"Strengthening Federal Workers' Compensation Programs: Ensuring Integrity, Efficiency, and Access"

This subcommittee on workforce protections will come to order. I note that a quorum is present. Without objections, the chair is authorized to call a recess at any time. Today's hearing will examine programs in the Department of Labor's Office of Workers' Compensation programs also known as OWCP since its establishment in nineteen sixteen, OWCP, has supported workers who experience an injury on the job or develop an occupational disability or disease. Through these programs, workers and their families may receive wage replacement benefits, medical treatment, vocational rehabilitation, and other assistance. As part of its duties, OWCP administers the Federal Employees' Compensation Act, also known as FICA, and the Energy Employees' Occupational Illness Compensation Program Act, long, much longer acronym, uh, and these programs provide billions of dollars in benefits each year to the hundreds of thousands of workers who depend on them. These programs play a critical role in supporting injured workers, which we heard about during our hearing on this subject just last year. Following that hearing, we received valuable input, observations, and perspectives from stakeholders. Today's hearing gives us an opportunity to build on what we've learned and seek out common sense improvements to these programs that help injured work uh workers access high quality care and return to their careers. H R forty-one twenty-two, the Health Care for Energy Workers Act, introduced by committee members Allen and McPath, is one example. This bipartisan bill would expand access to qualified providers and reduce delays in care by providing or by allowing nurse practitioners and physician assistants to order care in this program. Last year, the committee unanimously approved a similar bill introduced by Chairman Wahlberg and Representative Courtney, the Improving Access to Workers' Compensation for Injured Federal Workers Act which amends FICA. Together, these bills cut unnecessary red tape and helped to reduce the hurdles that injured workers are forced to jump through in order to receive the care that they need. By embracing solutions like this, we can deliver the savings and efficiency the taxpayers deserve, while also streamlining the care that injured workers count on. In addition to these reforms, we should consider ways to help OWCP run their programs more efficiently. Many state workers' compensation programs have adapted to the evolving technology and health care landscapes, identifying best practices for these programs, or from those programs could help our federal programs improve in terms of efficiency and connecting workers with quality care. From adopting artificial intelligence for assistance in claims processing to strengthening predictive modeling, these practices could help reduce administrative burdens, streamline care, and save money for the American taxpayer. I look forward to hearing from today's witnesses about their perspectives and their recommendations on how these programs can better be

Thank you, Mister Chairman, and thank you to our witnesses for being here. At its core, workers' compensation represents a fundamental uh promise we make to the people who keep this country running. To the federal employees who deliver our mail, inspect our food, supply and care for our veterans, to the miners and energy workers who power our economy, and to the longshore and harbor workers who keep trade flowing and maintain our mastery of the seas. When those workers are injured on the job, federal workers' compensation programs ensures that they are not left to face the consequences alone. When a worker is hurt on the job, it often disturbs their lives and their family's life. And a serious injury can mean months without a paycheck, mounting medical debt, and uncertainty about whether a worker will ever return to their job. Workers' compensation provides stability in those moments through wage replacement medical coverage and rehabilitation support. Across the country, however, many worker compensation systems are slowly being eroded. Over the past several decades, states have reduced benefits, narrowed eligibility and added administrative burdens. Many injured workers receive less support precisely when they need it most. What is complet- that is completely unacceptable. The federal workers' compensation programs should not repeat those same mistakes. The workers covered by these programs, from federal employees to coal miners, perform work that the public relies on and often is demanding in dangerous conditions. The system that protects them after an injury should reflect that reality. Unfortunately, in recent years, worker protections have not been prioritized. President Trump's deregulatory agenda rolls back safeguards across many areas of workplace safety policy and provisions enacted in Trump's " big ugly bill" have contributed to an environment where protecting the health of workers is more difficult. That makes it even more important programs like FICA remain strong, accessible, and centered on workers' needs. We should be careful not to weaken one of these key systems that employees rely on when they are injured on the line of duty. We must always ensure that cost of workplace injury and illness are not borne by workers and their families, but instead paid by the employees who create and save workplaces. And on that note, I hope we can spend some time in this hearing exploring the labor department's apparent decision to abandon the twenty twenty-four final rule on the amount of collateral that needs to be reserved by self-injured coal mine operators we have seen hundreds of millions of dollars in black lung liability shifted onto the taxpayers after self-injured operators who had posted too little collateral when bankrupt. Ranking member Scott and I have asked the OL to come clean with the public about what they are doing to protect taxpayers and hold corporations accountable. But the department has so far failed to give us any straight answers. However, I am encouraged that our workers' compensation programs have long been an area of bipartisan cooperation. Members on both sides of the aisle have recognized that supporting injured federal workers is not partisan. It is a matter of fairness and respect for the public service. That partisan spirit from legislation such as the improving access for workers' compensation for injured federal workers' act must continue. One guiding principle that I suggest is how do these reforms help workers? Any discussion about changing workers' compensation must start by centering the rights and livelihoods of American workers. Since the cost of workers' compensation is often a direct result of unsafe workplace, workers and their families should not be required to bear more cost in the name of e- efficiency. Reforms should improve efficiency, ensure timely care, and support workers' recovery and return to work whenever possible. But they must never come at the expense of the core promise that FICA was created to uphold. Most importantly, the voices of workers and their families must remain part of this conversation. The decisions made here affect real people dealing with pain, lost income, and uncertainty about their future. Keeping their experiences at the center will help ensure that any reform strengthens, not undermines, their lifesav- these lifesaving programs. I look forward to hearing from our witnesses about FICA, its working in practice, and how Congress can censure it to continue to serve the federal worker workforce effectively. Thank you and I yield back.

Thank you. Pursuant to Committee Rule eight C, all members who wish to insert written statements into the record may do so by submitting them to the committee clerk electronically in Microsoft's Word format by five p m fourteen days after this hearing and without objection the hearing record will remain open for fourteen days to allow such statements and other extraneous material noted during the hearing to be submitted for the official hearing record I note that some of m- our colleagues who are not permanent members of this subcommittee may be waving on for the purpose of today's hearing. Next we're gonna go to the introduction of witnesses, and our first witness is Mister Robert Johnson, the President of Sedgwick Government Solutions in Bethesda, Maryland. Our second witness is Miss Stephanie McLeod, Administrator and CEO at the Ohio Bureau of Workers' Compensation Programs in Columbus, Ohio. Our third witness is Mister Christopher Godfrey, the Director of Research at the Workers Injury Law and Advocacy Group in Washington, DC. And our final witness is Mr. Patrick Howe, an Executive Vice President at Nuclear Care Partners in Grand Junction, Colorado. Uh, we're going to, uh, go to each of you individually, and I'd like to thank all of you for being here today. We look forward to each of your testimonies. Pursuant to committee rules, I will ask that each of you limit your oral testimony to a three minute summary of the written statement which you've provided. As committee members may have many questions, the clock will count down from three minutes, pr- pursuant to committee rule eight D and committee practice, however, we will not cut off testimony until you reach the five minute mark. I'd like to remind each of the witnesses to be aware of their responsibility to provide accurate information to the subcommittee, and with that, I will recognize our first witness today. Mister Johnson, you are recognized for your testimony.

