FOREST SERVICE HANDBOOK
Taos, New Mexico
FSH 6109.12 - EMPLOYMENT AND BENEFITS HANDBOOK
Carson Supplement 6109.12-93-1
Effective June 14, 1993
POSTING NOTICE. Supplements to this title are numbered
consecutively by Handbook number and calendar year. Post by
document name. Retain this transmittal as the first page of this
document.
Document Name
31.2
Superseded New
(Number of Pages)
0
7
Digest:
31.2 - Adds Carson National Forest direction for medical benefits
for emergency medical care to individuals who suffer a
job-related injury or illness.
LEONARD L. LUCERO
Forest Supervisor
FSH 6109.12 - EMPLOYMENT AND BENEFITS HANDBOOK
CARSON SUPPLEMENT 6109.12-93-1
EFFECTIVE JUNE 14, 1993
CHAPTER 30 - INJURY/ILLNESS COMPENSATION
31.2 - Medical Benefits.
Agency Provided Medical Care (APMC).
The initial intent of APMC was to provide emergency medical care
to individuals who suffer a job-related injury or illness while
engaged in an emergency incident, such as fire situations. It
includes treatment by hospitals, medical clinics, physician
services and supplies, and prescriptions.
It is used in cases where it is apparent that the injury is such
that no lost time is anticipated and will not require more than
two follow-up doctor visits after initial treatment.
We have now been authorized to use APMC in other than just
emergency incidents. The Forest is responsible for paying the
medical provider and for resolving any disputed matters with the
individual treated.
Employees who suffer a job-related injury or illness have the
right to initial selection of a physician through APMC.
If a non-lost time injury requires medical upgrade (beyond two
follow-up doctor visits) then the entire case must be submitted
to OWCP.
The objective of APMC procedures in non-emergency incidents is to
reduce OWCP costs by providing direct payment to medical
facilities for treatment and prescription drugs for non-lost
time injuries, avoid delayed payments to medical facilities,
lower injury administration costs, and eliminate the multi-tier
OWCP charge-back cost.
1.
Responsibility
a. Personnel Officer. Responsible for the overall
Forest Program, ensuring that persons responsible for
handling APMC cases are fully informed on thegoverning
laws and regulations. Adequately reviewing the program
to ensure compliance with regulations and reporting
requirements.
b. Supervisors.
include:
Responsibilities of each supervisor
(1) Ensure employees are informed of their rights and
responsibilities under APMC procedures when injured.
(2)
Authorize APMC medical treatment for employees
sufferingjob-related injuries.
(3) Furnish employees with the necessary APMC forms to
report
injuries and illnesses and providing assistance
in completing the forms when necessary.
(4) Submitting required forms to the designated APMC
coordinator or Compensation Specialist responsible for
processing injury cases for their unit, within the
established time frames for reporting injuries.
c. Compensation Specialist. The individual with primary
responsibility for compensation functions, such as case
processing. Receives and reviews all APMC forms for
completion and accuracy. Insures timely submission of
forms.
2.
Individuals Covered by APMC - Any individual who becomes
injured or ill while engaged in work activities for the Forest
may be provided medical assistance through APMC.
3.
Procedures and Forms Required for APMC - The Forest APMC
Coordinator will be the Personnel Clerk located in the
Supervisor's Office in the Personnel Section. The BMO at each
District will serve as the District APMC Coordinator.
Each unit will maintain a log of medical control numbers ("M"
numbers). Each individual APMC case will be assigned an "M"
number followed by the calendar year. This same "M" number will
be shown on all bills, doctor's reports, prescriptions, etc.,
for that individual case.
Example: Canjilon RD would assign an APMC "M" number of
"M-100-93" to their first APMC Case, "M-101-93" to
second case,
etc.
El Rito RD would assign "M-200-93," "M-201-93," etc.
Jicarilla RD would assign "M-300-93," "M-301-93," etc.
Camino Real RD would assign "M-400-93," "M-401-93," etc.
Tres Piedras RD would assign "M-600-93," "M-601-93," etc.
Questa RD would assign "M-700-93," "M-701-93," etc.
Supervisor's Office would assign "M-001-93," "M-002-93," etc.
All documents and records pertaining to APMC case files will
bemaintained in the Supervisor's Office Personnel Section for a
minimum of three years.
a. Traumatic Injury or Illness (No Lost Time) Requiring
APMC.
Forms Required Action Taken
CA-1 (Injury) Complete CA-1/CA-2 by already established
or
OWCP guidelines.
CA-2 (Illness)
Assign "M" number and insert that number on
top of the CA-1/CA-2. The following
statement will appear on the CA-1/CA-2:
"M-100-93 TREATMENT BY APMC - DO NOT FORWARD
TO OWCP FOR PAYMENT".
FS-6100-16,AMPC
duly
Authorization and
In an
( Medical Report
hospital maay
Prepare FS-6100-16 for APMC treatmennt to a
qualified physician of the employee's choice.
emergency any duly qualified physician or
See Exhibt A)
treatment.
be used for initial
DO NOT CONFUSE APMC PROCEDURE WITH OWCP.
NOT ISSUE CA-16 FOR APMC.
DO
The injured employee's supervisor completes
Part A of the FS-6100-16, which authorizes
treatment. If the supervisor is not
available; i.e., emergency situation, the
Unit APMC Coordinator or other
employee who
has authority to authorize treatment may
complete the form for the employee.
