U.S. Department of Labor’s new Black Lung Medical Payments Proposed Rule

Does it Reduce Costs or Eliminate Benefits?

The Office of Workers’ Compensation Programs (Agency) in the U.S. Department of Labor issued a notice of Proposed Rulemaking and request for comments on January 4, 2017. The proposal deals specifically with the Black Lung Benefits Act (BLBA): Medical Benefit Payments from the Black Lung Trust Fund to every category of medical provider including hospitals, doctors and clinics.

The background information provided by the Agency notes several times that the payments to providers for Black Lung related services will be reduced. The Agency also stresses on numerous occasions that payment reductions will be advantageous because the…“Trust Fund is more likely to be fully reimbursed for the payments it makes on an interim basis.” They also anticipate cost savings based on reduced payments from the Trust Fund for miners eligible to receive medical treatment when the operator responsible for their Black Lung treatments cannot or will not make the required payments.

“The United Mine Workers has carefully reviewed the Rule proposed by the Office of Workers Compensation Programs and is deeply concerned that in an effort to unilaterally reduce costs, they have lost sight of what is important—the health and well-being of the miners and their families,” stated President Roberts. “It is unclear when you examine the proposal if the Agency is looking out for the best interest of disabled miners or trying to save money for mine operators who are ultimately responsible for paying the medical bills of these individuals. This is a bad proposal, and the Union will do whatever it can to see that it doesn’t take effect.”

The Proposed Cuts would be Devastating

While the Agency claims the average cuts to the program amount to approximately 7 percent of total benefits paid, the decreases for some states are drastic. In Kentucky, for instance, inpatient hospital costs in 2014 were paid at 36 percent of total billing. Under the Proposed Rule those payments would be reduced to 26.5 percent of billing, a cut in benefit payments of almost $1.3 million per year. In Florida, where many UMWA Members reside, the cuts would be even more severe, from 64 percent of total billing to less than 18 percent. The most glaring example of these draconian cuts are the payments made for outpatient hospital services, cuts that would affect every state in the program. The Agency is proposing reimbursement for these services at just 20 percent of current payments; a reduction of 72 percent.

“The Union is convinced that the Proposed Rule, as it is written, would damage the Black Lung Program so severely that it would eventually become even more ineffective, leaving miners disabled from the Disease without adequate medical care,” said International Secretary-Treasurer Scaramozzino. “The Agency discusses how the cuts they are proposing will have little impact on the health care industry as a whole, but they seem to ignore the fact that small communities, where these services are offered, are not reflective of large metropolitan areas in the Country. The proposal appears to be aimed at reducing payment schedules to the point it forces providers to stop offering services that miners are entitled to under the BLBA. The UMWA Department of Occupational Health and Safety has already submitted comments opposing the Agency’s Proposed Rule. It will continue doing whatever is necessary to ensure miners receive the benefits the BLBA is required to pay.”