Thank you, Chairman McKenzie. Thank you, Chairman Wahlberg, Ranking Member Omar, Ranking Member Scott, uh, members of the subcommittee, very pleased to be here today and appreciate the opportunity to to meet with you. Or organizations like mine, we agree. We have a huge responsibility in the marketplace and in the workplace in the United States. We take care of literally millions of injured workers in a given year. We have at any one point in time thousands of people calling us day in and day out making contact with us that are in a time of need. Uh, they are uh, they've been injured at work, they are worried about what's gonna go on, they are confused by a system with lots of rules, they have uh, a lot of them are afraid, frankly, about what the future may hold. And when they call us, we have to take that responsibility very seriously, and we do. We have an organization of folks that are carrying uh, day in and day out. Our motto is carrying counts, actually that's the way we go. about our business, and they depend on us, they depend on us to explain to them what's gonna happen in two days, in two weeks, in two months, because a lot of this is so foreign to them. They want us to help them get the best medical care that they can get, they want us to help them recover their lost wages, they want us to help them repair their body and their injury, they want ultimately to, for us to help them return to work, and they also want us to help them address, uh on, on often occasion uh mental anguish because a lot of times the toll that a workplace injury takes affects a person's um uh uh mental uh uh faculties as well. So that's always something that's in the back of our mind, it's something that needs to to be addressed and and cared for. Uh we're concerned that the latest and best practices in the industry have not had an opportunity to flow completely through the federal workers' compensation system. So the things that we've been doing so successfully for over five decades, and particularly some of the n- new technological advances that have happened in the last several years, uh we're uh concerned that those don't have an opportunity to help federal workers in the same way as those workers that we um that we help and care for on the private sector and the public sector uh day in and day out. So we want to talk about that and certainly answer any questions that we can. Uh the tech that we will talk about we we believe is gonna help in uh better communication with injured workers better medical care for injured workers better accuracy and coverage of lost wages. better coordination with external stakeholders, and also better controls of fraud, waste, and abuse. Uh, we believe that costs are best controlled by the best care, and that's the bottom line. If we can get somebody better, well, and ultimately return them to productivity and to the workplace, that is what most people, the vast majority of people that have workers' compensation injuries want to have occur in um i- in the course of their transactions with us. So, we believe the best care processes and the best use of technology can coexist. to provide for the best for the three main parties, the injured worker, the employing agency, and ultimately a physically conscious taxpayer. Thank you. With that, I'll yield back.

Thank you. I'll now recognize Ms. McLeod for your testimony.

Good morning, Chair McKenzie, Vice Chair Mesmer, Ranking Member Omar, and members of the Workforce Protection Committee. My name is Stephanie McLeod. I'm the CEO and Administrator of the Bureau of Workers' Compensation in Ohio. the heart of it all. Uh, we are responsible for the prevention and treatment of workplace injuries for six roughly six million Ohioans. We have about two hundred and fifty thousand employers in the state of Ohio that we work with. We have about seventy-eight thousand new claims each year, and we're currently managing a little less than two hundred thousand active claims at any given time. I'm proud to be here today to provide testimony on BWC's operation and our history of outsourcing medical management and return to work service services to injured workers, to managed care organizations or MCOs. These managed care organizations are a little bit different than what your commonplace MCO may be. A lot of people think of managed care and that they're actually providing the care to, they are the providers. That is not the case in Ohio. Our managed care organizations uh begin working as soon as the injury occurs, but they help file and manage the medical portion of the workers' compensation claim. They insure the injured workers, receive quality care, and help get employees safely back to work after an injury. Prior to managed care, dealing with Ohio's working workers' compensation uh program was very difficult and not very helpful. Uh, at that time it was then Governor Voinovich and then Lieutenant Governor DeWine. Some of you may recognize that name from former Representative DeWine, former Senator DeWine, former Senator uh De Voinovich. Uh, but we were referred to as the silent killer of jobs. The program did not run well, not for the employer, not for the injured worker, not for the state. Now we are considered an envy of a lot of other states. We've in reduced employer premiums to their lowest in sixty-five years and we rank in the top for lowest premiums in the country for our employers. This of course is due to multiple factors, including the culture of workplace safety, employers utilizing BWC services and offerings, the work we've done with managed cares and statewide industry changes. Uh, we've seen a lot of changes in our workers' compensation dealing, since dealing with managed care. For instance, uh, the average time for filing a workers' compensation claim before managed care was about sixty-five days. And determination within the first two weeks was about one percent. If you understand workers' comp, you understand this is not good statistics. Now on average it takes about seventeen days from the time an incident occurs until it's filed with us and nearly forty-six percent of the time we're making claim determinations within two weeks. The result in the change of the managed care program now named HPP was initiated in March first nineteen ninety-seven. I've attached for you to my written testimony the agreement between all of the parties that came to the table to g- to summarize and to agree on HPP, the health partnership program. It's about nine pages. You will see four of those pages are signatures. That is the number of stakeholders brought together to design this system, to agree to this system, and to understand the system better. HPP applied two foundational principles to Ohio's We would now contract with medical management specialists to manage injured workers' medical claims and partner with MCOs to apply best-in-class private sector concepts to our operations such as injury reporting, medical management, and return to work services. We've also done uh we we had some issues if you think about um we reduction in workforce at that time when we outsourced our managed care we had a reduction in workforce. We were about forty-two hundred employees at the time, and as uh in the history of my long resume which you have before you, I was actually at the bureau as we I was actually at BWC as we were outsourcing. We worked with the employees to reassign them. We also engaged in a pardon me, in a buyout, a pension buyout, where we bought out many years of their pension so that they could retire early. That created a wave of hirings actually. So we didn't have people displaced for layoffs. We created a wave of hirings. And if you've done the math in your head, that's about thirty some years ago. So right now we're experiencing a lot of retirements, which is a good thing for those folks, not a great thing for us as we see experience go out the door. So we have been uh doing a lot of hiring of course, and in the meantime trying to use AI to fill that gap. And I'm happy to answer more questions about that if you have those. Thank you.

Thank you. Next, I'll recognize Mister Godfrey for his testimony.

