!!ID 6109.12-94-1 Page 1 of 10

Expiration Date: Upon issuance of

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INTERIM DIRECTIVE: 6109.12-94-1

EFFECTIVE DATE: June 9, 1994

EXPIRATION DATE: Upon issuance of R1 direction

CHAPTER: 30 - INJURY/ILLNESS COMPENSATION

POSTING NOTICE: This is the first ID to FSH 6109.12

This interim directive (ID) to chapter 30 provides direction on the use of Agency Provided Medical Care (APMC) for nonfire work situations.

/s/ Mike Ramos

MIKE RAMOS

ACTING FOREST SUPERVISOR

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38 - PAYMENTS BY FOREST SERVICE. Following are authorities in addition to those listed in parent text.

5. The Office of Personnel Management has authorized Agencies to provide services necessary for emergency diagnosis and treatment of injury or illness, whether or not the employee was injured while in the performance of duty or whether or not the illness was caused by their employment.

6. The Department of Labor has authorized Agencies to provide medical services for diagnosis and treatment of work-connected injuries/illnesses that are covered under the Federal Employees' Compensation Act (FECA) administered by the Office of Workers' Compensation Programs (OWCP).

38.1 - Policy. The Lolo Forest shall make use of the Agency Provided Medical Care (APMC) Program, coverage, and procedures for routine day-to-day employee job-related injuries or illness that fall under coverage of the Federal Employees' Compensation Act (FECA) and the Office of Workers' Compensation Program (OWCP) authorization and payment procedures.

FSH 5109.34, Interagency Fire Business Management Handbook contains extensive guidance for use of APMC in fire situations. Guidance contained here is specifically for administering APMC to cover routine day-to-day employee job-related injuries or illness that fall under coverage of FECA and OWCP procedures.

38.2 - APMC Coverage and Procedures. The intent of APMC is to provide up-front payment of medical care for employee occupational injuries/illness in order to secure responsive medical assistance and reduce costs associated with lengthy OWCP payment procedures and administrative fees.

APMC does not replace FECA coverage and entitlements applicable to employee work-connected injuries/illness. Use of APMC does not preclude payment by the Agency of continuation of pay (COP) or compensation payments from OWCP for such things as loss of wages under circumstances entitling an injured employee to receive these benefits. With exception of some "first aid" injuries, we must notify OWCP of incidents handled through APMC procedures and forward reports (CA-1/2, doctor's reports, etc.) to them for information and protection of the individual's future rights under FECA.

Use of APMC may not be mandated over OWCP procedures. OWCP is an entitlement, where when an employee files a claim for a job-related injury, we may not preclude authorizing medical care and coverage. Employees covered by FECA, who suffer a job-related injury or illness, have the right to initial selection of physician through OWCP or to receive medical care through APMC. If the employee receives treatment through APMC from a physician who is not their physician of choice (e.g., clinic or "Now Care" situation), this does not constitute initial selection of physician if further medical care is required or requested by the individual.

38.3 - Situations Covered by APMC

APMC procedures may be used in any situation where FECA coverage and OWCP procedures are applicable; e.g., the incident is caused (aggravated, etc.) by the job and the individual files notification/claim on a CA-1 or CA-2.

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Expiration Date: Upon issuance of

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In serious and immediate medical care situations such as apparent heart attacks, convulsions, epileptic seizures, fainting spells, and emotional disturbances, OWCP will normally pay for all reasonable services and supplies required for emergency treatment even if it is later determined that the condition is not covered by FECA. APMC may also be used in these situations.

APMC is not an entitlement and there may be circumstances where Agency judgment and discretion would preclude authorizing coverage. APMC procedures should not be used, and the case processed through OWCP adjudication, if the following situations can be identified:

a. If the unit has a reason to controvert the claim.

b. Employee requires hospitalization.

c. Known fatality at the time of report of the accident.

If there is a question as to whether a case is going to be under APMC or OWCP, initial treatment can be paid for under APMC under most circumstances. Thereafter, APMC may be followed by authorization, treatment, and payment through OWCP if necessary.

