Office of Workers’ Compensation Programs …

1 Office of workers Compensation Programs division of Federal Employees Compensation Interagency MeetingFebruary 15, Department of LaborOffice of workers Compensation Programs division of Federal Employees CompensationAntonio A. RiosDirector, division of Federal Employees Department of LaborOffice of workers Compensation Programs division of Federal Employees CompensationCase Create Trends100,000110,000120,000130,000140,00 0150,000160,000170,000180,000190,0001990 1992199419961998200020022004200620082010 201220142016 Cases Department of LaborOffice of workers Compensation Programs division of Federal Employees CompensationPeriodic Roll Trends4000042000440004600048000500005200 054000560005800060000 Number ofCases Paid onthe Periodic RollPRM Units ImplementedNew Policies Nurse@ 2 weeks of TTD 2ndOp Exams @ 12 months of Department of LaborOffice of workers Compensation Programs division of Federal Employees CompensationChargeback Trends 2007 - in Comp CostsCorresponds with Drop in PR Universe2015 Rise in Compounds2016-2017 Drop in Compounds Department of LaborOffice of

2 Workers Compensation Programs division of Federal Employees CompensationWe re ECOMP Document Upload Categories such as: Job Offer Rejections or Non-Responses Case Copy/Document Request Employer s Claim Challenge Compensation QuestionAverages Inquiries per Month Increased by 85%Average Response Time Decreased by 30% Department of LaborOffice of workers Compensation Programs division of Federal Employees Compensation0100020003000400050006000700 08000FY2017FY2018 thru Jan 31 Average Inquiries per Department of LaborOffice of workers Compensation Programs division of Federal Employees Compensation0510152025FY2017FY2018 thru Jan 31 Average Days to Department of LaborOffice of workers Compensation Programs division of Federal Employees

3 Compensation Pharmacy Benefit Manager (PBM) Pause any PBM contract renewals/awards Consult with DOL OWCP before doing so End to End Case Management Opioid Policy Implementation Expanding Program Integrity Collaborative Case Management oDisability Management Interface (DMI)Continuing to Improve Department of LaborOffice of workers Compensation Programs division of Federal Employees CompensationDisability Management Interface (DMI)No RTW after Job Found Suitable Department of LaborOffice of workers Compensation Programs division of Federal Employees CompensationDisability Management Interface (DMI) Department of LaborOffice of workers Compensation Programs division of Federal Employees CompensationDisability Management Interface (DMI) Department of LaborOffice of workers Compensation Programs division of Federal Employees CompensationDisability Management Interface (DMI) Department of LaborOffice of workers Compensation Programs division of Federal Employees CompensationDisability Management Interface (DMI) Department of LaborOffice of workers Compensation Programs division of Federal Employees CompensationDisability Management Interface (DMI)

4 Letter shell is populated with text entered in Department of LaborOffice of workers Compensation Programs division of Federal Employees CompensationDisability Management Interface (DMI) Department of LaborOffice of workers Compensation Programs division of Federal Employees CompensationDisability Management Interface (DMI)To u s e DMI, a Federal Agency must: Have a completed ECOMP MOU on file with DOL and demonstrate a current forms filing status in the system Contact DOL sBranch of Technical Assistance to request access Review and agree to the DMIR ules of Behavior Complete DMItraining Department of LaborOffice of workers Compensation Programs division of Federal Employees CompensationJulia A.