Thank you. Good morning. Uh, Chairman McKenzie, Ranking Member Omar, members of the committee. Good morning. Uh, Chairman McKenzie, uh, Ranking Member Omar, members of the committee, thank you for the opportunity to testify uh today regarding the federal workers' compensation programs administered by the Department of Labor's, Office of Workers' Compensation programs. I've been employed in workers' compensation programs since nineteen ninety eight, representing injured workers. employers insurers and self-insured entities i've also served in the public service roles uh at the state local uh and federal uh levels including the iowa workers compensation commission uh chief judge of the employees compensation appeals board and the director at the office of workers compensation programs at the department of labor in addition i've served on the executive board of the international association of industrial accident boards and commissions where i've had the opportunity to serve alongside commissioners and system leaders from across all of the United States jurisdictions, and from other jurisdictions in Canada, Europe, Australia, and Southeast Asia. Workers' compensation is built on the grand bargain. Workers gave up the right to sue for civil damages in exchange for prompt and adequate uh compensation delivered through an administrative system and the important words there are prompt and adequate. That balance has largely sustained the system, for more than a century and it should guide any changes that Congress uh considers. A particularly urgent uh matter right now in the federal system is access to medical care. The FICA program uh and its statute explicitly protects an injured worker's right to choose their own physician, and that's a principle which is born in American values of people being allowed to choose their own doctor. But in practice the federal workers are finding it very difficult to find doctors who are willing uh to participate in the program. But the problem isn't the statute. It's the administrative burden surrounding medical authorization, billing, and reimbursement. And it's a problem that's the direct result of outsourcing core federal program functions to a private contractor. And it eats up a large part of OWCP's administrative st- uh budget. So as a word of warning from my twenty years in private service in public service, replacing accountable federal employees with private vendors does not reduce costs It reduces accountability. And my experience tells me that contractors are not rewarded for improving uh programmatic outcomes, they're rewarded for reducing costs for one side of the grand bargain. And obviously the easiest way to reduce expenditures are to delay, deny, or complicate care. But proposals framed as cost savings often don't eliminate costs at all, they shift them. When workers cannot access care, those costs are just shifted. private health insurance to Medicare, Medicaid, or other private programs like, or public programs such as the VA. That's not savings, it's shifting costs, and it's real. During my tenure at OWCP, I established a working group to improve physician participation and access to care. But its effectiveness was limited by the necessary reliance on an outside vendor that consumed significant resources while contributing to the very barriers that were driving physicians out of the program. That situation should not be repeated by outsourcing even more of the federal work uh to for-profit vendors. There are other uh constructive changes that Congress should consider. I've included those, a list of those, uh within uh my written testimony, and I'm anxious to answer any questions you may have about those. I also want to note that if Congress wants to strengthen federal workers' compensation, I think the path is clear. Improve access to care for workers. Reduce administrative barriers to allow physicians to practice with the federal programs, and ensure timely decisions, especially on wage loss benefits. And finally, invest in federal workforce that's responsible for administering claims of injured and ill federal workers. The grand bargain is endured because it reflects a very simple principle. When workers are injured serving this country, the system should respond with prompt care, fair compensation, and dignity, strengthening that system means honoring that promise, not outsourcing it to for-profit entities. Thank you and I look forward to your questions.

Thank you. Lastly, I'll recognize Mister Howell for his testimony.

Thank you, Chair McKenzie, Ranking Member Omar, and members of the subcommittee. I am Patrick Howell, Executive Vice President of Nuclear Care Partners. I started out as an Army combat medic, but now my role is to support all of the Nuclear Care Partners patients through their continuum of care. Our company provides in-home health care across twenty-eight states for former Department of Energy nuclear weapons workers. These patients suffered serious illnesses caused by their exposures to radiation and toxic substances. Nuclear Care Partners strongly believes that these Cold War heroes deserve compassionate and exceptional care. In two thousand, the Energy Employees' Occupational Illness Compensation Act became law. former energy workers with illnesses related to their workplace exposure to receive compensation and medical benefits. This health care program is run by the Department of Labor's Office of Workers' Compensation. This program is in urgent need of modernization. Congress should pass the health care for energy workers act, sponsored by Representatives Allen and McBath. This bipartisan legislation will modernize twenty-five year old statute to improve health care for these heroes. The current statute only allows physicians to order care for these patients. This new bill would update the statute to allow care to be ordered by nurse practitioners and physician assistants in accordance with state practice laws. The current outdated policy has had devastating effects. Patients are not receiving timely health care. Many of our patients especially in the rural areas face long delays in securing physician appointments. Many patients are forced to travel long distances to r to see a physician. For example, one of our New Mexico patients had to make a four-hour trip to see his kidney doctor. This was very taxing for the patient. There were nurse practitioners who could have seen him closer to home, but the current policy does not allow it. In addition, the care authorization process and paperwork is challenging for physicians. Sometimes it makes it difficult to find a physician who are even willing to work with patients in the DOL health care program. HR forty-one twenty-two would improve the health care and quality of life for these patients. It would also align the DOL energy workers program with the VA and CMS systems. These systems utilize nurse practitioners and physician assistants as key

Thank you. Uh, appreciate the opening testimony from each of you, and now we'll move to member questioning of the witnesses under Committee Rule nine, we'll ask questions of each of you under the five-minute rule. And I'll recognize myself for a couple of questions. First of all, I'll go to Mister Howell. Thank you for your service. We appreciate that. And you uh are talking about IOCA, or uh the energy compensation program that the department uh administers and it was enacted more than a quarter century ago. Uh, there are likely to be eligible workers, though, who aren't even aware of the program or they aren't aware of the extent of the benefits and uh the medical care that cou- could be offered to them. In your experience, to what extent are eligible workers aware of this program and what stati- strategies could be used to improve outreach and enrollment?

Yes, thank you for the question. We still find uh workers who are not aware of the program and their right to enroll in the program. A lot of the outreach is performed currently by companies like Nuclear Care Partners. We host community events, educational seminars, we do mailers. About forty plus percent of our referrals come from current patients, so it's a lot of word of mouth. So going into the community and finding these individuals is is one step and then educating them on their potential benefits is another. One way that we can improve awareness is to work with the dol and their resource centers to help identify lists of former employees former workers and then have regular communications from the dol with updated educational packets uh information updates to the programs on a annual basis this would help to drive awareness in education

next i'm gonna go to misma cloud uh your written testimony described the use of artificial intelligence to optimize claim processing, improve risk assessment, and drive operational efficien efficiencies. Uh, what are some of the examples of how you're using this technology?

Uh, auto-adjudication is one of the the first ways that we've been using AI. This allows certain allowed conditions, minor scrapes, cuts, bruises to process much faster than with human hands touching them. So within days of receiving the claim information, we're able to approve claims and notices to injured workers and employers, all with little or no staff intervention. Uh, employers, of course, and injured workers, if need be, c- always have the option to file an appeal on any claim, including those auto-adjudicated. But this allows our staff to spend more time on complicated, high severity claims. We're also working on Auto-indexing. We get about four to five million documents a year, and through auto-indexing we're able, our initial estimate is that we can uh be able to s get those scanned in and auto-indexed at about twenty-five to thirty percent of those documents, with our ultimate long-term goal being eighty to ninety percent of those. We have what we call a chat BWC policy bot. This is an internal, it's all of our policies, all of our statutes, all of our rules. that allow staff to find answers quicker, more efficiently, more thoroughly. They're all sourced. Everything in our uh AI world, when we're summarizing, when we're getting those kind of answers, everything is sourced for them so they can go to the source document. This is uh s- if we can scale this enterprise Y, we expect to save about twenty thousand hours annually. We have something called data chat, which allows our staff to ask natural language but it puts them into the structured query language. It improves access to insights and saving about five hundred hours a year, is our estimation. We, of course, the the basic use of AI, document creation, generating summaries for legal fraud, claims processes. This saves, of course, thousands of hours. And then we're exploring using Microsoft Co-pilot. That's an AI assistant, boosts productivity in Word, Excel, PowerPoint, Outlook, It helps users generate content, summarize automated tasks, and collaborate more efficiently by using AI in their workflow.

