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 Document Name 31.2 Superseded New (Number of Pages) 0 7 Digest: 31.2 - Adds Carson National Forest direction for medical benefits for emergency medical care to individuals who suffer a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.:____________________