits can be alphabetical or numeric. The decimal is placed after first three characters.

2. All injury types are categorized by body part. The first three digits of the ICD code will identify the category. The second three digits identify the etiology, anatomic site and severity. The last digit is an extension that identifies the episode of care. Code extensions (the seventh digit) have been used in many instances to identify the encounter as initial, subsequent or sequelae.

3. DFEC will utilize ICD-9 codes for all cases accepted through and including September 30, 2015. ICD-10 codes will be utilized for all cases accepted on or after October 1, 2015. For medical providers, ICD-9 codes should be used for services rendered through 11:59PM on September 30, 2015. ICD-10 codes are to be used for services rendered at or after 12:00AM on October 1, 2015.

4. ICD-9 codes added prior to October 1, 2015, will remain in the case management system and be automatically cross-matched to the corresponding ICD-10 codes by ACS for medical bill payment. ACS will utilize a general equivalency mapping program to transition the ICD-9 codes in the case management system to ICD-10 codes for appropriate bill processing. The medical bill processing team will use the bill's dates of service and/or coverage dates to determine which version of ICD diagnosis and procedure codes should be billed, and will edit accordingly.

5. The ACS Web Portal contains information and informational links for providers seeking information about the ICD-10 conversion. The portal can be accessed at the OWCP web bill portal.

6. DFEC has notified the employing agencies that all data extracts that are sent electronically to them will be modified for this transition.

7. In anticipation of the ICD-10 transition, the 2011 update of the FECA Regulations at 20 C.F.R. 10.801 (c) instructs providers to use "International Classification of Disease, 9th Edition, Clinical Modification" (ICD-9-CM), or as revised." [Emphasis added] See also 20 CFR. 10. 802.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff

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FECA CIRCULAR NO. 15-06

April 8, 2015

SUBJECT: Labor for America (LFA)

PURPOSE: To announce the Office of Workers' Compensation Programs' (OWCP) web-based Labor for America (LFA) Program.

LFA is the Office of Workers' Compensation Programs' (OWCP) new web-based recruitment resource that allows public and private sector employers nationwide to search for, and connect with, vocationally rehabilitated injured workers who are currently in receipt of wage loss compensation in accordance with the Federal Employees' Compensation Act (FECA). While workers with acquired disabilities may no longer be able to perform their previous Federal jobs, many have significant transferrable work experience and have maintained/developed skills which qualify them for alternate positions with other employers. OWCP is committed to assisting these employees in returning to the workforce. Federal hiring will support Executive Order 13548 aimed at increasing disability hiring and increasing the return-to-work rate of federal employees who suffer from work-related injury or illness. [Exec. Order No. 13548, 75 Fed. Reg. 45039 (July 26, 2010)]. Federal employers may also use Schedule A hiring authority for this program. State, local and private sector employers may be eligible for an Assisted Reemployment salary reimbursement subsidy for up to three years.

Aims and Intended Use

1. LFA serves to connect employers with injured workers engaged in the placement phase of the vocational rehabilitation process. The website provides interested employers with the ability to view and search the profiles of injured workers who are ready to return to employment. This free candidate database is a recruitment resource for public and private sector employers nationwide seeking to recruit, hire and retain skilled workers who have employment histories with the Federal government, but are unable to return to their prior positions because of workplace injury or illness. LFA showcases hiring incentives to employers and provides support to all parties during the recruitment, hire and transition to work.

2. ASSISTED REEMPLOYMENT (AR) is a hiring incentive program which began in 1991. See FECA Bulletin 92-08 (Return to Work/Reemployment: Assisted Reemployment), issued on December 17, 1991. AR's goal is to increase the number of disabled employees who could successfully return to the labor force even though they could not be placed with their former employer. AR is now a staple of the FECA program used to assist injured workers with a return to gainful employment.1 OWCP has authority to use the FECA fund to pay a portion of the salary of a newly reemployed Federal worker (who is eligible for disability benefits under the FECA) via AR. Additional information regarding AR can be found in FECA PM 8-0800.

3. ROLE OF FECA VOCATIONAL REHABILITATION: During the vocational rehabilitation placement process, Vocational Rehabilitation Counselors (VRCs) will assist injured workers in developing resumes/professional profiles to use during their job searches. Injured workers may be advised of the opportunity to include their professional profiles on LFA. With the injured worker's agreement, the VRC will enter this information onto the LFA website as a Job Seeker profile. The Division of Federal Employees' Compensation (DFEC) Vocational Rehabilitation Specialist (VRS) reviews and approves the uploading of these Job Seeker profiles, at which time they become visible to prospective employers. Job Seeker profiles will remain active on the LFA website for the duration of the DFEC's vocational rehabilitation placement phase provided that the injured worker is fully cooperative with the vocational rehabilitation effort(s) during that period. If a candidate is placed, the VRC will, with the consent of the candidate, provide follow-up services to both the injured worker and the employer for at least 60 days of employment, to assist with any necessary accommodations including assistive technology and in recognition that this initial period is one of readjustment and/or transition for both.

4. THE LFA PROGRAM IS VOLUNTARY: The penalty provisions of 5 U.S.C. 8113(b) will not apply for refusal to participate in LFA. As a result, Job Seeker profiles may be deleted at the injured worker's request.

5. EMPLOYERS: Prospective employers can search the LFA database for qualified Job Seekers by general job category, geographic area or using key words. Employers will also have the ability to calculate the estimated AR subsidy. The AR subsidy calculator on the LFA website is used to make an approximate calculation of the reimbursement to the employer specific to the candidate of interest.

Note: Due to the provisions of the Privacy Act of 1974, a Job Seeker profile on LFA will not include the candidate's name or other Personally Identifiable Information (PII), but will include all pertinent information about the injured worker's work history, education, skills and experience. The Job Seeker's name and contact information will not be provided to interested employers without the injured worker's express consent.

a. Registered Employers: In addition to all of the tools available to non-registered users, registered users will have access to additional tools which include the ability to save search criteria, to save specific Job Seeker profiles for future reference (these profiles will remain available only as long as the injured employee is active on LFA), and to make contact with VRCs regarding potential job candidates.

b. Connecting with OWCP: When an employer is interested in a profile, they use LFA to send a message to the assigned VRC. The VRC will then make initial contact with the employer to learn about the job opportunity, determine whether the job's duties are compatible with that injured worker's rehabilitation goals and work tolerance limitations and subsequently facilitate direct contact between the injured worker and the employer, if appropriate.

c. Non-Registered Employers: Non-registered users can search LFA for Job Seeker profiles to obtain information about the Job Seeker's work history, experience and skills. Non-registered users can also calculate the approximate AR subsidy and/or download a PDF of the Job Seeker profile.

6. TRAINING AND ASSISTANCE: Training modules and videos for the various LFA functions are available on the LFA website. These include specific instructions for non-registered employers on how to search for Job Seekers and on how to use the AR subsidy calculator. For registered employers, the training modules include how to register; how to change account settings; and how to search for Job Seekers, save profiles and use expanded LFA tools as a registered employer. These training modules are available on the LFA website to any user/employer, whether registered or non-registered with LFA.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

1 Appropriations language for the Department of Labor provides "Provided, that amounts appropriated may be used under 5 U.S.C. 8104 by the Secretary to reimburse an employer, who is not the employer at the time of injury, for portions of the salary of a re-employed, disabled beneficiary..."

Distribution: All DFEC Staff, Vocational Rehabilitation Counselors

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FECA CIRCULAR NO. 15-05

February 26, 2015

SUBJECT: Reimbursement Rates Payable for the Use of Privately Owned Automobiles Necessary to Secure Medical Examination and Treatment.

Effective January 1, 2015, GSA increased the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile to 57.5 cents per mile. As in the past, the determination has been made to apply the applicable rate to FECA beneficiaries traveling to secure necessary medical examination and treatment.

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.

Attached to this Circular is an updated listing of mileage reimbursement rates from January 1, 1995 through the current date.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

 

Attachment: Private Automobile Mileage Reimbursement Rates

Distribution: List No. 2 - Folioviews Groups A and D (Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Fiscal Personnel).

 

ATTACHMENT TO FECA CIRCULAR NO. 15 – 05

PRIVATE AUTOMOBILE MILEAGE REIMBURSEMENT RATES

Dates

Cents per mile

01/01/1995 – 06/06/1996
06/07/1996 – 09/07/1998
09/08/1998 – 03/31/1999
04/01/1999 – 01/13/2000

30.0 cents per mile
31.0 cents per mile
32.5 cents per mile
31.0 cents per mile

01/14/2000 – 01/21/2001
01/22/2001 – 01/20/2002
01/21/2002 – 12/31/2002
01/01/2003 – 12/31/2003
01/01/2004 – 02/03/2005
02/04/2005 – 08/31/2005
09/01/2005 – 12/31/2005
01/01/2006 – 01/31/2007
02/01/2007 – 03/18/2008
03/19/2008 – 07/31/2008
08/01/2008 – 12/31/2008
01/01/2009 – 12/31/2009

32.5 cents per mile
34.5 cents per mile
36.5 cents per mile
36.0 cents per mile
37.5 cents per mile
40.5 cents per mile
48.5 cents per mile
44.5 cents per mile
48.5 cents per mile
50.5 cents per mile
58.5 cents per mile
55.0 cents per mile

01/01/2010 – 12/31/2010
01/01/2011 – 04/16/2012
04/17/2012 – 12/31/2012
01/01/2013 – 12/31/2013
01/01/2014 – 12/31/2014
01/01/2015 to Present

50.0 cents per mile
51.0 cents per mile
55.5 cents per mile
56.5 cents per mile
56.0 cents per mile
57.5 cents per mile

 

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FECA CIRCULAR NO. 15-04

February 26, 2015

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, 2015 through December 31, 2015. This new rate has been updated in the Central Bill Payment system tables.

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 1.0 percent for the period of January 1, 2015 through December 31, 2015. This new rate has been updated in the iFECS system tables.

Ordinarily, the rate of interest charged on debts due the U.S. Government is only changed in January, and is effective for the entire year. However, the rate may be changed in July if there is a difference in the Current Value of Funds (CVF) interest rate of more than two percent. The rate will be reviewed on July 1, 2015 to determine if the Treasury has changed the rate.

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.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Attachments:

Prompt Payment Interest Rates
Debt Management Interest Rates

 

Distribution: List No. 2--Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, Staff Nurses and Fiscal Personnel)

 

ATTACHMENT TO FECA CIRCULAR NO. 15 – 04

PROMPT PAYMENT INTEREST RATES

Dates

Percentages

01/1/15 - 12/31/15
07/1/14 - 12/31/14
01/1/14 - 12/31/14
07/1/13 - 12/31/13
01/1/13 - 12/31/13
07/1/12 - 12/31/12
01/1/12 - 12/31/12
07/1/11 - 12/31/11
01/1/11 - 06/30/11
01/1/10 - 12/31/10
01/1/10 - 12/31/10

2 ⅛ %
2.0 %
2 ⅛ %
1 ¾ %
1 ⅜ %
1 ¾ %
2.0 %
2 ½ %
2 ⅝ %
2 ⅝ %
3 ¼ %

PROMPT PAYMENT INTEREST RATES

Dates

Percentages

Dates

Percentages

07/1/09 - 12/31/09
01/1/09 - 06/30/09
07/1/08 - 12/31/08
01/1/08 - 06/30/08
07/1/07 - 12/31/07
01/1/07 - 06/30/07
07/1/06 - 12/31/06
01/1/06 - 06/30/06
07/1/05 - 12/31/05
01/1/05 - 06/30/05
07/1/04 - 12/31/04
01/1/04 - 06/30/04
07/1/03 - 12/31/03
01/1/03 - 06/30/03
07/1/02 - 12/31/02
01/1/02 - 06/30/02
07/1/01 - 12/31/01
01/1/01 - 06/30/01
07/1/00 - 12/31/00
01/1/00 - 06/30/00

4 ⅞ %
5 ⅝ %
5 ⅛ %
4 ¾ %
5 ¾ %
5 ¼ %
5 ¾ %
5 ⅛ %
4 ½ %
4 ¼ %
4 ½ %
4.0 %
3 ⅛ %
4 ¼ %
5 ¼ %
5 ½ %
5 ⅞ %
6 ⅜ %
7 ¼ %
6 ¾ %

07/1/99 - 12/31/99
01/1/99 - 06/30/99
07/1/98 - 12/31/98
01/1/98 - 06/30/98
07/1/97 - 12/31/97
01/1/97 - 06/30/97
07/1/96 - 12/31/96
01/1/96 - 06/30/96
07/1/95 - 12/31/95
01/1/95 - 06/30/95
07/1/94 - 12/31/94
01/1/94 - 06/30/94
07/1/93 - 12/31/93
01/1/93 - 06/30/93
07/1/92 - 12/31/92
01/1/92 - 06/30/92
07/1/91 - 12/31/91
01/1/91 - 06/30/91
07/1/90 - 12/31/90
01/1/90 - 06/30/90

6 ½ %
5.0 %
6.0 %
6 ¼ %
6 ¾ %
6 ⅜ %
7.0 %
5 ⅞ %
6 ⅜ %
8 ⅛ %
7.0 %
5 ½ %
5 ⅝ %
6 ½ %
7.0 %
6 ⅞ %
8 ½ %
8 ⅜ %
9.0 %
8 ½ %

PROMPT PAYMENT INTEREST RATES

Dates

Percentages

Dates

Percentages

01/1/89 - 06/30/89
07/1/88 - 12/31/88
01/1/88 - 06/30/88
07/1/87 - 12/31/87
01/1/87 - 06/30/87

9 ¾ %
9 ¼ %
9 ⅜ %
8 ⅞ %
7 ⅝ %

07/1/86 - 12/31/86
01/1/86 - 06/30/86
07/1/85 - 12/31/85
01/1/85 - 06/30/85

8 ½ %
9 ¾ %
10 ⅜ %
12 ⅛ %

 

ATTACHMENT TO FECA CIRCULAR NO. 15 - 04

DEBT MANAGEMENT INTEREST RATES

Dates

Percentages

01/1/15 - 12/31/15

1 %

01/1/14 - 12/31/14

1%

01/1/13 - 12/31/13

1%

01/1/12 - 12/31/12

1%

01/1/11 - 12/31/11

1%

1/1/10 - 12/31/10

1%

 

 

1/1/09 - 12/31/09

3%

7/1/08 - 12/31/08

3%

1/1/08 - 6/30/08

5%

1/1/07 - 12/31/07

4%

7/1/06 - 12/31/06

4%

1/1/06 - 12/31/06

2%

1/1/05 - 12/31/05

1%

   

1/1/04 - 12/31/04

1%

1/1/03 - 12/31/03

2%

7/1/02 - 12/31/02

3%

1/1/02 - 06/30/02

5%

1/1/01 - 12/31/01

6%

1/1/00 - 12/31/00

5%

 

 

1/1/99 - 12/31/99

5%

1/1/98 - 12/31/98

5%

1/1/97 - 12/31/97

5%

1/1/96 - 12/31/96

5%

7/1/95 - 12/31/95

5%

1/1/95 - 06/30/95

3%

 

 

1/1/94 - 12/31/94

3%

1/1/93 - 12/31/93

4%

1/1/92 - 12/31/92

6%

1/1/91 - 12/31/91

8%

1/1/90 - 12/31/90

9%

   

1/1/89 - 12/31/89

7%

1/1/88 - 12/31/88

6%

1/1/87 - 12/31/87

7%

1/1/86 - 12/31/86

8%

1/1/85 - 12/31/85

9%

 

 

Prior to 01/01/84

Not applicable

 

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FECA CIRCULAR NO. 15-03

January 28, 2015

SUBJECT: Dual Benefits - FERS Cost of Living Adjustments


Effective December 1, 2014, benefits issued by the Social Security Administration (SSA) will be increased by 1.7%. 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.

This adjustment will be made from the National Office for all cases that were correctly entered into the iFECS Compensation program. The adjustment will be effective with the periodic roll cycle beginning December 14, 2014. There will be no adjustment or overpayment declared for the period of December 1, 2014 through December 13, 2014.

The historical SSA cost of living adjustments are as follows:

The historical SSA cost of living adjustments are as follows:

Dates

Percentage

12/01/2014 - 11/30/2015
12/01/2013 - 11/30/2014
12/01/2012 - 11/30/2013
12/01/2011 - 11/30/2012
12/01/2010 - 11/30/2011
12/01/2009 - 11/30/2010
12/01/2008 - 11/30/2009
12/01/2007 - 11/30/2008
12/01/2006 - 11/30/2007
12/01/2005 - 11/30/2006
12/01/2004 - 11/30/2005
12/01/2003 - 11/30/2004
12/01/2002 - 11/30/2003
12/01/2001 - 11/30/2002
12/01/2000 - 11/30/2001
12/01/1999 - 11/30/2000
12/01/1998 - 11/30/1999
12/01/1997 - 11/30/1998
12/01/1996 - 11/30/1997
12/01/1995 - 11/30/1996
12/01/1994 - 11/30/1995

1.7%
1.5%
1.7%
3.6%
0.0%
0.0%
5.8%
2.3%
3.3%
4.1%
2.7%
2.1%
1.4%
2.6%
3.5%
2.4%
1.3%
2.1%
2.9%
2.6%
2.8%

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 1 – FolioViews Groups A, B and D (Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists, Staff Nurses and Fiscal Personnel)

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FECA CIRCULAR NO. 15-02

October 29, 2014

SUBJECT: SSA Contacts for FERS Dual Benefits


Reference is made to FECA Bulletin 97-9, where the procedures for computing FERS Dual Benefits are outlined. Action item 3 indicates that the National Office will provide updated points of contact of the individuals from the SSA who are responsible for performing the necessary computations for OWCP.

These computations are currently assigned to a number of modules based on the last 2 digits of the SSN as follows:

Modules and module managers' contact information

Module

Terminal Digit/
Alpha Range

Module Manager

Deputy Module Manager

Fax Number

1

00-24

Gekia Gant
410-965-9388

Ismael Navarro
410-966-8544

410-965-5882

2

25-49

Loraima Gonzalez-Cortes
410-965-8063

Brandon Johnson
410-965-7227

410-966-6782

3

50-74

Victor Hamilton
410-966-5566

Kevin Jones
410-965-7335

410-965-8054

4

75-99

Natalie Hamlett
410-965-5255

Troy English
410-965-9382

410-965-9409

BET FAXES

410-966-5552
410-966-1042

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: All Claims Staff and Fiscal Personnel

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FECA CIRCULAR NO. 15-01

October 14, 2014

SUBJECT: Outpatient Prospective Payment System


Applicability: Appropriate National Office and District Office personnel.

Reference: Federal Employee's Compensation Act (FECA) Procedure Manual and 5 USC 8103; 20 C.F.R. Part 10.

5 U.S.C. 8103 provides that an injured employee is entitled to receive medical services, appliances or supplies which a qualified physician prescribes or recommends and which OWCP considers necessary to treat the work-related injury. This section further provides that an employee may be furnished necessary and reasonable transportation and expenses incident to the securing of such services, appliances and supplies when authorized. This Circular describes the FECA program's adoption of an Outpatient Prospective Payment System (OPPS).

On August 28, 2011, the final rule updating the regulations implementing the FECA took effect after notice and comment. Changes made to 20 C.F.R. § 10.801(c)(1)(ii) gave the Office of Workers' Compensation Programs (OWCP) the authority to adopt an OPPS being developed by the Center for Medicare and Medicaid Services (CMS).

Now that the OPPS has been implemented by CMS, OWCP now exercises its authority in accordance with these regulations and is implementing an OPPS as described below, effective October 1, 2014 as follows:

(a) OWCP will pay for hospital outpatient medical services according to Ambulatory Payment Classifications (APC) based on the OPPS devised by CMS (42 CFR parts 412, 419, 424, 485 and 489). Under this system, CMS assigns individual services [Healthcare Common Procedure Coding System (HCPCS) codes] to APCs based on similar clinical characteristics and similar costs. Using this system, payment is derived by multiplying the labor portion of the national unadjusted payment rate for the APC weight by the hospital wage index.

(b) Hospital outpatient services will be classified according to the APC prescribed by the CMS for that service in the form of the OPPS Grouper software program. Each payment is derived by multiplying the prospectively established scaled relative weight for the service's clinical APC by a conversion factor (CF) to arrive at a national unadjusted payment rate for the APC. The labor portion of the national unadjusted payment rate (60%) is further adjusted by the hospital wage index for the area where payment is being made.

(c) If a payable service has no assigned APC, the payment will be derived from the OWCP fee schedule.

OWCP will review the pre-determined outpatient hospital rates at least once a year, and may adjust any or all components when OWCP deems it necessary or appropriate.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: DFEC Staff

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FECA CIRCULAR NO. 14-01

June 2, 2014

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, 2014 through December 31, 2014. This new rate has been updated in the Central Bill Payment system tables.

The rate for assessing interest charges on debts due the government has not been changed. The interest rate for assessing interest charges on debts due the government remains 1.0 percent for the period of January 1, 2014 through December 31, 2014.

Ordinarily, the rate of interest charged on debts due the U.S. Government is only changed in January, and is effective for the entire year. However, the rate may be changed in July if there is a difference in the Current Value of Funds (CVF) interest rate of more than two percent. The rate will be reviewed on July 1, 2014 to determine if the Treasury has changed the rate.

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.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

 

Attachments

Distribution: List No. 2--Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, Staff Nurses and Fiscal Personnel)

FC 14-01 Attachment 1:

PROMPT PAYMENT INTEREST RATES

Date

Percentage

Date

Percentage

01/1/14-12/31/14
01/1/13 - 12/31/13
07/1/12 - 12/31/12
01/1/12 - 06/30/12
07/1/11 - 12/31/11
01/1/11 - 12/31/11
01/1/10 - 12/31/10
07/1/09 - 12/31/09
01/1/09 - 06/30/09
07/1/08 - 12/31/08
01/1/08 - 06/30/08
07/1/07 - 12/31/07
01/1/07 - 06/30/07
07/1/06 - 12/31/06
01/1/06 - 06/30/06
07/1/05 - 12/31/05
01/1/05 - 06/30/05
07/1/04 - 12/31/04
01/1/04 - 06/30/04
07/1/03 - 12/31/03
01/1/03 - 06/30/03
07/1/02 - 12/31/02
01/1/02 - 06/30/02
07/1/01 - 12/31/01
01/1/01 - 06/30/01
07/1/00 - 12/31/00
01/1/00 - 06/30/00
07/1/99 - 12/31/99
01/1/99 - 06/30/99

2 ⅛ %
1 ⅜ %
1 ¾ %
2.0 %
2 ½ %
2 ⅝ %
3 ¼ %
4 ⅞ %
5 ⅝ %
5 ⅛ %
4 ¾ %
5 ¾ %
5 ¼ %
5 ¾ %
5 ⅛ %
4 ½ %
4 ¼ %
4 ½ %
4.0 %
3 ⅛ %
4 ¼ %
5 ¼ %
5 ½ %
5 ⅞ %
6 ⅜ %
7 ¼ %
6 ¾ %
6 ½ %
5.0 %

07/1/98 - 12/31/98
01/1/98 - 06/30/98
07/1/97 - 12/31/97
01/1/97 - 06/30/97
07/1/96 - 12/31/96
01/1/96 - 06/30/96
07/1/95 - 12/31/95
01/1/95 - 06/30/95
07/1/94 - 12/31/94
01/1/94 - 06/30/94
07/1/93 - 12/31/93
01/1/93 - 06/30/93
07/1/92 - 12/31/92
01/1/92 - 06/30/92
07/1/91 - 12/31/91
01/1/91 - 06/30/91
07/1/90 - 12/31/90
01/1/90 - 06/30/90
07/1/89 - 12/31/89
01/1/89 - 06/30/89
07/1/88 - 12/31/88
01/1/88 - 06/30/88
07/1/87 - 12/31/87
01/1/87 - 06/30/87
07/1/86 - 12/31/86
01/1/86 - 06/30/86
07/1/85 - 12/31/85
01/1/85 - 06/30/85

6.0 %
6 ¼ %
6 ¾ %
6 ⅜ %
7.0 %
5 ⅞ %
6 ⅜ %
8 ⅛ %
7.0 %
5 ½ %
5 ⅝ %
6 ½ %
7.0 %
6 ⅞ %
8 ½ %
8 ⅜ %
9.0 %
8 ½ %
9 ⅛ %
9 ¾ %
9 ¼ %
9 ⅜ %
8 ⅞ %
7 ⅝ %
8 ½ %
9 ¾ %
10 ⅜ %
12 ⅛ %

Prior to 01/01/85 Not Applicable

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FC 14-01 Attachment 2:

DEBT MANAGEMENT INTEREST RATES

Date

Percentage

01/1/14 - 12/31/14

1%

01/1/13 - 12/31/13

1%

01/1/12 - 12/31/12

1%

01/1/11 - 12/31/11

1%

1/1/10 – 12/31/10

1%

 

 

1/1/09 - 12/31/09

3%

7/1/08 - 12/31/08

3%

1/1/08 - 6/30/08

5%

1/1/07 - 12/31/07

4%

7/1/06 - 12/31/06

4%

1/1/06 - 12/31/06

2%

1/1/05 - 12/31/05

1%

   

1/1/04 - 12/31/04

1%

1/1/03 - 12/31/03

2%

7/1/02 - 12/31/02

3%

1/1/02 - 06/30/02

5%

1/1/01 - 12/31/01

6%

1/1/00 - 12/31/00

5%

 

 

1/1/99 - 12/31/99

5%

1/1/98 - 12/31/98

5%

1/1/97 - 12/31/97

5%

1/1/96 - 12/31/96

5%

7/1/95 - 12/31/95

5%

1/1/95 - 06/30/95

3%

 

 

1/1/94 - 12/31/94

3%

1/1/93 - 12/31/93

4%

1/1/92 - 12/31/92

6%

1/1/91 - 12/31/91

8%

1/1/90 - 12/31/90

9%

   

1/1/89 - 12/31/89

7%

1/1/88 - 12/31/88

6%

1/1/87 - 12/31/87

7%

1/1/86 - 12/31/86

8%

1/1/85 - 12/31/85

9%

 

 

Prior to 01/01/84

Not applicable

 

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FECA CIRCULAR NO. 13-01

November 27, 2012


SUBJECT: Dual Benefits - FERS Cost of Living Adjustments


Effective December 31, 2012, benefits issued by the Social Security Administration (SSA) will be increased by 1.7%. 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.

This adjustment will be made from the National Office for all cases that were correctly entered into the iFECS Compensation program. The adjustment will be effective with the periodic roll cycle beginning December 16, 2012. There will be no adjustment or overpayment declared for the period of December 1, 2012 through December 15, 2012.

The historical SSA cost of living adjustments are as follows:

Historical SSA cost of living adjustments

Date

Percentage

12/01/2012 - 11/30/2013
12/01/2011 - 11/30/2012
12/01/2010 - 11/30/2011
12/01/2009 - 11/30/2010
12/01/2008 - 11/30/2009
12/01/2007 - 11/30/2008
12/01/2006 - 11/30/2007
12/01/2005 - 11/30/2006
12/01/2004 - 11/30/2005
12/01/2003 - 11/30/2004
12/01/2002 - 11/30/2003
12/01/2001 - 11/30/2002
12/01/2000 - 11/30/2001
12/01/1999 - 11/30/2000
12/01/1998 - 11/30/1999
12/01/1997 - 11/30/1998
12/01/1996 - 11/30/1997
12/01/1995 - 11/30/1996
12/01/1994 - 11/30/1995

1.7%
3.6%
0.0%
0.0%
5.8%
2.3%
3.3%
4.1%
2.7%
2.1%
1.4%
2.6%
3.5%
2.4%
1.3%
2.1%
2.9%
2.6%
2.8%

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: All Claims Staff and Fiscal Personnel

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FECA CIRCULAR NO. 13-02

Issue Date: February 14, 2013


Expiration Date: Date of Next Rate Change


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, 2013, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile was increased to 56.5 cents per mile by GSA. No restriction is made as to the number of miles that can be traveled. As in the past, a 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 5, Benefit Payments, Federal (FECA) Procedure Manual and 5 U.S.C. § 8103.

