A proposal by the U.S. Department of Labor (DOL) to reduce payments to health care providers for black lung related services will force the providers to stop treating miners affected by the disease, says the United Mine Workers of America (UMWA).
Saving mine operators money?
“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,” said UMWA President Cecil Roberts.
The notice of Proposed Rulemaking and request for comments, which was issued by the DOL’s Office of Workers’ Compensation Programs on January 4, 2017, 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 clinic.
Under the rule, reducing payments to providers for black lung related services will be advantageous because the “Trust Fund is more likely to be fully reimbursed for the payments it makes on an interim basis.” Cost savings are also being 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.
Roberts said the UMWA “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.”
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 to reimburse outpatient hospital services that would affect every state in the program at just 20 percent of current payments; a reduction of 72 percent.
International Secretary-Treasurer Bob Scaramozzino said the proposed rule, as it is written, would eventually leave miners suffering from black lung disease without adequate medical care.
Big cities v. small communities
“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,” said Scaramozzino. “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 submitted comments opposing the proposed rule.
“This is a bad proposal, and the union will do whatever it can to see that it doesn’t take effect,” said Roberts.