Final Rule Will Streamline Bill Processing for Disabled Miners

The new regulations adopt industry-standard payment formulas derived from those used by Medicare and are similar to those used by other OWCP-administered compensation programs for federal employees, and the rule codifies the black lung program's current payment practice for prescription drug payments.

The U.S. Department of Labor's Office of Workers' Compensation Programs has published a final rule under the Black Lung Benefits Act conforming the department's payment of medical benefits for disabled coal miners to industry standards and streamlining bill-processing procedures. The rule was published June 14 and will take effect Aug. 31.

The new regulations adopt industry-standard payment formulas derived from those used by Medicare and are similar to those used by other OWCP-administered compensation programs for federal employees, and the rule codifies the black lung program's current payment practice for prescription drug payments and its bill-processing procedures.

"The new rule brings the U.S. Department of Labor's payment formulas into line with those used throughout the health care industry, particularly those used by Medicare and other OWCP programs," said Office of Workers' Compensation Programs Director Julia K. Hearthway. "These regulations will ensure that miners continue to receive the medical care they need for treatment of black lung disease, and they will see no change."

The Black Lung Benefits Act provides compensation to miners who are totally disabled due to pneumoconiosis -- black lung disease. Disabled miners are also entitled to medical services needed to treat their disease. The Black Lung Disability Trust Fund pays these benefits when there is no liable coal mine company or when the liable company either cannot or does not pay. When the trust fund pays on behalf of a liable coal company, the department seeks reimbursement. Current regulations require the trust fund to pay for medical services at prevailing community rates but don't specify how those rates are determined. Historically, OWCP's Division of Coal Mine Workers' Compensation relied on internally derived formulas to calculate payments to physicians, hospitals, and other providers. These formulas are now out of date, which is why the new rule was developed.

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