Action: The Central Bill Pay (CBP) facility has updated its 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.

The following is a list of the historical mileage rates used to reimburse claimant travel expense:

historical mileage rates
Date Rate

01/01/1995 – 06/06/1996
06/07/1996 – 09/07/1998
09/08/1998 – 03/31/1999
04/01/1999 – 01/13/2000

30.0 cents per mile
31.0 cents per mile
32.5 cents per mile
31.0 cents per mile

01/14/2000 – 01/21/2001
01/22/2001 – 01/20/2002
01/21/2002 – 12/31/2002
01/01/2003 – 12/31/2003
01/01/2004 – 02/03/2005
02/04/2005 – 08/31/2005
09/01/2005 – 12/31/2005

32.5 cents per mile
34.5 cents per mile
36.5 cents per mile
36.0 cents per mile
37.5 cents per mile
40.5 cents per mile
48.5 cents per mile

01/01/2006 – 01/31/2007
02/01/2007 – 03/18/2008
03/19/2008 – 07/31/2008
08/01/2008 – 12/31/2008
01/01/2009 – 12/31/2009
01/01/2010 – 12/31/2010
01/01/2011 – 04/16/2012
04/17/2012 – 12/31/2012
01/01/2013 to Present

44.5 cents per mile
48.5 cents per mile
50.5 cents per mile
58.5 cents per mile
55.0 cents per mile
50.0 cents per mile
51.0 cents per mile
55.5 cents per mile
56.5 cents per mile

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

 

Douglas Fitzgerald
Director for
Federal Employees' Compensation

 

Distribution: All Claims Staff and Fiscal Personnel

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FECA CIRCULAR NO. 13-03

February 14, 2013


SUBJECT: Employees' Compensation and Management Portal (ECOMP)

PURPOSE: To announce the Office of Workers' Compensation Programs' (OWCP) web-based portal for the electronic submission of Federal Employees' Compensation Act (FECA) claim forms and case related documents.

BACKGROUND: The OWCP completed a comprehensive update of the FECA regulations in 20 C.F.R. Part 10, effective August 29, 2011. 20 CFR §§ 10.100, 10.101, 10.102 and 10.103 (Claims for traumatic injury, occupational disease, wage loss compensation, and schedule awards respectively) direct that all such notices should be submitted electronically wherever feasible to facilitate processing of such claims. Each of these regulations also explicitly requires that, "All employers that currently do not have such capability should create such a method by December 31, 2012."

To facilitate electronic form filing, the OWCP has created its own web-based application (ECOMP), with a comprehensive electronic system for recording workplace injuries and illnesses, and processing claims under the FECA. ECOMP is available to all federal agencies who wish to use it for electronic form filing free of charge.

ECOMP, which was released to the public on November 2, 2011, can be accessed directly at the following url: https://www.ecomp.dol.gov. The site currently contains two different types of functionality – electronic submission of documents and electronic submission of FECA claim forms.

1. Web-Enabled Electronic Document Submission (WEEDS). At the time of initial release, the only available component was the electronic submission of documents. This component, WEEDS, enables all stakeholders to upload documents directly into a FECA case file. Utilizing WEEDS provides numerous important advantages: a) the document is viewable in the OWCP case file by the Claims Examiner usually within 4 hours of submission - thus the time it takes for documents to travel via mail or fax is eliminated; b) ECOMP provides a Document Control Number (DCN) when a document is uploaded so the user can track when it has been uploaded into the case file; and c) upon receipt of a claim number for a new injury, documents can be uploaded into the claim record right away rather than mailing or faxing them, which can facilitate and speed processing and adjudication of claims.

2. Electronic Form Filing. On February 27, 2012, the second component of ECOMP was made available. This component allows injured workers (employed by an enrolled federal agency) to electronically file specified FECA claim forms. Some employing agencies already provide an electronic means for form submission, and the OWCP will continue to accept forms submitted via those existing, currently approved employing agency electronic submission platforms.

ACTIONS:

A. Web-Enabled Electronic Document Submission (WEEDS)

1. This feature enables all stakeholders to upload documents directly into a FECA case file. Stakeholders include, but are not limited to, injured workers (and their representatives), employing agencies, contract field nurses and rehabilitation counselors, and medical providers. Many of the letters used by the Division of Federal Employees' Compensation (DFEC) contain language referencing this option for document submission.

2. A user does not have to register or enroll with ECOMP to use this feature. Rather, any stakeholder with an internet connection and specific information about a FECA claim can upload documents directly into the case file. Before attempting to upload documents via ECOMP, a user needs to have the following pieces of information: claim number, claimant's last name, claimant's date of birth, and the date of injury. If these pieces of information do not match the OWCP case data exactly, submission of a document is not allowed.

3. Once a document has been uploaded to the case file, ECOMP can only be used to verify that the OWCP received the document, not when or if a response has been provided. Any stakeholder having a question about a document that has been submitted must contact the servicing District Office.

4. Some specific documents should NOT be uploaded through the WEEDS component of ECOMP. The ECOMP interface and associated documentation clearly note these exceptions, which include the following:

a)

CA-1 (Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation)
CA-2 (Notice of Occupational Disease and Claim for Compensation)
CA-7 (Claim for Compensation)

These forms should all be sent to DFEC's Consolidated Case Create Facility (US Department of Labor, OWCP/DFEC, 400 West Bay Street, Room 827, Jacksonville, FL 32202), if not electronically filed through ECOMP (see next section) or other approved electronic forms submission platforms.

b)

CA-16 (Authorization for Examination and/or Treatment)
CA-2a (Notice of Recurrence)
CA-5 (Claim for Compensation by Widow, Widower, and/or Children)

These forms should be sent to the DFEC Consolidated Case Create Facility.

c)

OWCP-915 (Claim for Medical Reimbursement)
OWCP-957 (Medical Travel Refund Request)

These forms should be submitted to the DFEC's central mailroom (US Department of Labor, OWCP/DFEC, PO Box 8300, London, KY 40742-8300).

d)

Medical bills and requests for authorization of medical procedures from medical providers

These should be submitted through the OWCP's Central Billing and Authorization Facility (see the DFEC website for more information).

e)

Appellate requests for the Branch of Hearings and Review and the Employees' Compensation Appeals Board

Each should be sent to the specific address outlined in the appeal rights that accompany any formal decision.

B. Electronic Submission of Claims Forms

1. Employing Agency Enrollment

a)

Unlike the WEEDS feature for electronic document submission, registration and enrollment is required before claim forms can be electronically filed.

b)

An employing agency must enroll through the OWCP/DFEC. Once the agency is enrolled in ECOMP, an injured worker can register and create an account in order to file a claim. When creating an account, the injured worker selects his/her agency from a drop-down menu during the registration process. All federal agencies are listed in the drop-down menu but remain inactive until such time that an agency is enrolled.

c)

In order to enroll in ECOMP, each agency must sign a Memorandum of Understanding (MOU). The MOU is a template that sets forth the expectations and responsibilities of the agency with respect to the sharing and transmittal of data via ECOMP. The MOU is signed by the employing agency's Designated Approval Authority (DAA), and then countersigned by the OWCP's DAA.

d)

Once the MOU has been signed by both the employing agency and the OWCP, the agency designates its Agency Maintenance User (AMU) for ECOMP. This AMU then works directly with the OWCP to implement the agency's structure into the ECOMP platform. This structure includes a breakdown by Department, Agency-Group, Agency, Division and Duty Station. Specificity down to the Duty Station level is used so that the injured worker can more easily identify his/her workplace when filing a claim, and the appropriate charge back code can be associated with the claim.

e)

After verifying the agency's structure in ECOMP, the employing agency must then decide whether to allow submission of all forms or only certain forms. An agency may limit ECOMP form submission to new injury claims only (CA-1, Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation, and CA-2, Notice of Occupational Disease and Claim for Compensation), or to compensation claims only (CA-7, Claim for Compensation), or allow submission of all form types. This decision is entirely the employing agency's decision. If an agency chooses to limit submission by form type, the injured worker will be so notified if he/she attempts to file a claim form via ECOMP that is not currently permitted by the employing agency.

f)

For more information on enrolling in ECOMP, agencies may contact the DFEC's Branch of Technical Assistance.

2. Injured Worker (Claimant) Registration

a)

When the injured worker registers and creates an account with ECOMP, he/she must identify the employing agency as noted above.

b)

A new user must enter his/her Social Security Number (SSN) as part of the account creation process. When filing any claim form, the user must enter his/her SSN, which will be verified against the account information. If the information does not match, the user will be unable to file a claim. Also, when filing a CA-7, the SSN entered must match the SSN associated with the existing OWCP case file in order to proceed.

c)

The claimant must provide an email address that is to be used for communication from the ECOMP system. Note that ECOMP will not generate any email to an injured worker or agency user that contains sensitive Personally Identifiable Information (PII). Instead, ECOMP primarily uses the individual's initials, employing agency name, and the ECOMP Control Number (ECN) to identify the form in question. As explained below, this system may not be used by injured workers or agencies to communicate by email.

d)

The claimant must also provide answers to security questions to help safeguard the usage of the account.

3. Reporting an Injury or Illness

a)

The OSHA Form 301, Injury and Illness Incident Report, is completed by agencies when a recordable work-related injury or illness has occurred. This form helps the employer and OSHA develop a picture of the extent and severity of work-related incidents.

b)

For new injury claims, some agencies may require the injured worker to first file an OSHA Form 301 before filing a FECA form, while others may not. This is an employing agency decision, and ECOMP supports both options. The injured worker will be led through the process, step by step, regardless of the requirement selected by the agency. If an OSHA Form 301 is not required by a particular agency, the process begins with a CA-1 or CA-2 form – see Item 4 below.

c)

If required, the OSHA-301 is electronically routed to the Supervisor (based on the Supervisor's email address input by the user) and on to the agency's designated OSHA Record Keeper. It is then stored in the ECOMP database. The data can then be used to produce an OSHA-300, Log of Work-Related Injuries and Illnesses, and/or form OSHA-300A, Summary of Work-Related Injuries and Illnesses.

d)

Note that a contractor who is employed by an agency can also file an OSHA-301, but will not file a corresponding FECA claim form. (In the vast majority of situations, such contractors will not be considered employees for FECA purposes and may be covered under state workers' compensation law.)

4. Claims for Traumatic Injury and Occupational Disease

a)

Usually, the first step for a Federal employee who has sustained an injury or occupational disease is to file a CA-1 or CA-2 form. As noted above in Item 3, some agencies first require the completion of an OSHA Form 301. If an OSHA Form 301 is completed, some of the pertinent information will be pre-populated in the CA-1 or CA-2 form based upon the information input by the injured worker on the OSHA Form 301. However, the information can always be edited and/or updated by the injured worker when filing the FECA claim.

b)

The data required by ECOMP is the same as the data requested on the existing CA-1 and 2 forms; ECOMP only guides the user through the form's completion. The form is then electronically routed to the employee's supervisor (based on the Supervisor's email address input by the user), and then on to the agency's designated Agency Reviewer (usually an injury compensation or human resources specialist). Once completed, the form is then forwarded to the OWCP for case creation. See Item 6 below for signature requirements.

» If, however, the injury was designated as a First Aid or No Lost Time/No Medical Expense injury, it is stored in the ECOMP database unless or until it is reactivated by the Agency Reviewer.

c)

When initiating the claim, the injured worker can upload documents pertaining to that claim for submission to the OWCP, e.g. medical reports, witness statements, etc. Likewise, the supervisor and the Agency Reviewer can also upload pertinent documents. When the claim is submitted to the OWCP, the uploaded documents travel with the claim to the OWCP.

d)

As the form moves through the various review stages and is submitted to the OWCP, the injured worker and employing agency receive emails pertaining to that form each time it moves and/or the review status changes. When it is submitted to the OWCP and a case number is assigned, the injured worker receives one final email with the assigned case number. There is no further communication via ECOMP after the claim has been submitted and the case has been created.

e)

Once a case has been created by the OWCP, ECOMP no longer tracks the status of that case. ECOMP can only be used to submit the claim form to the OWCP. If the injured worker or employing agency has any questions about the claim after it has been assigned a case number, he/she must contact the servicing District Office in writing by either uploading a letter into ECOMP using the WEEDS application or mailing a printed letter using the U.S. Postal Service, or by phone. For certain "self-help" inquiries, certain stakeholders may use one of the following web-based options:

» The injured worker can view his/her case and compensation claim status, billing updates (including reimbursements), coverage limitations, and other information via the Claimant Query System (CQS) by clicking on the word "Claimant" next to the FECA photo online at: OWCP web bill portal.

» Employing agencies can use the Agency Query System (AQS), a secure internet site that provides access to similar information for authorized personnel from federal agencies. There is a link to the AQS site on the ECOMP home page.

5. Claims for Wage Loss and Schedule Award

a)

CA-7 forms for wage loss or schedule award are submitted in a similar manner. Like the CA-1 and CA-2, the data required by ECOMP is the same as the data requested on the existing CA-7 form; ECOMP only guides the user through the form's completion. The form is then electronically routed to the employee's supervisor (based on the Supervisor's email address input by the user) and then on to the Agency Reviewer. Once completed, the form is then forwarded on to the OWCP.

b)

CA-7 forms can be filed for all injuries, including new injury claims filed through ECOMP and any existing claims previously filed with the OWCP using other approved forms filing methods. In order to file a CA-7 for an existing OWCP case, the user will need to have the following pieces of information: claim number, claimant's last name, claimant's date of birth, and the date of injury. If these pieces of information do not match the OWCP case data exactly, electronic submission of a CA-7 is not allowed. The user must also input his/her SSN, which must match the SSN of the case for which the form is being filed.

c)

When initiating the CA-7, the injured worker can upload documents pertaining to that claim for submission to the OWCP, e.g. supporting medical documentation. Likewise, the supervisor and the Agency Reviewer can also upload pertinent documents. When the claim is submitted to the OWCP, the uploaded documents travel with the claim to the OWCP. Form CA-7a (Time Analysis Form) can also be submitted through ECOMP when a CA-7 is filed by the injured worker.

d)

As the CA-7 moves through the various review stages within ECOMP, the injured worker and employing agency receive emails pertaining to that form each time it moves and/or the review status changes. When the form is submitted to the OWCP, the injured worker receives one final email indicating that the form has been received. There is no further communication via ECOMP after the claim has been received by the OWCP.

e)

Once the CA-7 has been received by the OWCP, ECOMP no longer tracks the status of that form. ECOMP can only be used to submit the claim form to the OWCP. If the injured worker or employing agency has any questions about the claim after it has been received by the OWCP, he/she must contact the servicing District Office or use one of the electronic methods outlined in 4e, above.

6. Signatures on Claim Forms

a)

Since these claim forms are submitted electronically, they will not bear an actual signature from the injured worker or the Supervisor. As required by the OWCP and explicitly set forth in the MOU, however, the employing agency must retain signed hard copies.

b)

The MOU provides that, "To the extent that any forms containing the signature of an employee are submitted electronically, including, but not limited to, Form CA-1, CA-2, CA-7, CA-7a, [AGENCY NAME] agrees that it will retain the original form(s) submitted by the employee, bearing original signatures, and make such forms available for inspection by the DFEC. Although the signed copies of such forms are physically maintained by the employing agency, they remain covered by the government-wide Privacy Act system of records entitled DOL/GOVT-1."

c)

DFEC claims staff will be able to ascertain whether a claim form was submitted via ECOMP by checking the marking on the top right corner of the form. If the claim has been submitted via ECOMP, a black box will appear showing the ECOMP Control Number and the email address/user name of the various individuals who initiated and reviewed the form (e.g. injured worker, supervisor and Agency Reviewer).

d)

If a designated Agency Reviewer submits a claim on behalf of an employee, his/her name will appear in the signature block on the claim form.

7. Training and Assistance

a)

Training modules and videos for the various filing functions are available on the ECOMP site. These include specific instructions for how to file the various forms as an injured worker, how to review the forms as a Supervisor, and how to review the forms as an OSHA Record Keeper or Agency Reviewer. These training modules are available on the ECOMP site to any user, whether registered with ECOMP or not.

b)

Once an employing agency signs the required MOU, the DFEC's Branch of Technical Assistance will provide training for designated agency officials, as needed, on the use of ECOMP.

8. Time Requirements for Claims Submission

Reminder: The OWCP's regulations prescribe employing agency time limitations for the submission of claims for traumatic injury and occupational disease, as well as claims for compensation. ECOMP has several features that allow an employing agency to actively manage the timely submission of claim forms, including automatic and manual reminders for the supervisor and Agency Reviewer.

a)

Claims for traumatic injury and occupational disease should be filed no more than 10 working days after receipt of the notice from the employee. See 20 CFR § 10.110.

b)

Claims for compensation due to disability or permanent impairment should be filed no more than 5 working days after receipt from the employee. See 20 CFR § 10.111.

 

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation

Distribution: All DFEC Staff; Employing Agencies

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FECA CIRCULAR NO. 13-04

March 21, 2013

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


The interest rate to be assessed for the prompt payment bills is 1.375 percent for the period of January 1, 2013 through December 31, 2013. This new rate has been updated in the Central Bill Payment system tables.

The rate for assessing interest charges on debts due the government has not been changed. The interest rate for assessing interest charges on debts due the government remains 1.0 percent for the period of January 1, 2013 through December 31, 2013.

Ordinarily, the rate of interest charged on debts due the U.S. Government is only changed in January and is effective for the entire year. However, the rate may be changed in July if there is a difference in the Current Value of Funds (CVF) interest rate of more than two percent. The rate will be reviewed on July 1, 2013 to determine if the Treasury has changed the rate.

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.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

 

Attachments

Distribution: List No. 2--Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, Staff Nurses and Fiscal Personnel)

FC 13-04 EXHIBIT 1 –

PROMPT PAYMENT INTEREST RATES

Date

Percentage

Date

Percentage

01/1/13 - 12/31/13
07/1/12 - 12/31/12
01/1/12 - 06/30/12
07/1/11 - 12/31/11
01/1/11 - 12/31/11
01/1/10 - 12/31/10
07/1/09 - 12/31/09
01/1/09 - 06/30/09
07/1/08 - 12/31/08
01/1/08 - 06/30/08
07/1/07 - 12/31/07
01/1/07 - 06/30/07
07/1/06 - 12/31/06
01/1/06 - 06/30/06
07/1/05 - 12/31/05
01/1/05 - 06/30/05
07/1/04 - 12/31/04
01/1/04 - 06/30/04
07/1/03 - 12/31/03
01/1/03 - 06/30/03
07/1/02 - 12/31/02
01/1/02 - 06/30/02
07/1/01 - 12/31/01
01/1/01 - 06/30/01
07/1/00 - 12/31/00
01/1/00 - 06/30/00
07/1/99 - 12/31/99
01/1/99 - 06/30/99

1 ⅜ %
1 ¾ %
2.0 %
2 ½ %
2 ⅝ %
3 ¼ %
4 ⅞ %
5 ⅝ %
5 ⅛ %
4 ¾ %
5 ¾ %
5 ¼ %
5 ¾ %
5 ⅛ %
4 ½ %
4 ¼ %
4 ½ %
4.0 %
3 ⅛ %
4 ¼ %
5 ¼ %
5 ½ %
5 ⅞ %
6 ⅜ %
7 ¼ %
6 ¾ %
6 ½ %
5.0 %

07/1/98 - 12/31/98
01/1/98 - 06/30/98
07/1/97 - 12/31/97
01/1/97 - 06/30/97
07/1/96 - 12/31/96
01/1/96 - 06/30/96
07/1/95 - 12/31/95
01/1/95 - 06/30/95
07/1/94 - 12/31/94
01/1/94 - 06/30/94
07/1/93 - 12/31/93
01/1/93 - 06/30/93
07/1/92 - 12/31/92
01/1/92 - 06/30/92
07/1/91 - 12/31/91
01/1/91 - 06/30/91
07/1/90 - 12/31/90
01/1/90 - 06/30/90
07/1/89 - 12/31/89
01/1/89 - 06/30/89
07/1/88 - 12/31/88
01/1/88 - 06/30/88
07/1/87 - 12/31/87
01/1/87 - 06/30/87
07/1/86 - 12/31/86
01/1/86 - 06/30/86
07/1/85 - 12/31/85
01/1/85 - 06/30/85

6.0 %
6 ¼ %
6 ¾ %
6 ⅜ %
7.0 %
5 ⅞ %
6 ⅜ %
8 ⅛ %
7.0 %
5 ½ %
5 ⅝ %
6 ½ %
7.0 %
6 ⅞ %
8 ½ %
8 ⅜ %
9.0 %
8 ½ %
9 ⅛ %
9 ¾ %
9 ¼ %
9 ⅜ %
8 ⅞ %
7 ⅝ %
8 ½ %
9 ¾ %
10 ⅜ %
12 ⅛ %

Prior to 01/01/85 Not Applicable

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FC 13-04 EXHIBIT 2 –

DEBT MANAGEMENT INTEREST RATES

Dates

Percentage

01/1/13 - 12/31/13

1%

01/1/12 - 12/31/12

1%

01/1/11 - 12/31/11

1%

1/1/10 – 12/31/10

1%

 

 

1/1/09 - 12/31/09

3%

7/1/08 - 12/31/08

3%

1/1/08 - 6/30/08

5%

1/1/07 - 12/31/07

4%

7/1/06 - 12/31/06

4%

1/1/06 - 12/31/06

2%

1/1/05 - 12/31/05

1%

   

1/1/04 - 12/31/04

1%

1/1/03 - 12/31/03

2%

7/1/02 - 12/31/02

3%

1/1/02 - 06/30/02

5%

1/1/01 - 12/31/01

6%

1/1/00 - 12/31/00

5%

 

 

1/1/99 - 12/31/99

5%

1/1/98 - 12/31/98

5%

1/1/97 - 12/31/97

5%

1/1/96 - 12/31/96

5%

7/1/95 - 12/31/95

5%

1/1/95 - 06/30/95

3%

 

 

1/1/94 - 12/31/94

3%

1/1/93 - 12/31/93

4%

1/1/92 - 12/31/92

6%

1/1/91 - 12/31/91

8%

1/1/90 - 12/31/90

9%

   

1/1/89 - 12/31/89

7%

1/1/88 - 12/31/88

6%

1/1/87 - 12/31/87

7%

1/1/86 - 12/31/86

8%

1/1/85 - 12/31/85

9%

 

 

Prior to 01/01/84

Not applicable

 

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FECA CIRCULAR 13-05

April 10, 2013

SUBJECT: Offsets as the result of the receipt of lump-sum incentive payments made by the United States Postal Service


PURPOSE: This circular is being issued to provide supplemental guidance on the necessary claims actions when a claimant in receipt of disability compensation receives a lump-sum incentive payment from the United States Postal Service (USPS) as the result of (1) choosing optional retirement pursuant to a Voluntary Early Retirement Authority (VERA), or (2) voluntarily resigning.

BACKGROUND: Certain eligible full-time employees of the USPS who voluntarily elected to retire or resign by December 2012 qualified for a $15,000 lump-sum incentive, with $10,000 to be paid on or about May 24, 2013, and $5,000 to be paid on or about May 23, 2014. Part-time employees were also eligible for the incentive, with the amount to be prorated based upon hours worked.

An offset is required only where the claimant receives an incentive payment when in receipt of (or eligible to receive) compensation for temporary total disability (TTD). No offset is required when the claimant is in receipt of compensation for loss of wage-earning capacity (LWEC), schedule award, etc.

ACTIONS: Upon receipt of documentation (e.g. personnel action form or other documentation from the USPS) that a claimant in receipt of compensation for TTD has received a separation incentive payment, the claims examiner (CE) should take the following steps:

(1) Review PM 2-1000.17 with respect to separation pay. For purposes of this offset, TTD compensation should be suspended effective the date of each lump-sum incentive payment.

(2) Determine the claimant's weekly salary at the time of separation.

(3) Divide the amount of the incentive payment by the weekly salary amount.

(4) The resulting number is the number of weeks that the claimant is not entitled to compensation. If the resulting number is a decimal, use the following to calculate the number of days equivalent to the decimal.

Calculate the number of days equivalent to the decimal

Decimal

Equals

Days

Decimal

Equals

Days

.1

=

1 day

.6

=

4 days

.2

=

1 day

.7

=

5 days

.3

=

2 days

.8

=

6 days

.4

=

3 days

.9

=

6 days

.5

=

4 days

 

 

 

 

(5) Determine the correct time period (weeks plus days) that the claimant is not entitled to compensation.

(6) Complete a memo for the file outlining the offset calculation and period.

(7) Terminate compensation effective the date of the incentive payment. Send the claimant a letter outlining the period of ineligibility for FECA benefits. This letter should advise the claimant to submit a Form CA-7 at the expiration of the period if he/she wishes to resume FECA benefits in an effort to verify employment status and payment eligibility to avoid improper payments.

8) If a CA-7 is received at the end of the period (and the claimant is not working or in receipt of retirement benefits), the claimant should be placed back on the periodic roll as long as new medical evidence has not been received in the interim period indicating that the claimant's condition has resolved or he/she can return to full duty.

• If the claimant is in receipt of retirement benefits, an election of benefits is required, and compensation should not be paid until OPM confirms annuity payments have stopped.

(9) If TTD compensation resumes at the expiration of the offset period, send the claimant a CA-1049. In the first payment, HB/LI deductions should be made retroactive to the date compensation was suspended (if applicable and if not made by OPM). This should be explained in the CA-1049.

(10) Set a reminder for early May, 2014 to check the case to ascertain whether the second incentive payment is still scheduled to be made on May 23, 2014 as planned so that appropriate actions can be taken.

Note - A claimant, if eligible, may elect to receive benefits from OPM on or before the date of the incentive payment. Such an election should be processed consistent with established procedure.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


 

Distribution: List No. 2--Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, Staff Nurses and Fiscal Personnel)

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FECA CIRCULAR NO. 13-06

May 13, 2013


Subject: Employees' Compensation and Management Portal (ECOMP) Agency Reviewer Imaging (ARi)


PURPOSE: To announce a new component of ECOMP that allows Agency Reviewers to securely view documents in the Office of Workers' Compensation (OWCP) case file concerning claims under the Federal Employees' Compensation Act (FECA).

BACKGROUND: ECOMP was released to the public on November 2, 2011 and can be accessed directly at the following url: https://www.ecomp.dol.gov. The site originally contained two different types of functionality – electronic submission of documents and electronic submission of Federal Employees' Compensation Act (FECA) claim forms. See FECA Circular 13-03, Employees' Compensation and Management Portal (ECOMP), for more detail on those features.

Effective April 9, 2013, ECOMP was enhanced to create a third functionality to allow designated ECOMP Agency Reviewers (AR) the ability to view imaged documents for cases assigned to their agency. The new functionality is called Agency Reviewer Imaging (ARi). Initially, only a few specific agencies were granted such access; however, after this initial deployment phase, ARi access will be provided to other enrolled agencies on a rolling basis.

