The geographic areas used in making determinations regarding recruitment/retention difficulties are defined by the National Wildfire Coordinating Group (NWCG) Geographic Area Coordination Center (GACC) of the DOI and USDA. Claims under the Federal Employees' Compensation Act due to COVID-19 c. Similar to disability cases, following appropriate development, the claims examiner should refer supportive medical evidence to a DMA in accordance with item 4(d) above. 10.310; 20 C.F.R. b. 3. iv Diana L. Nadler, Igor G. Zurbenko, "Estimating Cancer Latency Times Using a Weibull Model", Advances in Epidemiology, vol. If the COVID-19 Task Force determines the case specific employment is considered high-risk, a high-risk determination memorandum is created and placed in the applicable case file at the time of adjudication. Pursuant to FECA Bulletin No. Since the date and time of transmission may not always be known due to the nature of the virus, OWCP DFELHWC will use the date of last exposure prior to the medical evidence establishing the COVID-19 diagnosis as the date of injury. Refills. Employing agency users will access a claimant case in ECOMP in the same manner they do now, and will, thereby, have access to the PBM Claimant Portal. Director for Claims accepted for COVID-19 diagnosed after January 27, 2023, will be included in the annual chargeback billing. The injured worker was an employee within the meaning of the FECA; 2. This identification should be made based on evidence, not accepted condition and could be made in scenarios that include but are not limited to (1) while reviewing a copy request, (2) while reviewing a second opinion report or other medical evidence, or (3) while taking a phone call. b. A rationalized medical report establishing a causal link between a diagnosis of COVID-19 and factors of Federal employment is required in all claims for COVID-19 diagnosed after January 27, 2023. See our prior articles discussing these forms of relief in detail here, here and here. .manual-search ul.usa-list li {max-width:100%;} A positive Antibody or Antigen COVID-19 test result, together with contemporaneous medical evidence that the claimant had documented symptoms of and/or was treated for COVID-19 by a physician (a notice to quarantine is not sufficient if there was no evidence of illness); or The only exception to this condition is with respect to sudden cardiac events or strokes as defined in item 2(a)(15) above. For example, if an employee was first engaged in fire protection activities in January of 2008, stopped working in fire protection activities in December 2009, and returned to their fire protection activities from January 2013 through their retirement in November 2017, their total engagement is between six-years-and-nine-months and six-years-and-eleven-months, depending on the specific dates involved. VIII. Mesothelioma This review includes an examination of how COVID-19 was caused by the positions work-related activities. The Employees' Compensation Operations and Management Portal (ECOMP) should be used to file new claims. If additional opioids are needed, prescribers must continue to seek prior authorization before the end of each prior authorization period. First, whether the California Workers' Compensation Act bars an employee's household member's claim against an employer; and second, whether the employer's duty to protect its employees from COVID infections extends to the home. FECA BULLETIN NO. A determination as to whether a claim based on a COVID-19 diagnosis is treated under the ARPA COVID-19 provisions will be based exclusively on the date of the positive COVID-19 test result1. Authorizations will be made by the Chief or Assistant Chief of the Branch of Fiscal Operations or the National Director of Field Operations. Case Indicator. A. This network spans the Continental United States and its permanently inhabited territories. Claimants can also contact the PBM at (833)-FECA-PBM to request home delivery. Payments received through CRS will be posted to the account via the debt management application in the integrated Federal Employees' Compensation System (iFECS). If the claimant has a designated authorized representative, a copy of the requested medical records should instead be provided to the authorized representative of record. If no medical documentation present reflects a diagnosis by a valid physician of one or more of the specified conditions, such documentation should be requested by the claims examiner. Daniels, RE,et al, Occup Environ Med 2015; 0:1-8. In conjunction with the most current CDC guidance, the FECA Program is hereby updating its policy with respect to the authorization of opioid medication. 