Issue Date: March 24, 2008
Effective Date: March 24, 2008
Expiration Date: March 24, 2009
Subject: Medical Expense Reimbursement for Extended Travel
Background: The Division of Energy Employees Occupational Illness Compensation (DEEOIC) requires pre-authorization for reimbursement of transportation, lodging, meals, and incidental expenses incurred when a claimant travels in excess of 200 miles round trip for medical care of an approved condition. DEEOIC’s bill processing agent will process reimbursement claims for claimant travel without pre-authorization when travel is less than 200 miles round trip.
Upon acceptance of a medical condition, the claimant receives a medical benefits package from the DEEOIC that includes instructions on how to submit a written request for prior approval of medical travel when such extended travel (over 200 miles round trip) is required. Despite these instructions, it is not uncommon for claimants to submit their request for reimbursement after a trip has been completed, and without having obtained prior approval. EEOICPA Bulletin 03-09, “Travel over 200 Miles Round Trip,” provided instructions for processing travel authorization and reimbursement requests, whether received before or after claimant travel.
This Bulletin streamlines the existing procedures to improve the efficiency (timeliness) and effectiveness (quality and accuracy) of the travel authorization and reimbursement process.
It should be noted that Resource Center personnel now have an increased role in assisting claimants with pre-authorization requests and submission of claims for reimbursement.
References: 20 CFR Parts 1 & 30, Subpart E, Medical and Related Benefits, § 30.400.
Purpose: To streamline the policies and procedures for authorizing medical travel requests (over 200 miles round trip), and the process for approving claims for reimbursement, regardless of whether or not the claimant obtained prior approval for the trip. The changes in the authorization process are needed to facilitate this important benefit and provide superior customer service.
Note: Bulletin 03-09 is superseded by this Bulletin.
Applicability: All staff.
1. By regulation, claimant travel to receive medical care exceeding 200 miles round trip must be authorized by DEEOIC claims personnel. Claims that are submitted to DEEOIC’s bill processing agent, for reimbursement of travel expenses arising from medical travel in excess of 200 miles roundtrip, will not be processed for payment unless authorization has been provided by the district office.
2. Upon receipt of a travel authorization request from the claimant, the claims examiner (CE) must take immediate action to ensure that the request meets one basic requirement: that the medical treatment or service is for the claimant’s approved condition(s). The CE should be aware that the medical provider’s enrollment in the DEEOIC program is not a prerequisite to approving medical travel if the claimant chooses to receive medical services from a non-enrolled provider.
3. If the travel request involves authorization for a companion to accompany the claimant, the claimant must provide medical justification from a physician. That justification must be in written form, relating the treatment to the accepted condition and rationalizing the need for the companion. If the doctor confirms that a companion is medically necessary, and provides satisfactory rationale, then the CE may approve companion travel. In the alternative, the CE can authorize the claimant to stay overnight in a hospital or medical facility, and can approve payment for a nurse or home health aide if a companion is not available. The CE must use discretion when authorizing such requests and may approve one of the above alternatives when there is a definite medical need, accompanied by written justification from the physician.
4. The claimant must be allowed to specify his/her desired mode of travel. It is the CEs role to authorize the desired mode of travel for the time period(s) requested. When a request is received from the claimant that does not identify the mode of transportation, the CE must contact the claimant by telephone and assist in determining the desired mode of travel. (Resource Center staff may be utilized to assist in this process.)
5. Once the basic requirements for travel over 200 miles are met, as outlined above, the CE will prepare and send the claimant a travel authorization letter following the guidelines below. The CE may approve an individual trip, or any number of trips within a specified date range, all in one letter to the claimant. Once an initial approval letter has been sent, future visits to the same doctor or facility may be approved by telephone, followed by a confirming letter.
In the travel authorization letter, claimants are to be advised that travel costs are reimbursable only to the extent that the travel is related to obtaining medical treatment. The authorization letter should delineate the specifics of the trip being authorized, based upon the mode of travel the claimant has selected. When completed, the authorization letter will be mailed to the claimant as part of an approval package as follows (See sample Authorization Letter in Attachment 1):
a. The approval package must include the following: two copies of the detailed authorization letter; two copies of a blank OWCP-957; and an express mail prepaid envelope, addressed to DEEOIC’s bill processing agent, for the claimant’s use.
b. The authorization letter will advise claimants to complete Form OWCP-957, Request for Reimbursement, and forward the reimbursement request to DEEOIC’s bill processing agent, in accordance with the information and conditions outlined below. The letter also invites claimants to contact the nearest Resource Center for assistance prior to or upon completing any trip, particularly if they need help understanding reimbursement limits for lodging or airfare, or need help preparing their reimbursement requests.
(1) MIE: Reimbursement for meals and incidental expenses (MIE) will be based on a daily, flat-rate allowance, and that MIE allowance will be paid in full for each day of authorized travel. A separate daily allowance will also be paid for any authorized companion. The daily MIE allowance will be determined by the Government Services Administration (GSA) published per diem rate for the specific locality where the claimant is staying on any given day, whether in route or at their destination city. First and last days of travel will be paid at the ¾ rate. The claimant will not be required to submit receipts for meals or miscellaneous expenses reimbursed under this category, nor will any reimbursement be paid in excess of the daily MIE allowance. (For further information regarding locality rates for MIE, claimants may contact their nearest resource center.)