Employing Agencies can currently review/obtain case file documents, but must do so by other means, such as submitting a written request to the OWCP or by visiting the district office and reviewing/printing documents on a kiosk. Deployment of ARi allows the OWCP and Employing Agencies to contain costs and increase program efficiencies by providing ARs access to the case documents without generation and submission of a written request or scheduling a visit with the district office, and by eliminating the time and expense it takes the OWCP to respond to such requests. Allowing the ARs to view case file documents also facilitates better Employing Agency collaboration with the OWCP in regard to disability management and return-to-work efforts. For example, the Employing Agency can view work restrictions in a case and craft a job offer for the injured worker without first making a request to the OWCP for such medical evidence and waiting for the OWCP's response. This allows the injured workers to return to work as soon as possible, which furthers the OWCP's mission to facilitate reemployment of injured workers who are able to work.

STATUTORY AND REGULATORY PROVISIONS: FECA claim file information is covered by the Privacy Act of 1974. See 5 U.S.C. 552a. The FECA regulations at 20 C.F.R. §10.11 provide in part that "All records relating to claims for benefits filed under the FECA, including any copies of such records maintained by an employing agency, are covered by the government-wide Privacy Act system of records entitled DOL/GOVT-1 (Office of Workers' Compensation Programs, Federal Employees' Compensation Act File). This system of records is maintained by and under the control of the OWCP, and, as such, all records covered by DOL/GOVT-1 are official records of the OWCP." DOL/GOVT-1 provides that federal agencies that employed the claimant at the time of the occurrence or recurrence of the injury or occupational illness can access OWCP case file information in order to verify billing, to assist in administering the FECA, to answer questions about the status of the claim, to consider rehire, retention or other actions the agency may be required to take with regard to the claim, or to permit the agency to evaluate its safety and health program. 77 Fed. Reg. 1728, at 1738-41 (January 11, 2012), viewable at http://www.gpo.gov/fdsys/pkg/FR-2012-01-11/pdf/2012-345.pdf.

ACTIONS:

A. Intended Use

1. Each time an AR accesses a case, he/she receives a Privacy Act warning consistent with DOL/GOVT-1, which is referenced above:

Access to this case file and data must be restricted to only those authorized employees who need it to perform their official duties, and confidentiality of the records should be protected in such a way that unauthorized persons do not have access to any such records.

Case documentation and data contained in this system is and remains Department of Labor data that is subject to the Privacy Act (5 U.S.C. 552a) and to the Systems Notice for DOL/GOVT-1. Absent a court order from a court of competent jurisdiction or a written release from the individual FECA claimant, such data may only be used pursuant to DOL's OWCP interpretation of a routine use published in DOL/GOVT-1 and in a manner that is compatible with the purpose for which the record was created; that purpose is the administration and payment of FECA compensation. Before any data from DOL/GOVT-1 can be used in a personnel or similar action, there must be a written release from the claimant or an order from a court of competent jurisdiction, or agreement by DFEC management that disclosure of the information is permitted under the Privacy Act. For further information see http://www.dol.gov/sol/privacy/dol-govt-1.htm.

2. By proceeding with the retrieval of the case after having received such warning, the AR is certifying that he/she is accessing the case file information for a reason consistent with a published routine use.

B. Access

1. ARi is a feature granted only to agencies that have executed a Memorandum of Understanding (MOU) with the OWCP relative to ECOMP (see FECA Circular 13-03), and are actively using ECOMP to electronically file workers' compensation forms (CA-1/2s and/or CA-7s).

2. ARi functionality is limited to users granted access to a Digital Rights Management (DRM) license. A specific number of licenses is provided to agencies actively using ECOMP for forms filing.

3. DRM licenses are granted to an agency's ECOMP Agency Maintenance User (AMU) by the ECOMP DFEC Administrator. These licenses are then assigned to specific AR users under that AMU's jurisdiction. When providing ARi access to an AR, the AMU is required to instruct each user that only that single user may utilize his/her license in accordance with this guidance. The DFEC Administrator and the AMU can verify who has access to ARi for a specific agency at any time via a specific application in ECOMP.

4. The assignment of a DRM license activates the ARi feature enabling designated ARs to view imaged workers compensation cases assigned to chargeback codes to which that AR is already assigned.

C. Reviewing Cases

1. The ARi user must have the following pieces of information: claim number, claimant's last name, claimant's date of birth, and the date of injury. If these pieces of information do not match the OWCP case data exactly, or if the case is not assigned to a chargeback code to which the AR has been granted access in ECOMP, viewing of the requested case will not be permitted.

2. ARi users may download up to 5 cases to their Review Cases Dashboard. It takes approximately 24 hours from the time the request is made to the time the imaged case becomes available to the ARi user.

3. Cases may be viewed for up to 5 calendar days, but an ARi user may release a case at any time to free-up a slot on the Dashboard. The user can only see documents available at the time the case is requested; there is no refresh option.

4. ARi users can view all imaged documents in a case that have been received within the last 3 years, as well as all other imaged documents beyond 3 years old that are indexed in the OWCP case file as a decision, a form, or as outgoing correspondence.

D. Saving and Printing Documents

1. ARi users may download/save any or all documents in a case on their dashboard.

2. When the user chooses to download a document, he/she must first indicate why the documents are being saved. An available list of the "routine uses" is provided, but there is no default. The ARi user must choose an available option before ECOMP will download the documents. Available choices are:

  • To answer questions about the status of the claim
  • To consider return-to-work opportunities
  • To evaluate the agency's safety and health program
  • To assess continuing eligibility for FECA benefits
  • To verify billing

3. Documents are downloaded via a secure PDF document. This PDF document is encrypted using DRM and is accessible only to the ARi user who created the document.

4. Each time the secure PDF document is accessed, the ARi user is required to enter his/her ECOMP user ID and password. If the user ID and password for the document are not valid, the user will not be granted access to that document.

5. Each page of every document downloaded from ECOMP by an ARi user will be marked with an annotation atop the document that indicates it was "Printed from ECOMP," with the user's ECOMP user ID and the date it was printed.

E. Documentation of Case File Review and Record of Saved/Printed Documents

1. The fact that a case was reviewed in ARi is recorded in the OWCP case file via an automated memo uploaded directly to the case by the ECOMP system. This memo denotes when a case was accessed and who accessed it.

2. The memo for the OWCP case file also details any documents that the ARi user saved/printed and the reason for such action. See D2 above.

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation

Distribution: All DFEC Staff; Employing Agencies

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FECA CIRCULAR NO. 13-07

September 6, 2013


Subject: Improper Document Submissions


PURPOSE: This circular is being issued to clarify the policy of the Office of Workers' Compensation Programs (OWCP) Division of Federal Employees' Compensation (DFEC) with respect to the submission of case file records of another injured worker as evidence in support of a claim for compensation under the Federal Employees' Compensation Act (FECA).ACTIONS: OWCP has determined it will not permit the inclusion of case file records about another individual in the FECA claim file maintained under the name and personal identifier of the claimant who is the subject of the case file in question.

The provisions of the Privacy Act are meant to assure the private citizen's right to confidentiality of personal information, including financial and medical history, in records filed in a system of records under the individual's own name. This law sets forth the government's responsibility to properly maintain and restrict access to these records. The contents of an employee's case file, to include medical records (including District Medical Advisor reports), decisions of the Branch of Hearings and Review, etc. are protected under the Privacy Act. More specifically, 5 U.S.C. 552a(e)(5) requires a federal agency to "maintain all records which are used by the agency in making any determination about any individual with such accuracy, relevance, timeliness, and completeness as is reasonably necessary to assure fairness to the individual in the determination."

OWCP has concluded that, absent unusual circumstances such as group injuries (where such information would be relevant but the names and personal identifiers of the other individuals would be redacted), it is not consistent with the Privacy Act to permit the inclusion of documents from one case file in the case file of another individual.

In addition to OWCP's Privacy Act responsibilities, such submissions interfere with and are inconsistent with OWCP's adjudicatory responsibilities under the FECA.

MEDICAL REPORTS FROM OTHER CLAIMANTS - As medical reports about other individuals are not relevant to any determination in another FECA case and do not serve as precedent, the inclusion of such medical reports serves only to confuse the individual physicians reviewing the record, agency workers' compensation specialists reviewing documents for return to work, Office of Inspector General agents, as well as any individuals within the Department of Labor who exercise review authority over FECA determinations (such as an OWCP Hearing Representatives and Employees' Compensation Appeals Board judges).

DECISIONS OF OWCP'S BRANCH OF HEARINGS AND REVIEW - OWCP formal decisions (including decisions of Hearing Representatives from the OWCP Branch of Hearings & Review) are limited to the facts in each specific case, are Privacy Act protected, are not published, and are not considered to be precedential. Because these decisions are not precedential, they are not relevant, probative, or material in any way to OWCP's adjudication of a different claim.

The above restrictions on document submission apply regardless of whether (1) the personally identifiable information (PII) of the other individual is redacted (except in extraordinary circumstances such as group injuries as addressed above), or (2) a waiver or release has been obtained from the other individual authorizing use of his or her case file records.

ECAB DECISIONS - Decisions of the Employees' Compensation Appeals Board (ECAB) may of course continue to be submitted as precedent in support of a claim for FECA compensation. The full name or OWCP case file number of the corresponding injured worker should not be used or otherwise appear in the submission. ECAB decisions should be properly cited by using their caption such as D.F., Docket No. 2013-xxxx (issued July 1, 2013).

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation

Distribution: DFEC Staff

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FECA CIRCULAR NO. 12-01

Issue Date: February 24, 2012

 


SUBJECT: Dual Benefits - FERS Cost of Living Adjustments


Effective December 1, 2011, benefits issued by the Social Security Administration (SSA) were increased by 3.6%. 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.

This adjustment will be made from the National Office for all cases that were correctly entered into the Compensation application of the Integrated Federal Employees Compensation System (iFECS). The adjustment will be effective with the periodic roll cycle beginning December 18, 2011. There will be no adjustment or overpayment declared for the period of December 1, 2011 through December 17, 2011.

The historical SSA cost of living adjustments are as follows:

The historical SSA cost of living adjustments are as follows:

Dates

Percentage

12/01/2011 - 11/30/2012
12/01/2010 - 11/30/2011
12/01/2009 - 11/30/2010
12/01/2008 - 11/30/2009
12/01/2007 - 11/30/2008
12/01/2006 - 11/30/2007
12/01/2005 - 11/30/2006
12/01/2004 - 11/30/2005
12/01/2003 - 11/30/2004
12/01/2002 - 11/30/2003
12/01/2001 - 11/30/2002
12/01/2000 - 11/30/2001
12/01/1999 - 11/30/2000
12/01/1998 - 11/30/1999
12/01/1997 - 11/30/1998
12/01/1996 - 11/30/1997
12/01/1995 - 11/30/1996
12/01/1994 - 11/30/1995

3.6%
0.0%
0.0%
5.8%
2.3%
3.3%
4.1%
2.7%
2.1%
1.4%
2.6%
3.5%
2.4%
1.3%
2.1%
2.9%
2.6%
2.8%

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation

Distribution: All Claims Staff and Fiscal Personnel

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FECA CIRCULAR NO. 12-02

Issue Date: February 24, 2012

 


SUBJECT: Agency Query System (AQS) Access for Agency Employees, Contractors and Inspector General Offices

PURPOSE: Because of continued heightened concerns over disclosure of personal information, the Office of Workers' Compensation Programs (OWCP) is instituting this formal policy on AQS access.

While OWCP realizes that AQS information could be useful to other entities such as pharmacy providers, OWCP believes that the very limited information needed by these entities is available through other means, such as the bill pay portal.

BACKGROUND:

1. AQS is a secure internet site that provides access to certain information on Federal Employees' Compensation Act (FECA) claims to authorized personnel from federal agencies. The information available includes the claimant's name, social security number, home address, current claim status, compensation payment history, medical bill payment history, and COP Nurse assignment information.

2. Within each federal agency, there is a designated Intra-Agency Coordinator (IAC) recognized by DFEC as the sole point of contact for AQS user access within that particular agency. Any employing agency personnel who contact DFEC directly for AQS access are routed to the applicable IAC. The IAC then contacts the Division of Federal Employees' Compensation (DFEC) to gain permission for that user. A specific user name is assigned to that user; access is password protected.

3. Access to AQS cannot be granted on a case-by-case basis, nor can AQS data fields be limited by user. Access is granted based on employing agency chargeback codes.

4. All records relating to claims for FECA benefits are covered by the government-wide Privacy Act system of records entitled DOL/GOVT-1. Information from the FECA file may only be released pursuant to a need to know (applicable only to disclosures within the Department of Labor), a published routine use, a signed Privacy Act waiver, or a court order from a court of competent jurisdiction. Release of information in accordance with a routine use must be consistent with the purpose for which the file was created; that purpose is the administration of the FECA claim. The FECA regulations at 20 C.F.R. §10.11 make clear that the protection, release, inspection, and copying of records covered by DOL/GOVT-1 should be carried out in accordance with the rules, guidelines, and provisions of Subpart A of the FECA regulations, as well as those contained in 29 C.F.R. parts 70 and 71, which are the Department of Labor's regulations implementing the Freedom of Information Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C. 552a) respectively, as well as with the notice of system of records and routine uses published in the Federal Register.

5. A "routine use" authorizes disclosing information from the FECA claim file without first obtaining the claimant's permission. Such disclosure is acceptable because the routine use is listed and published in the Privacy Act Systems Notice for DOL/GOVT-1; because OWCP has concluded that disclosure in the particular circumstance is compatible with the routine use; and because the anticipated use of the information is consistent with the purpose for which the information was collected. A listing of the universal routine uses which apply to all Department of Labor (DOL) systems of records can be found at http://www.dol.gov/sol/privacy/intro.htm. A listing of the routine uses specific to DOL/GOVT-1 can be found at http://www.dol.gov/sol/privacy/dol-govt-1.htm. [See DOL Privacy Act System of Record Notices, 67 FR 16825, at 16827-16828 (April 8, 2002).] Further guidance can also be found at http://www.dol.gov/sol/privacy/intro.htm.

A. Access for Employing Agency Personnel and Certain Agency Contractors

1. A routine use published in the Federal Register permits disclosure to "federal agencies that employed the claimant at the time of the occurrence or recurrence of the injury or occupational illness in order to verify billing, to assist in administering the FECA, to answer questions about the status of the claim, to consider rehire, retention or other actions the agency may be required to take with regard to the claim, or to permit the agency to evaluate its safety and health program." This, combined with another routine use, permits access to contractors performing workers' compensation functions for agencies, e.g. federal contractors retained to provide claims filing, case management and return to work services. In limited circumstances, other individuals may be granted access based on a particular routine use.

2. Based on DOL OWCP's responsibility to protect the information that resides in a Privacy Act System of Records, AQS access must be limited to authorized users in federal agencies (and, where appropriate, contractor employees) who are performing activities authorized by the language in the routine use above. Examples of such authorized users include agency injury compensation specialists. Other employing agency personnel (such as immediate supervisors, safety and health officials without any workers' compensation duties, and Accident Review Panels) generally do not have a sufficient business reason for access to this level of personal information and will not qualify as authorized users.

3. DOL does not consider medical providers and entities that perform ancillary functions (for example, pharmacy billing and management) authorized users, as AQS provides a level of detail and personal information far beyond what is needed by those entities. If such providers and entities need information on a particular claim, other methods for accessing the more limited information needed by them are available through the billing portal or from the agency, but direct access to AQS will not be authorized.

4. Agencies may wish to encourage their employees to utilize the Claimant Query System as an additional resource to meet their needs.

B. Access for Employing Agency Inspector general Offices

1. FECA Circular 08-04 (DFEC Protocol Statement - OIG Audits, Evaluations and Investigations) was released in response to the increased number of requests for information received from the Office of Inspector General (OIG) community as they performed audits, evaluations, inspections and investigations. DFEC recognizes that employing agencies and their respective OIG offices have an interest in reducing costs, returning people to work, and identifying and preventing fraud. In an effort to fully cooperate with the OIG community, while simultaneously coordinating the interaction in a way that would not interfere with our ability to perform our mission, DFEC outlined a specific protocol that would be used to respond to such requests that would preserve program resources and avoid duplication of effort. This circular detailed that when an employing agency OIG investigator requests to view a case record, he/she will be required to sign a brief statement prior to gaining access to the file indicating that access to the file is being requested based on an investigation into a potential violation of law. The guidance provided in FECA Circular 08-04 has not changed.

2. FECA Circular 09-05 (Release of Documents from Federal Employees' Compensation Act (FECA) Files) was released to provide District Offices guidance in situations where information or copies of documents are requested from a claimant's FECA case file. The circular focused on such requests made by employing agencies and clearly outlined that all records relating to claims for FECA benefits are covered by the government-wide Privacy Act system of records entitled DOL/GOVT-1. Specifically, this circular provided that DFEC may grant requests from employing agencies for records pertaining to their employees as a permitted routine use, but that blanket release of the entire case record is not appropriate, except to an investigative body. This circular also outlined that a request from the employing agency for copies of documents contained in the FECA case record must contain a reason for the request, and that the use of these copies must be consistent with the reason the information was collected (connected in some way with the compensation claim). The guidance provided in FECA Circular 09-05 has not changed.

3. Employing agency OIG access to information in the FECA file is permitted by the first sentence of routine use b of DOL/GOVT-1- the same routine use that permits the employing agency to receive information about specific cases of its own employees. However, DFEC's experience with providing employing agencies access to the AQS system has demonstrated that the current structure, which establishes the use of the agency IAC to provide the appropriate level of access to AQS for each individual within that agency who seeks access, has worked effectively and efficiently. For this reason, any request for independent AQS access received from a non-DOL employing agency OIG, or other investigative body, will not be granted. Access to the AQS system for any agency personnel, including any OIG offices or other agency investigative body, must be coordinated with and channeled through the agency IAC who has been recognized by DFEC. Separate access, outside that designated IAC channel, will not be granted by DFEC.

4. Upon receipt and review of a written request delineating in detail the need for such access and the specific timeframe requested, an exception to the access procedure in #3 above may be granted only by the Deputy Director for Federal Employees' Compensation.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff; Employing Agencies

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FECA CIRCULAR NO. 12-03

Issue Date: April 6, 2012

 


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


The interest rate to be assessed for the prompt payment bills is 2.0 percent for the period of January 1, 2012 through December 31, 2012. This new rate has been updated in the Central Bill Payment system tables.

The rate for assessing interest charges on debts due the government has not been changed. The interest rate for assessing interest charges on debts due the government remains 1.0 percent for the period of January 1, 2012 through December 31, 2012.

Ordinarily, the rate of interest charged on debts due the U.S. Government is only changed in January and is effective for the entire year. However, the rate may be changed in July if there is a difference in the Current Value of Funds (CVF) interest rate of more than two percent. The rate will be reviewed on July 1, 2012 to determine if the Treasury has changed the rate.

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.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Attachments

Distribution: All Claims Staff and Fiscal Personnel

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FC 12-03 EXHIBIT 1 - PROMPT PAYMENT INTEREST RATES

Dates

Percentage

Dates

Percentage

01/1/12 - 12/31/12
07/1/11 - 12/31/11
01/1/11 - 12/31/11
01/1/10 - 12/31/10
07/1/09 - 12/31/09
01/1/09 - 06/30/09
07/1/08 - 12/31/08
01/1/08 - 06/30/08
07/1/07 - 12/31/07
01/1/07 - 06/30/07
07/1/06 - 12/31/06
01/1/06 - 06/30/06
07/1/05 - 12/31/05
01/1/05 - 06/30/05
07/1/04 - 12/31/04
01/1/04 - 06/30/04
07/1/03 - 12/31/03
01/1/03 - 06/30/03
07/1/02 - 12/31/02
01/1/02 - 06/30/02
07/1/01 - 12/31/01
01/1/01 - 06/30/01
07/1/00 - 12/31/00
01/1/00 - 06/30/00
07/1/99 - 12/31/99
01/1/99 - 06/30/99
07/1/98 - 12/31/98

2.0 %
2 ½ %
2 ⅝ %
3 ¼ %
4 ⅞ %
5 ⅝ %
5 ⅛ %
4 ¾ %
5 ¾ %
5 ¼ %
5 ¾ %
5 ⅛ %
4 ½ %
4 ¼ %
4 ½ %
4.0 %
3 ⅛ %
4 ¼ %
5 ¼ %
5 ½ %
5 ⅞ %
6 ⅜ %
7 ¼ %
6 ¾ %
6 ½ %
5.0 %
6.0 %

01/1/98 - 06/30/98
07/1/97 - 12/31/97
01/1/97 - 06/30/97
07/1/96 - 12/31/96
01/1/96 - 06/30/96
07/1/95 - 12/31/95
01/1/95 - 06/30/95
07/1/94 - 12/31/94
01/1/94 - 06/30/94
07/1/93 - 12/31/93
01/1/93 - 06/30/93
07/1/92 - 12/31/92
01/1/92 - 06/30/92
07/1/91 - 12/31/91
01/1/91 - 06/30/91
07/1/90 - 12/31/90
01/1/90 - 06/30/90
07/1/89 - 12/31/89
01/1/89 - 06/30/89
07/1/88 - 12/31/88
01/1/88 - 06/30/88
07/1/87 - 12/31/87
01/1/87 - 06/30/87
07/1/86 - 12/31/86
01/1/86 - 06/30/86
07/1/85 - 12/31/85
01/1/85 - 06/30/85

6 ¼ %
6 ¾ %
6 ⅜ %
7.0 %
5 ⅞ %
6 ⅜ %
8 ⅛ %
7.0 %
5 ½ %
5 ⅝ %
6 ½ %
7.0 %
6 ⅞ %
8 ½ %
8 ⅜ %
9.0 %
8 ½ %
9 ⅛ %
9 ¾ %
9 ¼ %
9 ⅜ %
8 ⅞ %
7 ⅝ %
8 ½ %
9 ¾ %
10 ⅜ %
12 ⅛ %

Prior to 01/01/85 Not Applicable

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FC 12-03 EXHIBIT 2 - DEBT MANAGEMENT INTEREST RATES

Dates

Percentage

01/1/12 - 12/31/12

1%

01/1/11 - 12/31/11

1%

1/1/10 – 12/31/10

1%

 

 

1/1/09 - 12/31/09

3%

7/1/08 - 12/31/08

3%

1/1/08 - 6/30/08

5%

1/1/07 - 12/31/07

4%

7/1/06 - 12/31/06

4%

1/1/06 - 12/31/06

2%

1/1/05 - 12/31/05

1%

   

1/1/04 - 12/31/04

1%

1/1/03 - 12/31/03

2%

7/1/02 - 12/31/02

3%

1/1/02 - 06/30/02

5%

1/1/01 - 12/31/01

6%

1/1/00 - 12/31/00

5%

 

 

1/1/99 - 12/31/99

5%

1/1/98 - 12/31/98

5%

1/1/97 - 12/31/97

5%

1/1/96 - 12/31/96

5%

7/1/95 - 12/31/95

5%

1/1/95 - 06/30/95

3%

 

 

1/1/94 - 12/31/94

3%

1/1/93 - 12/31/93

4%

1/1/92 - 12/31/92

6%

1/1/91 - 12/31/91

8%

1/1/90 - 12/31/90

9%

   

1/1/89 - 12/31/89

7%

1/1/88 - 12/31/88

6%

1/1/87 - 12/31/87

7%

1/1/86 - 12/31/86

8%

1/1/85 - 12/31/85

9%

 

 

Prior to 01/01/84

Not applicable

Prior to 01/01/85 Not Applicable

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FECA CIRCULAR NO. 12-04

Issue Date: May 14, 2012

 


EXPIRATION DATE: Date of Next Rate Change


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 April 17, 2012, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile was increased to 55.5 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 5, Benefit Payments, Federal (FECA) Procedure Manual and 5 U.S.C. 8103.

Action: The Central Bill Pay (CBP) facility has updated its 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.

The following is a list of the historical mileage rates used to reimburse claimant travel expense:

historical mileage rates used to reimburse claimant travel expense

Dates

Cents per mile

01/01/1995 - 06/06/1996
06/07/1996 - 09/07/1998
09/08/1998 - 03/31/1999
04/01/1999 - 01/13/2000
01/14/2000 - 01/21/2001
01/22/2001 - 01/20/2002
01/21/2002 - 12/31/2002
01/01/2003 - 12/31/2003
01/01/2004 - 02/03/2005
02/04/2005 - 08/31/2005
09/01/2005 - 12/31/2005
01/01/2006 - 01/31/2007
02/01/2007 - 03/18/2008
03/19/2008 - 07/31/2008
08/01/2008 - 12/31/2008
01/01/2009 - 12/31/2009
01/01/2010 - 12/31/2010
01/01/2011 - 04/16/2012
04/17/2012 to Present

30.0 cents per mile
31.0 cents per mile
32.5 cents per mile
31.0 cents per mile
32.5 cents per mile
34.5 cents per mile
36.5 cents per mile
36.0 cents per mile
37.5 cents per mile
40.5 cents per mile
48.5 cents per mile
44.5 cents per mile
48.5 cents per mile
50.5 cents per mile
58.5 cents per mile
55.0 cents per mile
50.0 cents per mile
51.0 cents per mile
55.5 cents per mile

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

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: All Claims Staff and Fiscal Personnel

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FECA CIRCULAR NO. 12-05

Issue Date: May 14, 2012

 

SUBJECT: Insurance Deductions


This circular is being issued to provide supplemental guidance on the effective date of insurance deductions. It updates the information previously contained in Federal Employees' Compensation Act (FECA) Circular 09 - 04 (Health Benefits Insurance and Life Insurance - General Guidance), issued June 1, 2009.

When a Federal employee enters a leave without pay (LWOP) status, the employing agency is no longer able to deduct for health benefits and life insurance premiums. If compensation for wage loss is payable under the FECA, the responsibility for making those deductions transfers to the Office of Workers' Compensation Programs (OWCP).

As noted in Circular 09-04, OWCP deductions for health benefits and life insurance become effective on the first day of LWOP status. Historically, OWCP did not actually begin making the deductions until the claimant has been in receipt of compensation for 28 days. Once the claimant had received compensation for more than 28 days, deductions were made retroactively to the date compensation began.

Beginning in August, 2010, OWCP discontinued the practice of delaying deductions for that 28-day period and instead began the deductions effective the first day of LWOP. Beginning deductions promptly, rather than making a retroactive deduction at a later date, enables OWCP to provide continuity of payment for the injured worker with no interruptions in insurance deductions.

Note - Insurance deductions are not made for intermittent hours or days within a pay period.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: All Claims Staff and Fiscal Personnel

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FECA CIRCULAR 12-06

June 26, 2012

SUBJECT: Bill Payment Practices and Restrictions


This circular is being issued to document certain current billing practices and restrictions for the Division of Federal Employees' Compensation (DFEC) under the Federal Employees' Compensation Act (FECA). See 5 U.S.C. 8103. 20 C.F.R. Part 10, in particular Subpart I, also provides additional details concerning the responsibilities of claimants and providers in regard to medical billing and reimbursement.

I. Medication Dispensed by a Provider

20 CFR §10.809, which was updated effective August 29, 2011, outlines how payments are made for medication. This regulation specifically states that, "Payment for medicinal drugs prescribed by physicians shall not exceed the amount derived by multiplying the average wholesale price, or as otherwise specified by OWCP, of the medication by the quantity or amount provided, plus a dispensing fee."