17. ol{list-style-type: decimal;} The CE should provide the case number and recommendation to the Branch of Regulations and Procedures (R&P) through a designated e-mail address. Purpose: To provide notice that although the Sixth Edition of the AMA Guides have recently been updated, the FECA Program will be maintaining the use of the second printing of the Sixth Edition (2009) rather than adopting the latest updated version. 2. 22-03 January 12, 2022, Subject: Processing Claims for Anomalous Health Incidents (AHI) under the Federal Employees Compensation Act (FECA). Orange Book: Approved drug products with therapeutic equivalence evaluations. Mesothelioma COVID-19 claims filed or adjudicated under the ARPA standards after March 11, 2021 and where COVID-19 is diagnosed on or before January 27, 2023 will be accepted under the ARPA. Optum/FECA pharmacy cards and welcome letters will be mailed to current FECA claimants in multiple groupings. This program provides small businesses with funds to pay up to 8 weeks of payroll costs including benefits. Purpose: To provide additional guidance regarding special case handling of COVID-19 FECA claims. The following new protocol will apply to any cases scanned for Backfile Conversion, Privacy Act responses, MBE cases, and for BHR. The letters will be mailed to claimants and made available on the PBMs portals for claimants and prescribers to review. If the gross override payment is in fact eligible for annual CPI increases, the payment plate should be adjusted in the iFECS system to pay as a "Gross Override with CPI. Submission of an antigen test alone is now sufficient to establish the medical component of a COVID-19 claim. b. Cancer risk among firefighters: A review and meta-analysis of 23 studies. Claims for COVID-19 death benefits are adjudicated in a manner similar to other claims for death benefits. 8146(a) establishes the base month for the FECA CPI as December. Part 10, Subpart I (20 C.F.R. c. All medical evidence must be submitted from a qualifying physician. II. Within 21 days of your diagnosis of COVID-19, you carried out duties that required contact with patients, members of the public, or co-workers. Additional phases are estimated to be deployed over the next several months of Fiscal Year 2021, and will include the development and implementation of a (1) formulary management system (2) user interface for pharmacy authorization transmittals (3) utilization review programs (4) DME and diagnostic testing programs along with other programs to assist FECA claimants and FECA program staff. This report is not applicable for death cases since the FECA payment files used for the matching contain the SSN of the claimant (not the beneficiary(ies) being paid) and were not matched against DNP death data sources. $8,813.72 each four weeks MMWR Morb Mortal Wkly Rep 2017;66:265269. 4. Background: A person filing a new claim before the Office of Workers' Compensation Programs (OWCP) must submit sufficient evidence to establish the five basic requirements of a claim, which is known as the "burden of proof." There are no changes to the specialized requirements for medical evidence needed to establish a diagnosis of COVID-19 as noted in item III(c)(1) above. See also: FECA Bulletin 21-10 and FECA Bulletin 22-06. Dual Benefits: On October 8, 2021, President Biden signed the Havana Act into law. $9,172.31 per month A positive Antibody test result, together with contemporaneous medical evidence that the claimant had documented symptoms of and/or was treated for COVID-19 by a physician (a notice to quarantine is not sufficient if there was no evidence of illness); or. Reference: FECA Consumer Price Index (CPI) Amendment, dated January 6, 1981; Bureau of Labor Statistics Consumer Price Index Publication for December 2021 (USDL-22-0028). A position description should also be requested. Thus, even if a prescriber or claimant requests the brand name version, the prescription will be rejected at the point of sale. A provider may choose to conduct a routine medical appointment utilizing telemedicine options (including phone, video conferencing or similar technologies as permitted by state law) which the provider believes will provide the most appropriate medical benefit to the claimant. If the Task Force has made a high-risk determination based on position or case specific facts, as indicated in section A and B above, and a positive COVID-19 laboratory test result is submitted, no further medical development is necessary. If no problems arise during this period, the paper case documents may be destroyed after the end of the seven (7) work day period. The increase is effective March 1, 2021, and is applicable where disability or death occurred before March 1, 2020. Compensation Pay: Compensation Rate Changes for 2020. The condition(s) are deemed proximately caused by Federal firefighter employment and the claim may be acceptedi. 