(2) For authorizations approving travel by privately owned vehicle (POV), the authorization letter must specify the GSA-established mileage reimbursement rate for POV travel.
(3) If travel is to be by commercial airline, the travel authorization letter should advise the claimant that reimbursement will be based on actual ticket cost up to the amount of a refundable coach ticket (Y-Class airfare), unless the CE has specifically approved an exception to this rule.
(4) The daily lodging rate is established by GSA, based upon locality and single or double occupancy, whichever is applicable. This daily rate is exclusive of taxes which will be reimbursed in addition to the base rate.
(5) Approval for rental car reimbursement, if warranted, should include instructions limiting rental reimbursement to the cost of standard, economy-sized vehicles, unless the claimant provides justification for a larger vehicle. (Note: reimbursement for gasoline purchases applies only to rental cars.)
(6) Local transportation costs, such as taxis, airport shuttles or bus fares, are reimbursable separately from, and in addition to the daily MIE allowance. Services such as airport shuttles, hospital or hotel courtesy buses, etc., should be used when available.
(7) Receipts are not required for any allowable expenditure under $75.00, with the exception of lodging, airfare, rental cars, and gasoline purchases (rental car only).
(8) Expenses for both the claimant and any authorized companion must be submitted on Form OWCP-957, and will be reimbursed to the approved DEEOIC claimant, not to any other party.
(9) When submitting a reimbursement request to the DEEOIC bill processing agent, the claimant must include a copy of the authorization approval letter, the completed OWCP-957, and all applicable receipts.
6. DEEOIC’s bill processing agent will process reimbursement claims in accordance with GSA travel guidelines. Per diem rates for overnight stay and mileage reimbursement rates are published on GSA’s website, and air fare reimbursement is based on actual ticket cost up to the amount of a refundable coach ticket (Y-Class airfare).
7. All claims for travel reimbursement must be sent to DEEOIC’s bill processing agent. Should the CE receive a reimbursement request directly from the claimant, for an authorized trip, the CE will forward it immediately to DEEOIC’s bill processing agent to begin the reimbursement process. In the event the CE receives a claim for travel reimbursement that was not approved in advance, the CE will immediately forward the claim to the bill payment processor, and will concurrently begin the process of approving or denying the trip. This will ensure that all claims are adjudicated promptly and are properly recorded and tracked by DEEOIC’s bill processing agent, throughout the reimbursement process. When adjudicating claims submitted after the trip has been completed, but for which prior approval was not obtained, the CE will follow the same steps as for pre-authorized trips, until reaching the point of sending an authorization package. At that point the CE will send only the authorization (or denial) letter to the claimant, not an entire authorization package.
8. If a travel request is denied (either before or after a trip), the CE must notify the claimant in writing, detailing the reason(s) for the denial. The CE’s unit supervisor must provide sign-off for all denials of claimant travel before the denial letter is sent to the claimant. The following wording must be included in the denial letter: “This is the final agency decision on your request for approval of travel expense reimbursement.”
9. In conjunction with sending the claimant an approval or denial of travel request, the CE must convey his/her decision to DEEOIC’s bill processing agent via the office’s Fiscal Officer (FO), who is the point of contact with DEEOIC’s bill processing agent for such issues. The CE prepares an email to the FO, who in turn will generate an electronic thread to the bill processing agent. In the email the CE must provide the information specified below. The CE must also enter this information into the case notes field of ECMS (Select the note type of “T” for Travel Authorization):
¨ Approved dates for a single trip; or in the alternative, a date range and number of trips authorized within that time frame.
¨ Approved mode of transportation.
¨ Starting point and destination: claimant address and provider address (city & state at a minimum).
¨ Authorization for rental car reimbursement, if appropriate.
¨ Companion travel if approved.
10. DEEOIC’s bill processing agent will promptly pay any approved claims directly to the claimant, not to any other party. However, if the claimant completes the form in error or neglects to submit the proper information, DEEOIC’s bill processing agent will attempt to resolve the issue by accessing the authorization letter or the pre-approval notification (thread) from the FO. If unable to issue payment based on information provided in one of these two sources, DEEOIC’s bill processing agent will contact the FO, requesting clarification and/or assistance.
11. The FO and responsible CE will take immediate action to review the claim as submitted, contact the claimant when appropriate, make a determination as to the correct amount of reimbursement or denial if warranted, and send an authorization notification or correction (electronic thread) back to DEEOIC’s bill processing agent.
12. District office CEs and FOs responsible for travel authorization processing must keep upper management apprised of issues impacting prompt and accurate processing of travel authorizations and reimbursements. Claims staff should be especially vigilant to identify any real or perceived problems with the processing interfaces between and among the district office, the Resource Center and DEEOIC’s bill processing agent. Problems must be elevated (reported via email) immediately to the National Office to the attention of the Branch Chief for Policy, with a copy of the notification to the Branch Chief for the Branch of ADP Systems (responsible for oversight of DEEOIC’s bill processing agent).
Disposition: Retain until incorporated in the Federal EEOICPA Procedure Manual.
PETER M. TURCIC
Director, Division of Energy Employees
Occupational Illness Compensation
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