Division of Coal Mine Workers' Compensation (DCMWC)

On June 14, 2018, the Office of Workers' Compensation Programs (OWCP) issued a Final Rule governing the Black Lung Disability Trust Fund's payment of medical benefits under the Black Lung Benefits Act. The Final Rule:

  • Adopted modern payment formulas for physicians, hospitals, and other providers that are derived from the formulas used in the Medicare program. These formulas are similar to those used by the Federal Employees Compensation and Energy Employees Occupational Illness Compensation programs;

  • Codified the black lung program's current practices for prescription drug payments and submitting medical bills for payment;

  • Provided greater clarity about fees paid to providers, which should speed processing and payment of benefits as well as make it easier for the Trust Fund to obtain reimbursement from coal companies; and

  • Prohibited providers from seeking additional payments from miners for covered services that have been paid by the Trust Fund.

The revised regulations became effective on August 31, 2018. Most of them, including those governing payments for medical equipment, prescription drugs, and inpatient medical services, applied immediately. However, the regulations governing payment of professional medical services and outpatient medical services had a later applicability date of November 30, 2019, so that a new computer system could be developed to process these bills.

OWCP is delaying the applicability date of the regulations governing payments for professional medical services and hospital outpatient services from November 30, 2019, to April 26, 2020, due to unforeseen delays in developing the computer system.

The Final Rule updating the applicability date for 20 CFR 725.708(a), 725.708(b), and 725.710 was published on November 21, 2019.