Black Lung Benefits Act: Medical Benefit Payments
| Published date | 21 November 2019 |
| Citation | 84 FR 64197 |
| Record Number | 2019-25282 |
| Section | Rules and Regulations |
| Court | Workers' Compensation Programs Office |
Federal Register, Volume 84 Issue 225 (Thursday, November 21, 2019)
[Federal Register Volume 84, Number 225 (Thursday, November 21, 2019)]
[Rules and Regulations]
[Pages 64197-64198]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-25282]
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DEPARTMENT OF LABOR
Office of Workers' Compensation Programs
20 CFR Part 725
RIN 1240-AA11
Black Lung Benefits Act: Medical Benefit Payments
AGENCY: Office of Workers' Compensation Programs, Labor.
ACTION: Final rule; delay of applicability date.
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SUMMARY: The Office of Workers' Compensation Programs (OWCP) has
encountered unforeseen delays in implementing a new computer system to
process payments for professional medical and hospital outpatient
services made by the Black Lung Disability Trust Fund (Trust Fund)
under the Black Lung Benefits Act (BLBA). This action delays the
applicability date of two rules relevant to these payments, which were
published in the Federal Register on June 14, 2018.
DATES:
Effective date: This rule is effective November 21, 2019.
Applicability date: The applicability date for 20 CFR 725.708(a)
and (b) and 725.710 is delayed from November 30, 2019 to April 26,
2020.
FOR FURTHER INFORMATION CONTACT: Michael A. Chance, Director, Division
of Coal Mine Workers' Compensation, Office of Workers' Compensation
Programs, U.S. Department of Labor, 200 Constitution Avenue NW, Suite
N-3520, Washington, DC 20210. Telephone: 1-800-347-2502. This is a
toll-free number. TTY/TDD callers may dial toll-free 1-800-877-8339 for
further information.
SUPPLEMENTARY INFORMATION: The Trust Fund pays for covered medical
services and treatments provided to certain miners who are entitled to
BLBA disability benefits. See generally 33 U.S.C. 907, as incorporated
by 30 U.S.C. 932(a); 83 FR 27690 (June 14, 2018). On June 14, 2018,
OWCP published a final rule revising its regulations governing the
payment of medical benefits by the Trust Fund. 83 FR 27690-27699. The
revised rules adopt payment formulas that accurately reflect prevailing
community rates for authorized treatments and services.
While the revised regulations became effective on August 31, 2018,
83 FR 27690, the Department set a separate applicability date for the
rules governing payments for professional medical and outpatient
services. Id.; see
[[Page 64198]]
also 20 CFR 725.708(c) and 725.710(d). In adopting this approach, the
Department explained that payment of these bills ``would require
extensive modifications to the existing computer processes for full
implementation. The Department is currently transitioning to a new
computer system and will realize cost-savings by building the new
payment methodologies into that system rather than modifying the
existing one.'' 83 FR 27691.
The Department has been diligently working toward developing and
deploying a new computer system to implement the new payment formulas
but has encountered unforeseen delays. While many of the issues causing
these delays have been resolved, OWCP cannot complete development of
the new computer system without shifting significant resources from
other critical workloads in time to process professional and outpatient
bills by the current November 30, 2019 applicability date. As an
alternative, OWCP considered, but rejected, manually processing these
bills in the interim. Based on black lung program data from FY 2015
through FY 2017, OWCP estimates it receives an average of approximately
69,000 requests annually for payment of professional medical services
alone. OWCP does not have the staff necessary to manually process this
volume of bills. Thus, without an adequate computer system, it would be
impractical for OWCP to timely process and pay professional and
outpatient bills due to the volume. As a result, the Department is
delaying the applicability date of the rules governing payment of these
bills until April 26, 2020, the day before the new computer system is
now scheduled to become operational.
The Department's implementation of this action without opportunity
for public comment, effective immediately upon publication, is based on
the good cause exceptions in the Administrative Procedure Act, 5 U.S.C.
553(b)(B) and 553(d)(3). Section 553(b)(B) provides that an agency may
issue a rule without notice and comment when the agency for ``good
cause'' finds ``that notice and public procedure thereon are
impracticable, unnecessary, or contrary to the public interest.''
Section 553(d) provides that final rules may not become effective less
than thirty days after publication in the Federal Register ``except . .
. as otherwise provided by the agency for good cause,'' among other
exceptions.
Under these standards, the Department has determined that there is
good cause for making this rule final without notice and comment
procedures, and effective immediately upon Federal Register
publication. As already noted, OWCP does not have the capacity to
manually process the volume of bills it receives for professional and
outpatient medical services. Thus, delaying the rule's application is a
necessity: Without the delay, OWCP would no longer be able to promptly
pay medical professionals and hospitals who provide treatment services
to totally disabled coal miners. That result is contrary to the
interests of miners and medical providers alike. Delaying the rules'
application also does not impose any additional procedural burdens on
the treatment providers. They will continue to seek payment in the same
manner they do now no matter when the rules become applicable. See
generally 20 CFR 725.714 and 725.715.
Finally, neither medical professionals nor outpatient services
providers will be harmed economically by the delay in any significant
way. The Department summarized its economic impact analysis of the new
payment formulas in its notice of proposed rulemaking. 82 FR 739, 745-
765 (Jan. 4, 2017). The Department compared payments it actually made
from the Trust Fund in FY 2014 with payments it would have made if the
new payment formulas in the proposed (and eventually final) rules
applied. For both medical professionals and outpatient services, total
annual Trust Fund payments decreased, in the aggregate, under the new
payment formulas: $8,493 for professionals and $1,719,543 for
outpatient services. 82 FR 746-748. Thus, delaying application of the
new payment formulas will not, in the aggregate, harm the providers of
either professional or outpatient services.
List of Subjects in 20 CFR Part 725
Administrative practice and procedure, Black lung benefits, Claims,
Coal miners' entitlement to benefits, Health care, Reporting and
recordkeeping requirements, Survivors' entitlement to benefits, Total
disability due to pneumoconiosis, Vocational rehabilitation, Workers'
compensation.
For the reasons set forth in the preamble, the Department of Labor
amends 20 CFR part 725 as follows:
PART 725--CLAIMS FOR BENEFITS UNDER PART C OF TITLE IV OF THE
FEDERAL MINE SAFETY AND HEALTH ACT, AS AMENDED
0
1. The authority citation for part 725 continues to read as follows:
Authority: 5 U.S.C. 301; 28 U.S.C. 2461 note (Federal Civil
Penalties Inflation Adjustment Act of 1990); Pub. L. 114-74 at sec.
701; Reorganization Plan No. 6 of 1950, 15 FR 3174; 30 U.S.C. 901 et
seq., 902(f), 921, 932, 936; 33 U.S.C. 901 et seq.; 42 U.S.C. 405;
Secretary's Order 10-2009, 74 FR 58834.
Sec. 725.708 [Amended]
0
2. In Sec. 725.708, amend paragraph (c) by removing the date
``November 30, 2019'' and adding in its place ``April 26, 2020''.
Sec. 725.710 [Amended]
0
3. In Sec. 725.710, amend paragraph (d) by removing the date
``November 30, 2019'' and adding in its place ``April 26, 2020''.
Julia K. Hearthway,
Director, Office of Workers' Compensation Programs.
[FR Doc. 2019-25282 Filed 11-18-19; 4:15 pm]
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