38.4 - Covered Medical Services. APMC procedures may be used to provide the same medical care as would be provided through OWCP; e.g., physician services, surgery, hospitalization, drugs and medicines; other supplies and appliances such as crutches; ambulance services; transportation expenses incurred when seeking medical treatment; and to provide replacement, for example, of glasses broken in an accident causing a personal injury. Refer to parent text for further definitions and explanations.

38.5 - Authorizing Medical Treatment and Travel Under APMC . All injuries and illnesses must be documented on a CA-1, "Federal Employee's Notice of Traumatic Injury and Claim for Continuation/Compensation" or CA-2, "Federal Employee's Notice of Occupational Disease and Claim for Compensation." When APMC procedures are used to pay for medical care, the following notation will be made across the top of the forms, "MEDICAL TREATMENT PAID FOR UNDER APMC."

38.51 - Employee Notice. Employees must be informed of their right to initial selection of physician, and that receipt of medical care through APMC does not wave this right or any other entitlements under FECA or through the OWCP process. This may be accomplished by posting notice with OWCP material in a prominent place and covering this information annually at orientation sessions.

38.52 - Issuing Authorization for Treatment. Authorize medical care using Lolo form 16-6180/6320-1, Agency Provided Medical Care Authorization and Medical Report (see end of this ID). Employing office and physician instructions are on the reverse of the form.

Do not use form FS-6100-16, "APMC Authorization and Medical Report," for local application. This form is specific to fire and does not contain the necessary information or procedures for local non-fire use of APMC.

Each unit should designate the person(s) responsible for authorizing APMC medical care in normal situations. In an emergency, travel status, or other situations where access to designated "authorizing" officials is not possible or practical, any first-line supervisor may issue the APMC authorization.

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Under no circumstances should a CA-16, "Authorization for Examination and/or Treatment," or CA-17, "Duty Status Report," be issued for any treatment intended for coverage under the APMC program.

Forms CA-16/17 are used strictly to initiate the OWCP process and billing/payment procedures. APMC authorization and treatment may be followed by authorization, treatment, and payment through OWCP if continued treatment is required or complications, such as the decision to hospitalize, arise in the course of treating an injury/illness initially handled through APMC procedures. However, APMC procedures for medical treatment should normally not follow those of OWCP. Where APMC procedures have been followed by issuance of a CA-16 and initiation of OWCP procedures, continued use of APMC for the case should normally be limited to such things as reimbursement for travel expenses to seek medical treatment and miscellaneous costs for such things as prescriptions or other supplies.

Units may use any numbering system specific to their needs for the "Medical Resource Request "M" Number" entry. This identification number should be inserted on the top of CA-1/2 and any other documents/forms applicable to the particular incident. Only one authorization form and "M Number" are needed to cover all services provided in conjunction with the APMC treatment; e.g., ambulance, hospital, doctor, prescriptions, X-rays, crutches, etc. Additional copies of the form may be needed to provide backup for imprest payments, etc.

If verbal authorization is given in an emergency situation, form 16-6180/6320-1 must be issued within 24 hours after the medical treatment is obtained.

It is important and required that the medical provider complete a report at time of examination on evaluation/diagnosis, treatment provided, and any work restrictions. Management needs this information to make determination on duty status for the employee.

38.53 - Selecting a Medical Provider. An injured employee must receive treatment from a physician as defined by State law. Chiropractors may only provide treatment for manual manipulation of the spine to correct a subluxation, demonstrated by x-rays to exist.

Blanket purchase arrangements may be utilized for APMC coverage, and/or medical providers may be authorized on a case-by-case basis dependent on employee's choice of physician and type of medical service needed.

Blanket purchase arrangements currently in affect for APMC purposes on the Lolo Forest are:

BPA #312 -- St. Patrick's Hospital - Missoula

BPA #313 -- Community Hospital (associated services & doctors) - Missoula

BPA #324 -- Western Montana Clinic (Branch clinics & Now Care extensions) -

Missoula, Lolo

If procurement arrangements are made with a doctor of the employee's request, it needs to be noted on the authorization 16-6180/6320-1 that the employee's selected physician was used. Where the employee's selected physician is a member of a facility such as Western Montana Clinic that is covered by BPA, this should be noted and the doctor's name included in the physician/medical facility block along with the facility name.

