COVID-19 Updates | CWP
Department of Labor Temporarily Allows Telemedicine in Certain Instances During the COVID-19 Pandemic
April 8, 2020
April 8, 2020
The Department of Labor’s Division of Energy Employees Occupational Illness Compensation issued Final Bulletin 20-03 to allow claimants and their provider to participate in telemedicine. Telemedicine visits pertain to reauthorizations of home health care and durable medical equipment claims. Please note that some physicians may not be able to participate in telemedicine because their states where they are licensed may not allow it.
Currently, it is necessary currently for claimants to undergo a face-to-face examination with their physician within 60 days of the date of a Letter of Medical Necessity (LMN) supporting any request for a claimant to receive home health care (HHC) or durable medical equipment (DME).
Because of new “stay at home” instructions imposed to limit interpersonal contact, DEEOIC is temporarily permitting Medical Benefit Examiner (MBE) staff to accept LMNs that a physician prepares using information collected from alternative methods of patient evaluation.
The new, temporary policy applies to HHC or DMC at an existing level of care. The MBE is to review the circumstance of a request for continuing the HHC/DME at the previously approved or existing level. While the MBE must obtain a well-rationalized LMN supporting a need for renewal, if a physician reports being unable to see a claimant face-to-face for medical reasons, the MBE may grant an allowance to extend the current level of HRHC/DME for a new period of authorization.
Telemedicine options will be required for new or increased care. Telemedicine will occur only under those circumstances where the physician has the legal or licensing authority to conduct such an examination. It will also occur only under those circumstances where the claimant’s physician has chosen to undertake such an evaluation.
In the absence of a LMN where the physician reports the inability to perform a face- to-face examination, the MBE is to obtain evidence of either a face-to-face examination, or telemedicine consistent with the guidelines for new or increased care below.
When weighing the evidence for a decision regarding authorization, the MBE may accept that a face-to-face examination occurred within 60 days of the LMN when the evidence establishes the following:
- The LMN or other evidence submitted from the claimant’s physician explains that the physician conducted a face-to-face evaluation of the claimant using remote video conference, via computer or mobile devices.
- The physician may use any viable software or technology to conduct the video conference, as long as the physician attests to having visually interacted with the claimant.
- While the physician can assess the claimant using a video connection, the MBE must obtain evidence that a Registered Nurse (RN), Advanced Practice Nurse was present with the claimant during the physician’s video conference.
- The presence of the RN, APNP, or PA is necessary to ensure the physician is able to obtain physical findings or other expert medical input necessary for a comprehensive physical assessment of the claimant.
If the MBE is unable to obtain evidence that a qualifying face-to-face evaluation occurred, the MBE may proceed with a decision to deny the claim.
DEEOIC will treat the cost for the evaluation of the claimant by the physician using video conference technology, as the same as if it had occurred in the physician’s office. DEEOIC will reimburse time and services provided by the RN, ARNP, or PA in accordance with current home billing without any prior approval required.
DEEOIC also updated their Frequently Asked Questions page on the COVID-19 pandemic.