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Division of Federal Employees' Compensation (DFEC)

Vocational Rehabilitation Counselor Handbook

Part 13


Part 13 – Requirements and Procedures for Billing and Purchases

Paragraph and Subject

Date

RCHB Trans. No.

Table of Contents

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1. Overview

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2. RC Billing and Payment - Responsibilities

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3. The OWCP Central Bill Processing System

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4. Authorization for Payment of RC Services

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5. RC Service Billing Categories

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6. RC Procedural Billing Codes

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7. Documenting RC Activities and Expenditures

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8. RC Billing Invoice

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9. RC Billing Procedures

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10. RC Reimbursement

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11. Purchases - Roles and Responsibilities

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12. Services and Items Which May be Purchased

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13. Services and Items Which May Not Be Purchased

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14. Forms Used to Authorize Purchases

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15. Purchase Guidelines

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16. Equipment Status

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Exhibit 1: RC Billing Codes, Definitions, and Associated Units of Service

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Exhibit 2: RC Activity Record

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Exhibit 3: Associated RC Billing Invoice

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Exhibit 4: Sample Equipment Agreement

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1. Overview. The DFEC is committed to ensuring prompt and accurate payment for services rendered by the Rehabilitation Counselor (RC). The Prompt Payment Act (31 U.S.C. Chapter 39) requires the Office of Workers' Compensation (OWCP) to pay correctly submitted bills for authorized services and supplies within 30 days of receipt. To that end, the OWCP has instituted specific billing procedures and requirements for the processing of RC bills.

The FECA authorizes payment for vocational rehabilitation services by the RC, authorized by the Rehabilitation Specialist (RS), which are expected to improve the skills and knowledge of a worker with a disability, assist him or her in obtaining and keeping employment, and which are meant to restore earning capacity, or minimize the loss of such. Payment for medical services, appliances and supplies which are likely to cure, give relief, reduce the degree or period of disability or aid in lessening the amount of compensation may also be authorized, usually by the Claims Examiner (CE). As such, both medical services and supplies as well as rehabilitation services, supplies and maintenance may be funded as appropriate during the DFEC vocational rehabilitation process.

Paragraphs 2 through 10 of this Part of the RC Handbook focus on RC billing requirements and processes while the latter paragraphs (11 through 16) explain procedures for making purchases including: the types of services and items which may or may not be authorized as part of the rehabilitation process; forms and procedures used for authorization of purchase and reimbursement; and information regarding ownership of items and maintenance requirements.

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2. Billing and Payment– Responsibilities.

a. The RC is held responsible for the accuracy of service-related billing invoices, as stipulated under the procedures set forth herein. Additionally, the RC is subject to the provisions of the False Claims Act (31 U.S.C § 3729) which imposes, in part, liability on any person who submits a claim to the Federal Government that he or she knows (or should know) is false; knowingly submits a false, fictitious or fraudulent record(s) in order to obtain payment from the Government; and/or knowingly obtains money from the Federal Government to which he or she is not entitled, and uses false statements or records in order to retain the money.

The RC is responsible for submitting timely and accurate bills for his/her rehabilitation services, for the authorized purchase of supplies and equipment, and for the payment of authorized vendors. The RC is also responsible for the submission of regular progress reports, receipts and any other documentation which is needed to validate invoiced charges.

b. The RS is responsible for the review and approval of RC and vendor bills for accuracy and consistency with DFEC vocational rehabilitation policies. The RS is also responsible for authorizing and facilitating the payment of bills in accordance with FECA procedures.

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3. The OWCP Central Bill Processing (CBP) System. The OWCP CBP system is the method by which RC and other rehabilitation-related billing invoices are submitted and processed for payment. As discussed in Part 12 of this handbook, the CBP system is an automated web based system that provides the OWCP stakeholders a central domain for the submission, processing and monitoring of reimbursements/bill payments. The CBP system also provides a mechanism for the simultaneous submission of progress reports, receipts and other such required documentation.

a. The RC should enroll with the OWCP contracted bill processing provider to obtain a unique provider identification number (provider ID) prior to billing for any services rendered in connection with the FECA program.

b. The RC should submit all reimbursement requests via the CBP's secure web portal automated bill entry page.

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4. Authorization for Payment of RC Services. RC services as well as vendor purchases are subject to a prior authorization system which guides the reimbursement and bill payment process. These prior authorizations stipulate the dates of service and expenditure limits allowed in each specific case. The procedures documented below should assist the RC in meeting the requirements of the established authorization limits. While these authorization limits may be adjusted during the course of the rehabilitation assignment, any changes require discussion with, and written approval by, the RS prior to rendering continued services.