That's great. It sounds like a very positive use of AI. We're glad to see state government adopting that. And as a former state legislator, myself and somebody who worked at our our state uh Department of Labor and Industry, one of the challenges we found in our our structures were that uh statutes were sometimes so prescriptive, in the workers' comp space that it didn't allow for innovation like that. So, is it something that was in your state statute that was sufficiently broad that allowed you to do this? Or did you have to seek some kind of uh change from the state legislature?

The, uh, to the chairman, thank you. Um, the state legislature has allowed, and we have some restrictions on AI. We have statewide restrictions, not just my agency, but all agencies. that puts guardrails uh especially on generative AI, but we have a statewide AI governance committee. Agencies must follow a formal process for identifying, documenting, reviewing, and they approve all AI use cases. AI solutions must align with the AI core principles uh for Ohio, which is fairness, accountability, security, transparency, and ethics.

Great. Thank you. Appreciate that uh insight into what's going on in Ohio. Next, I'll go to ranking member Omar for her questions.

Uh, since the nineties, um, more states have been, uh, enacting aggressive reforms to workers' compensation programs. Um, Mister Godfrey, I want to discuss, uh, one of these common reforms in more detail. If the federal workers' comp programs adopt a managed care model, uh, and forced injury workers only to see physicians by OWCP or insurance contractors, how would this impact the doctor-patient relationship and the quality of care for injured workers?

Thank you for the question. Um, generally I think what we've seen with state workers' compensation systems and I've seen it through my work with the IAIABC, is that the best practices that we can have amongst agencies is really helpful to determine how to provide care but I think the other thing that we've seen is through the data some of it coming from the worker uh uh workers compensation research institute, shows that when uh employer choice uh takes over in a system from employee choice, you actually see costs go up, which may be somewhat surprising. But I think the thing that we've seen from a policy perspective is that when injured workers are not allowed to select their own physician, there becomes distrust within that system. Um doctors may have um uh treatment guidelines, uh they uh preclude them from uh doing necessary testing for a certain period of time uh before they do things like physical therapy um certain medications may not be permitted under a statute all of those things drive people from the workers' compensation system back to their private health care coverage and that shifts the burden from a workplace injury on to the insurance which is not meant for workplace injuries so i think one of the things that we have to keep um in our forefront in our mind is that when we look at who provides care, it has to be someone that provides prompt and adequate benefits and it's with someone that the worker will trust. That's the best outcome for a workers' compensation system.

Yeah. And in your um experience as a director, and we talk a lot about those sources of um waste fraud and abuse, um but if if we were to look at the workers' compensation program, is it the um claimants or the providers?

i think what we've seen over time um especially uh as we look at like the opioid

yeah

crisis that we had in the united states um over proscribing of medications compound medications those are things that have really driven up costs in the federal workers compensation programs and that comes from uh providers but i don't wanna say that providers overall because the vast majority of providers are you know the the doctors and the physician practitioners that we all use and rely upon. Um but we also heard uh Mister Johnson talk about waste, fraud and abuse and workers' compensation and how Sedgwick um has systems in place. Well, the US Department of Labor also has the Office of Inspector General, and we work directly with the Postal Inspectors. So we have a very robust waste, fraud and abuse uh system in place to drive out that type of fraud, to keep costs down and when we identify that, We worked directly with the Department of Justice when I was at the Department of Labor,

Thank you.

to make sure we prosecuted that.

Thank you. Uh, Mister Johnson, um, your company, Sedgwick, has been repeatedly fined and settled claims with estates. In California, um, you were subjected to over a million dollar penalty for the death of an injured worker whose claim you all denied. In Tennessee, you were fined over utilization review that led to uh erroneous high treatment denials. Um in fact, uh the Workers' Compensation Appeals Board in California uh had this to say about your company I quote "we have rarely encountered a case in which a defendant has exhibited such disregard for its legal and ethical obligations to provide medical care to critically injured workers." I just have one question for you. Why is so frequently cited for failing to provide adequate care for their workers.

Thank you for the question, uh, Ranking Member Omar. I I don't know the specifics of those those individual cases, but I would tell you just in my opening statement that that is not the way that we operate day in and day out we operate with from the sense of um helping millions of workers that have been injured in their workplaces every year get the best possible care ultimately return to work um those cases and had other extenuating circumstances. Um, I can't comment on those, certainly could follow back up at some point in time, but what I can tell you is that we have tens of thousands of colleagues of mine on the front lines across the country every day that are interacting with injured workers that are learning about their uh personal lives, that are understanding what their injuries have uh h- h- how they've taken place, what their goals are, and then ultimately are trying to use our systems, our data, our history ultimately to get them better, send them to the best possible treating providers, not the lowest cost providers in most cases, we're talking about those that produce the best outcomes, ultimately get them well and return to work. That story repeats itself over and over again, millions of time for us, over uh times for us every year. So those individual cases I can get some comments back to you on, but that's not the overall experience of our organization, and but because of that.

Yeah.

Well, I I I appreciate your answer. Um, the the the record reflects otherwise, I have a unanimous consent uh request to enter into the record.

Without objection.

Um and ex-

Um.

Oh.

Or ask not.

I know, but there's no time for unanimous consent request.

Uh, but I thought it was something for the record or

I would like to r- Yes, I would like to read what I want to submit into the record.

Okay. Okay. Okay.

Okay. An exchange of three letters between ranking members Scott and myself and the Department of Labor about the department's overs oversight of self-injured coal operators, a letter from the workers injury law and advocacy group, a letter from the American Academy of Physicians Association, a letter from nine one one uh nine eleven um health watch to managed care advisers about poor service to survivors of the nine eleven World Trade Center disaster an excerpt from a decision by the workers' compensation appeals board of the State of California referring to what the board calls it which disregard of the law. An excerpt from the Ohio Inspector General report on questionable data submissions by Care Workers CareWorks a Sedgwick company and an article from Business Insurance entitled Sedgwick pays one point five million to settle California comp violation.

Thank you. Next we'll go to Mister Wahlberg, Chairman of the full committee.

Thank you, Mister Chairman, and thanks to the panel for being here. And let me follow up with Mister Johnson. I believe a crucial sign of a successful workers' compensation uh is a high rate of quickly returning workers to the uh the workplace. Uh that shows that they've received a a timely, effective care uh and these programs then then I believe can focus on dollars uh needed for m- more patient who are in need. Let me ask you, what changes do you believe can be made to federal workers' compensation programs that could quickly translate to - to better return to work outcomes for injured workers?

Thank you for the question, uh, Chairman, um, uh, Wahlberg. The - the - the crux of returning to work is a c- is a coordination effort by multiple parties. Obviously, there has to be enough time and opportunity for the individual claims examiner to actively manage and proactively talk about the future with an injured worker, and ultimately coordinate those activities with managed care providers, and also the treating uh providers in the um um i- in the field. And once they have that um coordination and and plan, and once they understand what the future medical, maximum medical improvement is going to look like, then they can then go and coordinate with the employing agency, or particularly other employing agencies, ultimately to return that worker uh back to some production and and productive action in uh in society. We we think that several things can happen. Preferred providers are a big part of this, and again I'll talk about preferred providers from the sense of not those that are the least expensive but those that produce the best outcomes those that treat the most effectively those that um assign to physical rehabilitation in the most effective ways, and then ultimately those who coordinate return to work activities the best possible.

