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Updates to Procedure Manual v4.0 include:
The Procedure Manual contains a "Quick Link Index" (following the cover page) to assist you in quickly navigating Procedure Manual v4.0. The new version includes updates to the following Chapters and Exhibits:
Chapter 1, Definitions:
• Ch. 1.2ccc has been edited to correct a citation in compliance with 20 CFR § 30.5.
Chapter 7, Case Creation:
• Ch. 7.2 has been edited to comply with 20 CFR § 30.100 and 30.101 regarding the necessity for a claimant signed claim form.
• Ch. 7.5 has been edited to comply with 20 CFR § 30.100 and 30.101 and adds guidance regarding processing signed claim forms.
• Ch. 7.9a has been added to provide guidance on the resumption of development after the withdrawal of a claim.
Chapter 12, Representative Services:
• Ch. 12.4 has been edited to comply with 20 CFR. § 30.600 regarding obtaining claimant signed claim forms.
Chapter 14, Establishing Special Exposure Cohort Status:
• Ch. 14.7c has been edited to clarify that leukocytosis and thrombocytosis are not a diagnosis of cancer.
Chapter 15, Establishing Toxic Substance Exposure and Causation:
• Ch. 15.11d has been edited to provide instructions on how an Industrial Hygienist (IH) engages directly with a claimant in collecting exposure data for informing a toxic substance profile.
• Exhibit 15-4.3 has been edited to extend the temporal duration for the presumption of asbestos exposure for certain labor categories, to remove language requiring high levels of asbestos exposure, and to add the labor category of Uranium Miner/Miller.
Chapter 16, Developing and Weighing Medical Evidence:
• Ch.16.3a(3) has been edited to correct a citation reference relating to 20 CFR § 30.5.
• Ch. 16.5a(1) has been added to add distinction on how DEEOIC is to define a diagnosed condition vs. symptom.
• Ch. 16.9a-c has been edited to correct an error in the outline format.
Chapter 18, Eligibility Criteria for Non-Cancerous Conditions:
• Ch. 18.13 has been edited to clarify the appropriate use of SEM in cases of fibrotic lung diagnoses.
Chapter 22, Wage-Loss Determinations:
• Ch. 22.6a has been updated to comply with guidance found in Ch. 22.12.
Chapter 23, Consequential Conditions:
• Ch. 23.3 has been edited to comply with 20 CFR § 30.100 and 30.101 regarding the necessity of obtaining claimant signed claim forms.
Chapter 25, FAB Review Process:
• Ch. 25.7d(7) has been added to provide guidance on the resumption of development after the withdrawal of a claim:
Chapter 26, FAB Decisions:
• EEOICPA Bulletin No. 19-04 has been incorporated by updating the Exhibit 26-2, Medical Benefits Letter.
Chapter 28, Medical Bill Process:
• Ch. 28.2b has been updated to clarify the role of the Medical Benefits Examiner (MBE).
• Ch. 28.2c has been deleted due to the edit added at Ch. 28.2b. Accordingly, the remaining section Ch. 28.2 has been renumbered.
• Ch. 28.13d has been edited to reflect a change in the timeframe allowed for a response to a request for reconsideration.
Chapter 29, Ancillary Medical Services and Related Expenses:
• All references throughout Ch. 29 to CE have been changed to CE/MBE.
• Ch. 29.2d has been modified to provide updated development guidance regarding the medical necessity of prescribed ancillary services or equipment; and provide clarity regarding the 30 day medical development authorization period, including two development letters in 15-day increments.
• Exhibit 29-1 has been edited to reflect the above change in development periods from 30 to 15 days.
• Exhibit 29-2 has been edited to reflect the above change in development periods from 30 to 15 days.
• Ch. 29.4b has been modified to provide clear guidance regarding the evidence a physician may choose to use in support of a prescription for Oxygen Therapy or DME.
Chapter 30, Home and Residential Health Care:
• Ch. 30.7b has been updated to provide clarity regarding 30 day development periods, including two development letters in 15-day increments.
• Ch. 30.13 has been added to provide guidance to HRHC providers on their role and responsibility in providing travel assistance to covered employees receiving home health care.
Chapter 31, Tort Action and Election of Remedies:
• Ch. 31.5d has been updated to clarify that payments made by asbestos bankruptcy trusts trigger the offset provision of § 7385.
• Ch. 31.9 has been modified to delete language regarding paper file jackets.
Chapter 32, Coordinating State Workers' Compensation Benefits:
• Ch. 32.9 has been modified to delete language regarding paper file jackets.
Chapter 35, Overpayment Process:
• EEOICPA Bulletin No. 19-05 has been incorporated by updating a mailing address in the following Exhibits:
• Exhibit 35-2, Sample Initial Overpayment Notification Letter - Without Fault
• Exhibit 35-3, Sample Initial Overpayment Notification Letter – At Fault
• Exhibit 35-4, Sample Letter to Non-Claimant Regarding Federal Debt
• Exhibit 35-8, Sample Overpayment Final Decision – Preliminary At Fault Determination
Correct
• Exhibit 35-9, Sample Overpayment Final Decision – Without Fault - Waiver Denied
• Exhibit 35-11, Sample Overpayment Final Decision – Waiver Granted (Full or Partial) Based on Violate Equity and Good Conscience
Chapter 36, Debt Liquidation:
• EEOICPA Bulletin No. 19-05 has been incorporated by updating a mailing address in the following Exhibits:
• Exhibit 36-1, Sample Second Demand Letter
• Exhibit 36-2, Sample Third and Final Demand Letter
• Exhibit 36-4, Sample Repayment Agreement
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