See Parts 3 through 8 in this handbook for information regarding criteria for expenditure, calendar time and professional hours allowable for specific phases of DFEC vocational rehabilitation services as well as procedures to request additional funds or time extensions.

a. Initial Authorization. RC services, including expenditure limits, are authorized by the RS at the time the case is assigned. Separate authorizations are issued for each individual case assignment and are identified by the injured worker's (IW) specific case file number.

At the time of referral, the RS will complete two actions:

(1) The RS will forward an initial authorization to the RC on the DFEC Referral and Award Letter, Form OWCP-35 (or equivalent), establishing the dates of service and an authorization amount of up to $5,000 for rehabilitation services.

(2) The RS will also transmit the authorization to the CBP prior authorization unit, where the information regarding expenditure limits will be posted, which will facilitate the process for future bill submission and payment.

b. Authorization Verification.

(1) The RC should verify that prior authorization has been issued for his/her services via the CPB site prior to any attempts to enter billing data in the CBP system. This will confirm that there are no obvious errors which will affect or delay the billing entry process (e.g. to confirm that the authorization is in place and that the information is correct).

(2) If a system error occurs during the process of accessing the authorization or entering data, the user should receive a real-time error message which provides an explanation as to what is preventing the specific billing entry from being accepted. In most instances, real-time errors may be avoided if the RC has verified his/her prior authorization status before beginning the data entry process for RC billing.

(3) The RC should make note of the error message and contact the RS for assistance if s/he is unable to resolve the error edit and continue with the data entry process for billing.

c. Adherence to Authorization Limits.

(1) The RC should not bill for dates of service not authorized in the prior authorization.

(2) The RC case charges should not exceed the expenditure limits documented in the authorization.

(3) The RC should document for his/her records the authorized time and expenditure limits associated with each assigned case and track his/her cumulative progression towards these limits to ensure that no overages occur.

(4) In the event that the RC feels the case requires additional expenditure allowances beyond what has already been approved (and authorized in the CBP system), h/she should contact the RS. This action should be done proactively, prior to the RC reaching the authorized expenditure or other limits. The RC is only authorized to provide services within the established pre-authorized limits.

(5) To request an additional expenditure allowance, the RC should forward a memo to the RS detailing how the additional funds are to be allocated and utilized, and providing justification for such. The memo should be accompanied by a new Rehabilitation Plan and Award, Form OWCP-16, and if vendor services are included, a Vocational Rehabilitation Services Authorization Letter, Form OWCP-24.

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5. RC Service Billing Categories. Throughout the course of an assignment, the RC must keep track of both the types of activity being performed as well as the amount of time used for each activity in order to be able to itemize and code his/her services and expenditures correctly on the monthly billing invoice.

DFEC policy delineates the specific types of services for which the RC may and may not bill, and the maximum time limits for these. The services with allowable billing are grouped into three categories - Professional Services, Administrative (non-professional) services, and Travel. All have unique codes for billing and separate fee schedules (which are discussed in the following section). Non-allowable charges are also defined below.

a. Professional Services. These services involve the use of professional vocational rehabilitation knowledge, assessment and technical skills. Types of allowable billing for professional services include only the following kinds of activities, unless otherwise expressly allowed and pre-approved by the RS:

(1) Contacts. These include face–to-face, telephonic, and/or electronic contacts which address the IW's rehabilitation and return to work efforts. Specific examples, though not exclusive, may include:

(a) Meeting/communicating with IWs, medical and rehabilitation providers, previous or new employers and staff of the state employment agencies to facilitate the IW's rehabilitation and return to work.

(b) Communicating with all parties regarding progress and barriers in reaching the goals and objectives of the rehabilitation assignment.

(c) Performing vocational testing with the IW, if provided by the RC him/herself as per DFEC's guidelines (see Part 5 of this handbook).

(d) Assisting with preparation for, and arrangement of, vocational testing or medical/occupational rehabilitation programs.

(e) Working with DFEC Field Nurses (FN) to facilitate rehabilitation and return to work efforts.

(2) Professional Report Writing. Allowable billing for the composition and/or dictation of RC reports is limited to:

(a) Up to 90 minutes for the Individual Rehabilitation Plan (including Transferrable Skills Analysis (TSA) and Labor Market Survey (LMS) information)

(b) Up to 60 minutes for other complex or comprehensive reports (usually limited to Initial Evaluations and TSA or LMS reports requested outside of the initial plan development phase).

(c) Up to 30 minutes for general Progress Reports.