5 TritzDeputy Director, division of Federal Employees Department of LaborOffice of workers Compensation Programs division of Federal Employees Compensation Opioid Policy Development CE Identity Update End to End District Office Department of LaborOffice of workers Compensation Programs division of Federal Employees CompensationJennifer ValdiviesoDeputy Director, division of Federal Employees Department of LaborOffice of workers Compensation Programs division of Federal Employees Compensation Four Units: Jacksonville, Seattle, New Orleans, Chicago Medical Benefit Examiner Claims Examiner Cases Assigned by SSNP rescription Management Department of LaborOffice of workers Compensation Programs division of Federal Employees Compensation Identification of Risky Opioid Providers/PrescribersoHigh VolumeoHigh Morphine Equivalent Dose (MED)

6 Predictive Analytics and Risk MetricsProgram Integrity Department of LaborOffice of workers Compensation Programs division of Federal Employees Department of LaborOffice of workers Compensation Programs division of Federal Employees Department of LaborOffice of workers Compensation Programs division of Federal Employees CompensationFECA CIRCULAR 18-05, issued February 14, 2018 Payment will be denied if the items in the kit/medication: can typically be obtained separately and/or at a lower cost, there is a reasonable alternative or substitute, or the primary use is for a condition not normally not caused by a workers Compensation injury.

7 Initial denial list has 49 different NDCsMedication Kits and Combination Department of LaborOffice of workers Compensation Programs division of Federal Employees Department of LaborOffice of workers Compensation Programs division of Federal Employees CompensationFECA CIRCULAR NO. 17-03: Office of Inspector General (OIG) Investigations Pertaining to Federal Employees Compensation Act (FECA) Claimant and Medical Provider Fraud FECA BULLETIN NO. 17 04: Investigations related to Federal Employees Compensation Act (FECA) Claimant FraudFECA BULLETIN NO. 17-05: Investigations related to Federal Employees Compensation Act (FECA) Medical FraudAvailable at Department of LaborOffice of workers Compensation Programs division of Federal Employees CompensationTara N.

8 JonesChief,Branch of Technical Department of LaborOffice of workers Compensation Programs division of Federal Employees CompensationWhere do I sign up?Disability Management Interface (DMI) Department of LaborOffice of workers Compensation Programs division of Federal Employees Compensation Contact DFEC s Branch of Technical Assistance ( BTA ) Complete Training In person/WebEx, facilitated by BTA Agency must request cases through ARI in advance During training will work on actual claims Agree to Rules of BehaviorDisability Management Interface (DMI) Gaining Department of LaborOffice of workers Compensation Programs division of Federal Employees Compensation Non-negotiables.

9 Complete and accurate information No duplicates Upload requested information System abuseDisability Management Interface (DMI) Rules of Department of LaborOffice of workers Compensation Programs division of Federal Employees Compensation Requesting suitability on temporary job offers: See 20 CFR , 5 8106(c)(2) Requesting medical at unreasonable intervals: See 20 CFR Failing to provide useful data in requested fields of the applicationDisability Management Interface (DMI) Non-Compliance Department of LaborOffice of workers Compensation Programs division of Federal Employees Compensation Review and Monitor submissions Non Compliance will result in: Suspension and/or Termination Individual or DepartmentalDisability Management Interface (DMI) Department of LaborOffice of workers Compensation Programs division of Federal Employees Compensation WEEDS Page Limit Increased to 7 (from 6) PR Schedule for 2018 Posted Online CQS.

10 3,196 accounts since September 2017 1% reported registration issues Forms: CA-7/16/17/20 and OWCP5a/b/c General Department of LaborOffice of workers Compensation Programs division of Federal Employees Compensation Register for Listserv Notify Us of Staffing Changes That Affect User Accounts CHEP 2018 AnnouncementGeneral Department of LaborOffice of workers Compensation Programs division of Federal Employees CompensationJulia K. HearthwayDirector, Office of workers Compensation Department of LaborOffice of workers Compensation Programs division of Federal Employees CompensationFECA Legislative Reform Included in President s FY2019 Budget Subject to Interagency Department of LaborOffice of workers Compensation Programs division of Federal Employees CompensationPresident s 2019 Budget and FECA ReformFECA ProvisionsSimplifying Benefits Single rate of Compensation *Retirement conversion benefit*ImprovingProgram IntegrityPrevent retroactive election of OPM and FECA benefitsSuspend payments to indicted medical providersModernizing Program Administration Waiting