[Federal Register Volume 59, Number 36 (Wednesday, February 23, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-4069]


[[Page Unknown]]

[Federal Register: February 23, 1994]


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DEPARTMENT OF LABOR

Office of Workers' Compensation Programs

20 CFR Part 10

RIN 1215-AA

 

Claims for Medical Benefits Under the Federal Employees' 
Compensation Act

AGENCY: Employment Standards Administration, Office of Workers' 
Compensation Programs, Labor.

ACTION: Final rule.

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SUMMARY: On November 24, 1993, the Department of Labor published 
proposed revisions to the rules establishing a fee schedule and 
procedures for submitting bills for reimbursement for medical 
procedures and services provided to injured federal employees under the 
Federal Employees' Compensation Act (FECA) (58 FR 62063). The Office of 
Workers' Compensation Programs (OWCP) proposed to: Adopt where 
applicable the relative value units (RVUs) devised by the Department of 
Health and Human Services, Health Care Finance Administration (HCFA), 
published most recently on December 2, 1993, 58 FR 63626; eliminate the 
requirement to use the Washington State conversion factors; and allow 
the use of Geographic Practice Cost Indices (GPCIs) developed by the 
Urban Institute for HCFA to determine geographic adjustment factors. 
The rules also climate the requirement for original signatures on the 
bills.
    The comment period closed January 24, 1994, and no comments were 
received; the rules are now published in final in the same form as they 
were proposed.

EFFECTIVE DATE: April 25, 1994.

FOR FURTHER INFORMATION CONTACT:
Thomas M. Markey, Director for Federal Employees' Compensation, 
Employment Standards Administration, U.S. Department of Labor, room S-
3229, Frances Perkins Building, 200 Constitution Avenue, NW., 
Washington, DC 20210; Telephone (202) 523-7552.

SUPPLEMENTARY INFORMATION: The preamble to the proposed rule explained 
in detail the background of the schedule of maximum allowable charges 
for most medical services provided to injured workers under the Federal 
Employees' Compensation Act (FECA), 5 U.S.C. 8101 et seq. See 51 FR 
8276, for a complete explanation of the background and purpose of the 
schedule.
    Under the fee schedule and billing system individual procedures are 
assigned a descriptor code using the Physicians' Current Procedural 
Terminology (CPT) scheme developed by the American Medical Association. 
Each code is then assigned a relative value unit (RVU) reflecting the 
relative skill, effort, risk, and time required to perform the 
procedure. The maximum allowable amount payable for a given service is 
calculated by multiplying the RVU by a conversion factor (CF). This 
product is in turn multiplied by a geographic index (GI) which allows 
for regional variations in medical costs.
    The components of the fee schedule served OWCP well until recently, 
when the State of Washington (the system on which several factors of 
the fee schedule were based), announced that it was adopting a new fee 
schedule based on the newly published Health Care Financing 
Administrations (HCFA) RVUs for physicians' services, with 
modifications peculiar to Washington State.
    Rather than continue to use the Washington State system, the Office 
of Workers' Compensation Programs (OWCP) proposed to adopt elements of 
the HCFA fee schedule directly. OWCP will continue to use geographic 
localities (using Metropolitan Statistical Areas) designed by the Urban 
Institute for application of Geographic Practice Cost Indices (GPCIs), 
since Medicare pricing localities are carrier specific. Finally, the 
conversion factors (see 57 FR 5186) will be changed to accommodate the 
change in scale of the relative unit values.
    The proposed rules also change the provision requiring that the 
medical provider sign the billing form, in order to accommodate the 
practice of electronic transmission of medical bills and other similar 
practices.
    No comments at all were received on the proposed rules. 
Accordingly, the proposed changes are being implemented in final 
unchanged, except for minor changes to correct grammatical and 
typographical errors.

Statutory Authority

    5 U.S.C. 8149 provides the general statutory authority for the 
Secretary to prescribe rules and regulations necessary for 
administration and enforcement of the Federal Employees' Compensation 
Act.
    5 U.S.C. 8145 provides that the Secretary of Labor shall administer 
the Act, may appoint employees to administer it, and may delegate 
powers conferred by the Act to any employee of the Department of Labor.
    5 U.S.C. 8103 (a) and (b) specifies that the Secretary may approve 
or authorize ``necessary and reasonable'' expenses to be paid from the 
Employees' Compensation Fund; may issue regulations governing the 
provision of services, appliances and supplies; and may prescribe the 
form and content of the authorization certificate.

Classification

    The Department of Labor has concluded that the regulatory proposal 
is not a significant regulatory action under the criteria of section 
3(f) of Executive Order 12866.

Paperwork Reduction Act

    The information collection requirements entailed by the proposed 
regulations have previously been approved by OMB.

Regulatory Flexibility Act

    The Department believes that the rule will have ``no significant 
economic impact upon a substantial number of small entities'' within 
the meaning of section 3(a) of the Regulatory Flexibility Act. Pub. L. 
96-354, 91 Stat. 1164 (5 U.S.C. 605(b)). Although this rule will be 
applicable to small entities it should not result in or cause any 
significant economic impact, since the changes in the method of 
calculating the maximum allowable payments will not result in a 
significant difference in the outcome from that in the present method. 
The Secretary has so certified to the Chief Counsel for Advocacy of the 
Small Business Administration. Accordingly, no regulatory impact 
analysis is required.

List of Subjects in 20 CFR Part 10

    Claims, Government employees, Labor, Workers' compensation.

    For the reasons set out in the preamble, part 10 of chapter 1 of 
title 20 of the Code of Federal Regulations is amended as follows:

PART 10--CLAIMS FOR COMPENSATION UNDER THE FEDERAL EMPLOYEES' 
COMPENSATION ACT, AS AMENDED

    1. The authority citation for part 10 is revised to read as 
follows:

    Authority: 5 U.S.C. 301; Reorganization Plan No. 6 of 1950, 15 
FR 3174, 64 Stat. 1263; 5 U.S.C. 8149; Secretary's Order 1-93, 58 FR 
21190.

    2. Section 10.411 is amended by revising paragraphs (b) and (d)(3) 
to read as follows:


10.411  Submission of bills for medical services, appliances and 
supplies; limitation on payment for services

* * * * *
    (b) By submitting a bill and/or accepting payment, the physician or 
other medical provider signifies that the service for which 
reimbursement is sought was performed as described and was necessary. 
In addition, the physician or other provider thereby agrees to comply 
with all rules and regulations set forth in this subchapter concerning 
the rendering of treatment and/or the process for seeking reimbursement 
for medical services, including the limitation imposed on the amount to 
be paid for such services.
* * * * *
    (d) * * *
    (3) The Director shall assign the relative value units (RVUs) 
published by the Health Care Finance Administration (HCFA) to all 
services for which HCFA has made assignments, using the most recent 
revision. Where there are no RVUs assigned to a procedure, the Director 
may develop and assign any that he/she considers to be appropriate 
RVUs. The Director will also devise conversion factors for each 
category of service, and in devising such factors the Director may 
adapt the HCFA conversion factors as appropriate using OWCP processing 
experience and internal data. The geographic adjustment factor shall be 
that designated by Geographic Practice Cost Indices for Metropolitan 
Statistical Areas as devised for HCFA by the Urban Institute and 
published February 1, 1991, as Refining the Malpractice Geographic Cost 
Index, as updated or revised from time to time.
* * * * *
    Signed at Washington, DC, this 15th day of February, 1994.
Shelby Hallmark,
Acting Director, Office of Workers' Compensation Programs.
[FR Doc. 94-4069 Filed 2-22-94; 8:45 am]
BILLING CODE 4510-27-M