*There is a separate allowable fee for the administrative typing and submission of reports which is included in the following section.

b. Administrative Services. These services reflect clerical and/or general office- type activities. These activities do not require professional vocational rehabilitation knowledge or skills. Allowable billing for administrative services includes the following types of activities, unless otherwise expressly allowed and pre-approved by the RS:

(1) Preparation (typing) and submission of RC reports and billing invoices– Up to 30 minutes.

(2) Wait time. This refers to any time the RC spends in a provider's waiting room and/or otherwise waiting to meet with the IW, employer or provider as long as the RC is not interacting with the claimant and/or performing other billable work activities – Up to 60 minutes.

(a) The RC should bill for only 1 chargeable activity at a time. The RC cannot charge for billable activity on one case file while billing for wait time on another case file.

c. Travel.

(1) Time in transit should be billed as an administrative service charge.

(2) Travel should be prorated whenever possible. The RC should not charge for round trip transportation on one case file when the transportation was not round trip. For example, if the RC traveled from one location after providing services for a case assignment to another location to provide services on a different case assignment. In this situation, transportation/mileage billing should be parsed between the two case file assignments.

(3) Travel is reimbursed via fee per mile. Mileage should be billed at the GSA reimbursement rate, as authorized by the OWCP, for all billable travel miles.

(4) Parking costs and toll costs are reimbursed at the actual rate.

d. Other, Pre-Authorized. RCs may submit requests for reimbursement of other miscellaneous, itemized expenses related to a specific case or other purchases/payments which have been pre-authorized by the RS. Documentation of payment must accompany any request for reimbursement, unless otherwise specified by the RS.

e. Non-allowable charges. The RC should not bill for the following:

(1) General mailing or faxing, including postage unless specifically requested by the RS or CE to send a certified, return receipt document.

(2) Advanced payment for medical provider consultations or examinations.

(3) Meals.

(4) Overnight travel expenses unless pre-approved by the RS (if pre- approved by the RS, reimbursement will be paid at the Government's per diem rate).

(5) Research activities including, but not limited to: any electronic or physical method of research the RC may utilize to increase his/her general knowledge related to medical or disability issues; Occupation, employment or labor market information not related to a specific case; and/or any other information that was not specifically requested and pre-approved by the RS.

(6) Time spent on revising or correcting RC Reports, invoices and/or activity records that have been rejected and returned by the RS.

(7) Telephone or cell phone plans.

(8) Attempted telephone calls (no answer/leave message).

(9) Long distance charges unless pre-approved by the RS.

(10) Any charges for technology/equipment needed to perform vocational rehabilitation activities.

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6. RC Procedural Billing Codes. OWCP has developed procedural billing codes for explicit use by the OWCP/DFEC Vocational Rehabilitation Program. Each billing code defines a type of service, with a designated unit of service associated with the specific code. Each billing code has an associated reimbursement rate which has been established and approved by the OWCP National Office. Reimbursement rates are not published, but are provided to the RC at the time of certification.

These are the codes and units of service to be used for calculating the monthly expenditures for all RC charges reflected on the billing invoice. RC expenditures are calculated based upon the reimbursement rates established for each unit of service per given code.

a. Professional Service Charges should reflect codes:

(1) VR001 – Represents professional service charges billed per hour:

1 hour = 1 unit of service

(2) VUNT1 – Represents professional service charges of 59 minutes or less, billed per unit:

1 minute = 1 unit of service

b. Administrative (Non-Professional) Service Charges should reflect codes:

(1) VR002 – Represents administrative services charges billed per hour:

1 hour = 1 unit of service

(2) VUNT2 – Represents administrative service charges of 59 minutes or less, billed per unit:

1 minute = 1 unit of service

c. Travel and Other, Pre-Authorized:

(1) VR004 – Represents the billing code used to request reimbursement of travel mileage, which is reimbursed at the rate established by GSA per mile and authorized by the OWCP

(2) VR018 – Represents the billing code used to reimburse other miscellaneous itemized expenses such as parking fees and road tolls, or other purchases/payments which have been pre-authorized by the RS. Documentation of payment must accompany requests for reimbursement unless otherwise specified by the RS.

1 unit of service = actual fee paid by RC

d. Vendor and other charges:

(1) VRTST – Represents the billing code used to pay an outside vendor for vocational testing or transferable skills analysis.

1 unit = actual charge

(2) VR003 – Represents the billing code used to reimburse the RC for vocational testing or transferable skills analysis performed by a provider other than the RC (when the RC has paid the vendor and submitted to OWCP the original receipt and bill for reimbursement). Prior authorization is required.

