EEOICPA CIRCULAR NO. 19-03            DATE: April 25, 2019

 

SUBJECT:  Targeted Case Management for Home Health Care 

The purpose of this Circular is to notify all Division of Energy Employees Occupational Illness Compensation (DEEOIC) staff of a new policy regarding the authorization of Targeted Case Management for home health care services.

For the purposes of authorizing the reimbursement of Targeted Case Management (TCM), the DEEOIC will authorize a maximum of 15 minutes (1 unit) of TCM services per week.  TCM services may not exceed 26 units for a 6-month period, without the claimant’s physician providing sufficient written medical necessity justification.  TCM is authorized for reimbursement when an employee with accepted work-related illness or illnesses is receiving home health care services for multiple disciplines of care supplied by a single provider or multiple service providers.  Multiple disciplines of care are categorized by professional service levels including: skilled nursing, home health aide/personal care attendant, rehabilitative therapists or other licensed/certified service professionals. 

DEEOIC will consider exceptions to the guidance described in this circular on a case-by-case basis.

 

RACHEL P. LEITON

Director, Division of Energy Employees

Occupational Illness Compensation

 

 

Distribution List No. 1:  Claims Examiners, Supervisory Claims Examiners, Technical Assistants, Customer Service Representatives, Fiscal Officers, FAB District Managers, Operation Chiefs, Hearing Representatives, District Office Mail & File Section