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38.54 - Authorizing Followup Care. The APMC authorization does not allow referral, followup, and/or continuing treatment of an injury/illness without further, specific authorization. There are a number of reasons for this. A stipulation of using APMC is that the medical provider must complete a report on evaluation/diagnosis, treatment provided, and any work restrictions at the time they treat the injured/ill employee. The report must be returned to the unit so determinations can be made on duty status, COP entitlement, etc. Additionally, the report is needed to determine that APMC procedures continue to be appropriate, or that OWCP procedures should be initiated.

Where a followup visit(s) is necessary, you should issue another APMC authorization using the same "M Number" assigned initially to the incident, and indicate that the authorization is for followup treatment. You may send a copy of the initial authorization with "followup visit" and the date indicated on the form in the "Other/remarks" portion. You may give verbal authorization for a minor followup visit where another detailed physician's report is unnecessary; e.g., the employee has not been restricted on performance of duties due to the injury and they are returning to the doctor for something minor, such as having stitches removed.

38.55 - Authorizing Referral and/or Continuing Treatment. Normally, referral to other medical providers should be authorized through OWCP procedures by issuing a CA-16 to the employee choice of physician.

Where the APMC physician prescribes limited physical therapy and there will be no further or very minor followup that will be provided by that same APMC physician, you may allow the treatment under the APMC authorization, or you may elect to cover it under OWCP procedures. No CA-16 should be issued in this situation where you have elected to cover specialized/continuing treatment through OWCP payment procedures and where no physician other than the APMC physician will be involved. Advise the physical therapy provider that the situation is covered under the Federal Office of Workers' Compensation Programs, and instruct them to submit itemized bills to our office for forwarding with complete information to OWCP for payment.

When referral to a specialist is recommended for precautionary measures or confirmation of diagnosis (as opposed to referral for medical treatment), APMC procedures may be used, and a second APMC authorization using the same "M Number" may be issued to the physician referred. Note on the authorization if it is the employee choice of physician. When referral is recommended for medical treatment, you should issue a CA-16 under OWCP payment procedures to the employee choice of physician.

Contact SO Personnel for advice in these types of situations.

38.56 - Changing Physicians. If the employee wishes to change to another physician other than the APMC physician, and the APMC physician was not the employee choice of physician, issue CA-16 under OWCP procedures to the employee choice of physician.

Where the APMC physician is the employee choice of physician, change may be permitted only after OWCP approval as explained in the parent text.

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Expiration Date: Upon issuance of

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38.6 - Claims for Medical Expenses and Submission of Medical Bills . All services provided under one authorization and "M Number" must be summarized on or attached to the APMC authorization and provided to the payment unit to support payment of vendor bills.

Itemized doctor or other vendor bills are submitted according to Lolo Forest payment procedures for the procurement method used.

Any legal procurement method may be used to make payment for medical care authorized under APMC procedures, including imprest cash, credit card, third party draft, and blanket purchase order. Dollar limit for treatment is controlled by the method of payment, and authority of the person making the payment.

Where the employee has paid for any medical expenses resulting from the injury or disease/illness, such as for prescriptions or crutch rental, they should be reimbursed through Imprest Cash procedures. Authorized transportation expenses are reimbursed through the normal travel payment process. Mileage payments are subject to standard Government rates.

38.7 - Reporting and Processing Procedures. The original CA-1/2 is always forwarded to SO Personnel for filing in the employee's medical folder, whether or not medical care is received. The original APMC Authorization form, with the completed doctor's report, is included in submission to SO Personnel as applicable. The Compensation for Injury Specialist reviews all cases and determines necessary distribution, reporting, and followup action.

Note: CA forms and doctor's reports are restricted, confidential information. Do not send these documents through open mail. They should be transmitted in a blue "For Official Use Only" envelope to Personnel Management. Do not include copies of these forms or reports in payment packages submitted to B&F, imprest, etc.

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Expiration Date: Upon issuance of

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The following questions and answers are to aid in making determinations regarding use of APMC.