1 unit = actual fee paid by the RC

(3) VREDU – School tuition and fees. Note these are typically paid directly to the vendor.

1 unit = actual fee

(4) VRSUP – Supplies and tools for modifications, reasonable accommodations, school books and school supplies. Prior authorization required. Note these are typically paid directly to the vendor.

1 unit = actual charge

Exhibit #1 provides a summary of all RC billing codes, definitions, and associated units of service.

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7. Documenting RC Activities and Expenditures. The DFEC Vocational Rehabilitation Program utilizes the RC Progress Report and activity record to provide a detailed accounting of the provision of RC services and specific activities performed on an individual case during the given reporting/billing period. The Progress Report and activity record not only provide a detailed summary of RC activities, but are also reflective of, and provide justification for, the monthly charges on the RC's billing invoice.

a. Progress Report. The RC should submit a detailed Progress Report along with each bill submitted to the CBP system. See Part 12 of this handbook for specific information regarding requirements for, and elements of, the Progress Report.

b. Activity Report. The RC should track his/her billable activities each reporting period and submit a detailed listing of these along with the regular Progress Report and invoice. This report of activities may be attached as a separate document or may be included as a listing in the Progress Report itself. The report of activities should include:

(1) A detailed list of each separate and specific billable activity

(2) The date of each activity

(3) The type of service rendered (Professional, Administrative, etc.)

(4) The amount of actual time spent on the activity

The RC should utilize the activity record as a reference when entering the charges into the itemized summary format for billing invoice submission. The activity record and billing invoice should correspond.

Exhibit #2 provides an example of an activity record which may be included as a separate attachment to the Progress Report. This explicit record may also be provided, per RS approval, in the actual Progress Report.

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8. Billing Invoice. Each service period, the RC should enter charges via the CBP system's electronic bill entry page to create the billing invoice. This will be transmitted electronically to the RS along with the progress report and record of activities. The billing invoice should:

(1) Include dates of service which correspond to the service period documented on the associated Progress Report and activity record.

(2) Exclude any date of service billed during a prior billing/reporting period. There should be no overlap in dates of service from a previous billing/reporting period.

(3) Reflect a summary of the professional, administrative, and ancillary charges as detailed on the associated activity record using the procedural billing codes defined above.

(4) Not include charges for any activity for which billing is not allowed.

(5) RC charges should not exceed the total professional hours allotted per case status without receiving consent and prior authorization from the RS.

Exhibit #3 provides an example of a billing invoice, using the associated Exhibit #2 activity record.

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9. RC Billing Procedures. The RC is responsible for submitting accurate and timely billing invoices as per the DFEC guidelines discussed in this Part of the handbook and the procedures described below.

a. Billing invoice due dates and submission. RC charges are submitted on the same schedule as the RC Progress Reports. As such, the RC's initial billing invoice and report for each case should be received by the RS no later than 30 days after the date of referral. Subsequent billing invoices and reports should be received every 30 days, unless directed otherwise by the RS.

b. Billing invoice dates of service. As stated previously, the dates of service reflected on the billing invoice should correspond to the service period documented on the associated RC Progress Report and activity record. The invoice should exclude any date of service billed during a prior billing/reporting period. There should be no overlap in dates of service from a previous billing/reporting period. Dates of service should not exceed those on the original authorization.

c. Billing invoice documentation. Each bill submitted by the RC must be accompanied by required reports and documentation as follows:

(1) Progress Report

(2) Report of activities

(3) Electronic billing invoice

(4) Itemized receipts. If the RC is requesting reimbursement for the authorized purchase of books, tools/equipment or other supplies to be utilized as part of the IW's rehabilitation plan, an itemized receipt for each purchase must be forwarded to the RS with the billing invoice.

The RC must obtain the IW's signature on the original itemized receipt to verify that the IW did receive the item(s) purchased.

d. Submission of billing invoices. The RC should submit all reimbursement requests and accompanying documentation via the CBP's secure electronic bill entry page.

If there are documents/attachments which are not accepted by the CBP system for electronic transmittal, the RC should contact the RS to discuss how to securely transmit these documents to the RS via other methods (ECOMP, etc.).

e. RS review of billing invoices. Once the RC submits the billing invoice through the CBP system, notification is sent to the RS who can then access and review the documents and proceed with actions as appropriate – either approval of payment, or rejection/return of the billing invoice to the RC with a request for corrections or explanation. These topics are discussed further in the sections below.