Effective June 17, 2012, any bill submitted on a Form OWCP-1500 for the payment of medications dispensed in the office using one of the unlisted HCPC "J" codes (J3490, J8499, J8999 and J9999) will be paid based on the Average Wholesale Price or the Medispan Average Wholesale Price. The reimbursement will be determined based on the date of service and the price for the National Drug Code (NDC), which accompanied the unlisted drug code, as outlined below.

1. Providers submit bills for payment of medications dispensed in the office on an OWCP-1500 billing form. The bills for these services contain one of the following unlisted HCPC "J" codes: J3490, J8499, J8999, and/or J9999. These codes are accompanied with an NDC code and the day's supply, which are key factors for determining the payment amount.

2. The pharmacy system, using the billed diagnosis, will validate the appropriateness of the NDC with the claimant's accepted condition. If the medication is not payable in accordance with the claimant's accepted conditions, the bill will be denied. If the NDC code is payable and appropriate for the claimant's accepted condition, the bill will be paid.

3. The pharmacy system, based on the date of service, will systematically perform the pricing of the medication based on the date of service. If the date of service is prior to 09/30/2011, the pharmacy system will calculate the payment using the Average Wholesale Price (AWP). If the date of service is after 09/30/2011, the pharmacy system will calculate the payment using the Medispan Average Wholesale Price (MAW).

4. Similarly, if a bill is received with procedure code 99070 and the description of services is equal to "Dispensing Fee" and/or "Discount" (or any other description that represents a charge associated with the payment of medication), the line will be denied. If this procedure code is billed with a valid and appropriate supply description (tray, bandages, etc.), the line will be paid. Additionally, if the provider bills an NDC under this procedure code (99070), the NDC will be evaluated to determine payment just like the "J" code.

II. Generic Medication

20 CFR §10.809(c) provides that, "With respect to prescribed medications, OWCP may require the use of generic equivalents where they are available." This regulation was effective August 29, 2011. As the prior regulations already provided full authority for OWCP to require the use of generics, the most recent regulatory update did not alter DFEC's policy regarding generic medication. The regulatory update only moved the language referenced to a different section, as the same exact language now found in 20 CFR §10.809(c) was previously found in 20 CFR §10.310(b).

Effective November 01, 2008, DFEC revised the criteria for dispensing brand medication versus generic medication. As of that date, DFEC added an edit to review the Dispense as Written (DAW) field for all medication bills and claims for reimbursement. Brand medications process for payment only if the DAW is equal to one of the following:

DAW 1 (Brand selected when requested by physician)
DAW 8 (Brand dispensed as a result of generic not being available by the manufacturer)
DAW 0 (Brand drug selected when no generic available on the market)

Generic drugs will be selected automatically even when brand is available unless one of these DAW codes is present.

DFEC continues to use these criteria for medication authorizations.

III. Parenteral Fentanyl Products

On May 3, 2011, DFEC implemented a new policy and program to monitor and closely manage the use of fast-acting fentanyl products such as Actiq and Fentora and the prescribing of parenteral fentanyl products. An automatic processing rule was implemented whereby new prescriptions for fast-acting fentanyl products would be denied unless the claimant had an accepted work-related condition of cancer. See FECA Bulletin 11-05.

IV. Bills for Expenses Related to Medical Travel

Pursuant to 5 U.S.C. 8103 and 20 CFR §10.315, the employee is entitled to reimbursement of reasonable and necessary expenses, including transportation needed to obtain authorized medical services, appliances or supplies. In reviewing requests for reimbursement, OWCP considers the availability of services, the employee's condition, and the means of transportation. See also 3-0400 of the FECA Procedure Manual. Effective October 30, 2011, a new bill payment restriction was added such that any single claim in excess of 200 miles is rejected by the automated system so that it can be reviewed manually for approval. Prior to this change, the restriction was for any travel greater than 500 miles. Other restrictions, as outlined below, are also active.

A. Claimant Requests for Reimbursement

1. Claimants submit claims for reimbursement for travel expenses on Form OWCP-957. Items 5, 6 and 7 of this form are used to claim reimbursement for specific dates of travel. Data required to process such reimbursement is designated by specific alpha designated blocks for each date of service.

2. Only one date of travel will be accepted in block A (Date of Travel). Date ranges will not be accepted and will be returned to the claimant.

3. A Trip Code (one way or round trip) must be checked in block B. If not present, it will be returned to the claimant.

4. A departure and destination must be checked in elected blocks C (Travel From) and D (Travel To). If not present, it will be returned to the claimant.

5. The complete address of the facility to which the claimant traveled must be present in block E (Medical Facility Name and Address). If not present, the bill will be returned to the claimant. Note, however, this information is not required for travel to a pharmacy/medical supply facility.

6. Block F (Total Expenses/Cost) is used to claim reimbursement for items related to travel, other than the mileage. These items are listed below with applicable codes.

A0100 – Non-Emergency Transportation – Taxi
A0110 – Non-Emergency Transportation and Bus, Intra- or Inter-State Carrier
A0120 – Non Emergency Transportation Mini-Bus, Mountain Area Transportation or other Transportation System
A0170 – Transport Parking Fees/Tolls
A0180 – Non-Emergency Transport Lodging Recipient
A0200 – Non-Emergency Transport Lodging Escort
A0190 – Non-Emergency Transport Meals Recipient
A0210 – Non-Emergency Transport Meals Escort
A0130 – Non-Emergency Transportation Wheelchair Van
A0140 – Non-Emergency Transportation and Air Travel (Private or Commercial Intra- or Inter-State)

If the claimant requests reimbursement for any of these services, and the charges exceed $75.00, a receipt must accompany the reimbursement claim. Manual review is also required, and the Central Bill Payment Facility will seek approval and authorization to pay the services from the Claims Examiner. If the claim is less than or equal to $75.00, receipts are not required, and the service will pay without any manual review.

7. Block G (Private Auto Only Miles Traveled) is used to specify the number of miles claimed for reimbursement. Applicable codes are A0080 and A0090. If the mileage billed in block G is greater than 200 miles per day, manual review is required, and the Central Bill Payment Facility will seek approval from the Claims Examiner. If the mileage billed in block G is less than or equal to 200 miles per day, the reimbursement claim will be paid without manual review.

8. Reminder – Reimbursement for travel expenses related to medical treatment/evaluation in DFEC claims is generally based on GSA requirements for travel. As such, DFEC will not pay for meals or lodging unless the travel requires more than 12 hours to complete.

B. Provider Bills

1. Providers submit bills for travel-related expenses on Form OWCP-1500.

2. Providers billing for mileage (codes A0080 and A0090) will be paid based on the General Services Administration (GSA) mileage rate. Payment will be calculated based on the number of units billed in Block 24-G of the OWCP-1500 billing form.

3. If the service exceeds 200 miles per day, prior authorization is required. If there is no such authorization on file when the bill is received, the bill will be denied and the provider will be directed to complete the Medical Authorization – Transportation and Travel Authorization template, which can be found on the Central Bill Payment contractor's website. If the service is billed at 200 miles or less, the service will pay without prior approval.

4. A provider may also use Block 24-D of the OWCP-1500 to bill for services related to travel, other than the mileage. These items are listed below with applicable codes.

A0100 – Non-Emergency Transportation – Taxi
A0110 – Non-Emergency Transportation and Bus, Intra- or Inter-State Carrier
A0120 – Non Emergency Transportation Mini-Bus, Mountain Area Transportation or other Transportation Systems
A0170 – Transport Parking Fees/Tolls
A0130 – Non-Emergency Transportation Wheelchair Van
A0140 – Non-Emergency Transportation and Air Travel (Private or Commercial Intra- or Inter-State)

Prior authorization for any of these services is required if the charge will be more than $75.00. If the provider submits a bill for any of these services, and the charges exceed $75.00, prior authorization is required, and an invoice showing the Departure and Destination of the trip must accompany the bill or be reflected on the bill when submitted. If there is no attachment showing proof of the trip, or the information is not contained within the bill, it will be denied. If the bill does contain sufficient detail regarding the trip, and prior authorization is not on record, the bill will be denied, requesting the submission of the Medical Authorization – Transportation and Travel template. If the bill is for less than or equal to $75.00, documentation of the trip details is not required, and the service will pay without any manual review.

V. Anesthesia Fee Schedule

Effective 12/05/10, updates were made to the anesthesia fee schedule. Effective this date, the fee schedule allowance for anesthesia services was based upon the formula: (Time Units + Base Units) x Conversion Factor. In addition, every anesthesia procedure billed to OWCP required one of the following modifiers: AA, QY, QK, AD, QX, or QZ.

When multiple procedures are performed during a single anesthetic administration, reimbursement is based on the line item representing the most complex procedure.

VI. Procedure Codes

A. RP100

Effective 07/01/2010, DFEC no longer utilized DOL homegrown procedure code RP100 (Pain Management). Effective that date, when rendering pain management services, providers were required to bill and/or submit for prior authorizations the appropriate HCPCS/CPT codes applicable for the services.

B. Consultation Codes

Effective March 1, 2010 DFEC no longer accepted the use of the AMA/CPT consultation codes ranges 99241-99245 and 99251-99255 for outpatient and office settings. This policy adhered to the decision made by the Center of Medicare and Medicaid (CMS) announced in MLN Matters, #MM6740.

VII. Place of Service on OWCP-1500

Effective 07/15/2010, DFEC required the place of service to be present on the OWCP-1500 (Box 24b). This requirement, however, did not affect any facility services billed on a Form UB04 or professional services billed for third party carriers, billing agents, contract nurses, second opinion contractors, and vocational rehabilitation services.

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation

Distribution: DFEC Staff

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FECA CIRCULAR NO. 11-01

February 2, 2011


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, 2011, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile increased to 51 cents per mile by GSA. No restriction is made as to the number of miles that can be traveled. As in the past, a 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 5, Benefit Payments, Federal (FECA) Procedure Manual and 5 USC 8103.

Action: The Central Bill Pay (CBP) facility has updated its 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.

The following is a list of the historical mileage rates used to reimburse claimant travel expense:

historical mileage rates used to reimburse claimant travel expense

Dates

Cents per mile

01/01/1995 - 06/06/1996

30.0 cents per mile

06/07/1996 - 09/07/1998

31.0 cents per mile

09/08/1998 - 03/31/1999

32.5 cents per mile

04/01/1999 - 01/13/2000

31.0 cents per mile

 

 

01/14/2000 - 01/21/2001

32.5 cents per mile

01/22/2001 - 01/20/2002

34.5 cents per mile

01/21/2002 - 12/31/2002

36.5 cents per mile

01/01/2003 - 12/31/2003

36.0 cents per mile

01/01/2004 - 02/03/2005

37.5 cents per mile

02/04/2005 - 08/31/2005

40.5 cents per mile

09/01/2005 - 12/31/2005

48.5 cents per mile

 

 

01/01/2006 - 01/31/2007

44.5 cents per mile

02/01/2007 - 03/18/2008

48.5 cents per mile

03/19/2008 - 07/31/2008

50.5 cents per mile

08/01/2008 - 12/31/2008

58.5 cents per mile

01/01/2009 - 12/31/2009

55.0 cents per mile

01/01/2010 - 12/31/2010

50.0 cents per mile

01/01/2011 - Current

51.0 cents per mile

 

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

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 2 - Folioviews Groups A and D (Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Fiscal Personnel).

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FECA CIRCULAR NO. 11-02

February 2, 2011


SUBJECT: Dual Benefits - FERS Cost of Living Adjustments

For the second year in a row, there will not be a raise in the Social Security Administration (SSA) benefits for 2011. This is due to the fact that there was no increase in the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W) from the third quarter of 2008 to the third quarter of 2010, as reported by the Bureau of Labor Statistics. The CPI-W percentage of increase sets the amount of the SSA COLA, so the lack of increase results in no increase to SSA benefits.

Since there is no increase to account for, there will be no change to the amounts currently being offset for Federal Employees' Retirement System (FERS) Dual Benefits deductions.

The historical SSA cost of living adjustments are as follows:

historical SSA cost of living adjustments

Dates

Percentage

12/01/2010 - 11/30/2011

0.0%

12/01/2009 - 11/30/2010

0.0%

12/01/2008 - 11/30/2009

5.8%

12/01/2007 - 11/30/2008

2.3%

12/01/2006 - 11/30/2007

3.3%

12/01/2005 - 11/30/2006

4.1%

12/01/2004 - 11/30/2005

2.7%

12/01/2003 - 11/30/2004

2.1%

12/01/2002 - 11/30/2003

1.4%

12/01/2001 - 11/30/2002

2.6%

12/01/2000 - 11/30/2001

3.5%

12/01/1999 - 11/30/2000

2.4%

12/01/1998 - 11/30/1999

1.3%

12/01/1997 - 11/30/1998

2.1%

12/01/1996 - 11/30/1997

2.9%

12/01/1995 - 11/30/1996

2.6%

12/01/1994 - 11/30/1995

2.8%

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 1 - FolioViews Groups A, B and D (Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists, Staff Nurses and Fiscal)

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FECA CIRCULAR NO. 11-03

March 3, 2011


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

The interest rate to be assessed for the prompt payment bills is 2.625 percent for the period of January 1, 2011 through December 31, 2011. This new rate has been updated in the Central Bill Payment system tables. The rate for assessing interest charges on debts due the government has not changed. The interest rate for assessing interest charges on debts due the government remains 1.0 percent for the period of January 1, 2011 through December 31, 2011. Ordinarily, the rate of interest charged on debts due the U.S. Government is only changed in January, and is effective for the entire year. However, the rate may be changed in July if there is a difference in the Current Value of Funds (CVF) interest rate of more than two percent. The rate will be reviewed on July 1, 2011 to determine if the Treasury has changed the rate. 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.

Periodically, a question is raised as to whether the Prompt Payment Act (PPA) applies to situations where a request for payment is submitted by medical providers seeking reimbursement for services provided to federal employees under the Federal Employees' Compensation Act (FECA). The answer is no, as the PPA applies only to federal procurement contracts. It does not extend to the government's financial obligations that are statutory or regulatory in nature. 5 C.F.R. §§ 1315.1(a) - 1315.2(g); New York Guardian Mortgagee Corp. v. United States, 916 F.2d 1558 (Fed. Cir. 1990) (declining to award interest to mortgage company seeking interest on delayed payments made under VA mortgage-guarantee program); see also Boers v. United States, 243 F.3d 561, 2000 WL 1475538 at *3 (Fed. Cir. 2000) (unpublished) (declining to award interest on benefits under the Dairy Indemnity Payment Program administered by the Agriculture Department). The Prompt Payment Act does not apply to medical providers' invoices under FECA because the agency's obligation to pay arises not out of an enforceable procurement contract between medical providers and the agency, but rather out of a statutory obligation to injured federal employees. See 5 U.S.C. § 8103. The relationship between OWCP and treating medical providers under FECA is not contractual. The enrollment process does not result in any sort of agreement between the medical provider and OWCP; it merely informs medical providers of the procedures for seeking payment for services rendered to injured federal employees.

 

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation

Attachments

Distribution No. 2--Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, Staff Nurses and Fiscal Personnel)

 

Attachment to FECA Circular NO. 11-03 - PROMPT PAYMENT INTEREST RATES

Dates

Percentage

Dates

Percentage

01/1/11 - 12/31/11
01/1/10 - 12/31/10
07/1/09 - 12/31/09
01/1/09 - 06/30/09
07/1/08 - 12/31/08
01/1/08 - 06/30/08
07/1/07 - 12/31/07
01/1/07 - 06/30/07
07/1/06 - 12/31/06
01/1/06 - 06/30/06
07/1/05 - 12/31/05
01/1/05 - 06/30/05
07/1/04 - 12/31/04
01/1/04 - 06/30/04
07/1/03 - 12/31/03
01/1/03 - 06/30/03
07/1/02 - 12/31/02
01/1/02 - 06/30/02
07/1/01 - 12/31/01
01/1/01 - 06/30/01
07/1/00 - 12/31/00
01/1/00 - 06/30/00
07/1/99 - 12/31/99
01/1/99 - 06/30/99
07/1/98 - 12/31/98
01/1/98 - 06/30/98

2 5/8 %
3 1/4 %
4 7/8 %
5 5/8 %
5 1/8 %
4 3/4 %
5 3/4 %
5 1/4 %
5 3/4 %
5 1/8 %
4 1/2 %
4 1/4 %
4 1/2 %
4.0 %
3 1/8 %
4 1/4 %
5 1/4 %
5 1/2 %
5 7/8 %
6 3/8 %
7 1/4 %
6 3/4 %
6 1/2 %
5.0 %
6.0 %
6 1/4 %

07/1/97 - 12/31/97
01/1/97 - 06/30/97
07/1/96 - 12/31/96
01/1/96 - 06/30/96
07/1/95 - 12/31/95
01/1/95 - 06/30/95
07/1/94 - 12/31/94
01/1/94 - 06/30/94
07/1/93 - 12/31/93
01/1/93 - 06/30/93
07/1/92 - 12/31/92
01/1/92 - 06/30/92
07/1/91 - 12/31/91
01/1/91 - 06/30/91
07/1/90 - 12/31/90
01/1/90 - 06/30/90
07/1/89 - 12/31/89
01/1/89 - 06/30/89
07/1/88 - 12/31/88
01/1/88 - 06/30/88
07/1/87 - 12/31/87
01/1/87 - 06/30/87
07/1/86 - 12/31/86
01/1/86 - 06/30/86
07/1/85 - 12/31/85
01/1/85 - 06/30/85

6 3/4 %
6 3/8 %
7.0 %
5 7/8 %
6 3/8 %
8 1/8 %
7.0 %
5 1/2 %
5 5/8 %
6 1/2 %
7.0 %
6 7/8 %
8 1/2 %
8 3/8 %
9.0 %
8 1/2 %
9 1/8 %
9 3/4 %
9 1/4 %
9 3/8 %
8 7/8 %
7 5/8 %
8 1/2 %
9 3/4 %
10 3/8 %
12 1/8 %

 

Back to Top of FECA Circular No. 11-03

Attachment to FECA Circular NO. 11-03 - DEBT MANAGEMENT INTEREST RATES

Dates

Percentage

01/1/11 - 12/31/11

1%

01/1/10 - 12/31/10

1%

 

 

01/1/09 - 12/31/09

3%

07/1/08 - 12/31/08

3%

01/1/08 - 06/30/08

5%

01/1/07 - 12/31/07

4%

07/1/06 - 12/31/06

4%

01/1/06 - 06/30/06

2%

01/1/05 - 12/31/05

1%

 

 

01/1/04 - 12/31/04

1%

01/1/03 - 12/31/03

2%

07/1/02 - 12/31/02

3%

01/1/02 - 06/30/02

5%

01/1/01 - 12/31/01

6%

01/1/00 - 12/31/00

5%

 

 

01/1/99 - 12/31/99

5%

01/1/98 - 12/31/98

5%

01/1/97 - 12/31/97

5%

01/1/96 - 12/31/96

5%

07/1/95 - 12/31/95

5%

01/1/95 - 06/30/95

3%

 

 

01/1/94 - 12/31/94

3%

01/1/93 - 12/31/93

4%

01/1/92 - 12/31/92

6%

01/1/91 - 12/31/91

8%

01/1/90 - 12/31/90

9%

 

 

01/1/89 - 12/31/89

7%

01/1/88 - 12/31/88

6%

01/1/87 - 12/31/87

7%

01/1/86 - 12/31/86

8%

01/1/85 - 12/31/85

9%

 

 

Prior to 01/01/85

Not Applicable

 

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FECA CIRCULAR NO. 10-01

January 15, 2010


SUBJECT: Guidance for claims filed as a result of the 2010 Decennial Census

This circular is intended to provide instructions for calculating pay rates, determining Continuation of Pay (COP) entitlement, and understanding third party subrogation for claims filed by employees of the Department of Commerce as a result of the 2010 Decennial Census. While this information is not new, it is being provided so that claims staff can consistently apply the rules and regulations in these cases.

Background:
The Department of Commerce is responsible for conducting the Decennial Census and employs enumerators and crew leaders to gather statistical data through interviews with property residents. The Bureau of the Census expects to hire approximately one million individuals with temporary appointments not to exceed 180 days. These employees will work an average of 84 hours during a four to five week period, one week of which will be training. The peak employment period is April through June 2010.

Pay Rates:
Information pertaining to the 2010 Decennial Census has been updated in FECA PM Chapter 2-0900-12 and Chapter 2-0901-9 to reflect current work patterns. The current work schedule has been determined to be 4.5 hours per day, 4 days per week.

All positions, including enumerators, crew leaders and clerks are paid on an hourly basis. Below are the hourly wage rates for enumerators, crew leaders and clerks:

Work positions and their corresponding hourly wages

Position

Rates

Enumerator:

$10.93 to $22.10

Crew Leader:

$12.43 to $23.60

Clerk:

$ 8.20 to $15.82

 

Where disability does not exceed 90 days, compensation should be paid on a daily basis in accordance with section 5 U.S.C. 8114(c).

Where disability extends beyond 90 days and the claimant had similar employment during the year prior to the injury, compensation should be paid in accordance with section 5 U.S.C. 8114(d)(1) and (2). If this is not applicable, compensation should be paid on a weekly basis using the following formula: 150 x the actual daily wage divided by 52 (the actual daily wage should be determined by multiplying the hourly pay rate by 4.5 hours).

Any questions regarding pay rates may be referred to the Bureau of Census, Demographic and Decennial Staff, at (301) 763-9620.

COP:
Census workers are civil employees of the Federal government and are included under the COP provisions of 5 U.S.C. 8118; therefore, COP should be determined and calculated in the usual fashion in most instances. However, due to the shorter period of employment for most of these employees, there are a few regulatory provisions to keep in mind.

20 C.F.R. 10.220(d) provides that "an employer shall continue the regular pay of an eligible employee without a break in time for up to 45 calendar days, except when, and only when...the injury was not reported until after employment has been terminated." The employment termination date must be supported by official documentation in the file, such as an SF-50 (or equivalent).

20 C.F.R. 10.222(a)(5) provides that "where the employer has continued the pay of the employee, it may be stopped only when at least one of the following circumstances is present...(5) The employee's period of employment expires or employment is otherwise terminated (as established prior to the date of injury)." The Census Bureau can therefore terminate COP if an SF-50 (dated prior to the date of injury) reflects that the employment would end on a specific date. The key here though is that the SF-50 (or equivalent) must be dated prior to the date of injury.

Also, the Census Bureau sometimes enters into contracts with state, county and city governments to conduct various types of surveys. Most of the workers are hired for very short periods of time, and they are paid directly by the local entity conducting the study. It has been determined that they are not eligible for COP.

Third Party:
Because of statutory confidentiality requirements, Census workers (enumerators and field representatives) cannot file third party claims against home owners or the owners of business establishments unless there is a deliberate act by the resident or owner. Census workers are required by 13 U.S.C. 9(a)(2) to maintain the confidentiality of information provided by a resident or establishment, and are subject to criminal penalties including imprisonment under 13 U.S.C. 214 for the release of information protected by 13 U.S.C. 9. For this reason, it has been determined that OWCP will not require a Census enumerator or field representative who is injured on the private property of the resident or interviewee to pursue a third party claim against the resident or owner. The Bureau of Census has therefore been instructed to answer "no" on the Form CA-1 in response to the question regarding third party liability. The CE should therefore not release the CA-1045 in most instances.

There are only a few exceptions to this rule. If the CE confirms with the Bureau of the Census that the injury was the result of a deliberate act by a resident, or the injury was sustained in transit between interview sites in such a way that the Census worker can maintain confidentiality, the CE should proceed with the release of the CA-1045. For a more detailed discussion, see Federal FECA Procedure Manual at 2-1100-7(a)(3) and FECA Bulletin 99-30, issued August 30, 1999.

Pilot Programs:
Because of the intensive effort involved in the 2010 Census and the need to facilitate quick action on these cases, DFEC and the Bureau of Census are piloting expedited case file access and early nurse referral on a limited basis in order to assess the efficacy of such efforts in improving outcomes for injured employees.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 2—Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, Staff Nurses and Fiscal Personnel)

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FECA CIRCULAR NO. 10-02

January 29, 2010


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

The interest rate to be assessed for the prompt payment bills is 3.25 percent for the period of January 1, 2010 through December 31, 2010. This new rate has been updated in the Central Bill Payment system tables.

The rate for assessing interest charges on debts due the government has also been changed. The interest rate for assessing interest charges on debts due the government is now 1.0 percent for the period of January 1, 2010 through December 31, 2010.

Ordinarily, the rate of interest charged on debts due the U.S. Government is only changed in January, and is effective for the entire year. However, the rate may be changed in July if there is a difference in the Current Value of Funds (CVF) interest rate of more than two percent. The rate will be reviewed on July 1, 2010 to determine if the Treasury has changed the rate.

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.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Attachments

Distribution: List No. 2--Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, Staff Nurses and Fiscal Personnel)

 

PROMPT PAYMENT INTEREST RATES

Dates

Percentage

Dates

Perentage

01/1/10 - 12/31/10

3¼%

 

 

 

 

 

 

7/1/09 - 12/31/09

4 7/8%

7/1/99 - 12/31/99

6½%

1/1/09 - 12/31/09

5%

1/1/99 - 6/30/99

5.0%

7/1/08 - 12/31/08

5

7/1/98 - 12/31/98

6.0%

1/1/08 - 6/30/08

4¾%

1/1/98 - 6/30/98

6¼%

7/1/07 - 12/31/07

5¾%

7/1/97 - 12/31/97

6¾%

1/1/07 - 6/30/07

5¼%

1/1/97 - 6/30/97

6%

7/1/06 - 12/31/06

5¾%

7/1/96 - 12/31/96

7.0%

1/1/06 - 6/30/06

5%

1/1/96 - 6/30/96

5%

7/1/05 - 12/31/05

4½%

7/1/95 - 12/31/95

6%

1/1/05 - 6/30/05

4¼%

1/1/95 - 6/30/95

8%

7/1/04 - 12/31/04

4½%

7/1/94 - 12/31/94

7.0%

1/1/04 - 6/30/04

4.0%

1/1/94 - 6/30/94

5½%

7/1/03 - 12/31/03

3%

7/1/93 - 12/31/93

5%

1/1/03 - 6/30/03

4¼%

1/1/93 - 6/30/93

6½%

7/1/02 - 12/31/02

5¼%

7/1/92 - 12/31/92

7.0%

1/1/02 - 6/30/02

5½%

1/1/92 - 6/30/92

6%

7/1/01 - 12/31/01

5%

7/1/91 - 12/31/91

8½%

1/1/01 - 6/30/01

6%

1/1/91 - 6/30/91

8%

7/1/00 - 12/31/00

7¼%

7/1/90 - 12/31/90

9.0%

1/1/00 - 6/30/00

6¾%

1/1/90 - 6/30/90

8½%

 

 

 

 

7/1/89 - 12/31/89

9%

 

 

1/1/89 - 6/30/89

9¾%

 

 

7/1/88 - 12/31/88

9¼%

 

 

1/1/88 - 6/30/88

9%

 

 

7/1/87 - 12/31/87

8%

 

 

1/1/87 - 6/30/87

7%

 

 

7/1/86 - 12/31/86

8½%

 

 

1/1/86 - 6/30/86

9¾%

 

 

7/1/85 - 12/31/85

10%

 

 

1/1/85 - 6/30/85

12%

 

 

 

ATTACHMENT TO FECA CIRCULAR NO. 10 – 02

Back to Top of FECA Circular No. 10-02

DEBT MANAGEMENT INTEREST RATES

Dates

Percentage

1/1/10 – 12/31/10

1%

 

 

1/1/09 - 12/31/09

3%

7/1/08 - 12/31/08

3%

1/1/08 - 6/30/08

5%

1/1/07 - 12/31/07

4%

7/1/06 - 12/31/06

4%

1/1/06 - 12/31/06

2%

1/1/05 - 12/31/05

1%

   

1/1/04 - 12/31/04

1%

1/1/03 - 12/31/03

2%

7/1/02 - 12/31/02

3%

1/1/02 - 06/30/02

5%

1/1/01 - 12/31/01

6%

1/1/00 - 12/31/00

5%

 

 

1/1/99 - 12/31/99

5%

1/1/98 - 12/31/98

5%

1/1/97 - 12/31/97

5%

1/1/96 - 12/31/96

5%

7/1/95 - 12/31/95

5%

1/1/95 - 06/30/95

3%

 

 

1/1/94 - 12/31/94

3%

1/1/93 - 12/31/93

4%

1/1/92 - 12/31/92

6%

1/1/91 - 12/31/91

8%

1/1/90 - 12/31/90

9%

   

1/1/89 - 12/31/89

7%

1/1/88 - 12/31/88

6%

1/1/87 - 12/31/87

7%

1/1/86 - 12/31/86

8%

1/1/85 - 12/31/85

9%

 

 

Prior to 01/01/84

Not applicable

 

ATTACHMENT TO FECA CIRCULAR NO. 10 – 02

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FECA CIRCULAR NO. 10-03

Issue Date: January 29, 2010


Expiration Date: December 31, 2010


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, 2010, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile reduced to 50 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, Part5, Benefit Payments, 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.

