Division of Coal Mine Workers' Compensation (DCMWC)

Modernizing Payment of Medical Benefits under the Black Lung Benefits Act: Proposed Rule Overview

Miners will continue to receive medical care necessary to treat their black lung disease

Since 1968, black lung disease has caused or contributed to the deaths of more than 75,000 miners. These hardworking Americans should not have to sacrifice their health to provide for their families or to meet the nation's energy needs. Congress passed the Black Lung Benefits Act in 1969 to provide compensation to miners who are totally disabled by black lung disease arising out of coal mine employment. The act also provides eligible miners with coverage for medical treatment related to their black lung disease. These are called medical benefits.

An entitled miner's medical benefits are paid either by a coal mine company (or their insurance carrier) who employed the miner or the Black Lung Disability Trust Fund, which the Department administers. The Trust Fund pays benefits when there is no liable coal mine company or when the liable company either cannot or does not pay.

The current regulations require that the Trust Fund pay for medical services and treatments at the prevailing community rates, but do not specify how such rates are determined.

The proposed rule would modernize medical benefit payments from the Trust Fund:

  • Adopts modern payment formulas for hospital and non-hospital providers (e.g., physicians) that are derived from those used by the Centers for Medicare and Medicaid Services (CMS) in the Medicare program. These formulas are also similar to those used by other OWCP programs (e.g., Federal Employees Compensation and Energy Employees Occupational Illness Compensation programs).
  • Codifies the black lung program's current practice for the payment of prescription drugs and submission of medical bills for payment.
  • Provides greater clarity about fees paid to providers, which should speed processing and payment.

Miners would continue to receive the medical treatment they need. Miners would not see any change in the provision of medical care necessary to treat their coal-mine-related lung disease. Importantly, the proposed rule includes tools for OWCP to ensure that entitled miners continue to have access to medical care. The rule would also prohibit providers from billing for any covered charges not paid by the Trust Fund.

The NPRM is available for public inspection today on the Federal Register's website at: https://www.federalregister.gov/documents/2017/01/04/2016-31382/black-lung-benefits-act-medical-benefit-payments. The Federal Register will publish the NPRM tomorrow, January 4, 2017. The published version will be available online at the same website location.

The public may submit comments on the proposed rule online at www.regulations.gov (follow the instructions on the website) or by other methods set forth in the NPRM. Comments must be received no later than March 6, 2017.

PDF of the Notice of Proposed Rulemaking from the DCMWC website.

More information on the Black Lung Program and the Division of Coal Mine Workers’ Compensation is available at: http://www.dol.gov/owcp/dcmwc/.