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10. RC Reimbursement. Reimbursement is issued to the RC upon the RS review and approval of the submitted documents (RC report, activity record and billing invoice), and the successful processing of the billing invoice through the CBP system.

a. Approval of billing invoice and payment. Upon the review of the invoice and accompanying documentation, if charges are deemed correct, the RS will approve the billing invoice. It is then processed into the CBP system where the billing invoice is subject to an automated review and audit for quality assurance purposes. See section "c" below for information about the post-approval CBP audit process.

b. Return/rejection of billing invoice. The RS has the authority to return to the RC any billing invoice and/or reports that s/he determines are incomplete or incorrect, or when the charges do not correlate with the documented rehabilitation activities.

(1) If a billing invoice is rejected, the RS should return to the RC all documents associated with the submitted invoice via the web portal. The RS will provide an explanation for the return with questions which need to be answered and/or instructions for modification of the invoice.

The OWCP DFEC does not allow for the acceptance and processing of individual items that are submitted as part of an invoice package. A billing invoice will be processed only upon complete acceptance of an approved RC report and activity record; an RC report and activity record will be accepted only upon approval of the associated billing invoice total.

(2) The RC should review the returned documents and make the necessary modifications (changes, clarifications and/or corrections) as identified. These modifications should be made to the existing document(s). It is not necessary, or advisable, for the RC to create a new billing invoice document for items that require modification.

(3) Upon approval by the RS, the billing invoice and related documents are processed into the CBP system where the invoice is subject to an automated review and audit for quality assurance purposes. The related documents (RC report and activity record) are then automatically uploaded to the case file/record.

c. CBP post-approval audit of billing invoices. Some billing invoices approved by the RS may not pass the post-approval audit that is incorporated into the CBP's automated system. This may result in partial or no payment for a particular billing invoice. The RC will receive notification from the CBP system, which is referred to as a Remittance Voucher (RV)/Explanation of Benefits (EOB) form, which provides a line item description of charges per case, the amount reimbursed for each line item, and an explanation as to why some/all of the submitted charges were not reimbursed.

d. The RC should review all RVs to ensure appropriate payment has been issued. In the event a discrepancy is noted, the RC should contact the RS to discuss further.

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11. Purchases - Roles and Responsibilities. The DFEC provides for the purchase or payment of items, authorized by the RS, which are necessary for the implementation of approved vocational rehabilitation plans and services.

The RS, in conjunction with the CE, is responsible for the approval of funding for rehabilitation-related services, equipment and supplies needed throughout the course of an approved rehabilitation plan. This includes authorization of funds for RC and vendor services as well as the approval of maintenance funds for the IW and the purchase of equipment/supplies.

The RC is most often responsible for identifying the services and items needed by the IW during the rehabilitation process and facilitating the purchase of these, as per DFEC procedures and under the guidance of the RS.

Note - It is up to the discretion of the CE and RS, based on individual circumstances of a rehabilitation case, to approve, deny or make exception for any service purchase or reimbursement as described below.

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12. Services and Items Which May Be Purchased. Not exclusively, the following list of services and supplies are items which may be purchased during the rehabilitation process. The RC must have authorization from the RS before facilitating a purchase or the reimbursement of expenses to the IW.

a. Rehabilitation-related Services and Supplies. The following are the general types of services and supplies which may be purchased during the course of rehabilitation.

(1) Medical Rehabilitation.

(a) Durable medical equipment or other supplies as prescribed

(b) Assistive Technology or other equipment as recommended

(c) Services and items needed for vehicle and home modifications

Note - See Part 4 of this handbook for further information regarding specific Medical Rehabilitation services which may be funded during rehabilitation.

(2) Training and educational programs.

(a) Books

(b) Tools, equipment and supplies as needed for the training

(c) Assistive Technology, equipment or other items needed for approved accommodations

(d) Uniforms, safety shoes or specific clothing required for the training

Note - See Part 5 of this handbook for further information regarding specific training/educational services which may be funded during rehabilitation and procedures related to the payment of tuition, fees or other related costs.

(3) Room and board – Usually may be authorized only to the limits of the maintenance allowance (see below). However, in rare circumstances, this may be authorized if an appropriate treatment or training facility does not exist within the IW's reasonable commuting area.

(4) Job Placement.

(a) Assistive technology, equipment or other approved items needed for accommodations

(b) Required uniforms, safety shoes or specific clothing required for employment (not a general wardrobe)

In rare circumstances, clothing appropriate for interviewing will be funded. The RC must justify that the IW requires DFEC assistance with this due to lack of personal resources. Usually, this is limited to one reasonably priced, professional outfit costing no greater than $200 (including tax).

Note - See Part 8 of this handbook for further information related to the Job Placement process during rehabilitation.