 

The following is a list of the historical mileage rates used to reimburse claimant travel expense:

Historical mileage rates used to reimburse claimant travel expense

Dates

Cents per mile

01/01/1995 - 06/06/1996
06/07/1996 - 09/07/1998
09/08/1998 - 03/31/1999
04/01/1999 - 01/13/2000

01/14/2000 - 01/21/2001
01/22/2001 - 01/20/2002
01/21/2002 - 12/31/2002
01/01/2003 - 12/31/2003
01/01/2004 - 02/03/2005
02/04/2005 - 08/31/2005
09/01/2005 - 12/31/2005

01/01/2006 - 01/31/2007
02/01/2007 - 03/18/2008
03/19/2008 - 07/31/2008
08/01/2008 - 12/31/2008
01/01/2009 - 12/31/2009
01/01/2010 - Current

30.0 cents per mile
31.0 cents per mile
32.5 cents per mile
31.0 cents per mile

32.5 cents per mile
34.5 cents per mile
36.5 cents per mile
36.0 cents per mile
37.5 cents per mile
40.5 cents per mile
48.5 cents per mile

44.5 cents per mile
48.5 cents per mile
50.5 cents per mile
58.5 cents per mile
55.0 cents per mile
50.0 cents per mile

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

 

Douglas Fitzgerald
Director for
Federal Employees' Compensation

Distribution: List No. 2 -- Folioviews Groups A and D (Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Fiscal Personnel).

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FECA CIRCULAR NO. 10-04

January 29, 2010


SUBJECT: Dual Benefits - FERS Cost of Living Adjustments


For the first time since the enactment of Cost-of-Living (COLA) increases in 1975, there will not be a raise in the benefits issued by the Social Security Administration (SSA) for 2010. This is due to the fact that there was no increase in the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W) from the third quarter of 2008 to the third quarter of 2009, as reported by the Bureau of Labor Statistics. The CPI-W percentage of increase sets the amount of the SSA COLA, so the lack of increase results in no increase to SSA benefits.

Since there is no increase to account for, there will be no change to the amounts currently being offset for Federal Employees' Retirement System (FERS) Dual Benefits deductions.

The historical SSA cost of living adjustments are as follows:

Historical SSA cost of living adjustments

Dates

Percentage

12/01/2009 - 11/30/2010
12/01/2008 - 11/30/2009
12/01/2007 - 11/30/2008
12/01/2006 - 11/30/2007
12/01/2005 - 11/30/2006
12/01/2004 - 11/30/2005
12/01/2003 - 11/30/2004
12/01/2002 - 11/30/2003
12/01/2001 - 11/30/2002
12/01/2000 - 11/30/2001
12/01/1999 - 11/30/2000
12/01/1998 - 11/30/1999
12/01/1997 - 11/30/1998
12/01/1996 - 11/30/1997
12/01/1995 - 11/30/1996
12/01/1994 - 11/30/1995

0.0%
5.8%
2.3%
3.3%
4.1%
2.7%
2.1%
1.4%
2.6%
3.5%
2.4%
1.3%
2.1%
2.9%
2.6%
2.8%

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 1 – FolioViews Groups A, B and D (Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists, Staff Nurses and Fiscal Personnel)

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FECA CIRCULAR NO. 10-05

Issue Date: March 24, 2010


Expiration Date: March 24, 2011


Subject: Early disability management in 2010 Decennial Census claims.

Background: The Department of Commerce is responsible for conducting the Decennial Census and employs enumerators and crew leaders to gather statistical data through interviews with property residents. The Bureau of the Census expects to hire approximately one million individuals with temporary appointments not to exceed 180 days. These employees will work an average of 84 hours during a four to five week period, one week of which will be training. The peak employment period is April through June 2010. Because of the large number of temporary workers being hired, there will not necessarily be limited duty positions available for those who are injured on the job. OWCP is therefore piloting a new early disability management process that will attempt to return these temporary employees to suitable work quickly and appropriately.

Purpose: To provide guidance to claims staff, Staff Nurses and Rehabilitation Specialists on early disability management in Census claims under the pilot project.

Applicability: All National Office staff and District Office claims personnel, Staff Nurses and Rehabilitation Specialists.

Actions:

1. The assignment of nurses will be handled differently under this pilot project. COP nurses will be assigned earlier and have a more in-depth role in the management of the Census claims. Currently, a case does not automatically become eligible for a COP nurse assignment unless the claimant has stopped work for at least 15 days and has not returned to work. Beginning with the iFECS release on March 29, 2010, Census cases will be eligible for automatic assignment 7 days after the claimant stops work. The case will actually show up for assignment on day 8. The Staff Nurse (SN) should assign all COP cases on a daily basis.

Census will not be using the CA-3 to report a return to work (RTW); therefore, if a claimant returns to work after the CA-1 has already been submitted, Census will call the appropriate district office to report the RTW. The person taking the call should immediately update the RTW field in iFECS so that a COP nurse is not assigned. A telephone message (CA-110) should not be sent since the information needs to be entered on the day it is received; however, a closed CA-110 should be created documenting the call and return to work date. Entering a RTW date (prior to the data run on the night of day 7) will prevent the case from showing up as eligible for assignment on day 8.

Beginning with the March 29, 2010 iFECS release, agencies will be able to see that a COP nurse has been assigned to one of their cases by checking for a new flag in the Agency Query System (AQS).

It is possible that a claimant may stop work after the CA-1 has already been submitted, which makes that case ineligible for automatic COP nurse assignment. In these cases, Census can request that a nurse be assigned (after checking AQS to verify that a COP nurse has not already been assigned). The Field Nurse (FN) [or Telephonic Case Manager (TCM) if a FN cannot be assigned] is the available option at that point, if the case has been or can be accepted.

If the following criteria are met, Census may ask for a nurse assignment:

  • The claimant is currently out of work and there is no projected RTW date, or the projected RTW date is at least 1 week into the future; or
  • The claimant has been released to light duty but no light duty is available.

If these criteria have been met, Census will contact the applicable office via fax with a standardized request. The request submitted by the Census will contain the following information:

  • Claimant information to include name, case number and date of injury (DOI);
  • RTW information – date stopped work and anticipated RTW date, or an indication that no anticipated RTW date has been provided;
  • Agency contact person and telephone number; and
  • Whether light duty is available and if so how many hours and the type.

Each district office will determine the best way to channel these requests for the most effective use of resources in that particular office, but one contact person will be established for each office. That contact person will receive the faxed requests and track them to be sure that appropriate actions are taken.

The first step is to expedite adjudication.

2. COP Nurses will be expected to do more than just obtain RTW dates and close the case. In these cases, the COP nurse will be expected to take the following actions:

a) Make contact with the claimant, employing agency and physician's office.

b) From the claimant, obtain a brief history of injury, history of treatment and current work status, as well as attending physician contact information.

c) From the agency, confirm work status, find out if light duty is available, and confirm the date the claimant's position was expected to end.

d) From the attending physician's office, obtain verbal history of treatment and expected treatment plan, and provide OWCP address for submission of reports and ACS contact information to be used should the claim be approved. The nurse should also advise whether job modifications can be made, and, if appropriate, fax a CA-20 requesting that it be completed and submitted to OWCP.

e) The COP nurse will also make recommendations about assignment of a FN.

Once a COP nurse has been assigned, he or she will have 7 days to submit a closure report. Two new Census COP reports will be used for this purpose (one for RTW cases and one for cases with no RTW). These reports contain fields for information that the COP nurse is expected to obtain.

After obtaining this information, the COP Nurse should close the case, complete the report, and submit it to OWCP within 7 days of assignment. Upon receipt of a COP nurse report indicating no RTW, only partial RTW, or some other pending issue, OWCP will take two primary actions: 1) Claims will expedite adjudication of the case, and 2) The SN will assign a FN earlier than usual.

Each district office must determine the most effective way of communicating the COP nurse report findings to the assigned Claims Examiner (CE) so that appropriate action can be taken.

3. Case adjudication will need to be expedited in these claims so that a FN can be assigned as early as possible (when appropriate). If the claim cannot be accepted upon first review, development should be undertaken immediately. The claimant will be afforded the normal 30 day period to submit evidence but the claim should be monitored during that 30 day period so that an acceptance can be issued as soon as the supporting documentation is received. The CE should not wait until the 30 days have elapsed to review any evidence that has been submitted. However, if the claimant fails to submit evidence sufficient to warrant acceptance of the claim, the full 30 day period must be provided.

4. Field Nurses will be assigned once the claim has been accepted and continued disability is indicated. During this pilot project, FN assignment will occur within 7 days of acceptance even if the COP period has not elapsed. The FN will have the usual instructions regarding facilitating medical management and return to work, but she will also be expected to make recommendations for the assignment of a Vocational Rehabilitation Counselor (RC). On occasion, the FN and RC may be working on a claim at the same time. See below for more details on this process.

If the FN is assigned after a COP nurse assignment, the DM record will already exist. Once 45 days from DOI have elapsed, if no RTW full-time code has been entered in DM, the status code TCQ (QCM-Triage to QCM-Open) is auto populated via a nightly run and the category changes to QCM Open. The Start date and Track date are populated with the date the record is changed to QCM Open. If the claimant returns to work before the 45 days from DOI have elapsed, entry of the RTW information in DM tracking inputs the TRC status code (Closed -Triage with RTW during COP) in DM and changes the category to QCM Resolved Triage. Offices will either need to close the FN or open a new DM record if they follow Light Duty RTW with a nurse.

If the FN is assigned in a case with no prior COP nurse assignment (via a fax request from Census), the DM record should be created with a Track date equal to day 46 after the DOI for traumatic injuries (unless the case is accepted before day 46, then the Track date equals the current/start date). If the case is an occupational disease claim, the Track date should equal the date disability began.

5. Rehabilitation Counselors will be assigned earlier than usual and may, in some instances, be assigned prior to the FN concluding intervention, leading to a dual-track intervention. Dual intervention of FNs and RCs is not routinely utilized outside of catastrophic claims, but the unique circumstances and short term nature of Census employment will likely result in more disability due to limited availability of modified duty with the agency. Since private industry employment will be more common in these cases, dual tracking will lead to efficient disability management and an earlier return to work.

Dual assignment of FNs and RCs should be considered if both of the following criteria apply:

  • The claimant has a condition that will likely lead to permanent work related restrictions, which would prohibit a return to the date of injury position. The medical evidence should reflect expectations for when the restrictions will likely be permanent and the kinds of restrictions that are expected.
  • There will likely be no Census employment opportunities for an individual with the expected restrictions.

The FN will already be assigned to the case in most instances and he or she can make the recommendation to the CE when these circumstances are present. OWCP staff [the CE, SN or Rehabilitation Specialist (RS)] may also make this determination.

If these conditions exist, a rehabilitation referral should be considered. Part time referrals can be made in these cases even for placement with a new employer (since most Census workers are not full time), but the labor market survey has to support that any targeted jobs are reasonably available on a part-time basis.

  • The FN's focus in this situation is on the claimant's medical condition (obtaining permanent work tolerance limitations).
  • The RC's focus is on the early stages of plan development, to include an initial interview to gather the background information for a transferable skills analysis, a labor market survey, and perhaps vocational testing. A plan would typically not be finalized until the restrictions are considered stable and well defined.
  • To avoid any confusion with the medical providers, the FN would continue to communicate with the physician – providing information as necessary to the CE and RC. Any needed RC communication with the physician, while the FN is still assigned to the case, would flow through or be coordinated with the FN.

The FN should communicate with the SN and CE, and the RC should communicate with the RS and the CE. However, the FN and RC should also communicate with each other during this process to facilitate the best possible outcome. For example, if the RC has questions about the medical restrictions being imposed by the physician, he or she may contact the FN. This communication should be documented in both the FN and RC reports.

Once a case has been identified for dual tracking purposes, the CE should complete a referral to rehabilitation with an indication that Medical Rehabilitation is needed concurrently with FN services. When this referral is completed in iFECS, the CE should notify the SN and RS of the dual tracking.

Upon receipt of the referral, the RS should assign the case to a RC and place an M status in NRTS. The OWCP-35 to the RC will authorize 3 months and $1500 in services. The initial OWCP-3 to the RC will explain that a FN is on the claim and provide the nurse's contact information. It will explain the types of services that should be offered concurrently with the nurse services and indicate when the case should move forward in Plan Development. After the referral has been made to the RC, the CE and SN will be provided with the referral date and the RC's name and contact information. Rehabilitation Screeners are not to be utilized in these claims.

When the CE receives confirmation of the RC assignment, a letter should be sent to the claimant explaining that both a FN and RC are assigned to the claim. The letter will define the roles that each of these individuals will take as well as the claimant's responsibility to cooperate. The letter "Dual Track-Census" (in Correspondence Library) should be used for this purpose.

Any cases assigned for dual tracking must be reported monthly to the National Office.

Once the FN has obtained stable, well defined work restrictions, the nurse portion of disability management will cease and the RC will continue with the rehabilitation process.

Once the claim is in posture for plan development (i.e. stable and well defined medical restrictions are established), the RS should change the case status to D and notify the RC of the status change and applicable time frames. If this has not occurred by the end of the 3 month period allowed on the initial OWCP-3, then the case should likely be closed. Extensions are not allowed unless there is a pending work hardening or functional capacity evaluation or stable well defined work restrictions are imminently expected.

6. Closure Codes for Dual Tracking Cases

  • If the claimant happens to RTW with Census while both the FN and RC are on the case, the successful closure code will be entered in the nurse record as a successful nurse RTW.
  • If the claimant happens to RTW with a new employer while both the FN and RC are on the case, the successful closure code will be entered in the rehab record as a successful rehabilitation.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation
Attachments:

Distribution: List No. 1--Folioviews Groups A and D (Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists and Staff Nurses)

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FECA CIRCULAR NO. 10-06

Issue Date: May 14, 2010

Expiration Date: March 24, 2011


Subject: Overpayments in cases where lesser impairment is established after a schedule award has been paid for greater impairment.

Background: On May 1, 2009, the Office began using the Sixth Edition of the American Medical Association Guides to the Evaluation of Permanent Impairment (AMA Guides), instead of the Fifth Edition. When this change occurred, FECA Bulletin 09-03 was issued. That bulletin addressed situations of lesser impairment of a schedule member after a greater award has been paid if the ratings were based on different editions of the AMA Guides. Specifically, where a calculation under the Sixth Edition results in a lower impairment rating to a schedule member than the original award under the Fifth Edition, the Office (consistent with past practice) will make the finding that the claimant has no more than the percentage of impairment originally awarded; that the evidence does not establish an increased impairment; and that an overpayment will not be declared. That bulletin has since been incorporated into the Procedure Manual.

This circular is being issued to clarify what actions are appropriate when a lesser impairment is found after a greater award has been paid when the different impairment ratings are based on the same edition of the AMA Guides.

Purpose: To provide guidance on actions to be taken in cases where a schedule award has been paid based on a certain percentage of impairment, but a later determination based on the same edition of the AMA Guides substantiates a lesser degree of impairment of the schedule member.

Actions:

1. Before addressing the issue of whether an overpayment is appropriate in this circumstance, the schedule award issue must be resolved. In Richard Saldibar 51 ECAB 585 (2000), the ECAB found that an overpayment was not in posture for review because the Office had not properly resolved the schedule award issue. Therefore, before the amount of the overpayment can be determined, the evidence must clearly establish the degree of permanent impairment. The evidence should be carefully reviewed and the schedule award decision that establishes the lesser award should explain in detail the rationale for the lesser degree of impairment.

2. In the case of Michael Reed, Docket No. 04-734 (issued October 5, 2004), the ECAB stated:

"If a claimant receives a schedule award and the medical evidence does not support the degree of permanent impairment awarded, an overpayment may be created."

Therefore, if a schedule award decision is set aside (after a hearing or review by the ECAB, or as part of the reconsideration process) and additional development is undertaken to resolve the schedule award issue, a new schedule award decision should be issued that fully addresses the reasons for the change in rating. Declaring an overpayment thereafter is appropriate if the later decision substantiates a lesser degree of impairment than previously awarded.

Similarly, if a claimant requests an increased schedule award due to a belief that his or her medical condition has deteriorated since the original award has been issued, and additional development is undertaken to address this claim for an increased award, a new schedule award decision should be issued that addresses and substantiates the newly determined impairment rating. If a lesser degree of impairment than previously awarded is substantiated, an overpayment thereafter is appropriate.

3. Where a schedule award decision establishes a lesser impairment, after a greater award has been paid, the resulting overpayments will have a finding of without fault.

 

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation

Distribution: List No. 1--Folioviews Groups A and D
(Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists and Staff Nurses)

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FECA CIRCULAR NO. 09-01

February 15, 2009


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

The interest rate to be assessed for the prompt payment bills is 5.625 percent for the period of January 1, 2009 through June 30, 2009. This new rate has been updated in the Central Bill Payment system tables.

The rate for assessing interest charges on debts due the government has not changed. The interest rate for assessing interest charges on debts due the government remains at 3.0 percent for the period of January 1, 2009 through December 31, 2009.

Ordinarily, the rate of interest charged on debts due the U.S. Government is only changed in January, and is effective for the entire year. However, the rate may be changed in July if there is a difference in the Current Value of Funds (CVF) interest rate of more than two percent. The rate will be reviewed on July 1, 2009 to determine if the Treasury has changed the rate.

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.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Attachments

Distribution: List No. 2--Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, Staff Nurses and Fiscal Personnel)

PROMPT PAYMENT INTEREST RATES

Date

Percentage

Date

Percentage

       

 

 

7/1/99 - 12/31/99

6½%

1/1/09 - 12/31/09

5%

1/1/99 - 6/30/99

5.0%

7/1/08 - 12/31/08

5

7/1/98 - 12/31/98

6.0%

1/1/08 - 6/30/08

4¾%

1/1/98 - 6/30/98

6¼%

7/1/07 - 12/31/07

5¾%

7/1/97 - 12/31/97

6¾%

1/1/07 - 6/30/07

5¼%

1/1/97 - 6/30/97

6%

7/1/06 - 12/31/06

5¾%

7/1/96 - 12/31/96

7.0%

1/1/06 - 6/30/06

5%

1/1/96 - 6/30/96

5%

7/1/05 - 12/31/05

4½%

7/1/95 - 12/31/95

6%

1/1/05 - 6/30/05

4¼%

1/1/95 - 6/30/95

8%

7/1/04 - 12/31/04

4½%

7/1/94 - 12/31/94

7.0%

1/1/04 - 6/30/04

4.0%

1/1/94 - 6/30/94

5½%

7/1/03 - 12/31/03

3%

7/1/93 - 12/31/93

5%

1/1/03 - 6/30/03

4¼%

1/1/93 - 6/30/93

6½%

7/1/02 - 12/31/02

5¼%

7/1/92 - 12/31/92

7.0%

1/1/02 - 6/30/02

5½%

1/1/92 - 6/30/92

6%

7/1/01 - 12/31/01

5%

7/1/91 - 12/31/91

8½%

1/1/01 - 6/30/01

6%

1/1/91 - 6/30/91

8%

7/1/00 - 12/31/00

7¼%

7/1/90 - 12/31/90

9.0%

1/1/00 - 6/30/00

6¾%

1/1/90 - 6/30/90

8½%

       

 

 

 

 

7/1/89 - 12/31/89

9%

 

 

1/1/89 - 6/30/89

9¾%

 

 

7/1/88 - 12/31/88

9¼%

 

 

1/1/88 - 6/30/88

9%

 

 

7/1/87 - 12/31/87

8%

 

 

1/1/87 - 6/30/87

7%

 

 

7/1/86 - 12/31/86

8½%

 

 

1/1/86 - 6/30/86

9¾%

 

 

7/1/85 - 12/31/85

10%

 

 

1/1/85 - 6/30/85

12%

 

 

 

ATTACHMENT TO FECA CIRCULAR NO. 09 – 01

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DEBT MANAGEMENT INTEREST RATES

Dates

Percentage

1/1/09 - 12/31/09

3%

7/1/08 - 12/31/08

3%

1/1/08 - 6/30/08

5%

1/1/07 - 12/31/07

4%

7/1/06 - 12/31/06

4%

1/1/06 - 12/31/06

2%

1/1/05 - 12/31/05

1%

   

1/1/04 - 12/31/04

1%

1/1/03 - 12/31/03

2%

7/1/02 - 12/31/02

3%

1/1/02 - 06/30/02

5%

1/1/01 - 12/31/01

6%

1/1/00 - 12/31/00

5%

 

 

1/1/99 - 12/31/99

5%

1/1/98 - 12/31/98

5%

1/1/97 - 12/31/97

5%

1/1/96 - 12/31/96

5%

7/1/95 - 12/31/95

5%

1/1/95 - 06/30/95

3%

 

 

1/1/94 - 12/31/94

3%

1/1/93 - 12/31/93

4%

1/1/92 - 12/31/92

6%

1/1/91 - 12/31/91

8%

1/1/90 - 12/31/90

9%

   

1/1/89 - 12/31/89

7%

1/1/88 - 12/31/88

6%

1/1/87 - 12/31/87

7%

1/1/86 - 12/31/86

8%

1/1/85 - 12/31/85

9%

 

 

Prior to 01/01/84

Not applicable

 

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FECA CIRCULAR NO. 09-02

February 15, 2009

Subject: Dual Benefits - FERS Cost of Living Adjustments

Effective December 1, 2008, benefits issued by the Social Security Administration (SSA) will be increased by 5.8%. 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.

This adjustment will be made from the National Office for all cases that were correctly entered into the iFECS Compensation program. The adjustment will be effective with the periodic roll cycle beginning December 21, 2008. There will be no adjustment or overpayment declared for the period of December 1, 2008 through December 20, 2008.

The historical SSA cost of living adjustments are as follows:

Historical SSA cost of living adjustments

Dates

Percentage

12/01/2008 - 11/30/2009
12/01/2007 - 11/30/2008
12/01/2006 - 11/30/2007
12/01/2005 - 11/30/2006
12/01/2004 - 11/30/2005
12/01/2003 - 11/30/2004
12/01/2002 - 11/30/2003
12/01/2001 - 11/30/2002
12/01/2000 - 11/30/2001
12/01/1999 - 11/30/2000
12/01/1998 - 11/30/1999
12/01/1997 - 11/30/1998
12/01/1996 - 11/30/1997
12/01/1995 - 11/30/1996
12/01/1994 - 11/30/1995

5.8%
2.3%
3.3%
4.1%
2.7%
2.1%
1.4%
2.6%
3.5%
2.4%
1.3%
2.1%
2.9%
2.6%
2.8%

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 1 – FolioViews Groups A, B and D (Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists, Staff Nurses and Fiscal Personnel)

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FECA CIRCULAR NO. 09-03

June 1, 2009


Subject: Fees for Representatives' Services - Contingency Fees

Questions have continued to arise concerning the representative fee approval process under the Federal Employees' Compensation Act (FECA). Based on 5 U.S.C. § 8127 of the FECA, its implementing regulations and procedures as well as the precedent of the Employees' Compensation Appeals Board (ECAB), the fee application approval process for representatives of FECA claimants is within the discretion of the Department of Labor's Office of Workers' Compensation Programs (OWCP) which has been delegated the responsibility of administering the FECA program. The FECA regulations at 20 CFR Part 10, Subpart H describe procedures for designating a representative as well as the fee approval process before OWCP. See 20 C.F.R. §§ 10.701-703. Pursuant to 20 C.F.R. §10.703, a fee application must be in the form of an itemized statement showing the representative's hourly rate, the number of hours worked, and specifically identifying the work performed and a total amount charged for the representation (excluding administrative costs).

Contingency fee arrangements are not permitted. OWCP considers it unacceptable for a representative to create what amounts to a contingency fee in regard to any FECA matter including schedule awards or to manipulate extremely high hourly rates after the fact in a manner that guarantees a certain percentage fee. As such arrangements essentially amount to contingency fee agreements, they do not comport with OWCP's requirements and thus are not subject to the deemed approved process. While OWCP's current FECA regulations set forth a "deemed approved" method for streamlining the fee approval process and do not specifically prohibit contingency fees, the FECA regulations clearly anticipate use of an hourly rate. In order for the deemed approved process to apply, the claimant must specifically concur with a fee request that comports with the FECA regulatory requirement of an itemized statement and a specified hourly rate.

OWCP's requirement of an itemized statement and an hourly rate in its published regulations at 20 C.F.R. 10.703 makes it apparent that OWCP does not recognize any contract or agreement between representatives and clients for payment of a fee on a contingency basis (any agreement where a client agrees to pay a representative a percentage of any monies paid or recovered as part of an OWCP claim). As noted, OWCP's current regulations anticipate use of an hourly rate. Any question of whether contingency fees were allowable was resolved when ECAB held in Angela M. Sanden, Docket No. 04-1632 (issued September 4, 2004), in a case involving fees for services before OWCP, that contingency fee arrangements are not recognized under FECA, further noting that "the attorney's contingency fee arrangement is illegal under the laws applicable to this case." Section 2-1200-5(b) of the Federal (FECA) Procedure Manual reflects ECAB's holding against the use of contingency fees in the FECA process and describes how a fee may be approved.

ECAB more recently stated in its final rule on changes in the ECAB Rules of Procedure (in rejecting a commenter's urging contingency fees be allowed in fee applications on ECAB appeals in response to ECAB's Notice of Proposed Rulemaking in the Federal Register) that "The Board has found that the use of contingency fees by attorneys handling FECA claims before OWCP is not in keeping with section 8127." ECAB cited Sanden in support of that proposition in their final rule which appears at: http://www.dol.gov/ecab/welcome.html. See F.R. Vol. 73 at 62192 (October 20, 2008). ECAB further noted in its final rule that a representative's failure to follow the statutory approval process may subject that individual to criminal sanctions. See 18 U.S.C. § 292. As ECAB's fee approval process is also based on section 8127 of FECA and the representative fee approvals for work before OWCP may be appealed to ECAB, OWCP follows ECAB's clear guidance in this matter.