Get them back to work, yeah.

Yes. Uh so all of that has to be a a big part of what goes on in the federal program going forward. Uh, we think that there are several things that can happen. One is improving the guidance and the training and the navigation with the injured worker themselves. This is all about helping the injured worker understand what their future looks like and how the system is ultimately gonna take care of them and make sure that they do get back into productivity in society. That's another big part of it that I think can be improved in the federal environment at this time.

Okay. Thank you. Um, Mister Howe, uh, in addition to your

Thank you for the question. Telemedicine would be an additional tool to connect patients with their clinicians. It was proven to be effective during the COVID era to have that communication and provide care. For our patient population, several, several of our patients, all of our patients have to be renewed annually. And, and that is currently requiring a face-to-face visit. Like I said earlier, for some of these patients with the shortage of physicians, especially in rural areas, there's a lot of transportation or time travel to the physician, and for some of our patients, they're very sick, and uh and uh they're, some of them are even bedridden. So by offering telemedicine, it would be another venue for them to get the documentation and the the meeting that they need to continue on the program. And uh some of the limitations are telemedicine's not gonna work for every visit, because if the patient's health condition

Good option, in the in the in the coordination of care.

Mm-hmm.

Thank you.

Mm-hmm.

Uh, Mr. McLeod, um, how are managed care organizations maintaining the quality of participate in care providers cuz we want the providers to be qualified.

Thank you, through the chair to Chairman Wahlberg. Um, well, they must uh demonstrate a range. So our our experience, and again I can only speak to that, is that by bringing managed care organizations and we've actually substantially expanded the number of providers in our system. In nineteen ninety-five, prior to managed care, we had about two hundred and seventy-three thousand new claims each year. At that time, we had about sixty-nine hundred BWC certified providers in the system. Since managed care in this time, we now have about sixty-seven thousand new claims each year, but we have ninety-one thousand, eight hundred and sixty-nine providers in the system. Part of our requirement is that MCOs bring a robust panel to us, that they go out, that they get these providers BWC certified, that they agree to accept our fee schedules, our forms, our everything that it is to do, you know, the specific laws and and requirements that BWC provides. We do have the option that every injured worker can choose their own provider. And we're actually putting together a little concierge service. If it is, if your provider is not in the BWC system, we will go out and help them get in the BWC system if they are willing.

If they meet the qualifications and all of the rest.

Exactly. That's exactly right. But you can,

OK.

i- if they are willing to be a BWC certified provider, you can go to any provider the injured worker wants to go to.

OK, OK. Thank you.

Thank you.

My time has expired.

Thank you. Next we'll go to Mister Mesmer from Indiana.

Th- thank you, Mister Chairman, and thank you witnesses for being here today. Uh, the Federal Employees Compensation Act, or FICA, has not undergone a comprehensive modernization since nineteen seventy-four. even though state workers' compensi compensation systems have evolved sig sig significantly over the last fifty years, Mister Johnson, as Congress evaluates potential updates to FICA, what reforms would help improve uh coordination of care and recovery outcomes for injured federal workers?

I I think that the biggest thing that uh could be improved in the uh FICA um environment is the uh is the provider arrangement, a a network um of providers that again are the most effective in treating workers' compensation injuries. Uh, also an adjustments in the fees l- um is a possibility hopefully that um that the networks are allowed to be paid along the way. We have uh the situation on uh many of our uh we have over nine hundred thousand active providers that provide the best treatment in workers' compensation and our networks across the country produce those best outcomes that we talked about. We use historical data to judge those providers on their outcomes and ultimately the the maximum medical improvement and return to work that they achieve for those injured workers. We believe that in those cases those similar aspects of the things that work so well in the private sector should be carried over and considered in the FICA um in the FICA environment also and we think that's the main driver that would be that we'd be a proponent for. There are other obviously changes to FICA that are on the table that I'm not necessarily an expert in but uh but the one that uh that drives the most we believe is on the provider side.

Thank you. Ms. McLeod, in your written testimony, uh you credit the adoption of managed care organizations as a fundam- fundamental element of the success of Ohio's workers' compensation workers' compensation program. Similarly, in my home in my home state of Indiana, our workers' compensation system allows employers to coordinate care through designated providers to help get the injured worker, timely treatment, and return to work sooner. Uh, if we modernize FICA based on states like Indiana and Ohio, what would the overall impact of using managed care networks with federal workers' uh compensation be?

Uh, thank you through the chair to the vice chair Mesmer. Um, the the impact for Ohio again, what we've seen partnering with MCOs helps strengthen med medical management of claims and improve outcomes for both injured workers and employers and that's of course by ret- improving the return to work outcome. Between nineteen ninety eight and twenty twenty five we've seen our file lag reduced from thirty days to seventeen days, determination lag reduced by at least a day and a half, with our overall lag reducing about two weeks. Uh, we've also s- again, as I said, seen our number of providers grow substantially. It's, um, it's gonna be important that the MCOs meet the geographical needs, including rural areas, but our MCOs in Ohio have, uh, made extra efforts to do that.

Okay. Thank you. Uh what uh potential consequences should Congress be aware of when considering whether federal workers' compensation programs should use a managed care model?

Uh, clinical guidelines that promote consistent evidence-based uh decisions, reduce variability in case outcomes, um, beca- a lot of communication because MCOs can sometimes add complexity. There's a sometimes a who's on first for the injured worker of who am I dealing with, am I dealing with the managed care organization? Am I dealing with uh the federal employee? Communication monitoring, we have a whole division dedicated uh CPM, contract performance monitoring, that monitors our contract, our contract with our MCOs uh with appendices probably about four four to six inches uh on any given year. We're very proscriptive and prescriptive in what our MCOs can do. They work just for us. And then of course, quality focused incentives are gonna be necessary to manage the added burden.

Okay. Uh, what metrics does the Ohio Bu- Bureau of Workers' Workers' Compensation use to measure performance of managed care organizations? And how can that b- model be used for federal legislation?

Uh, the uh the metrics that we use, there's some um there's some in the attachment to my testimony that I gave you that will show you what we do as a a report card of every MCO. When we started we had fifty-seven, we're down to seven MCOs because of, again, the - the stringency in the prescriptive and proscriptive. But, um, we measured through a combination of administrative metrics. Uh, we tracked baseline service expectations and outcome-based metrics to focus on safe and timely return to work. MCOs that exceed these benchmarks can earn incentive payments, uh, while suffi- insufficient performance can result in financial set-offs. And we have implemented those. Uh, we have also uh, this comes up in our we certify all the MCOs about every two years. They have to go through a certification process to show that not only are they doing things as we go but just to make sure that they're meeting those baseline standards. Uh, the M the report card helps I think a lot with the transparency for Ohio employers as they're selecting MCO businesses.

Okay. Thank you, and I yield back my time.

Thank you.

Great, thank you. Next we'll go to Ranking member of the full committee, Mister Scott from Virginia.