Procurement Identification on the FS-6100-16
will
reflect the FS Credit Card Number and
the Management Code that will be charged for
the treatment and services provided.
The medical provider will complete Part B of
the FS-6100-16 and give to employee to return
to the employee's unit.
Treatment under APMC may be for the initial
medical care and one or two follow-up visits.
The medical provider must complete a report
for each visit. Therefore, it is
appropriate to issue the FS-6100-16 for up to
two follow-up visits.
b. Method of Payment.
be used to make payment
services, supplies, and
payment will be charged
Forest Service Credit Card will
to medical care providers for
prescriptions. Monies for
to project dollars.
Instructions to the medical provider regarding payment for
services provided will be attached to the FS-6100-l6 (See
Exhibit B).
District APMC Coordinators will make payment to
local medical providers for services provided for
their respective employees using the Forest
Service credit card. The Forest Compensation
Specialist will make payment to local medical
providers for employees located in the
Supervisor's Office. In situations where a Forest
employee is treated outside the geographic area of
their duty station; i.e., a District employee
treated in Santa Fe, or a field-going employee
from the SO treated by a physician or
hospital/clinic at a facility located in a
District Office community, the District APMC
Coordinator and Forest APMC Coordinator will
coordinate efforts to handle the situation in the
most efficient manner.
Since most pharmacies are reluctant to issue
prescriptions without payment, it is recommended
that APMC Coordinators contact the pharmacies in
their local communities and negotiate for the most
efficient procedures to make direct payment to
them. It is important that you impress upon your
employees that when using APMC, unlike OWCP, if
they pay for the prescription, we cannot reimburse
the employee; we can only make payment to the
pharmacy.
c. Records. A system of records must be
maintained on all APMC transactions.
The District Office will submit the CA-1/CA-2 to
the Forest Compensation Specialist with the
appropriately assigned "M" number and the notation
"TREATMENT BY APMC - DO NOT FORWARD TO OWCP FOR
PAYMENT," within 48 hours of the reported injury.
All other documents and transactions will be
submitted as soon as they are completed.
All APMC case files will be kept in the SO and
maintained for a minimum of three years.
If a non-lost time injury requires medical upgrade
(beyond two follow-up doctor visits), then the
entire case will be submitted to the Forest
Compensation Specialist for processing to OWCP.
Exhibit A
AGENCY PROVIDED MEDICAL CARE AUTHORIZATION AND MEDICAL REPORT
(Physician or Medical Facility Form may be used for Medical
Report)
PART A AUTHORIZATION
MEDICAL RESOURCE REQUEST "M
NUMBER"_______________________________
PROCUREMENT IDENTIFICATION (BPA/Field PO No.,
etc.)___________________
RESPONSIBLE PAYMENT
UNIT______________________________________________
EMPLOYEE NAME______________________SOCIAL SECURITY
NO._____________
EMPLOYING AGENCY__________________DATE OF
INJURY___________________
HOME UNIT AND
ADDRESS_________________________________________________
(or appropriate District Office)
______________________________________________________________________________
______________________________________________________________________________
PHYSICIAN/MEDICAL FACILITY
________________________________
________________________________
________________________________
Please provide initial diagnosis and treatment medically
necessary for injury/ illness. Surgery, other than emergency,
and/or hospitalization requires further authorization. Please
complete the following medical report at the time of treatment
and give to the employee for return to our office.
Authorizing
Signature________________________Date__________________
PART B ATTENDING PHYSICIAN'S REPORT
1.
Evaluation or Diagnosis:
2.
Description of Treatment:
3.
Medicine Prescribed and Potential Side Effects:
4.
Work Restrictions (if any) and Length of Restrictions:
Physician's
Signature__________________________Date_______________
FS-6100-16
(01/93)
Exhibit B
Instructions to Treating Physician or Medical Facility
Medical treatment for this injury/illness is provided by our
Agency under the Agency Provided Medical Care (APMC) Program.
These procedures are entirely apart from and not under the
authority or provisions of the Federal Employee Compensation Act
(FECA)/Office of Worker's Compensation (OWCP), and do not require
issuing a CA-16.
APMC allows our agency to make direct payment to you for
treatment provided to this employee who has incurred an
on-the-job injury/illness that will not result in lost work time
or loss of wages due to the injury/illness or treatment will not
require more than two follow-up visits after initial treatment.
If more than two follow-up visits for treatment are required the
injury/illness will then be required to be processed through OWCP
and a CA-16 will be issued.
Complete Part B, Attending Physician's Report, on the attached
FS-6100-16. If additional pages are needed to complete your
evaluation and diagnosis, or if you have your own form that
addresses the information requested, you may attach that report
to the FS-6100-16. Please write-in the "M Number" on any
documents that you attach to the FS-6100-16.
If medication is prescribed for this injury/illness, please
indicate the "M Number" on the prescription form.
You may give the employee the FS-6100-16 to return to our office,
along with the bill for your services. Or, if you prefer, you
may mail both to our office
at:_____________________________________________
_______________________________________________
_______________________________________________
In either situation, the documents should be returned as soon as
possible in order to expedite payment.
Upon receipt of your report and billing for services provided, a
Forest Service Representative will come to your office to make
payment. Payment will be by Forest Service Credit Card (VISA).
If you have any questions in this matter, please feel free to
call our APMC
Coordinator:___________________
Phone No.:____________________