Representatives utilizing retainer agreements that amount to contingency fee agreements should be advised to revise their fee agreement in accordance with these instructions. Such cases should be handled as follows:

1. Any fee application submitted by a representative in the form of a contingency fee must be returned to the representative with instructions to calculate the money owed for services rendered on an hourly basis and resubmit the fee application in the proper format as described in 20 C.F.R. §10.703.

2. When the representative resubmits the fee request, the attorney must submit a contemporaneously dated statement from the claimant that acknowledges concurrence with the fee and lists the hourly rate being charged in order for the deemed approved process to apply.

3. Any request by a claimant or representative for OWCP to issue a formal decision in order to allow an appeal should be promptly granted.

If a claims examiner receives an inquiry from a state bar association concerning OWCP's procedures on representative fee approvals (this occurs with increasing frequency), the claims examiner may provide links to the applicable statutory language, regulations and procedures but should refer further questions to the District Director who may consult with OWCP's Division of Federal Employees' Compensation (DFEC) National Office as needed in responding to such requests.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 2-Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, Staff Nurses and Fiscal Personnel)

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FECA CIRCULAR NO. 09-04

June 1, 2009


SUBJECT: Health Benefits Insurance and Life Insurance - General Guidance

Health Benefits

When a Federal employee enters a leave without pay (LWOP) status, the employing agency is no longer able to deduct for health and life insurance premiums. If compensation for wage loss benefits is payable under the Federal Employees' Compensation Act (FECA), the responsibility for making those deductions transfers to the Office of Workers' Compensation Programs (OWCP).

Health Benefit Insurance (HBI) Enrollment Requirements

Claims with health benefit deductions should not be on the daily roll for more than 90 consecutive days. Generally, claimants who are disabled for more than 90 days should be placed on the Periodic Roll and their health benefits enrollment should be transferred-in to the servicing district office in a timely manner. The sole exception would be when the evidence in the case record clearly indicates a return to work (RTW) in the near future. Please note that timely transfer-in of health benefits (HBs) is critical, as the information entered in the Integrated Federal Employees' Compensation System (iFECS) is used to report to the Office of Personnel Management's (OPM) Centralized Enrollment Clearinghouse (CLER) system. OPM/CLER reconciles the health benefits enrollment between iFECS and the HB carriers, matching up deductions with enrollment codes. The Division of Federal Employees' Compensation (DFEC) sends information to OPM on those periodic roll/death roll (PR/DE) cases that have been transferred-in. Cases without a transfer-in will not be reported even though DFEC is making deductions for the HB premiums.

Continued discrepancies due to the lack of a transfer-in will result in the claimant's HBI being terminated by the carrier. This problem can be compounded if/when the claimant's employment is terminated by the employing agency, as it will appear to OPM/CLER that the claimant has no entitlement to health benefits and this will be transmitted to the health benefit provider. Claimants who contact the district office with concerns that their right to health benefit coverage has been terminated must receive a prompt and substantive response given that any inability to confirm health benefit eligibility may have an adverse impact on their and/or their families' ability to receive medical services. If the district office is unable to resolve any issues of entitlement promptly, the district office Fiscal Operations Officer (FOS) should contact the Chief of the Branch of Fiscal Operations, National Office for assistance.

As soon as a claimant has been placed on the periodic roll, claims staff must notify the responsible fiscal personnel in the district office. The claims staff may use the CA-73 or the iFECS referral system to notify the appropriate fiscal personnel and advise them to initiate the transfer-in action. Once the transfer-in process is complete, the HB transfer flag in iFECS should be changed to "Y" and certified. The effective date for this action is the date that the deductions began.

Circumstances other than on-going disability may also trigger the need for a transfer-in of the HB enrollment, including the following:

- If the claimant elects OWCP benefits in lieu of OPM benefits, the servicing district office should request copies of the enrollment documents (SF-2809 forms) from OPM in order to accomplish the transfer-in.

- If FECA death benefits are approved for survivors and the enrollment has already been transferred to OPM, the district office should request copies of the enrollment documents from OPM to complete the transfer-in.

- If the claimant moves and the case record is transferred to a different district office, the new district office should complete the transfer-in process since the claimant is now the responsibility of the new "payroll" office, as that term is used by OPM.

Changes to the health benefits enrollment (the HB Plan) are only made during the annual Open Season period. The exception to this rule is generally due to a "life event" such as birth, marriage, divorce, etc. See the instructions to the SF-2809 for a full listing of all exceptions. (See PM 5-0400.8)

If the claimant is in receipt of compensation for a loss of wage-earning capacity (LWEC) and the periodic payment does not cover the amount of the HB premium, the claimant should be notified and offered a plan that will cost less. If the claimant wants to continue with his/her current plan, the claimant will be required to submit the difference between the LWEC and the HB premium on a quarterly or yearly basis to maintain coverage.

Making HBI Deductions

To authorize and set up these deductions in a compensation payment, the following steps need to be taken:

Determine the code for HBI and/or Life Insurance (LI) from Section 10 on the CA-7 claim form. If the Optional Life Insurance (OLI) code is not provided, but the agency provides information detailing the level of coverage, there is an OLI chart available to determine the correct code to enter. The chart is located on the Department of Labor's website at (http://esa/owcp/dfec/jac/oli.htm). It may also be found at the OPM website, which is http://www.opm.gov/insure/life/reference/handbook/sf50tbl.asp

Determine the date on which DFEC deductions become effective. Generally, the employing agency will make deductions through the last date for which the claimant received pay. Although OWCP deductions for HBI and LI become effective on the first day of LWOP status, DFEC does not actually begin making the HBI and LI deductions until the claimant has been in receipt of compensation for 28 days. Once the claimant has received compensation for more than 28 days, deductions should be made retroactively to the date compensation started. From that point on deductions should begin on the day immediately following the ending date of the last deduction.

The iFECS Compensation system has the ability to deduct partial premiums on a daily basis or for periods of compensation less than a full pay period, but the effective date of the deductions is dependent upon the employing agency. The deductions by the employing agency may occasionally run through the end of the pay period (rather than the first day of LWOP) in which the claimant last worked. If that is the case, DFEC deductions for HBI and LI become effective the next calendar day. If this date is not apparent from the CA-7 or from other documentation in file, the employing agency should be contacted to determine the date of last deduction. Once verified, the appropriate date should be documented in the case record.

Termination of HBI Enrollment

A claimant's health benefit enrollment can be terminated if:

- the claimant returns to work in the private sector, with no LWEC. (If there is some LWEC and OWCP is continuing to pay partial benefits, the deductions can be maintained if the claimant chooses to do so unless there is a return to work with the USPS. In those cases the USPS will always make the HBI/LI deductions.)

- the claimant is no longer eligible for compensation benefits.

- the claimant/beneficiary dies. (If the claimant dies and we are accepting the widow/er's claim for death benefits, request that the name of the enrollee be CHANGED to that of the widow/er, and ensure the coverage level is appropriate.)

If a claimant requests termination of his/her health insurance it is usually irrevocable and they may not re-enroll in the Federal Employees Health Benefits (FEHB) Program. Consult the SF-2809 instructions for all of the allowable reasons for reinstatement. Note that suspension of HBI (rather than termination) is possible if the claimant is enrolling in a Medicare/Medicaid based plan such as TRICARE or CHAMPVA. In these instances a letter is sent to the claimant advising them of the actions needed to suspend or reinstate coverage.

Life Insurance

Since DFEC does not enroll claimants in life insurance or make any changes to existing enrollments, any inquiries about enrollment should be referred to the claimant's employing agency, OPM, or the Office of Federal Employees Group Life Insurance (OFEGLI).

Basic Life Insurance (BLI)

Federal employees are automatically enrolled in BLI on the date employment begins unless they waive the coverage. However it cannot be assumed that every employee has BLI coverage. Deductions should only be made for BLI if DFEC receives verification that the claimant does in fact have the coverage. Note that premiums for BLI are free for all claimants with a date of injury prior to January 1, 1990. Deductions should be made for any claim with a date of injury after this date. Lastly, BLI premium deductions automatically stop at age 65. The BLI coverage then begins to reduce at a rate of 2% per month, until it reaches 25% of its value. Though the claimant is not paying premiums, they will always maintain that 25% coverage. Should the claimant die after the BLI coverage is reduced, the beneficiary/survivor will be entitled to whatever reduction level the BLI has reached at the time of death.

Optional Life Insurance (OLI)

In order to be eligible for OLI, the claimant must also be enrolled in BLI, unless the date of injury is prior to January 1, 1990. In that case the BLI coverage is free, so there is no need to key the deduction. The premiums for OLI are withheld until the claimant reaches age 65, and then they will automatically stop at the first full periodic roll payment after the claimant's 65th birthday. However, the claimant can elect to continue their Option B and/or Option C coverage past age 65. This is a "Post 65 Election" and it is open to all claimants who currently have Option B and/or C life insurance coverage. Note that this is not an opportunity to enroll in life insurance and elect coverage. A notice is sent to the claimant by DFEC two months prior to their 65th birthday warning them that their coverage will stop unless they contact OPM and elect to continue it. Should they elect to continue coverage past age 65, OPM will notify DFEC of the election and the level of coverage that is being maintained. Currently it is only possible to elect to continue Options B and C; Option A will always stop at age 65.

Post Retirement Basic Life Insurance (PRBLI)

At age 65, BLI coverage reduces by 75% in increments of 2% per month. Federal employees who retired or separated from Federal employment and continue to receive benefits from either DFEC or OPM on or after December 9, 1980, have the option of paying an extra premium for No Reduction or 50% Reduction in BLI, which is PRBLI. If the claimant selects a 50% reduction, coverage will reduce in 2% increments per month to the coverage option chosen. Claimants must elect this coverage when separated or retired from federal employment (usually after twelve months in LWOP status). DFEC is notified of this election via Form RI 76-13 from OPM and coverage is effective immediately. The deductions and coverage will continue until death or the claimant elects to reduce coverage. Note that prior to age 65, the claimant must pay for BOTH BLI and PRBLI if they elect it. At age 65 the BLI deduction will stop, though the PRBLI deductions will continue.

Upon notification of a PRBLI election, the claims examiner should adjust the periodic roll payment to include PRBLI and have the adjustment certified. The "75% reduction" option is free, and the "50% Reduction" and "No Reduction" options are calculated by iFECS. You must use the annual salary provided by OPM on the RI 76-13 form for PRBLI. This is considered the "final" annual salary for life insurance purposes. That figure should always be used when keying LI deductions, even if it is different from the annual salary used to calculate compensation.

Dental and Vision Insurance (FEDVIP)

Unlike health benefits and life insurance deductions, there is currently no process for Dental and Vision deductions to be added into the existing periodic roll payment by the claims examiner. This action must be taken by the National Office, and it is done when notified of coverage via a monthly update from OPM. Once notified, the National Office will add the deductions to the claimant's periodic roll payment and no action is required by the district office.

As with life insurance, DFEC does not enroll claimants in Dental/Vision benefits or make any changes to existing enrollments. Should the claims examiner receive a question from a claimant concerning this coverage, they should be advised to contact the FEDVIP program directly at (877) 888-3337. The claimant should indicate that they receive workers' compensation benefits so that their coverage can be added to the monthly update process noted above.

If the periodic roll payment is deleted and later re-entered for some reason, the Dental/Vision deduction will not be saved during the re-entry of the plate. Since it cannot be entered locally, the Chief of the Branch of Fiscal Operations, National Office must be contacted for assistance. Seek local guidance on your point of contact to initiate this communication with the National Office.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 1 - FolioViews Groups A and D (Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists and Staff Nurses)

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FECA CIRCULAR NO. 09-05

August 26, 2009


SUBJECT: Release of Documents from Federal Employees' Compensation (FECA) Files

This circular is intended to provide guidance in situations where information or copies of information are requested from a claimant's FECA case file. While such requests may come from the claimant or his/her authorized representative, the Department of Labor or employing agency Office of Inspector General, claimant's former spouse or other entity, this circular focuses primarily on what information may be requested by the employing agency and when it may be provided. Because FECA case files are governed by the Privacy Act of 1974 and because FECA case file documents contain Personally Identifiable Information (PII), great care must be taken in handling requests for information. The extent to which information may be released out of a FECA case file is governed by the Privacy Act. Descriptions of the agency's role in the claims process are set forth in the FECA statute, its implementing regulations, and guidance such as the program Procedure Manuals and the Agency Handbook, CA-810. While the agency is not a party to the claim, the agency plays a critical role in the FECA process, particularly in return to work; it may request and receive documentation, including medical reports, to fulfill its role in the claims process.

Background:

All records relating to claims for FECA benefits are covered by the government-wide Privacy Act system of records entitled DOL/GOVT-1. Information from the FECA file may only be released pursuant to a need to know within DOL, a published routine use, a signed Privacy Act waiver, or a court order from a court of competent jurisdiction. Release of information in accordance with a routine use must be consistent with the purpose for which the file was created, which is the administration of the FECA case.

The FECA regulations at 20 C.F.R. § 10.11 make clear that the protection, release, inspection and copying of records covered by DOL/GOVT-1 should be carried out in accordance with the rules, guidelines and provisions of Subpart A of the FECA regulations, as well as those contained in 29 C.F.R. parts 70 and 71, which are the Department's regulations implementing the Freedom of Information Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C. 552a) respectively, as well as with the notice of system of records and routine uses published in the Federal Register. The Office of Workers' Compensation Programs (OWCP) has determined that records covered by DOL/GOVT-1 may not be used in connection with a personnel action absent consent of the subject of the record. It is not permissible to use or release FECA documents in connection with personnel matters unless they have first obtained the claimant's written consent. Any questions an agency has concerning the disclosure of FECA-related documents or uses of such documents by the agency should be referred to the OWCP for resolution. 63 Federal Register 56752, 56753 (October 22, 1998).

A "routine use" authorizes disclosing information from the FECA claim file without first obtaining the claimant's permission—such disclosure is acceptable because the routine use is listed and published in the Privacy Act Systems Notice for DOL/GOVT-1, and because OWCP has concluded that the anticipated use of the document is consistent with the purpose for which the information was collected. These routine uses include: sending the record to medical providers asked by OWCP to examine or treat the claimant; providing relevant information about the nature and mechanism of the injury or illness to health and safety officials within the employing agency1; providing relevant documents to nurses and rehabilitation counselors assigned by OWCP to work on the case; providing documents to employing agency personnel (but only for purposes related to the claim, and not for other reasons such as personnel actions); providing documents pertaining to the factual circumstances of the case to credit bureaus; and others. A listing of the universal routine uses which apply to all Department of Labor (DOL) system of records can be found at http://www.dol.gov/sol/privacy/intro.htm. A listing of the routine uses specific to DOL/GOVT-1 can be found at http://www.dol.gov/sol/privacy/dol-govt-1.htm. [See DOL Privacy Act System of Record Notices, 67 FR 16825, at 16827-16828 (April 8, 2002).] Routine use b for DOL/GOVT-1 authorizes release of case file information "To federal agencies that employed the claimant at the time of the occurrence or recurrence of the injury or occupational illness in order to verify billing, to assist in administering the FECA, to answer questions about the status of the claim, to consider rehire, retention or other actions the agency may be required to take with regard to the claim or to permit the agency to evaluate its safety and health program."

Handling requests:

1. Regarding general requests from employing agencies, OWCP's Division of Federal Employees' Compensation (DFEC) may grant requests from agencies for records pertaining to their employees. If records are to be released, Claims Examiners (CEs) should ensure that the requestor is agency-authorized, and should require proper identification before releasing only that information directly relevant to the request. For example, if an agency needs to formulate a job offer and needs to know a claimant's medical restrictions, relevant medical reports may be released. Blanket release of the entire case record is not appropriate, except to an investigative body (DOL Office of Inspector General (OIG) or Employing Agency OIG), or to an Agency Injury Compensation Specialist who must understand that indiscriminate or widespread further release of the FECA record within the employing agency is not authorized or permitted by OWCP/DFEC.2

2. Employing agency personnel who inquire about releasing claims-related material from their files should be referred to 20 C.F.R. 10.10-10.13, as well as paragraph 9-2 of Injury Compensation for Federal Employees (Publication CA-810).

3. An agency representative may ask to inspect files at the district office. OWCP will accommodate all such requests subject to logistical and physical limitations, including reasonable advance notice of the visit and a list of cases to be reviewed. Once the agency representative has presented satisfactory identification, requested documents from the FECA claim file may be released. However, the agency representative must provide a separate statement regarding the reason for any requested documents for each FECA claim for which copies of documents are requested. Release of complete case records to employing agencies will occur very infrequently and the employing agency must establish a reasonable need for such a request.

4. Release of documents within the FECA case record to employing agencies is a permitted routine use. However, the Office may decline to release information not pertinent to the investigation or audit or may request the agency to provide additional rationale for requesting the information.

5. While documents within the FECA case record may be released to employing agencies, the use of these copies must be consistent with the reason the information was collected. In practice, this means that the use must be connected in some way with the compensation claim. Absent truly unusual circumstances (such as a FECA claimant's improper actions in the FECA claim forming the basis of a disciplinary action and with explicit DOL permission), agencies may not use copies of information from claim files in connection with EEO complaints, disciplinary actions or other administrative actions without the employee's consent.

6. A request for copies of documents contained in the FECA case record received from an employing agency must contain a reason for the request. If the reason stated is consistent with the purpose for which the information was collected, such copy requests will generally be honored. The CE is not required to determine whether the evidence of record indicates the claimant is currently capable of returning to work before providing the employing agency injury compensation specialist (or an individual performing those duties) with current medical reports for the stated purpose of attempting re-employment of the injured worker.

7. Whether in writing or in person, the agency representative may make a copy request using a standard request form attached to this Circular, or may use any signed statement which includes the required information. All such copy requests will be included in the FECA case record.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 2—Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, Staff Nurses and Fiscal Personnel)

 

Attachment 09-05

EMPLOYING AGENCY REQUEST FOR COPIES OF DOCUMENTS FROM FECA CASE RECORDS (place in case file)

Claim Number: __________________________________

Claimant Name: _________________________________

As an authorized representative of ___________________ I am requesting a copy of the following documents from the above noted FECA claim record:

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

These copies are being requested for the following reason(s):

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

I understand that the use of these document copies must be consistent with the reason for which they were collected and may not be used in connection with personnel actions without the employee's consent.

 

Signature: ________________________________________

Date: ____________________________________________

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FECA CIRCULAR NO. 08-01

December 15, 2007


SUBJECT: Debt Collection – Classification of Aged Delinquent Debts as Currently Not Collectable (CNC)

Pursuant to Office of Management and Budget (OMB) Circular No. A-129, and recent policy released by the Department's Office of the Chief Financial Officer (OCFO), the iFECS Debt System will re-classify aged delinquent debts. Specifically, all debts which remain delinquent for two years or more, including those referred to the U.S. Treasury, will be re-classified as "Currently Not Collectable" or "CNC". While this re-classification will remove the debts from the active debt balance that the Program maintains, per OMB and OCFO guidance, the debts will remain eligible for recoupment.

It will be the responsibility of the DFEC National Office to re-classify these debts as they become eligible for CNC status. Debts in CNC status will continue to be reported in the Receivables Report, under a separately defined reporting category. In addition, these debts remain eligible for both Treasury offset and cross-servicing. Should funds be recovered by Treasury on a CNC debt, monies will be applied to the debt in the same manner as all delinquent debts.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 2--Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Fiscal Personnel)

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FECA CIRCULAR NO. 08-02

December 31, 2007


SUBJECT: Dual Benefits - FERS Cost of Living Adjustments

Effective December 1, 2007, benefits issued by the Social Security Administration (SSA) will be increased by 2.3%. This requires the amount of the Federal Employee Retirement System (FERS) Dual Benefits deduction to be increased by the same amount, to ensure the dollar-for-dollar offset remains current.

This adjustment will be made from the National Office for all cases that were correctly entered into the iFECS Compensation program. The adjustment will be effective with the periodic roll cycle beginning December 23, 2007. There will be no adjustment or overpayment declared for the period of December 1, 2007 through December 22, 2007.

The historical SSA cost of living adjustments are as follows:

Historical SSA cost of living adjustments

Dates

Percentage

12/01/2006 - 11/30/2007
12/01/2005 - 11/30/2006
12/01/2004 - 11/30/2005
12/01/2003 - 11/30/2004
12/01/2002 - 11/30/2003
12/01/2001 - 11/30/2002
12/01/2000 - 11/30/2001
12/01/1999 - 11/30/2000
12/01/1998 - 11/30/1999
12/01/1997 - 11/30/1998
12/01/1996 - 11/30/1997
12/01/1995 - 11/30/1996
12/01/1994 - 11/30/1995

3.3%
4.1%
2.7%
2.1%
1.4%
2.6%
3.5%
2.4%
1.3%
2.1%
2.9%
2.6%
2.8%

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 1 - FolioViews Groups A and D (Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists and Staff Nurses)

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FECA CIRCULAR NO. 08-03

January 31, 2008


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

The interest rate to be assessed for the prompt payment bills is 4.75 percent for the period of January 1, 2008 through June 30, 2008. This new rate has already been updated in the Central Bill Payment tables.

The rate for assessing interest charges on debts due the government has also changed effective January 1, 2008. The interest rate for assessing interest charges on debts due the government is now 5.0 percent for the period of January 1, 2008 through December 31, 2008. The interest rate tables in the iFECS Debt System have been updated to reflect these changes.

Ordinarily, the rate of interest charged on debts due the government is only changed in January and is effective for the entire year. However, the rate may be changed in July if there is a difference in the Current Value of Funds (CVF) interest rate of more than two percent. The rates are reviewed each June and if the rate has changed another Circular will be published to advise all appropriate personnel of the new rate.

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.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

 

Attachments

Distribution: List No. 2--Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, Staff Nurses and Fiscal Personnel)

PROMPT PAYMENT INTEREST RATES

Dates

Percentage

7/1/07 - 12/31/07

5¾%

1/1/07 - 6/30/07

5¼%

7/1/06 - 12/31/06

5¾%

1/1/06 - 6/30/06

5%

7/1/05 - 12/31/05

4½%

1/1/05 - 6/30/05

4¼%

7/1/04 - 12/31/04

4½%

1/1/04 - 6/30/04

4.0%

7/1/03 - 12/31/03

3%

1/1/03 - 6/30/03

4¼%

7/1/02 - 12/31/02

5¼%

1/1/02 - 6/30/02

5½%

7/1/01 - 12/31/01

5%

1/1/01 - 6/30/01

6%

7/1/00 - 12/31/00

7¼%

1/1/00 - 6/30/00

6¾%

 

 

7/1/99 - 12/31/99

6½%

1/1/99 - 6/30/99

5.0%

7/1/98 - 12/31/98

6.0%

1/1/98 - 6/30/98

6¼%

7/1/97 - 12/31/97

6¾%

1/1/97 - 6/30/97

6%

7/1/96 - 12/31/96

7.0%

1/1/96 - 6/30/96

5%

7/1/95 - 12/31/95

6%

1/1/95 - 6/30/95

8%

7/1/94 - 12/31/94

7.0%

1/1/94 - 6/30/94

5½%

7/1/93 - 12/31/93

5%

1/1/93 - 6/30/93

6½%

7/1/92 - 12/31/92

7.0%

1/1/92 - 6/30/92

6%

7/1/91 - 12/31/91

8½%

1/1/91 - 6/30/91

8%

7/1/90 - 12/31/90

9.0%

1/1/90 - 6/30/90

8½%

   

7/1/89 - 12/31/89

9%

1/1/89 - 6/30/89

9¾%

7/1/88 - 12/31/88

9¼%

1/1/88 - 6/30/88

9%

7/1/87 - 12/31/87

8%

1/1/87 - 6/30/87

7%

7/1/86 - 12/31/86

8½%

1/1/86 - 6/30/86

9¾%

7/1/85 - 12/31/85

10%

1/1/85 - 6/30/85

12%

 

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DEBT MANAGEMENT INTEREST RATES

Dates

Percentage

1/1/07 - 12/31/07

4%

7/1/06 - 12/31/06

4%

1/1/06 - 12/31/06

2%

1/1/05 - 12/31/05

1%

   

1/1/04 - 12/31/04

1%

1/1/03 - 12/31/03

2%

7/1/02 - 12/31/02

3%

1/1/02 - 06/30/02

5%

1/1/01 - 12/31/01

6%

1/1/00 - 12/31/00

5%

 

 

1/1/99 - 12/31/99

5%

1/1/98 - 12/31/98

5%

1/1/97 - 12/31/97

5%

1/1/96 - 12/31/96

5%

7/1/95 - 12/31/95

5%

1/1/95 - 06/30/95

3%

 

 

1/1/94 - 12/31/94

3%

1/1/93 - 12/31/93

4%

1/1/92 - 12/31/92

6%

1/1/91 - 12/31/91

8%

1/1/90 - 12/31/90

9%

   

1/1/89 - 12/31/89

7%

1/1/88 - 12/31/88

6%

1/1/87 - 12/31/87

7%

1/1/86 - 12/31/86

8%

1/1/85 - 12/31/85

9%

 

 

Prior to 01/01/84

not applicable

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FECA CIRCULAR NO. 08-04

March 31, 2008


SUBJECT: DFEC PROTOCOL STATEMENT – OIG AUDITS, EVALUATIONS AND INVESTIGATIONS

Federal agencies' increased awareness of the monies spent on workplace injuries under the Federal Employees' Compensation Act (FECA) has prompted agencies and their respective Office of Inspectors General (OIG) to look for ways to reduce costs, return more people to work and increase identification and prevention of fraud in the program. Consequently the Division of Federal Employees' Compensation (DFEC) is receiving an increasing number of requests for information from the OIG community as they perform audits, evaluations, inspections and investigations. While, as a program, we want to be fully cooperative with the OIGs, OIG projects must be coordinated in a way that does not interfere with our ability to perform our mission. It is important that DFEC approach these requests with a consistent and coherent process that ensures that DFEC coordinates, cooperates and supports these requests in a manner that preserves program resources and avoids duplication of effort.

Each district office will designate a point of contact (POC) for all OIG requests. The designee should be easily accessible and readily available to the OIG representative. These names will be provided to the OIG community for use solely for this purpose.

It is important to differentiate between types of IG requests such as:

1) Investigations of a single case or medical provider.
Such investigations are normally directed toward a single case or a single medical provider where a potential violation of law is under investigation. Agency IG investigate fraud cases involving their own agency employees/former employees and may also investigate related medical provider fraud in such cases.

2) Audits and evaluations
Audits and evaluations tend to review a specific process or processes. Data mining is an audit function. An IG is permitted to audit only its own agency's processes. The only data that could be made available would pertain solely to the requesting agency's cases; the primary focus of such an evaluation is the agency's part in the FECA process. (The Department of Labor Office of Inspector General has overall audit responsibility for the FECA program, as FECA is a DOL administered program.)

Single case investigations

The OIG should provide advance notice to the district's POC when coming into the office to review cases. The necessary lead time will be dependent on local usage of the viewing kiosk and may be as much as three weeks for a non-emergency review. Case records may also be supplied on encrypted CD-ROM if the case is fully imaged. When an employing agency IG investigator requests to view a case record, he/she will be required to sign a brief statement prior to gaining access to the file to the effect that access to the file is being requested based on an investigation into a potential violation of law. These statements will not be placed in the individual case records but should be maintained by the district's POC in a separate file.