Thank you, Mister, Mister Speaker, uh, Mister Chairman. Um, Mister Godfrey, if you're an employee uh and get hurt on the job, you get lost wages, medical um, medical costs, and a disability if you're disabled, which of those would you get if you're misclassified as an independent contractor?

As an independent contractor you would not qualify for workers' compensation unless you pay for insurance on your own.

So you wouldn't get any of those as an independent contractor. Uh, you'd tell us the um research uh the relationship between private equity investment in health care and quality of care. Uh, can you say something about that?

Sure. Uh, overall private equity involvement in managed care and workers' compensation has been problematic for injured and ill workers. Um, it it leads to cost shifting. Um, one of the things that, uh, I have, uh, witnessed is that, uh, private equity can come into a workers' compensation system, uh, basically be paid to take on high-risk, uh, or high-dollar cases, and then we know that because they receive that money, they are going to try to keep costs under the dollar value of what they basically were paid to take on the, the liability for that case. And as you can imagine, that's going to lead to denials, delays, um, cuts in - in, uh, benefits to the worker, and ultimately that shifts to taxpayers.

And has research uh shown that?

Um, I - I think the investment, uh, or the involvement of private equity is somewhat new, so the data is not clear. Um, but it is an area that we are, uh, looking at very carefully.

And what does cost shift mean?

Cost shifting means that when someone has liability for an injury or illness, if they can deny liability and force someone to go to a doctor with their private health insurance or if they're a veteran and they have qualifications at the VA shifting their care uh to that facility so they can get more prompt, and adequate coverage.

Who sets the um who selects the doctors that are able to handle um workers comp cases on the federal level

on the federal level for the feca program uh uh five usc eighty one O three a says that the injured worker gets to choose their own physician

ok uh and is there a fee schedule

yes there is a fee schedule

who sets the fee schedule

the fee schedule is set annually by the uh united states department of labor um it is done in conjunction other entities to make sure that it is a competitive fee schedule which is has cost savings, uh but also is competitive to keep doctors within the system.

And are the fees set at a rate where doctors actually wanna participate?

Yes.

OK. Um You have mentioned the value of permitting schedule awards to be issued concurrently with wage compensation. with wage loss compensation. What did you mean by that and can it take place now?

I have concerns with the current uh administration of schedule awards. A schedule award is compensation that's paid to a worker in an accepted claim because of the loss or loss of use of a scheduled number, for instance your arm. If you have your arm amputated because of a workplace injury, you should be compensated for that loss in addition to the wage loss compensation that you're receiving because you cannot go back to the same job you were at before. Um, it is pretty well settled in workers' compensation that those are two separate elements of damages. Uh, under the current administration of the FICA program, uh, they are not paid, um, they're only paid, uh, consecutively, uh, so they, if you want to receive a schedule award you have to stop receipt of wage replacement benefits. I think that is an improper, uh, administration of the law and I would urge Congress to take a look at that.

Well, is that, is that applied to um long short cases too?

No, I believe that's the FICA program, specifically.

Well, so d- you think it's a violation of the law, so they just sorta changed the practice.

I think that the uh regulations and uh procedures of the Office of Workers' Compensation uh should be reviewed by Congress to make sure that people are paid schedule awards that they're entitled to under the law.

Thank you, Mr. Chairman.

Thank you. Next we're gonna go to Mister Grothman from Wisconsin.

Holy cow.

You c- you can have a moment to get settled.

Right away. Uh.

Right on time. So that's good.

Yes.

I like it.

We'll start with mister. We'll start with uh Uh, we'll start with Mister Howe here. Uh, as we evaluate the effectiveness of the energy workers program, I wanna make sure I'm getting the full picture. What met metrics should be used to assess the energy workers program?

Uh, thank you for the question. Uh, critical metrics that we should use is the time we identify a potential patient to the time they receive care, and going through the approval process. Uh, this is a a metric that, uh, we wanna make sure is as fast as possible. The bill that, uh, we are discussing today would be a critical uh, positive opportunity to shorten that time, access to nurse practitioners and access to physician assistants will increase or shorten the time to get that initial visit and that'll shorten the time to get the documentation to the DOL for them to make their determination. So, I feel uh a priority matrix is the timing from identification to delivery of care.

Thanks. What enhancements could we make to the claims process To better support the claimants and improve their experience.

Yeah, anything we can do to support and facilitate the process of getting approved. The the important component of this program is you have to ha- identify your work history, you have to identify your exposure, and then that has to coincide with the the disease or the illness that you're suffering. So there's a there's a lot of paperwork and a lot of assessment that's done at that time. the critical piece of that is getting with the clinician to make that assessment and determine if these are all linked together. So speeding up the process is is key to that and and I firmly believe that this bill will help to do that.

OK. We'll switch to Mister Johnson here. Uh your written testimony highlights several applications of artificial intelligence in workers' comp. However, you also recognize the need for proper control and safeguards. How can we make sure the balance, how can we balance an effective use of AI while also making sure these programs safeguard patient privacy?

Thank you for the question, Representative. I, I, in our view, the use of AI has been very powerful in the claims management arena, mainly in assisting the claims examiner in helping to promptly identify trends, upcoming milestones, help the injured worker in a better possible way from historical learnings, and then ultimately supplement the way that they're able to effectively do their job. What we believe in the use of artificial intelligence is that there should always be a human on both ends of the transaction. There should be a human that evaluates the ultimate uh that evaluates the the case that is before them, and then ultimately manages that case throughout its continuum, uh using the AI tools to supplement their their abilities as as a as a person and one person managing numbers of cases, and then ultimately a human that reviews the outcome and decides whether or not that AI recommendation was the best uh was the best care was the best procedure and the best ultimate outcome for that injured worker we think that that oversight and that constant monitoring of the AI that's involved in claims management is the the utmost importance. We also think the data should remain internal, the data needs to remain within federally compliant systems. We believe that only certain tools should be used in the AI world, and that needs to be um closely governed. So all those controls that are in place in the AI environment we believe are of the utmost importance to be able to make sure that claims are managed effectively and ultimately the injured worker gets the best possible outcome.

Can you can you give us any specific examples of success stories of patient privacy safeguards being implemented uh as part of AI usage?

I I think keeping those within the federal environment that are of the utmost um cyber security requirements is key in in any one of these discussions, in any one of these rollouts. Um uh the uh the fact that we've got you know uh we do constant um uh reviews of these programs making sure that all of the cyber security efforts that are in place for any federal program and sharing of information back and forth are ultimately present in any AI that becomes involved with a particular claim. So none of that ceases it actually um increases in scope if you will given the fact that we're bringing in now an an additional party in um in weighing in on the ultimate management of a claim

miss mcleod i'm gonna ask you kind of a broad question uh if i go back home and ask people what do they think about the uh um the workers compensation program uh they always have anecdotal evidence of of the program being abused could you comment on that on a scale of zero to ten Where do you think we are as far as putting together a a good uh workers comp program without people? It seems the people who are genuinely injured don't get the workers comp, and the people who aren't injured are the ones who wind up getting it. So could you comment on where you think we are right now as far as putting together a successful program?