(5) Transportation. Transportation is most often authorized as part of the IW's maintenance allowance (see Maintenance below).

In rare circumstances, additional transportation costs may be authorized when the rehabilitation plan requires evaluation, training or other activities which are outside of the IW's normal and customary commuting area and/or at a distance sufficient to require the IW to live away from home for a specified period of time.

Sufficient distance to permit authorization of transportation beyond the maintenance allowance would usually be more than 50 miles, more than 1 1/2 hours of one-way travel time or, alternatively, more than the usual and customary commute in a given area (or to the IW's date of injury work site). The RC should seek and follow the guidance of the RS to determine whether transportation outside of maintenance allowance may be authorized.

GSA rules govern mileage in a privately owned vehicle.

b. Injured Worker Maintenance. 5 USC Section 8111(b) allows IWs to receive additional compensation for expenses of up to $200 a month while participating in an approved rehabilitation program. This is a statutory limit and as such, is not subject to modification.

(1) Expenses for which maintenance may be authorized are:

(a) Room and board

(b) Child care or day care

(c) Lunches

(d) Laundry expenses directly related to the rehabilitation effort; including dry cleaning of uniforms, if necessary

(e) Transportation

(f) Internet service

(i) If the IW does not already have access to this

(ii) If needed primarily to complete an online training program as part of the approved rehabilitation plan

(g) Other expenses incurred exclusively as the result of participation in an approved rehabilitation program

(2) While in an approved training or educational program, maintenance may be continued during:

(a) Vacation periods and semester breaks, if the IW is enrolled on a 12 month basis

(b) Unscheduled breaks and emergency closings of facility for up to two weeks

(3) Exclusions for maintenance payments. An IW may not receive maintenance while:

(a) Enrolled in a vocational program with rules precluding payments from other sources

(b) Involved in a program which entails no expenses, as with a correspondence or internet-based course where the IW already has Internet service.

(c) Working in paid employment

(4) Maintenance may be terminated by the RS for:

(a) Lengthy and/or unexcused absences from training or other required programs

(b) Lack of participation in the rehabilitation effort

(c) Absence of regular reporting of approved expenses, as per DFEC procedures and the RS's instructions

(d) Reporting of false expenses

(5) Application for, and authorization of, maintenance.

(a) The RC should discuss with the IW whether there are expenses related to his/her rehabilitation plan which may be eligible for reimbursement under the Maintenance provision.

(b) If so, the IW may apply for maintenance payments, with the assistance of the RC, via the Rehabilitation Maintenance Certificate, Form OWCP-23. The RC should forward this to the RS for review.

(c) If approved, the RS will confirm authorization for maintenance via the Injured Worker Maintenance Letter, Form OWCP-18, or equivalent. This will provide the IW and RC with instructions to report expenses and request reimbursement.

(d) To claim reimbursement, the IW must complete the Maintenance Request, Form OWCP-17, on a monthly basis or as per the instructions of the RS. The RC endorses it and forwards it to the RS for review.

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13. Services and Items Which May Not Be Funded. Unless otherwise authorized by the RS, the following services and supplies are examples of what may not be purchased during the DFEC rehabilitation process.

a. Dentures, dental work, contact lenses and eyeglasses unless related to the compensable injury-related condition and authorized by the CE

b. Repairs of cars, trucks and motorcycles

c. Hotel/motel accommodations above the maintenance allowance

e. Costs of meals above the maintenance allowance

f. Travel unrelated to the rehabilitation plan

g. Clothing, uniforms and shoes unrelated to the approved rehabilitation plan

h. Any services, equipment or supplies unrelated to the approved rehabilitation plan

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14. Forms Used to Authorize Purchase or Reimbursement. The following OWCP/DFEC forms (or equivalent) are used by the RC and RS in the process of making purchases or requesting reimbursement.

a. Referral and Award Letter, Form OWCP-35. The RS uses the Form OWCP-35 to authorize initial services from the RC. The usual limit of authorization is $5,000 and two years, but shorter periods and amounts may be specified by the RS.

b. Rehabilitation Plan and Award, Form OWCP-16. The RC must use the Form OWCP-16 to request funding for rehabilitation-related services and supplies as part of the approved rehabilitation plan. The RC must fill out and use a new Form OWCP-16 whenever an extension of funds or time beyond that on the initial authorization is needed.

c. Vocational Rehabilitation Services Authorization Letter, Form OWCP-24. This form must be used to authorize a vendor other than the RC to provide training and other specific services and equipment, except where the RC subcontracts testing under the initial Form OWCP-35 authorization.

d. Rehabilitation Maintenance Certificate, Form OWCP-23. See "Maintenance" above.

e. Injured Worker Maintenance Letter, Form OWCP-18, or equivalent. See "Maintenance" above.

f. Rehabilitation Maintenance Certificate, Form OWCP-17, or equivalent. See "Maintenance" above.