Investigative memoranda (IM) and supporting documentation should not be placed in the DFEC case record until the investigation is completed. However, a decision cannot be rendered that considers evidence in an IM until the IM and any supporting documentation is included in the case record. Our longstanding policy, as set forth in the OWCP Procedure Manual, Part 1-0400.7(a)(1)(b), states that "Most documents that originate with an investigative agency and are given to OWCP with the expectation that OWCP act on them, become releasable as a part of the case file. The only exception would be for witness statements that would jeopardize the privacy of the witness." As the Privacy Act requires that a FECA claimant is entitled to a copy of his/her case record upon request, it follows that a claimant is entitled to receive the investigative materials (including videotapes) that are part of the case file.

Of course, not all investigations will lead to criminal prosecution. When IMs are referred to the district office, a designated individual should review each IM to determine if the investigation establishes inconsistencies or calls into question the validity of the medical evidence, the severity of the employment injury or the reported work restrictions or whether it establishes unreported work activity. Such documentation of misrepresentation of physical disability does not result in immediate termination of compensation. However, it will be placed in the file and used for future case management actions such as an amendment to the Statement of Accepted Facts or second opinion medical examination. (See FECA PM 2-0402.6.) The Employees' Compensation Appeals Board now requires that a claimant be notified if a videotape is being provided to a doctor performing an OWCP-directed medical examination. See J.M., ECAB Docket No. 2006-0661 (April 25, 2007) (OWCP "has the responsibility to make the claimant aware that it is providing videotape evidence to a medical expert.")

OIGs may be asked to differentiate between questionable physical disability and unreported work activity. Memoranda reflecting possible questionable physical disability will be considered a Report of Investigation rather than an IM. IMs will be specifically assigned and tracked in each district office. However, Reports of Investigation will not be tracked, although the district office may expect the OIG to confirm with the POC that the Report of Investigation was fully reviewed for possible claims action. Physical evidence of investigations submitted to DFEC should be in an easily viewable format; currently Windows Media Player compatible. DFEC will maintain the security of the physical evidence.

Should the claims examiner discover actual or suspected abuse or fraud in FECA claims, an OWCP referral to OIG will be made based on instructions contained in the FECA Procedure Manual at PM 2-0402.7 and PM 2-0402.8.

Audit and evaluation processes

An IG is permitted to audit its own agency's processes. Much of the information necessary for official investigative purposes should be contained in the weekly, monthly and quarterly extracts provided to each agency's compensation management office. The weekly extracts contain case management, bill payment and compensation payment detail data; monthly extracts contain new case-create data; quarterly extracts contain agency chargeback data. We will not duplicate our efforts to reproduce these data runs. The OIG should be referred to their agency's injury compensation management program coordinator. However, if the audit requires data that is not routinely sent by OWCP to the employer, the agency OIG should schedule a meeting with the DFEC Deputy Director to discuss the request. The discussion will cover the project's objectives, clarify the types of data needed and identify the format for receiving them. This initial meeting is intended to pinpoint data needs and availability, thereby reducing additional data requests to OWCP and preserving program resources while supporting these requests. The OIG should also notify DOL OIG Assistant Inspector General for Audit (AIGA) of the planned work.

Any single case investigation requests received by the district office's POC that cross district office jurisdictional lines must be forwarded to the DFEC Deputy Director for review in order to avoid repetition of data runs and to pinpoint the OIG needs. Additionally, any data requests for audit or evaluation purposes should be forwarded to the DFEC Deputy Director for review and response. This allows DFEC to track these requests closely and to explain fully to the various OIG offices what information is available in the system and what the information means.

All OWCP records relating to claims for benefits, including copies of such records maintained by an employer, are considered confidential and may not be released, inspected, copied or otherwise disclosed except as provided in the Freedom of Information Act (5 U.S.C. § 552) and the Privacy Act of 1974 (5 U.S.C. § 552a). OWCP information is available to be used by employing agencies only for purposes consistent with the routine uses in OWCP's system of records for FECA information, DOL/GOVT-1. Requests from an agency for materials in a case file should include the specific reason for requesting the information.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 1 – FolioViews Groups A and D (Claims Examiners, All Supervisors, District Medical Advisers, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

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FECA CIRCULAR NO. 08-05

August 15, 2008


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

The interest rate to be assessed for the prompt payment bills is 5.125 percent for the period of July 1, 2008 through December 31, 2008. This new rate has already been updated in the Central Bill Payment tables.

The rate for assessing interest charges on debts due the government has also changed effective July 1, 2008. The interest rate for assessing interest charges on debts due the government is now 3.0 percent for the period of July 1, 2008 through December 31, 2008. The interest rate tables in the iFECS Debt System have been updated to reflect these changes.

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.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Attachments

Distribution: List No. 2--Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, Staff Nurses and Fiscal Personnel)

PROMPT PAYMENT INTEREST RATES

Dates

Percentage

7/1/08 – 12/31/08

5%

1/1/08 – 6/30/08

4¾%

7/1/07 - 12/31/07

5¾%

1/1/07 - 6/30/07

5¼%

7/1/06 - 12/31/06

5¾%

1/1/06 - 6/30/06

5%

7/1/05 - 12/31/05

4½%

1/1/05 - 6/30/05

4¼%

7/1/04 - 12/31/04

4½%

1/1/04 - 6/30/04

4.00%

7/1/03 - 12/31/03

3%

1/1/03 - 6/30/03

4¼%

7/1/02 - 12/31/02

5¼%

1/1/02 - 6/30/02

5½%

7/1/01 - 12/31/01

5%

1/1/01 - 6/30/01

6%

7/1/00 - 12/31/00

7¼%

1/1/00 - 6/30/00

6¾%

 

 

7/1/99 - 12/31/99

6½%

1/1/99 - 6/30/99

5.00%

7/1/98 - 12/31/98

6.00%

1/1/98 - 6/30/98

6¼%

7/1/97 - 12/31/97

6¾%

1/1/97 - 6/30/97

6%

7/1/96 - 12/31/96

7.00%

1/1/96 - 6/30/96

5%

7/1/95 - 12/31/95

6%

1/1/95 - 6/30/95

8%

7/1/94 - 12/31/94

7.00%

1/1/94 - 6/30/94

5½%

7/1/93 - 12/31/93

5%

1/1/93 - 6/30/93

6½%

7/1/92 - 12/31/92

7.00%

1/1/92 - 6/30/92

6%

7/1/91 - 12/31/91

8½%

1/1/91 - 6/30/91

8%

7/1/90 - 12/31/90

9.00%

1/1/90 - 6/30/90

8½%

   

7/1/89 - 12/31/89

9%

1/1/89 - 6/30/89

9¾%

7/1/88 - 12/31/88

9¼%

1/1/88 - 6/30/88

9%

7/1/87 - 12/31/87

8%

1/1/87 - 6/30/87

7%

7/1/86 - 12/31/86

8½%

1/1/86 - 6/30/86

9¾%

7/1/85 - 12/31/85

10%

1/1/85 - 6/30/85

12%

 

ATTACHMENT TO FECA CIRCULAR NO. 08 – 05

 

Back to Top of FECA Circular No. 08-05

DEBT MANAGEMENT INTEREST RATES

Dates

Percentage

7/1/08 - 12/31/08

3%

1/1/08 - 6/30/08

5%

1/1/07 - 12/31/07

4%

7/1/06 - 12/31/06

4%

1/1/06 - 12/31/06

2%

1/1/05 - 12/31/05

1%

   

1/1/04 - 12/31/04

1%

1/1/03 - 12/31/03

2%

7/1/02 - 12/31/02

3%

1/1/02 - 06/30/02

5%

1/1/01 - 12/31/01

6%

1/1/00 - 12/31/00

5%

 

 

1/01/99 - 12/31/99

5%

1/01/98 - 12/31/98

5%

1/01/97 - 12/31/97

5%

1/01/96 - 12/31/96

5%

7/01/95 - 12/31/95

5%

1/01/95 - 06/30/95

3%

 

 

1/1/94 - 12/31/94

3%

1/1/93 - 12/31/93

4%

1/1/92 - 12/31/92

6%

1/1/91 - 12/31/91

8%

1/1/90 - 12/31/90

9%

   

1/1/89 - 12/31/89

7%

1/1/88 - 12/31/88

6%

1/1/87 - 12/31/87

7%

1/1/86 - 12/31/86

8%

1/1/85 - 12/31/85

9%

 

 

Prior to 01/01/84

not applicable

 

ATTACHMENT TO FECA CIRCULAR NO. 08 – 05

 

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FECA CIRCULAR NO. 07-01

February 1, 2007


SUBJECT: Dual Benefits - FERS

Reference is made to FECA Bulletin 97-9, where the procedures for computing FERS Dual Benefits are outlined. Action item 3 indicates a point of contact at SSA who was performing the necessary computations for OWCP. These computations are currently assigned to a number of modules based on the last two digits of the SSN as follows:

Points of contact at SSA and corresponding SSN and modules

Module number

Numbers

Contact

Phone

FAX

Module 1

00-16

Pat Shahverdian

410-965-9388

410-597-0498

Module 2

17-32

Zorita Shivers

410-965-8063

410-966-6782

Module 3

33-49

Dennis Profili

410-966-5566

410-965-8054

Module 4

50-66

Shirley Davis

410-965-9425

410-965-9409

410-965-6030

Module 5

67-82

Wanda Russell

410-965-5255

410-966-5552

410-965-6539

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FECA CIRCULAR NO. 07-02

August 1, 2007


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

The interest rate to be assessed for the prompt payment bills is 5.25 percent for the period of January 1, 2007 through December 31, 2007. This new rate has already been updated in the Central Bill Payment tables.

The rate for assessing interest charges on debts due the U.S. Government changed in June 2006, despite the increase in January 2006. The interest rate for assessing interest charges on debts due the U.S. Government is now 4.0 percent for the period of July 1, 2006 through December 31, 2007. The interest rate tables in the iFECS Debt System have been updated to reflect these changes.

Ordinarily, the rate of interest charged on debts due the U.S. Government is only changed in January, and is effective for the entire year. However, the rate may be changed in July if there is a difference in the Current Value of Funds (CVF) interest rate of more than two percent. The rates are reviewed each June, and if the rate has changed another Circular will be published to advise all appropriate personnel of the new rate.

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.

 

Douglas Fitzgerald
Director for
Federal Employees' Compensation

Attachments

Distribution: List No. 2--Folioviews Groups A, B, and D
(Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Fiscal Personnel)

PROMPT PAYMENT INTEREST RATES

Dates

Percentage

7/01/07 - 12/31/07

5.750%

1/01/07 - 6/30/07

5.250%

7/01/06 - 12/31/06

5.750%

1/01/06 - 6/30/06

5.125%

7/01/05 - 12/31/05

4.500%

1/01/05 - 6/30/05

4.250%

   

7/01/04 - 12/31/04

4.500%

1/01/04 - 6/30/04

4.000%

7/01/03 - 12/31/03

3.125%

1/01/03 - 6/30/03

4.250%

7/01/02 - 12/31/02

5.250%

1/01/02 - 6/30/02

5.500%

7/01/01 - 12/31/01

5.875%

1/01/01 - 6/30/01

6.375%

7/01/00 - 12/31/00

7.250%

1/01/00 - 6/30/00

6.750%

 

 

7/01/99 - 12/31/99

6.500%

1/01/99 - 6/30/99

5.000%

7/01/98 - 12/31/98

6.000%

1/01/98 - 6/30/98

6.250%

7/01/97 - 12/31/97

6.750%

1/01/97 - 6/30/97

6.375%

7/01/96 - 12/31/96

7.000%

1/01/96 - 6/30/96

5.875%

7/01/95 - 12/31/95

6.375%

1/01/95 - 6/30/95

8.125%

 

 

7/01/94 - 12/31/94

7.000%

1/01/94 - 6/30/94

5.500%

7/01/93 - 12/31/93

5.625%

1/01/93 - 6/30/93

6.500%

7/01/92 - 12/31/92

7.000%

1/01/92 - 6/30/92

6.875%

7/01/91 - 12/31/91

8.500%

1/01/91 - 6/30/91

8.375%

7/01/90 - 12/31/90

9.000%

1/01/90 - 6/30/90

8.500%

 

 

7/01/89 - 12/31/89

9.125%

1/01/89 - 6/30/89

9.750%

7/01/88 - 12/31/88

9.250%

1/01/88 - 6/30/88

9.375%

7/01/87 - 12/31/87

8.875%

1/01/87 - 6/30/87

7.625%

7/01/86 - 12/31/86

8.500%

1/01/86 - 6/30/86

9.750%

7/01/85 - 12/31/85

10.375%

1/01/85 - 6/30/85

12.125%

Back to Top of FECA Circular No. 07-02

DEBT MANAGEMENT INTEREST RATES

Dates

Percentage

1/01/07 - 12/31/07

4%

7/01/06 - 12/31/06

4%

1/01/06 - 12/31/06

2%

1/1/05 - 12/31/05

1%

   

1/01/04 - 12/31/04

1%

1/01/03 - 12/31/03

2%

7/01/02 - 12/31/02

3%

1/01/02 - 06/30/02

5%

1/01/01 - 12/31/01

6%

1/01/00 - 12/31/00

5%

 

 

1/01/99 - 12/31/99

5%

1/01/98 - 12/31/98

5%

1/01/97 - 12/31/97

5%

1/01/96 - 12/31/96

5%

7/01/95 - 12/31/95

5%

1/01/95 - 06/30/95

3%

 

 

1/01/94 - 12/31/94

3%

1/01/93 - 12/31/93

4%

1/01/92 - 12/31/92

6%

1/01/91 - 12/31/91

8%

1/01/90 - 12/31/90

9%

   

1/01/89 - 12/31/89

7%

1/01/88 - 12/31/88

6%

1/01/87 - 12/31/87

7%

1/01/86 - 12/31/86

8%

1/01/85 - 12/31/85

9%

 

 

Prior to 01/01/84

not applicable

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FECA CIRCULAR NO. 06-01

March 1, 2006


SUBJECT: Dual Benefits - FERS Cost of Living Adjustments

Effective December 1, 2005, benefits issued by the Social Security Administration (SSA) will be increased by 4.1%. This requires the amount of the Federal Employee Retirement System (FERS) Dual Benefits deduction to be increased by the same amount, to ensure the dollar-for-dollar offset remains current.

This adjustment will be made from the National Office for all cases that were correctly entered into the iFECS Compensation application. The adjustment will be effective with the periodic roll cycle beginning January 22, 2006. There will be no adjustment or overpayment declared for the period of December 1, 2005 through January 21, 2006.

The National Office will provide a notice to each beneficiary affected. A copy will also be provided for each case record.

The historical SSA cost of living adjustments are as follows:

Dates

Percentage

12/01/2004 - 11/30/2005
12/01/2003 - 11/30/2004
12/01/2002 - 11/30/2003
12/01/2001 - 11/30/2002
12/01/2000 - 11/30/2001
12/01/1999 - 11/30/2000

12/01/1998 - 11/30/1999
12/01/1997 - 11/30/1998
12/01/1996 - 11/30/1997
12/01/1995 - 11/30/1996
12/01/1994 - 11/30/1995

2.7%
2.1%
1.4%
2.6%
3.5%
2.4%

1.3%
2.1%
2.9%
2.6%
2.8%

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 1 - Folioviews Groups A and
(Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitations Specialists, and Staff Nurses)

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FECA CIRCULAR NO. 06-02

March 1, 2006


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

The interest rate to be assessed for the prompt payment bills is 4.5 percent for the period of January 1, 2006 through December 31, 2006.

The rate for assessing interest charges on debts due the U.S. Government has changed this year, for the first time since January 2004. The interest rate for assessing interest charges on debts due the U.S. Government is now 2.0 percent for the period of January 1, 2006 through December 31, 2006.

Ordinarily, the rate of interest charged on debts due the U.S. Government is only changed in January and is effective for the entire year. However, the rate may be changed in July if there is a difference in the Current Value of Funds (CVF) interest rate of more than two percent. The rates are reviewed each June and if the rate has changed another Circular will be published to advise all appropriate personnel of the new rate.

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.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Attachments

Distribution: List No. 2--Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Fiscal Personnel)

ATTACHMENT TO FECA CIRCULAR NO. 06-02

PROMPT PAYMENT INTEREST RATES

Dates

Percentage

1/1/06 - 12/31/06

4 1/2%

   

1/1/05 - 12/31/05

4 1/4%

1/1/04 - 12/31/04

4.0%

7/1/03 - 12/31/03

3 1/8%

1/1/03 - 6/30/03

4 1/4%

7/1/02 - 12/31/02

5 1/4%

1/1/02 - 6/30/02

5 1/2%

7/1/01 - 12/31/01

5 7/8%

1/1/01 - 6/30/01

6 3/8%

7/1/00 - 12/31/00

7 1/4%

1/1/00 - 6/30/00

6 3/4%

 

 

7/1/99 - 12/31/99

6 1/2%

1/1/99 - 6/30/99

5.0%

7/1/98 - 12/31/98

6.0%

1/1/98 - 6/30/98

6 1/4%

7/1/97 - 12/31/97

6 3/4%

1/1/97 - 6/30/97

6 3/8%

7/1/96 - 12/31/96

7.0%

1/1/96 - 6/30/96

5 7/8%

7/1/95 - 12/31/95

6 3/8%

1/1/95 - 6/30/95

8 1/8%

 

 

7/1/94 - 12/31/94

7.0%

1/1/94 - 6/30/94

5 1/2%

7/1/93 - 12/31/93

5 5/8%

1/1/93 - 6/30/93

6 1/2%

7/1/92 - 12/31/92

7.0%

1/1/92 - 6/30/92

6 7/8%

7/1/91 - 12/31/91

8 1/2%

1/1/91 - 6/30/91

8 3/8%

7/1/90 - 12/31/90

9.0%

1/1/90 - 6/30/90

8 1/2%

 

 

7/1/89 - 12/31/89

9 1/8%

1/1/89 - 6/30/89

9 3/4%

7/1/88 - 12/31/88

9 1/4%

1/1/88 - 6/30/88

9 3/8%

7/1/87 - 12/31/87

8 7/8%

1/1/87 - 6/30/87

7 5/8%

7/1/86 - 12/31/86

8 1/2%

1/1/86 - 6/30/86

9 3/4%

7/1/85 - 12/31/85

10 3/8%

1/1/85 - 6/30/85

12 1/8%

 

Back to Top of FECA Circular No. 06-02

DEBT MANAGEMENT INTEREST RATES

Dates

Percentage

1/1/06 - 12/31/06

2%

1/1/05 - 12/31/05

1%

1/1/04 - 12/31/04

1%

1/1/03 - 12/31/03

2%

7/1/02 - 12/31/02

3%

1/1/02 - 06/30/02

5%

 

 

1/1/01 - 12/31/01

6%

1/1/00 - 12/31/00

5%

1/1/99 - 12/31/99

5%

1/1/98 - 12/31/98

5%

1/1/97 - 12/31/97

5%

1/1/96 - 12/31/96

5%

 

 

7/1/95 - 12/31/95

5%

1/1/95 - 06/30/95

3%

1/1/94 - 12/31/94

3%

1/1/93 - 12/31/93

4%

1/1/92 - 12/31/92

6%

1/1/91 - 12/31/91

8%

 

 

1/1/90 - 12/31/90

9%

1/1/89 - 12/31/89

7%

1/1/88 - 12/31/88

6%

1/1/87 - 12/31/87

7%

1/1/86 - 12/31/86

8%

1/1/85 - 12/31/85

9%

 

 

Prior to 1/1/84

not applicable

 

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FECA CIRCULAR NO. 06-03

July 1, 2006


SUBJECT: Loss of Wage Earning Capacity Calculations Under Performance Based Alternative Pay Systems

While there have been alternative personnel systems in the federal government for over 20 years, the Department of Homeland Security's use of performance based alternative pay systems for several of their occupational series has raised the possibility that more federal employees will be moving out of the General Schedule and into alternative pay systems.

There are numerous performance-based pay systems but they all link individual base pay and bonuses to performance. Most options do not provide for any automatic pay increases. These pay systems give managers more flexibility in setting the pay for new hires as well as current employees.

In performance based pay systems (also known as pay banding), agencies may collapse the 15 General Schedule grades into a smaller number of pay ranges. For example, the GS grades could be collapsed into 4 bands which cover GS 1-5, GS 6-11, GS 12-13 and GS 14-15. Once the bands are defined, the agency may hire an employee at any pay amount within a band and determine how employees move within and across bands.

In calculating wage earning capacity, if the date of injury (DOI) position was paid based on a specific grade and step, there is no change in the process for determining the current pay rate for the date of injury position. However, as a result of the fluidity of pay rates within pay bands, there may not be a definitive grade and step for the date of injury pay rate. When calculating a loss of wage earning capacity in cases where a specific grade and step were not assigned to the date of injury position, the Claims Examiner (CE) will first need to determine the injured employee's DOI pay rate as a percentage of the appropriate band.

Once that percentage has been established, the current pay rate for the date of injury job (as entered in the Shadrick formula) will be the same percentage of the current pay range for the band in which the employee was being paid on the DOI. For example, if the employee was hired in the second band (with a range of $28,085 through $60,049) at a salary of $50,000, then they earn 69% of the total range. If the current range of the band in which they were being paid on the DOI is $35,000 through $72,000, then $60,530 will be the current salary since it is 69% of the new range. When calculating the percentage of the pay band range, normal rounding rules apply.

The steps for determining the percentage of the band on the date of injury are as follows:

1) Determine the range of the DOI pay band by deducting the lowest salary from the highest salary within that band.
2) Deduct the salary at the low end of the band from the actual salary paid to the claimant.
3) Take the amount from step 2 and divide it by the amount from step 1. This will give you the percentage of the salary range that the claimant earned on the date of injury.

The steps for determining the current salary for the date of injury job are as follows:

1) Determine the range of the current salaries for the DOI pay band by deducting the lowest salary from the highest salary within that band.
2) Multiply the amount from step 1 by the percentage of the band that the employee was earning at the date of injury.
3) Add the number obtained in the second step to the lowest salary in the current range for the appropriate band. This will give you the current pay rate for the job held when injured.

Once the current pay rate for the job held when injured is calculated according to the above instructions, it can be entered into the Shadrick formula so that a loss of wage earning capacity can be paid to the claimant.

References: FECA Procedure Manual Chapters 2-0814, 2-0900 and 2-0901

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 1--Folioviews Groups A and D
(Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists and Staff Nurses)

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FECA CIRCULAR NO. 06-04

August 28, 2006


SUBJECT: Case Management and Coding of Beryllium Claims

As noted in the MEDGUIDE as well as FECA Circular 05-03, there are several medical conditions which may result from exposure to beryllium, the more common being the pulmonary form or Chronic Beryllium Disease (CBD). These resources provide guidance on the initial adjudication of beryllium related claims, including medical facilities that provide the necessary objective testing.

Beryllium sensitization occurs in a subset of the people exposed to beryllium. In some of the workforce studies, the rate of CBD among those individuals with Beryllium Sensitivity (BeS) varied from 14 to 100%. The course of CBD is variable, ranging from a stable condition controllable with or without prescription medications to a poorly controlled, progressive condition that is debilitating and can be fatal. Because beryllium sensitization can progress to CBD in the presence or absence of added exposure, and, additionally, CBD can be treated, it is important to detect the pathologic changes in the lungs as early as possible. As a result, medical care will include the costs of periodic monitoring for the development of CBD where the accepted diagnosis is BeS.

Medical monitoring for patients with BeS includes:

Physical examination (CPT codes 99241 - 99245)
Chest x-ray (CPT codes 71010 - 71030)
CAT scan of the thorax (CPT codes 71250 - 71260)
Pulmonary function studies (CPT codes 94010, 94060-94070, 94375)
Diffusing capacity studies (CPT codes 94720 - 94725)
Exercise tolerance test (CPT codes 94620 - 94621)
Complete blood count (CPT codes 85004 - 85032)
Multiple blood chemistries (CPT codes 80048 - 80053)
Arterial blood gases (CPT codes 82800 - 82820)
Bronchoscopy (CPT codes 31622 - 31629, 31632-31633)
     w/trans bronchial lung biopsy w/wo fluoroscopic guidance
     w/trans bronchial needle aspiration biopsy
     w/biopsy (rigid or flexible)
Serum neopterin

These tests are usually performed on a yearly basis when the claimants are stable and symptom-free. However, if changes in the clinical condition of a claimant are noted, the treating physician may want to perform some or all of these tests at shorter intervals. A definitive diagnosis of CBD hinges on the presence of granulomas and/or mononuclear cell infiltrates in a lung biopsy, so a bronchoscopy and bronchial lung biopsy are the most important tests.

Unlike a more common condition, there are a limited number of physicians who specialize in the testing and treatment of beryllium related illnesses. When a request for authorization of testing or treatment is received (to include travel authorization when necessary), it should be reviewed and approved when reasonable. In order to insure that bills are paid correctly, please use the following acceptance codes:

Beryllium Sensitivity - V81.4
Chronic Beryllium Disease (Berylliosis) - 503

These codes are active in Code It Fast and should be utilized on all beryllium claims. The related objective testing and treatment authorizations are a part of the treatment suites for these codes, simplifying claims management.

 

DOUGLAS FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List 1 (Claims Examiners, All Supervisors, District Medical Advisers, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

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FECA CIRCULAR NO. 05-01

November 19, 2004


SUBJECT: DUAL BENEFITS - FERS COLA

Effective December 1, 2004, Social Security Benefits will be increased by 2.7%. This requires the amount of the FERS dual benefits deduction to be increased by the same amount.

This adjustment will be made from the National Office for all cases that were correctly entered into the ACPS Program. The adjustment will be effective with the periodic roll cycle beginning January 23, 2005. There will be no adjustment or overpayment declared for the period December 1, 2004 through January 22, 2005.

The National Office will provide a notice to each beneficiary affected. A copy will be provided for each case record.

SSA COLA's are as follows:

SSA COLA's
Effective Date Percentage

Effective December 1, 2004

2.7%

Effective December 1, 2003

2.1%

Effective December 1, 2002

1.4%

Effective December 1, 2001

2.6%

Effective December 1, 2000

3.5%

Effective December 1, 1999

2.4%

Effective December 1, 1998

1.3%

Effective December 1, 1997

2.1%

Effective December 1, 1996

2.9%

Effective December 1, 1995

2.6%

Effective December 1, 1994

2.8%

 

E. MARTIN WALKER
Acting Director for
Federal Employees' Compensation

Distribution: List No. 1, Folioviews Groups A and D(Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

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FECA CIRCULAR NO. 05-02

January 16, 2005


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

The interest rate to be assessed for the prompt payment bills is 4.25 percent for the period of January 1, 2005 through December 31, 2005.

The rate for assessing interest charges on debts due the government has not changed. The interest rate for assessing interest charges on debts due the government remains 1.0 percent for the period of January 1, 2005 through December 31, 2005.

Ordinarily, the rate of interest charged on debts due the government is only changed in January, and is effective for the entire year. However, the rate may be changed in July if there is a difference in the Current Value of Funds (CVF) interest rate of 2.0 percent or more. The rates are reviewed each June, and if the rate has changed another Circular will be published to advise all appropriate personnel of the new rate.

Attached to this Circular is an updated listing of both the prompt payment and DMS interest rates from January 1, 1985 through the current date.