Uh thank you through the chair uh representative. Um I can speak to Ohio and Ohio's experience is is not that we have a robust fraud program of course both it investigates employers as well as injured workers but um we do not see um we have identified a lot of savings but we do not see the level of fraud either in injured workers or employer efforts uh certainly we have seen in the past just by uh getting injured workers back to work quicker um has has helped quite a bit as well as uh our work with the managed care organizations.

You Okay.

Thank you. Next we'll go to Mister Fein from Florida.

Thank you. Thank you, Mister Chairman. Look, I think this is an important issue because we have two competing things that we need to balance. One is we should be making sure workers who get injured, particularly federal workers, are taken care of. I don't think anyone disputes that. But as we've seen, in virtually every program in this country where the government takes money and gives it to someone there is massive endemic and crippling fraud which will lead ultimately to the collapse of our country if we don't get these things under control and one of the things that amazes me in this situation is you're getting workers' compensation right so you're compensated for not being able to work but then when you wouldn't be able to work anyway you're still being compensated for not being able to work.

Thank you for the question, representative. Well, first of all, the l- we leverage predictive analytics to identify

Mm.

risk not to presume wrongdoing in in any way so we're trying to understand the uh the patterns that are involved in any in particular workers compensation case and patterns that patterns that may be anomalies when compared to larger sources of data. That's one of the benefits of organizations that manage uh multi millions of workers compensation claims is the fact that the data elements behind the scenes are so robust that we have the ability to mine those on a constant basis and take a look for those anomalies. not just on potentially the um acclaimant's side, but also on the provider's side. So we look for anomalies in the treatment patterns, the uh prescribing of medications, the utilization of uh rehabilitation efforts, all of those things that come out of our system and look at those patterns in the data from the past, cause us to then say that a human needs to take a look at this a little bit further. It's not the system ultimately making that decision, but the use of all that data, artificial intelligence, and those predictive analytics allow the humans to focus in and then dig into that case and get an understanding as to whether or not something needs to be pursued there because of some potential wrongdoing.

OK. So, so what barriers follow up for you? What barriers have states and your own organization encountered when you're trying to implement this technology?

But most of the time the states are concerned about over overdoing it, over-reporting. And so you don't want to get a situation where um you know they they want to see legitimate

Okay. Um, Okay. Um, shifting focus, shifting focus, I've got about two minutes left, I got about two minutes left, Miss McClellan, Miss McClellan, I have a question for you. a question for you. Your written testimony notes the significant reduction in the average time for injured workers to file a claim since your agency made significant changes to its operations thirty years ago. What improvements are the Ohio Bureau of Workers' Compensation continuing to make to improve its efficiency in serving injured workers?

Thank you for the question, through the chair, to the representative. Um, tri- we do a triage-based claims management system that creates experts in each phase of the claim that can help the injured worker with a higher level of expertise. We have a specialized team for occurrence needs. We've spent a lot of time when the pandemic hit, we put together a COVID-19 c- uh claim group to make sure that they got the special attention that they need. We do the same for claims that involve more than three injuries, uh, catastrophic claims, and any complex claims. They have individual staffing groups that they meet regularly working the MCOs and the employers to try to help those injured workers. We've increased communications, text messaging, email notifications, et cetera. Uh, I've talked a little bit about auto automatic claims processing and, uh, working a lot in the vocational rehab with, uh, what we call, it's a program called Ohio Means Jobs. And it's to help those injured workers find work even if it's not in the job if they're unable to return to their previous employment. How do we get them back to work? Because what we know in workers' comp is the longer you're off work, the longer you're off work. So getting people into a job that where they can be successful, and as Governor DeWine would say, live up to their God-given potential and be able to re-enter the workforce, um, we work hard on that with our MCOs.

Well, thank you. Thanks for working on this. Uh, it's an important issue, and thanks for being here today. Mister Chairman, I yield back.

Thank you.

Next we'll go to Ms. Misbath.

Thank you, Mr. Chair. Thank you very, very much. Um, uh, thank you, Chairman McKenzie. But also thank you to the O the, uh, ranking member of the entire committee, Chairman Scott and ranking member Omar, uh, for allowing me to sit in today. Thank you so much for Letting me wave on. And thank you to our witnesses today for uh convening this important discussion on how we can better support our public servants uh who have given years of lives years of their lives to service. For our federal workers who have worked at our nuclear sites, the Energy Employees' Occupational Illness Program is a lifeline, providing compensation and medical benefits for current and former workers who have gotten ill on the job. However, our energy workers who qualify and are living in our rural areas often face very long wait times and unnecessary delays for just routine and lifesaving care. It is why I am proud to partner with my colleague across the aisle, uh, my Georgia delegation, uh, member, Congress, Congressman Rick Allen, uh, we have both partnered on this legislation that would cut the red tape. and improve access for our public servants. The Health Care for Energy Workers Act would modernize an outdated provision that unnecessarily restricts access to care for those who live in health care deserts, ensuring that our public servants have access to the care that they need, what they need, when they truly need it. Georgia is home to over seven thousand energy workers, many of whom are current or former workers who benefit or qualify under this program. But we are facing a critical shortage of medical providers in our home state. Those problems compound as you get further out of the Atlanta metropolitan area. There are forty-two counties in Georgia that do not have an internal medicine doctor, ten counties that have no physicians at all. And for the people living in Webster, Montgomery, or Chattahoochee County, the provider shortage forces six pat- six patients to travel long distances to receive care, that could otherwise be offered by providers closer to home. This is an issue that deeply impacts our neighbors in Georgia. This is an issue specific not just to Georgia, though, as our country as a whole struggles with a nationwide provider shortage, so many Americans, especially in our rural communities, are being left behind. But the area you live in should not dictate how long you must wait for lifesaving care. Right now, our rural neighbors are feeling and bearing all the brunt of the pain. Running up the tally on hours spent on the road so they can get the lifesaving care and route routine treatments that they need. Like our neighbor down in Coweta County, who after years working as a pipe fitter at a nuclear site, settled down in Sharpsburg, Georgia, as he battles cancer and pneumo pneumoco is uh, excuse me, but it's pneumoconiosis, a severe irreversible lung condition caused by inhaling toxic dust. The current law forces him to regularly drive over six hours round trip in order to verify his health benefits. Our federal workers definitely deserve better than this. Mine and Congressman Allen's legislation will modernize the program to reflect the shortage shortages that patients are facing on the ground. This bill gives patients the ability to Work with providers that they already have built a relationship with, and who are already in their communities, gives back patients their time. Time not spent driving for hours in a car, not worrying about when they'll be able to find an appointment with their next physician's visit. More time to heal in the comfort of their own home their own home, and more time with their families and their communities. Mister Howell, can you share a little more about this? specific health issues that our energy workers face and why timely access to their care is essential for these patients.