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15. Guidelines for Rental or Purchase. When purchasing an item as part of the approved rehabilitation plan, the RC must follow the DFEC purchase procedures as outlined below and/or as per the instructions of the RS. See FECA Procedure Manual at 2-0810-17 for durable medical equipment including hearing aids and 2-1800 for housing and vehicle needs.

a. Purchase or rental. The RC should determine whether purchase or rental of an item is most appropriate and cost-effective given the circumstances of each case. The RC should discuss options with the RS and follow guidance provided.

b. Cost- Levels and Purchases.

(1) When the total price of a purchase of a non-medical device (e.g. a laptop or tablet) is less than $2,500, a purchase may usually be made without a bidding process. The RC may gather item/pricing options and present these options to the RS with a recommendation for purchase. When purchases are recommended for products that are available from a number of vendors, the RC is required to show that pricing competition is encouraged and that vendors offering the same goods and equipment are utilized on a rotating basis.

(2) When the total price ranges between $2,500 to $10,000 or more, the RC should contact the RS to discuss how to proceed. The Government may have a contractual mechanism in place for purchase of certain goods or services or a bidding process may be required.

(3) When a bidding process is required:

(a) The RC must solicit quotes from at least two vendors (if possible and available)

(b) The RC must submit to the RS a report which includes:

(i) The names and addresses of all vendors submitting bids/quotes

(ii) Date that bids/quotes were received

(iii) Written bids/quotes from vendors describing in detail the basic, unadorned item meeting the vocational requirements, and a breakdown of all costs, including delivery, set-up, etc.

(iv) The RC's written recommendation for the purchase of the item as well as the recommendation and justification for which vendor to utilize

(v) If the RC's proposed vendor does not present the lowest bid, the RC must justify why the proposed vendor presents the best option

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16. Equipment Status. Certain items purchased as part of an approved rehabilitation plan technically remain the property of the DFEC while the IW is in training, in employed status or otherwise participating in rehabilitation services. However, at the time of rehabilitation case closure, ownership may be transferred to the IW or the IW's employer depending upon the circumstances of the case.

a. If the IW needs the equipment to remain employed, or if the item has depreciated significantly, the IW (or the employer) may assume ownership of the equipment upon OWCP approval.

(1) At the discretion of the RS, the items retained may include the following:

(a) Items of a personal nature such as protective lenses, uniforms, clothing, safety shoes, etc., meant to be utilized for specific training programs and/or employment

(b) Books and supplies/equipment, including computers or laptops, used for training or educational programs

(c) Assistive technology or equipment used for accommodations purposes

(2) Responsibility for maintenance. If in the IW's possession it is the responsibility of the IW to utilize the equipment safely and to keep it in good condition. DFEC may pay for maintenance and servicing due to vendor or factory requirements and/or normal usage while the IW is participating in rehabilitation services. However, any deterioration, depreciation or repairs needed due to factors beyond normal usage, or wear and tear, is the responsibility of the IW.

If the IW retains possession of the equipment upon closure of vocational rehabilitation services, he/she is responsible for all regular and unusual maintenance of equipment.

(3) Ownership transferred to IW's employer.

(a) In some circumstances, items used by the IW in employment may be turned over to the employer if/when no longer needed by the IW. This is most common in situations where the IW is employed with his/her previous Federal employer and the item is applicable only to the employer's mission, with no other useful purpose to other entities. Examples include, but are not limited to, chairs used in the U.S. Postal Service for sit/stand accommodations; computers purchased under the employer's contracting process with programming applicability for the employer; etc.

(b) Responsibility for maintenance. It is the IW's responsibility to maintain good general condition of equipment used in the employment setting.

b. Equipment Agreement and Documentation. With the authorization of the RS, the RC is responsible for explaining and establishing the status and maintenance requirements with the IW for any items/equipment purchased as part of an approved rehabilitation plan.

The IW is also responsible for obtaining the IW's agreement with DFEC policies and his/her signature on the DFEC Equipment Agreement (see Exhibit 4 - Equipment Agreement), which is then forwarded to the RS for inclusion in the IW's case file.

The issues of maintenance should be discussed with the IW prior to the purchase of items. The RC should document the above information in the monthly Progress Report along with the date that the items were successfully delivered and/or the IW took possession and the expected length of time that the IW will utilize and retain the item(s).