Q. An Employee receives treatment through APMC while away from their unit on fire suppression activity. They need to see a doctor to have stitches removed on their return home. Can this followup visit be handled through APMC procedures?

A. Yes. Issue form 16-6180/6320-1 to authorize treatment. Submit all paperwork to SO Personnel for determinations on reporting requirements to OWCP, chargeable or non-chargeable status, etc.

Q. An employee treated through APMC procedures has lost time because they cannot work for 1 week and are placed on COP. They must return to the doctor at the expiration of that first week, and indications are that they may need to have further followup visits. Do you need to switch to OWCP procedures after the first physician treatment?

A. No. Unless the employee is going to be referred to another medical provider, hospitalization or surgery needs to be scheduled, physical therapy sessions are prescribed, etc., there is no need to issue a CA-16 and switch to OWCP procedures. Changing payment methods in mid-stream may cause everyone confusion, possibly resulting in dual payments or delayed payments. This incident must be reported to OWCP. The incident is chargeable. The payment method has no bearing on these determinations or actions taken by the Compensation for Injury Specialist when processing the case.

Q. An employee in travel status at a temporary duty station becomes ill, cuts their finger while off-duty, has a tooth that becomes absessed, gets an infection, or suffers some other type of injury/illness. Can they be treated by APMC.

A. Yes. An employee in travel status is covered 24 hours a day by OWCP.

Q. May an employee who is injured on their way to the job site be treated through APMC?

A. If they are enroute from their home to their duty station, no. If they are enroute from their duty station, the Ranger Station for example, to a field job site, yes. Apply OWCP rules.

Q. An employee of a private employment firm who is working as a member of a slash crew with regular Forest Service employees suffers a chainsaw cut. Can they be treated through APMC?

A. No. Contract employees are covered by State Workers Compensation. They are not covered by FECA provisions.

Q. Can a member of a crew covered by P.L. 94-148 be treated by APMC in the same circumstances as the previous question.

A. Yes. Agreements under P.L. 94-148 cover participating individuals by FECA and OWCP procedures. Agreements under differing authorities may be different. You need to be aware of the language in regard to FECA coverage.

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Q. An employee comes down with a bad cold, bronchites, etc. Can they be treated through APMC?

A. That depends. Has the employee been on control burn and filed a CA-1/2? This is covered by OWCP, and is therefore payable through APMC.

Q. Let's say the employee hasn't been doing anything that they can relate to the job and they just have a horrible sinus infection. APMC okay?

A. Probably not under provisions for using APMC to cover work-related injury/illness covered by FECA. We need a few more facts. Is the employee a permanent or a temporary employee? Is it a local person or someone brought in by student requisition from somewhere such as Florida? Can the employee receive medical treatment on credit? Nothing is black and white. Remember, all the facts need to be looked at and a judgment call has to be made. Depending on the circumstances, medical treatment may be appropriate under an authority other than that provided by FECA.

Q. An employee who fell and broke his leg was treated through APMC. He is a student attending college in another state and the season is almost over. He can work in the office until time for him to resign and return home. He will need to have his cast removed about 4 weeks later. What procedures, APMC or OWCP, should be used to obtain this medical care?

A. You may issue a CA-16 under OWCP procedures to the employee's selected physician in his home town, or you may continue with APMC. Preferred method would be to continue with APMC as it provides us with better controls and tracking systems.

Q. An employee who was struck in the face, and suffered a broken tooth as a result, was sent to a dentist through APMC procedures. The dentist performed additional work on the employee's teeth that could not be attributed to treatment authorized for repairing the broken tooth. What should be done?

A. The same thing should be done that OWCP would do if a CA-16 had been issued in this situation--question the bill and pay only the cost of repairing the damage caused by the accident. Form 16-6180/6320-1 is specific on treatment authorized. We do not have to honor bills for unauthorized medical care. This should always be made clear to employees and medical providers.

Q. An employee treated initially through APMC for an injury continued to see the physician for followup treatments without reporting this to their supervisor or receiving authorization for followup care. Are we obligated to pay any bills incurred as a result of this injury, just as we are obligated when issuing a CA-16?