Yes, thank you for this very important question. You mentioned pneumoconiosis. Uh, we do see a lot of respiratory illness, uh, specifically to silicosis and asbestosis, two forms of pneumoconiosis. We are also seeing a significant increase in chronic kidney disease, related to heavy metal exposure like cadmium, lead, mercury, and this is something we're proud uh nuclear care partners created the first of its kind in-home dialysis care for these patients we're very proud of that. We also have specialized care for respiratory illnesses. There are also neurological defects, but the one that you mentioned also was cancer. There are twenty-two forms of cancer associated with exposures to these uh, materials and radiation. And patients who are in the end stages of cancer, earlier stages of cancer, delaying care for them, even by a week, a month, or two months to get a physician's appointment would delay the entire process to getting approved. Some of these people don't have the gift of time. And at Nuclear Care Partners, we are fighting to get into that home, and I wanna sit in the chair of a patient, family for just one second we're fighting to get them to that home to give them care and comfort as they transition and if we're delaying things because of access to physician care or getting uh the proper documentation we're delaying that care that we can get in we fight to get in even for one day to provide care and comfort for that support you also mentioned transportation a pneumoconiosis patient that has to drive six hours it's very likely that if they're not already on they will be on permanent oxygen for their disease. Think about the transportation and driving with an oxygen tank for six hours and being fearful that that tank could run out. Uh, time to get an appointment, time to get care is critical. This bill will help several people. It will help them. It will provide better quality of care. And this is, at Nuclear Care Partners, our passion, and we thank you so much for bringing this bill to to life.

Oh, thank you so much, I'm out of time, but thank you for caring for our energy patients. Thank you. I yield.

Thank you. Next we'll turn to Mister Allen from Georgia.

Well, not to repeat the uh this uh subject, but I want to thank you, Chair McKenzie, for allowing me to wave on into this hearing and I thank the witnesses here for testifying. Uh, and I want to thank Nuclear Care Partners for its support of HR uh forty-one twenty-two, the Healthcare for Energy Workers Act, which I introduced introduced alongside Representative uh Uh, Georgia. Uh, this legislation uh i i is is important in updating Energy Employees' Occupational Illness Compensation Program Act, which is the EEOI CPA, to allow nurse practitioners and physician's assistants to order care for current and former Department of Energy workers who receive health care under this Department of Labor program. Uh, Georgia's twelfth district is home thousands of energy workers employed at Plant Vogel and Sav- Savannah Riverside, uh many of whom uh qualify for the EEOI CPA for their health care needs. However, those who live in rural areas, as uh Representative McBath mentioned, are often hours from the nearest uh physician, highlighting the need for greater flexibility to ensure these beneficiaries receive the care that they deserve. Uh, this legislation addresses an unf unfortunate reality that there is a critical shortage of eligible care providers in many parts of this country. Uh, and by cutting unnecessary red tape and improving access to care for energy workers in Georgia and nationwide, in addition to allowing uh, Mister Howell, in addition to allowing patients to seek more local care options, how else can H R four one two two reduce administrative delays increase program efficiency and reduce overall cost by allowing uh, you know, these uh these providers to actually uh uh help folks uh in these rural areas.

Yes, thank you for the question. It will uh reduce delays by improving speed of access to the care providers. Like you said, uh getting uh care by a nurse practitioner or a family uh a physician assistant in your community will much uh will be faster. Uh, it's going to reduce redundancies because certain situations now where a patient is seeing a nurse practitioner or physician assistant, they would also have to go see a medical physician to get the proper documentation. So it's a duplication of of services. So that, that's uh not efficient. Most importantly is the savings of cost.

Mm-hmm.

Our health care system is burdened, our hospitals are full, and we know through our nursing programs and a big goal at Nuclear Care Partners is to get nurses into the home where we can assess patients, we can reduce complications and subsequent hospital visits, we can reduce cost by preventing patients from having to go to the hospital. The faster we get in the home, the better we can uh keep these patients healthier, keep them out of the hospital and reduce cost to the system.

Well, uh, you know, the the other thing we did uh through the Working Families Tax uh uh Act is uh provided additional resources for our rural hospitals. And uh what I've experienced with our rural hospitals, you know, the telemedicine program's been around, it actually uh uh it started there in my district at Augusta University. And it's been around since nineteen sixty, it evolved in in COVID obviously heavily. And uh and in fact now you can walk in at a hospital and you can get within sixty seconds a physician uh from Augusta to look at the issue and and provide the uh care. And so I think that is a big plus uh that we need to uh, it which wou- which would be included in H R forty-one twenty-two to allow uh these uh nurse practitioners and others to get immediate care for our our our patients. Uh, in your written testimony it calls for passage uh which would allow nurse practitioners and physician assistants which we talked about, to order care for patients in the energy workers program. Uh, are there other federal health care programs al- already allowing nurse practitioners and physician assistants to order care?

Yes. Currently, both the VA and the CMA CMS systems allow nurse practitioners and physician assistance to provide care and rate for care.

OK. And why has the energy workers program not adopted this pro- practice?

I I can't speak for why the program hasn't adopted the practice. I can speak uh to conversations I've had with people who have spoken to members of the DOL that they do not have the process or the law in place to make these changes.

Right.

So that's why I'm making this bill, this bill is so important to the process.

That's why we need the legislation.

We need the legislation to make the change

Yeah.

uh, to get us equal to both the VA and the CMS systems.

OK, great. Thank you. I'm feel back. I'm out of time. Thank you, Mister Chairman McKenzie, for allowing me to wave on. Thank you to the witnesses.

Thank you. That concludes member questioning. I appreciate, uh, all of the testifiers for their responses. We will head to closing remarks and I'll recognize the ranking member for her closing statement.

Thank you, Mister Chairman, and thank you again to our witnesses for sharing their testimony with us. Today's discussion reminds us that the federal workers' compensation programs are not just a line item in a federal budget, they are a promise, a promise that when federal employees are injured while serving the public, they will not be abandoned. Whether it is a postal worker deli- delivering mail or a firefighter uh battling wildfires on public land, these workers perform essential duties every single day. in demanding conditions and deserve our support when things go wrong. When an injury happens, the impact extends beyond the workplace. Families might face lost income, medical bills, and uncertainty about the future. Programs like FICA provide stability in those moments, making sure that injured workers can access medical care, receive wage replacement, and when possible return to work once they are recovered. At the same time, these laws are quite old. FICA is mark is more than a century old, and the energy workers program recently marked its twenty fifth anniversary. So it is appropriate for Congress to review how the programs are functioning, and whether improvements can be made. Those discussions should start with one guiding principle. Strengthening the system so it works better for the workers it was created to serve. Reforms that improve efficiency and sup

Thank you. Well,

Thank you.

I'd like to thank everybody again.

Thank you. Thank you.

for joining us today and discussing ways we can improve federal workers' compensation programs, care for injured workers, and return to work outcomes. By cutting through red tape, simplifying paperwork, and embracing the digital solutions, we can reduce administrative burdens and ensure injured workers receive the compensation they deserve without una- unnecessary delays. As today's witnesses have highlighted, there is also a clear need to increase access to care for program claimants. Fortunately, there are bipartisan solutions that address these problems, some of which were discussed today. We must advance policies that reduce and prevent abuse of the system as well, and provide greater access to care for critical uh needs that our workers face. With that, again I'd like to thank everybody for being here, especially our testifiers. We appreciate your testimony and for traveling uh to join us today. And without objection, there's no further business before the committee and the subcommittee stands adjourned. wow