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Exhibit 1: RC Billing Codes, Definitions, and Associated Units of Service

VR001 = professional time reflected in hourly increments

1 unit = 1 hour


VUNT1 = professional time reflected in minutes; 59 or less, billed per unit

1 unit = 1 minute


VR002 = administrative time reflected in hourly increments

1 unit = 1 hour


VUNT2 = administrative time reflected in minutes; 59 or less, billed per unit

1 unit = 1 minute


VR003 = reimbursement to the RC for outside testing

1 unit = actual charge paid by RC


VR004 = number of miles traveled

1 unit = 1 mile


VR018 = reimbursement for miscellaneous expenses including parking fees and tolls

1 unit = actual charge paid by RC for expense


VREDU = school or training tuition and fees

1 unit = actual charge


VRSUP = supplies and tools/equipment for training or school, reasonable accommodations, modifications.

1 unit = actual charge for individual supply/tool/equipment


VRTST = payment for outside testing

1 unit = actual charge

 

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Exhibit 2: RC Activity Record - Sample

DATE

SERVICE

Professional
Time

VR001/VUNT1

Admin.
Time

VR002/VUNT2

Parking/tolls


VR004

Travel (MILEAGE)

VR018

4/01/12

Received referral. Call to IW to introduce self and schedule first meeting

12 minutes
(12 units- VUNT1)

 

 

 

4/02/12

Call to supervisor at previous Federal employer and discussed possible return to work

12 minutes
(12 units – VUNT1)

 

 

 

4/7/12

Initial meeting with IW. Reviewed medical and work history. Discussed FECA rehab program. Agreed to plan of action for the next month. Will refer for voc testing.

2.0 hours
(2 units -VR001)

 

 

15 miles
VR004

4/08/12

Call to Career Assessment Associates to schedule voc testing

6 minutes
(6 units – VUNT1)

 

 

 

4/22/12

Meeting with CVE at Career Ass't Associates and IW to discuss results of voc testing. Paid for testing, as pre-approved by RS.

1 hour
(1 unit - VR001)

 

$5.00 parking fee
VR018

21 miles
VR004 -

4/23/12

Email communication with IW regarding possible vocational goals; scheduled next meeting date for plan development

11 minutes
(11 units VUNT1)

 

 

 

4/26/12

LMS research for possible voc goal- telephone, on-line

1 hour
(1 unit - VR001)

 

 

 

4/28/12

Progress report writing – initial evaluation. Submission to RS

1 hour
(1 unit - VR001)

15 minutes typing and submission
(15 units – VUNT2)

 

 

 

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Exhibit 3: Associated RC Billing Invoice

Line

Date from

Date to

Procedure Code

Units

Charge per unit

total

1

04/01/2012

04/30/2012

VR001

5

60.00

300.00

2

04/01/2012

04/30/2012

VUNT1

41

1.00

41.00

3

04/01/2012

04/30/2012

VR002

 

30.00

 

4

04/01/2012

04/30/2012

VUNT2

15

.50

7.50

5

04/01/2012

04/30/2012

VR003

 

Fee paid

500.00

6

04/01/2012

04/30/2012

VR004

36

.57 p/mile
(GSA rate)

20.52

7

04/01/2012

04/30/2012

VR018

5.00

Fee paid

5.00

Total Charges

 

 

 

 

 

874.02

 

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Exhibit 4: Sample Equipment Agreement

U.S. Department of Labor
Office of Workers' Compensation Programs
Division of Federal Employee's Compensation
District Office Address and Phone Number

Injured Worker: ____
OWCP Case File#: ____
Employer: ____
DOI: ____

Date: ____

Dear ____:

The Office of Workers' Compensation Programs (OWCP) plans to purchase the following item(s) costing $____ or less to help you succeed in your approved vocational rehabilitation program.

Description of Item(s)

Cost

 

$

 

$

Taxes

$

Total

$

Unless otherwise specified, you may be required to relinquish the item(s) at the completion/termination of your approved vocational rehabilitation program to OWCP or to your Federal employer. Please sign and date the following verification and agreement.

Sincerely,

 

Rehabilitation Specialist


I verify that the list above contains the item(s) costing $____ or less that OWCP plans to purchase for my approved vocational rehabilitation program. I also verify that the description and cost is correct. If so directed, I agree to relinquish the item(s) at the completion/termination of my approved vocational rehabilitation program. I understand that all shipping costs will be paid by the OWCP.

______________________________________________
Injured Worker

  ___________________
  Date

 

 

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