 

JAMES L. DEMARCE
Acting Director for
Federal Employees' Compensation

Attachments

Distribution: List No. 2--Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, Systems Managers, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Fiscal and Bill Pay Personnel)

PROMPT PAYMENT INTEREST RATES

Date Percentage

1/1/05 - 12/31/05

4 1/4%

1/1/04 - 12/31/04

4.0%

7/1/03 - 12/31/03

3 1/8%

1/1/03 - 6/30/03

4 1/4%

7/1/02 - 12/31/02

5 1/4%

1/1/02 - 6/30/02

5 1/2%

7/1/01 - 12/31/01

5 7/8%

1/1/01 - 6/30/01

6 3/8%

7/1/00 - 12/31/00

7 1/4%

1/1/00 - 6/30/00

6 3/4%

 

 

7/1/99 - 12/31/99

6 1/2%

1/1/99 - 6/30/99

5.0%

7/1/98 - 12/31/98

6.0%

1/1/98 - 6/30/98

6 1/4%

7/1/97 - 12/31/97

6 3/4%

1/1/97 - 6/30/97

6 3/8%

7/1/96 - 12/31/96

7.0%

1/1/96 - 6/30/96

5 7/8%

7/1/95 - 12/31/95

6 3/8%

1/1/95 - 6/30/95

8 1/8%

 

 

7/1/94 - 12/31/94

7.0%

1/1/94 - 6/30/94

5 1/2%

7/1/93 - 12/31/93

5 5/8%

1/1/93 - 6/30/93

6 1/2%

7/1/92 - 12/31/92

7.0%

1/1/92 - 6/30/92

6 7/8%

7/1/91 - 12/31/91

8 1/2%

1/1/91 - 6/30/91

8 3/8%

7/1/90 - 12/31/90

9.0%

1/1/90 - 6/30/90

8 1/2%

 

 

7/1/89 - 12/31/89

9 1/8%

1/1/89 - 6/30/89

9 3/4%

7/1/88 - 12/31/88

9 1/4%

1/1/88 - 6/30/88

9 3/8%

7/1/87 - 12/31/87

8 7/8%

1/1/87 - 6/30/87

7 5/8%

7/1/86 - 12/31/86

8 1/2%

1/1/86 - 6/30/86

9 3/4%

7/1/85 - 12/31/85

10 3/8%

1/1/85 - 6/30/85

12 1/8%

 

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DMS INTEREST RATES

Date Percentage

1/1/05 - 12/31/05

1%

1/1/04 - 12/31/04

1%

1/1/03 - 12/31/03

2%

7/1/02 - 12/31/02

3%

1/1/02 - 06/30/02

5%

1/1/01 - 12/31/01

6%

1/1/00 - 12/31/00

5%

 

 

1/1/99 - 12/31/99

5%

1/1/98 - 12/31/98

5%

1/1/97 - 12/31/97

5%

1/1/96 - 12/31/96

5%

7/1/95 - 12/31/95

5%

1/1/95 - 06/30/95

3%

 

 

1/1/94 - 12/31/94

3%

1/1/93 - 12/31/93

4%

1/1/92 - 12/31/92

6%

1/1/91 - 12/31/91

8%

1/1/90 - 12/31/90

9%

 

 

1/1/89 - 12/31/89

7%

1/1/88 - 12/31/88

6%

1/1/87 - 12/31/87

7%

1/1/86 - 12/31/86

8%

1/1/85 - 12/31/85

9%

 

 

Prior to 1/1/84

not applicable

 

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FECA CIRCULAR NO. 05-03

March 1, 2005


SUBJECT: Adjudication of Claims - Claims Related to Beryllium Exposure

It has come to the attention of OWCP that there is likely to be an increase in claims filed under the FECA for illness and disability resulting from work-related exposure to beryllium. The Occupational Safety and Health Administration (OSHA) has provided extensive information regarding this issue in its OSHA Hazard Information Bulletins and pamphlets. The most likely federal employees to claim FECA coverage due to industrial exposure to beryllium are those of the Department of Energy and certain categories of employees at OSHA.

When OWCP receives claims for beryllium sensitivity, chronic beryllium disease (CBD) or other illnesses related to industrial exposure to beryllium, claims examiners (CEs) should note that even minimal or one instance of exposure can result in beryllium sensitization. The Med Guide (available in FolioViews) has been updated with information that will assist CEs in the adjudication of these cases. In addition, CEs are reminded that the 5 basic requirements necessary to establish entitlement under the FECA apply to these claims. Guidance for adjudicating occupational disease cases as set forth in the FECA Procedure Manual, Chapter 2-0806, should be used to establish the period, length, and levels of exposure in beryllium claims. Claims for schedule awards should also be processed in accordance with established regulations and procedures. It should be noted, however, that because this disease is closely connected to industrial exposure, CEs need not be concerned with possible non-work-related exposure if exposure during Federal employment is documented.

Although receipt of benefits under the Energy Employees' Occupational Illness Compensation Program Act (EEOICPA) does not affect a claimant's entitlement to benefits under the FECA, 42 U.S.C. § 7385c(c), the EEOICPA should serve as the primary payer of medical benefits for these FECA cases.

 

DOUGLAS FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 1--Folioviews Groups A and D (Claims Examiners, All Supervisors, Systems Managers, District Medical Advisors, Technical Assistants, Rehabilitation Specialists and Staff Nurses)

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FECA CIRCULAR NO. 05-04

April 18, 2005


SUBJECT: Bill Pay – Revised Form CA-16

To better inform medical providers and streamline our billing process, Form CA-16 now includes language outlining the specific types of services it covers and those it excludes. Under the heading "Information for Physician," the following three sentences were added to the subsection "Your Authorization":

This form covers office visits and consultations, laboratory work, hospital services (including inpatient), x-rays, MRIs, CT scans, physical therapy, emergency services (including surgery) and chiropractic services. Chiropractic services are limited to charges for physical examinations and x-rays to diagnose a subluxation of the spine and treatment consisting of manual manipulation of the spine to correct a subluxation demonstrated by x-ray.

This form does not cover elective and non-emergency surgery, home exercise equipment, whirlpools, mattresses, spa/gym membership and work hardening programs.

Although Form CA-16 was revised in February of this year, OWCP will continue to accept both versions of the form through June 30, 2005. However, effective July 1, all bills submitted under a Form CA-16 will be processed by ACS in accordance with the new coverage policy outlined above.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 1--Folioviews Groups A and D (Claims Examiners, All Supervisors, Systems Managers, District Medical Advisors, Technical Assistants, Rehabilitation Specialists and Staff Nurses)

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FECA CIRCULAR NO. 05-05

March 18, 2005


SUBJECT: Due Process – Revised Appeal Rights

As a part of our ongoing efforts to improve customer service, the Appeal Request Form has been updated in order to clarify the hearing options that are available to potential appellants. Specifically, under "ORAL HEARING," the revised form advises potential appellants of the following:

Depending on your geographical location, the issue involved in your case, the number of hearing requests in your area, and at the discretion of the hearing representative, we may be able to expedite your appeal by offering you a telephone hearing. If OWCP deems your case suitable for teleconference and you are open to this option, please check here. _____

This policy affords claimants who reside in areas where hearings are not frequently held the opportunity to receive an expedited hearing. It should be noted, however, that this option is granted solely at the Office's discretion.

 

DOUGLAS FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 1--Folioviews Groups A and D (Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

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FECA CIRCULAR NO. 05-06

July 1, 2005


SUBJECT: Imaged FECA Cases to Be Provided in Portable Document Format (PDF) on CD-ROM

In accordance with the Freedom of Information Act (FOIA) (5 U.S.C. 552) and the Privacy Act, with implementing regulations at 29 C.F.R. Parts 70 (FOIA) and 71 (Privacy) governing the production or disclosure of information or materials, it has been the practice of OWCP to provide copies of FECA case files to claimants and/or their authorized representatives. Up to the present time, this has involved the provision of paper copies only. However, with the recent use and proliferation of electronic media for access, research, documentation, and storage of records, it has become reasonable to expect and request access to one's records in an electronic format. In response to such requests from claimants or their representatives, OWCP has considered the issue and determined that FECA case records that are already in an imaged format can be readily reproduced at a reasonable cost in portable document format (PDF) on CD-ROM.

Regarding the provision of case records on CD-ROM, it was necessary to develop a consistent policy as well as a method for handling them expeditiously. To that end, this circular provides guidance for the uniform handling of requests for copies of imaged case records on CD-ROM. The procedures described below will be effective within thirty (30) days of the release of this circular. Please ensure that proper notification/training is provided to all district office personnel that are affected.

When a written request for a copy of a FECA case record on CD-ROM under the FOIA/Privacy Act is received, the responsible claims examiner (RCE) should first determine whether the case record contains sensitive documents that should not be released directly to the claimant. Where the RCE determines that the case file contains such evidence, a paper copy without the sensitive documents will be provided in lieu of a CD-ROM in order to preserve the integrity of the electronic record. The RCE should follow established procedures for releasing the redacted medical evidence to the physician designated by the claimant. This policy applies regardless of whether it is the claimant or his/her representative who makes the copy request.

As a consequence of the regulations found at 29 C.F.R. § 71.6(a) and 20 C.F.R. § 70.40(c)(4), the OWCP may only charge claimants for a CD-ROM copy of the case record where the following two conditions exist: (1) the claimant has recently received a printed copy of his or her entire file and (2) the cost of providing a CD-ROM copy will exceed $15.00.

The ability to create CD-ROM copies of electronic case records within iFECS will be restricted to only two DFEC employees per district office. The local iFECS Site Manager (ISM) will provide the authorized individuals with access to the appropriate function (i.e., Imaging Allow Printing to any Printer - No Bulk Printer Restriction) once the DFEC iFECS Supplemental Privileges Request Forms have been completed. (The authorized individuals must have Adobe® Acrobat® 6.0 or later installed on their computers in order to create case record copies in PDF format.)

In those instances where it is appropriate to release a CD-ROM copy, the RCE should refer the matter, in writing, to the designated district office staff dedicated to handling such requests. The referral from the RCE will also instruct this person to indicate both the appropriate file number and date the case record copy was created on the CD label template prior to printing it.

The designated staff person for case records production on CD-ROM will, upon receiving the instructions from the RCE, proceed to create a copy of the case record by way of a secure PDF file, and then copy it onto a CD-ROM.

For the purposes of security, privacy, and quality assurance, the completed CD-ROM copy should be returned to the RCE for inspection before release to the requestor. The RCE should ensure that the PDF file is password protected, and the appropriate file number and date appear on the CD label. Along with the CD-ROM copy, the RCE will send the appropriate Privacy Act-response form letter (located in the Correspondence Library) to the requestor, which includes instructions on how to access the secure PDF file.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 1, Folioviews Groups A and D (Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

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FECA CIRCULAR NO. 05-07

August 9, 2005


SUBJECT: Dual Benefits - FERS

Reference is made to FECA Bulletin 97-9, where the procedures for computing FERS Dual Benefits are outlined. Action item 3 indicates a point of contact at SSA who was performing the necessary computations for OWCP. These computations are currently assigned to a number of modules based on the last 2 digits of the SSN as follows:

Points of contact at SSA

MOD

SSN RANGE

MGR

FAX #

01

00-16

JOHN WIGGINS

410-965-5882

02

17-32

ZORITA SHIVERS

410-966-6782

03

33-49

WANDA RUSSELL

410-965-8054

04

50-66

SHIRLEY DAVIS

410-965-6030

05

67-82

JOHN REUISING

410-966-5552

06

83-99

PINA CULOTTA

410-965-6029

 

Please change the SSA contact information in Bulletin 97-9 to reflect these assignments.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 1, Folioviews Groups A and D (Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

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FECA CIRCULAR NO. 04-01

November 28, 2003


Subject: Forms - Electronic Submission

The 2003 Government Paperwork Elimination Act (GPEA) requires that federal government agencies make submissions of information from members of the public electronically-interactive where practical. The Division of Federal Employees Compensation (DFEC) has developed a process for electronic submission of certain forms from members of the public to DFEC. At this time, the only forms that can be electronically submitted are those that are submitted directly to the office by the initiator, and require only one signature.

The forms that have been identified for electronic submission to DFEC include the CA-20, Attending Physicians Report; OWCP-5a, Work Capacity Evaluation Psychiatric/Psychological Conditions; OWCP-5b, Work Capacity Evaluation Cardiovascular/Pulmonary Conditions; OWCP-5c, Work Capacity Evaluation for Musculoskeletal Conditions; and OWCP-44, Rehabilitation Action Report.

Effective immediately, when an initiator accesses one of the forms identified above on the DFEC web site they will be asked whether they want to submit the form electronically. The initiator will be advised that a digital signature is required for electronic submission. The initiator will be provided the opportunity to apply for a digital signature at no cost if they do not already have a signature registered to their PC.

The initiator will be directed to the digital signature trust (DST) site to register for a digital signature certificate. Obtaining a digital signature certificate will take 5-10 business days. Once the certificate is received, the user can go back to the forms page, fill in the form on-line and submit it electronically to DFEC.

After passing a validation process, the form will be forwarded to a shared email address monitored by National Office staff. It will be received by DITMS, copied to an archive database, and forwarded to the central mailroom facility for imaging.

Forms submitted electronically will contain the submitter's name with small text annotating DST validation. District office staff should treat the electronic signature as a valid signature.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation

Distribution: List No. 3 - Folioviews Groups A, B, C and D All FECA Employees)

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FECA CIRCULAR NO. 04-02

January 27, 2004


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

The interest rate to be assessed for the prompt payment bills is 4.0 percent for the period of January 1, 2004 through December 31, 2004.

The rate for assessing interest charges on debts due the government has also changed. The interest rate for assessing interest charges on debts due the government is 1.0 percent for the period of January 1, 2004 through December 31, 2004.

Ordinarily, the rate of interest charged on debts due the government is only changed in January, and is effective for the entire year. However, the rate may be changed in July if there is a difference in the Current Value of Funds (CVF) interest rate of 2.0 percent or more. The rates are reviewed each June, and if the rate has changed another Circular will be published to advise all appropriate personnel of the new rate.

Attached to this Circular is an updated listing of both the prompt payment and DMS interest rates from January 1, 1985 through the current date.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation

Distribution: List No. 2--Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, Systems Managers, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Fiscal and Bill Pay Personnel)

Attachments

PROMPT PAYMENT INTEREST RATES

Date

Percentage

1/1/04 - 12/31/04

4.0%

7/1/03 - 12/31/03

3 1/8%

1/1/03 - 6/30/03

4 1/4%

7/1/02 - 12/31/02

5 1/4%

1/1/02 - 6/30/02

5 1/2%

7/1/01 - 12/31/01

5 7/8%

1/1/01 - 6/30/01

6 3/8%

7/1/00 - 12/31/00

7 1/4%

1/1/00 - 6/30/00

6 3/4%

 

 

7/1/99 - 12/31/99

6 1/2%

1/1/99 - 6/30/99

5.0%

7/1/98 - 12/31/98

6.0%

1/1/98 - 6/30/98

6 1/4%

7/1/97 - 12/31/97

6 3/4%

1/1/97 - 6/30/97

6 3/8%

7/1/96 - 12/31/96

7.0%

1/1/96 - 6/30/96

5 7/8%

7/1/95 - 12/31/95

6 3/8%

1/1/95 - 6/30/95

8 1/8%

 

 

7/1/94 - 12/31/94

7.0%

1/1/94 - 6/30/94

5 1/2%

7/1/93 - 12/31/93

5 5/8%

1/1/93 - 6/30/93

6 1/2%

7/1/92 - 12/31/92

7.0%

1/1/92 - 6/30/92

6 7/8%

7/1/91 - 12/31/91

8 1/2%

1/1/91 - 6/30/91

8 3/8%

7/1/90 - 12/31/90

9.0%

1/1/90 - 6/30/90

8 1/2%

 

 

7/1/89 - 12/31/89

9 1/8%

1/1/89 - 6/30/89

9 3/4%

7/1/88 - 12/31/88

9 1/4%

1/1/88 - 6/30/88

9 3/8%

7/1/87 - 12/31/87

8 7/8%

1/1/87 - 6/30/87

7 5/8%

7/1/86 - 12/31/86

8 1/2%

1/1/86 - 6/30/86

9 3/4%

7/1/85 - 12/31/85

10 3/8%

1/1/85 - 6/30/85

12 1/8%

 

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DMS INTEREST RATES

Date

Percentage

1/1/04 - 12/31/04

1%

1/1/03 - 12/31/03

2%

7/1/02 - 12/31/02

3%

1/1/02 - 06/30/02

5%

1/1/01 - 12/31/01

6%

1/1/00 - 12/31/00

5%

1/1/99 - 12/31/99

5%

1/1/98 - 12/31/98

5%

1/1/97 - 12/31/97

5%

1/1/96 - 12/31/96

5%

7/1/95 - 12/31/95

5%

1/1/95 - 06/30/95

3%

 

 

1/1/94 - 12/31/94

3%

1/1/93 - 12/31/93

4%

1/1/92 - 12/31/92

6%

1/1/91 - 12/31/91

8%

1/1/90 - 12/31/90

9%

 

 

1/1/89 - 12/31/89

7%

1/1/88 - 12/31/88

6%

1/1/87 - 12/31/87

7%

1/1/86 - 12/31/86

8%

1/1/85 - 12/31/85

9%

 

 

Prior to 1/1/84

not applicable

 

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FECA CIRCULAR NO. 04-03

February 9, 2004


SUBJECT: DUAL BENEFITS - FERS COLA

Effective December 1, 2003, Social Security Benefits were increased by 2.1%. That required the amount of the FERS Dual Benefits Deduction to be increased by the same amount.

This adjustment was made from the National Office for all cases that were correctly entered into the ACPS Program. The adjustment was made effective with the periodic roll cycle beginning January 25, 2004. There will be no adjustment or overpayment declared for the period December 1, 2003 through January 24, 2004.

The National Office provided a notice to each beneficiary affected. A copy was provided for each case file.

SSA COLA's are as follows:

Date

Percentage

Effective December 1, 2003

2.1%

Effective December 1, 2002

1.4%

Effective December 1, 2001

2.6%

Effective December 1, 2000

3.5%

Effective December 1, 1999

2.4%

Effective December 1, 1998

1.3%

Effective December 1, 1997

2.1%

Effective December 1, 1996

2.9%

Effective December 1, 1995

2.6%

Effective December 1, 1994

2.8%

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation

Distribution: List No. 1, Folioviews Groups A and D (Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

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FECA CIRCULAR NO. 03-01

December 2, 2002


SUBJECT: DUAL BENEFITS - FERS COLA

Effective December 1, 2002, Social Security Benefits were increased by 1.4%. This required the amount of the FERS Dual Benefits Deduction to be increased by the same amount.

This adjustment was made from the National Office for all cases that were correctly entered into the ACPS Program. The adjustment was made effective with the periodic roll cycle beginning December 1, 2002.

The National Office provided a notice to each beneficiary affected. A copy was provided for each case file.

SSA COLA's are as follows:

Date

Percentage

Effective December 1, 2002

1.4%

Effective December 1, 2001

2.6%

Effective December 1, 2000

3.5%

Effective December 1, 1999

2.4%

Effective December 1, 1998

1.3%

Effective December 1, 1997

2.1%

Effective December 1, 1996

2.9%

Effective December 1, 1995

2.6%

Effective December 1, 1994

2.8%

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation

Distribution: List No. 1, Folioviews Groups A and D (Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

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FECA CIRCULAR NO. 03-02

September 5, 2003


SUBJECT: SELECTED ECAB DECISIONS FOR JANUARY – MARCH, 2002

The attached group of summaries of selected ECAB decisions is provided for study and filing by subject.

The subjects addressed include: forfeiture of compensation – effective date; performance of duty – premises doctrine; performance of duty – recreational and/or social activities; performance of duty – travel, special mission, or temporary duty; reconsideration – one-year time limitation

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation

Distribution: List No. 1—Folioviews Groups A and D (Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists and Staff Nurses)

 

FORFEITURE OF COMPENSATION – EFFECTIVE DATE

Brady L. Fowler, Docket No. 00-850, Issued January 11, 2002

In this case, the Office properly determined that the claimant had forfeited his right to compensation under section 5 U.S.C. § 8148. The interesting issue, however, was whether the Office had terminated the claimant's compensation on the proper effective date.

The Office terminated the claimant's compensation effective January 20, 1999, which was the date the claimant formally entered his plea of guilty to violating 18 U.S.C. § 1920. In its decision, the Board determined that the Office had improperly set the effective date of termination, explaining:

"Section 8148 specifically states that the forfeiture shall be effective as of the date of the conviction. The Office's regulation, found at 20 C.F.R. § 10.17, states that when a beneficiary under the Act pleads guilty to defrauding the government in connection with a claim for benefits, "the beneficiary's entitlement will terminate effective the date... the guilty plea is accepted...." In this case, the Office used January 20, 1999 as the effective date of the forfeiture. However, the record shows that, while appellant entered his plea of guilty on January 20, 1999, the plea was not accepted by the judge until April 8, 1999 and guilt was adjudicated at that time. The date of the conviction is not the date appellant entered his guilty plea but the date that the plea was accepted and guilt adjudicated. The effective date of forfeiture of compensation, therefore, was April 8, 1999."

Consequently, it is imperative to remember that when terminating compensation under 5 U.S.C. § 8148, the claimant does not forfeit his or her right to compensation until the actual date of conviction.

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PERFORMANCE OF DUTY – PREMISES DOCTRINE

Londa Lee, Docket No. 01-1183, Issued January 22,2002

The issue in this case was whether the claimant had sustained an injury while in the performance of duty.

The claimant filed a notice of traumatic injury alleging that she injured her right elbow and arm after tripping over a parking block. She indicated that the injury occurred at her duty station address. By letter, the Office requested that the claimant's employing agency indicate whether or not she was on premises that were owned and operated by the agency at the time of the alleged work injury. The employing agency never responded to the Office's request. By decision dated March 12, 2001, the Office denied her claim on the basis that she had failed to establish that she had sustained an injury while in the performance of duty.

In its decision, the Board detailed the Office's responsibilities when adjudicating a claim:

"In this case, the Office requested information from the employing establishment to ascertain whether the parking lot where appellant was injured was in its control. The employing establishment, however, did not respond to the Office's inquiry. Appellant should not be penalized for the failure of the Office to develop the evidence. Proceedings under the Act are not adversarial in nature nor is the Office a disinterested arbiter. While appellant has the burden to establish entitlement to compensation, the Office shares the responsibility in the development of the evidence, particularly when such evidence is of the character normally obtained from the employing establishment or other governmental source.

The Board finds that the Office must make a determination on where the injury occurred and whether that location was considered to be on the employing establishment premises. The Office may not simply conclude, in light of the employing establishment's failure to respond, that appellant has not met her burden."

Accordingly, the Board found that the case was not in posture for a decision. The Office's decision was vacated and the case was remanded.

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PERFORMANCE OF DUTY – RECREATIONAL/SOCIAL ACTIVITIES

James W. Hockaday, Docket No. 01-152, Issued March 25, 2002

The issue was whether the claimant sustained an injury in the performance of duty.

The claimant filed a traumatic injury claim alleging that on August 18, 1999 he tore his left anterior cruciate ligament and left lateral meniscus while playing basketball at a training seminar. At the time of his injury, the claimant was attending a weeklong training course at Virginia Tech University. The Office denied the claim on the basis that the claimant had not sustained an injury while in the performance of duty.

The Board found that the claimant sustained an injury while in the performance of duty, and remanded the case for further development. The Board's decision is important because of its explication of issues concerning workers injured while at employer-sponsored events:

"When the degree of employer involvement descends from compulsion to mere sponsorship or encouragement, the questions become closer and it is necessary to conduct further inquiry. This inquiry focuses on the issues of whether the employing establishment sponsored the event and whether attendance was voluntary and whether the employing establishment financed the event. The record indicates that appellant's attendance at the training course was sponsored and paid for by the employing establishment and that the costs of the picnic, including the food and the rental on August 18, 1999 of the entire Blacksburg Recreational Center and all its associated facilities and equipment, were covered by the course fees paid by the employing establishments of the participants. In addition, the picnic was included in the course schedule as a regular meal activity and a special shuttle bus was arranged to carry course attendees to and from the picnic site, which was reserved for their exclusive use. Separately, each of these factors might not support that appellant was in the course of employment. However, under the circumstances, taking all of these factors together, the employing establishment can be said to have encouraged participation through sufficient financial control to bring the picnic within the course of employment sponsorship. In addition, these factors further support a finding that the basketball game during which appellant was injured was reasonably incidental to the assigned activities of the training seminar itself and that, therefore, appellant's participation in the basketball game did not constitute the type of voluntary deviation from his regular activities which would remove him from the protection of the Act."

Accordingly, the Board ruled that the injury occurred in the performance of duty and remanded the case for further development.

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PERFORMANCE OF DUTY – TRAVEL, SPECIAL MISSION, OR TEMPORARY DUTY

Trina Bornejko, Docket No. 01-1118, Issued February 27, 2002

The claimant filed a notice of traumatic injury alleging that she injured her ankle after slipping on ice while on the way to the airport for a temporary duty assignment. On two separate occasions, the claimant indicated that the injury occurred at her son's school, where she had stopped to drop him off while on the way to the airport. The Office denied the claim on the basis that the claimant had taken herself out of the performance of duty.

The Board affirmed the Office's decision, on the basis that the claimant's actions were not "reasonably incidental" to her work activities or travel assignment, explaining:

"The Board has recognized the rule that the Act covers an employee 24 hours a day when he or she is on travel status, a temporary duty assignment, or a special mission and engaged in activities essential or reasonably incidental to such duties. However, when the employee deviates from the normal incidents of his or her trip and engages in activities, personal or otherwise, which are not reasonably incidental to the duties of the temporary assignment contemplated by the employer, the employee ceases to be under the protection of the Act and any injury occurring during these deviations is not compensable.

At the time of her February 14, 2000 injury, appellant was on travel status, on her way to the airport, away from her regular place of employment. While on travel status she is covered 24 hours a day with respect to any injury that results from activities incidental to such duties. In this case, however, appellant acknowledged to her physician on February 14, 2000 that she hurt her ankle while dropping her son off at his school. She also stated this same fact in the March 23, 2000 conference call. Taking her son to school is personal in nature and does not constitute a normal activity reasonably incidental to her employment or travel assignment. As a purely personal pursuit, such activity constitutes a deviation from the performance of duty of an individual on travel status or on a temporary duty assignment, such that the 24 hour-a-day coverage under the Act does not apply."

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RECONSIDERATION – ONE-YEAR TIME LIMITATION

Gwendolyn Thomas, Docket No. 01-1513, Issued January 18, 2002

In this case, the Office denied the claimant's request for reconsideration on the basis that the request had not been timely filed.

The Board remanded the case, holding that the Office had improperly determined that the claimant's request for reconsideration had been untimely. In its decision, the Board provides an excellent explanation of how to determine the timeliness of a reconsideration request:

"In this case, by letter dated April 12, 2001, appellant requested reconsideration of the Office hearing representative's decision dated April 12, 2000. The postmark of appellant's reconsideration request was not retained in the record. The date stamp indicates that appellant's letter was received on April 16, 2001.

It is well established under the Office's procedures that the timeliness of a reconsideration request is determined by the postmark of the envelope, but if the envelope is not available, the date of the letter itself is used. Thus, the date of appellant's letter, April 12, 2001, will be used to determine the timeliness of her request. The Board has also held that in computing a time period, the date of the event from which the designated period of time begins to run shall not be included, while the last day of the period so computed shall be included unless it is a Saturday, a Sunday or a legal holiday. As such, the one-year time period for appellant's reconsideration request began to run on the day after the Office's April 12, 2000 merit decision, or April 13, 2000. Since appellant's request for reconsideration was dated April 12, 2001, her request was timely."