A. This depends on whether we have done our job. If the employee and physician were advised that followup treatment/visits needed to be authorized, we are under no obligation to make APMC payment for the unauthorized treatment. In this situation, we could elect to have the medical provider submit bills to OWCP for determination and payment.

The Lolo APMC authorization form 16-6180/6320-1 is very specific in regard to what is authorized and what requires further authorization. Use of this form fulfills notification requirements to employee and medical provider.

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(Physician or Medical Facility Form may be used for Medical Report)

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| PART A AUTHORIZATION |

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|Medical Resource Request "M Number" |

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|Procurement Identification (BPA/Field PO No., etc) |

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|Responsible Payment Unit and Management Code |

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|EMPLOYEE NAME DATE OF INJURY |

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|Home Unit |

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| PHYSICIAN/MEDICAL FACILITY: |

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| Please provide initial diagnosis and treatment medically necessary for employee |

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| injury/illness. Surgery (other than emergency), hospitalization, followup visits,|

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| referral, and/or continuing treatment require additional separate authorization. |

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| Other/remarks: |

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|Authorizing Signature |Date |

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| PART B ATTENDING PHYSICIAN'S REPORT |

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| Please complete the following medical report at the time of treatment |

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| and give to the employee for return to our office. |

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|1. Evaluation or Diagnosis: |

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|2. Description of Treatment: |

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|3. Medicine Prescribed and Potential Side Effects: |

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|4. Work Restrictions (if any) and length of restrictions: |

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|Physician's Signature | Date |

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Attachment to CA-1/CA-2 (See Reverse) 16-6180/6320-1

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Medical treatment for this injury/illness is being provided by the Forest Service under the Agency Provided Medical Care (APMC) program, whereby the Department of Labor, Office of Workers' Compensation Programs (OWCP) has authorized Agencies to provide initial treatment and payment for such treatment through procurement with local medical providers. Do NOT submit bills or reports for treatment provided under this APMC authorization to OWCP.

Treatment under APMC may be authorized for initial medical care and minor followup visits. Any treatment under APMC following initial visit must be authorized, and the medical provider must complete a report for each visit at the time they treat the employee for immediate return to the employing office so that pay, light duty need determinations, etc., can be made. Followup visits may be authorized verbally; by issuance of another APMC authorization using the same request "M Number" initially assigned to the incident; or by a copy of the original APMC authorization with notation in the "Other/remarks" portion of Part A that the authorization is for followup treatment.

One authorization and "M Number" cover all services/treatment associated with an injury or illness (ambulance services, prescriptions, X-rays, etc.) that are provided through the APMC process. All services provided must be summarized and provided to the payment unit with a copy of the APMC authorization to support payment. This includes verbally authorized followup visits. Payment cannot be made without documentation that services provided were authorized and received.

Billing address, unless other arrangements are made: Lolo National Forest

Building 24, Fort Missoula

Missoula, MT 59801

1. Complete PART A AUTHORIZATION. Send original and one copy with employee to medical facility. Instruct employee to obtain the Doctor's Report at the time of treatment and to return it to your office. Advise the employee of limitations on referral to other medical sources, followup treatment, etc.

2. Provide copy with PART A AUTHORIZATION only to payment unit (e.g., SO B&F, Procurement & Contracting, Imprest Cashier, etc.) to support APMC payment(s).

3. Attach completed form (PART A AUTHORIZATION and PART B ATTENDING PHYSICAN'S REPORT) to CA-1/CA-2 and forward to Personnel Office for filing in Employee Medical Folder and forwarding to OWCP, as applicable. Where medical provider uses their own form for physician's report, attach both the physician's report and a copy of this form to the CA-1/CA-2.

4. Verbal request and authorization may be given to a medical provider in an emergency. In these situations, complete this form within 24 hours following medical treatment. Send one copy to the medical provider for their records. Attach one copy, along with the physician's report that was provided at the time of treatment, to the CA-1/CA-2 and forward to Personnel.

Medical reports and most CA (injury/illness report) forms are confidential information. Do not include these reports with payment documentation or in files other than the official Employee Medical Folder. Treatment authorizations and itemized billings are appropriate payment documentation.