3. include a risk of exposure to the novel coronavirus. If there is no clear, identifiable incident or incidents over a single work day or work shift to which the COVID-19 diagnosis is attributed, then a Form CA-2 should be used. In such cases, there is an implicit recognition of a higher likelihood of illness related to such federal employment. AB 152 expands COVID-19 Supplemental Sick Leave benefits through December 31, 2022, allowing employees to take paid leave for COVID-related reasons and/or for treating themselves or a family. The below protocols supersede the reimbursement authorization process outlined in the FECA Procedure Manual, 5-202(15) and 5-202(16). You can view this instructional video to learn how to file a COVID-19 claim. The PBM will allow no more than one 7-day supply of an on-formulary, immediate release opioid prescription for new opioid users with non-cancer pain, without prior authorization. The PBM will not authorize the provision of more than two opioids at the same time in accordance with current best practice guidelines. 5. 2015; 58:715-29. iii Recent studies have demonstrated marked increase in incidence of certain cancers, heart and lung diseases in individuals engaged in fire protection activities for fire years or more. b. 2. Those circumstances have now passed, so this change is being made so that COVID-19 is treated similarly to other airborne infectious disease where the specific etiology is unclear. 5. If the claim does not meet the five basic requirements for adjudication, given the caveats noted in items 1 and 2 above, the claims examiner should proceed with a denial. Washington, DC 202101-866-4-USA-DOL1-866-487-2365www.dol.gov. Cases involving COVID-19 diagnosed after January 27, 2023, will have a case indicator of CVD. It would require the procurement, learning, and understanding of a new and digital edition of the Guides despite such edition having no material impact on impairment ratings provided under the FECA. b. Self-administered COVID-19 tests, also called home tests, at-home tests, or over-the-counter (OTC) tests have become available and more prevalent over the course of the COVID-19 pandemic. Based on that review, the Task Force finds whether there is sufficient evidence to accept that the diagnosis of COVID-19 is proximately caused by employment. 23-05 Issue Date: March 20, 2023, Subject: Special Case Handling in Certain Firefighter FECA Claims Processing and Adjudication. On December 23, 2022, the James M. Inhofe National Defense Authorization Act of 2023 (NDAA), Pub. In these circumstances, the physician may have a Registered Nurse (RN), Advanced Practice Nurse Practitioner (APNP), or Physician Assistant (PA) present with the claimant during the telemedicine appointment. Determination of COVID-19 as a Quarantinable Communicable Disease; Telework; Sick Leave and Other Time Off; Weather and Safety Leave; Evacuation Payments During a Pandemic Health Crisis; Employee Relations; Hazardous Duty Pay Related to Exposure to COVID-19; Workplace Precautions to Prevent Exposure to COVID-19 Action: The firefighters who are affected by this legislation are those who have effective pay rate dates of October 1, 2021 or later. However, as some claimants are located in remote areas overseas and may have limited access to a qualifying physician, a claims examiner may refer the report of a nurse or physicians assistant to a DMA for review and concurrence with the original providers assessment. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. 2006; 48(11): 1189-202; Daniels RD, et al. Subject: Compensation Pay: Compensation Rate Changes for 2020. Action: The claims examiner (CE) should take the following steps if he or she identifies a case in which there is an indication that there may be a health or safety risk in allowing a claimant direct immediate access to his or her medical records. Available at: https://purplebooksearch.fda.gov/. The alleged event(s) or employment factor(s) occurred while the employee was in the performance of duty; and. 2. FECA BULLETIN NO. Coverage for Injuries Resulting from the COVID-19 Vaccination Mandate for Federal Employees. Therefore, any claim for which COVID-19 is diagnosed between January 27, 2020, and January 27, 2023, will continue to be processed in accordance with the guidelines established under the ARPA. Refills. In this instance, supportive medical evidence from a physician on the relationship between the illness and the claimed disability and/or medical expenses is needed regardless of the employment determination (high-risk or not high-risk); or. In all instances where a case number is changed to a "55" or 19 prefix based on the date COVID-19 is diagnosed, a letter will be sent to the claimant and agency notifying them of the change. You will need to provide medical evidence establishing that the diagnosed COVID-19 was aggravated, accelerated, precipitated, or directly caused by your work-related activities.
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