,i #aaith ,,congress #b;d ,session ,h4 ,r4 #ihfi ,,in ,,the ,,house ,,of ,,representatives ,july #bb1 #bjbf,mr4 ,patronis 7for himself and ,mr4 ,bean of ,florida7 introduced the following bill2 which was referred to the ,committee on ,education and ,workforce ,a ,,bill ,to amend chapter #ha of title #e1 ,united ,states ,code1 to improve outcomes for injured ,federal workers and reduce costs and fraud1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,,feca ,modernization and ,cost ,containment ,act of #bjbf4 #b4 ,findings ,congress finds the following3 7#a7 ,the ,federal ,employees' ,compensation ,act has not undergone significant reform since #aigd1 despite advancements in workers' compensation practices4 7#b7 ,federal employees' compensation costs are significantly higher than those in the private sector1 creating a burden on taxpayers4 7#c7 ,the inability of ,federal employers to direct injured employees to managed care networks results in increased medical costs1 inconsistent treatment1 poor clinical outcomes and extended recovery times4 7#d7 ,fraud in the ,federal employees' compensation system remains a significant issue1 requiring enhanced monitoring and predictive fraud detection measures4 7#e7 ,implementing industry best practices1 including employer-directed medical care1 standardized treatment protocols1 and case management programs1 will improve efficiency1 reduce costs1 improve clinical outcomes for injured employees1 and accelerate employee recovery4 #c4 ,,feca modernization 7a7 ,requirement ,to seek care through managed care network ,section #hajc7;a7 of title #e1 ,united ,states ,code1 is amended-- 7#a7 by amending paragraph 7#c7 to read as follows3 7#c7 except in the case of a medical emergency1 through the managed care network that contracts with the employing agency of the employee pursuant to subsection 7c77#a74 2 and 7#b7 in the matter following paragraph 7#c71 by striking ,the employee and inserting ,subject to subsection 7c71 the employee4 7b7 ,managed care networks ,section #hajc of title #e1 ,united ,states ,code1 is amended by adding at the end the following3 7c7 ,managed care networks 7#a7 ,in general ,to meet the requirements of subsection 7a71 the head of each employing agency shall enter into a contract with a managed care network to furnish services1 appliances1 and supplies to employees of such agency4 7#b7 ,employee 7,a7 ,out-of-network services ,in a case in which the ,,mcn with which the employing agency has a contract is unable to furnish prescribed or recommended services1 appliances1 or supplies to an employee1 the employee may select a provider for such services1 appliances1 and supplies in accordance with the matter at the end of subsection 7a7 that follows paragraph 7#c7 of such subsection4 7,b7 ,second opinion ,in a case in which the ,,mcn with which the employing agency has a contract furnishes a provider to an employee and such employee disputes a diagnosis or treatment recommendation received from such provider1 the ,,mcn shall furnish the employee a second opinion from a different provider4 7,c7 ,dispute resolution ,the ,secretary of ,labor shall establish a system for review of disputes to ensure employees are furnished services1 appliances1 and supplies in a timely manner4 7#c7 ,requirements ,to be eligible to enter into and maintain a contract under paragraph 7#a71 an ,,mcn shall meet the following requirements3 7,a7 ,services ,the ,,mcn shall make reasonable attempts to provide the services1 appliances1 and supplies required to be furnished to an employee under subsection 7a74 7,b7 ,practices ,the ,,mcn shall comply with the standardized treatment protocols established pursuant to paragraph 7#d74 7,c7 ,limitation on fees ,the ,,mcn may not charge a fee for a service1 appliance1 or supply in excess of the fee established under the fee schedule 7or a successor document7 published by the ,office of ,workers ,compensation ,programs of the ,department of ,labor for such service1 appliance1 or supply4 7,d7 ,geographic accessibility ,the ,,mcn shall maintain a sufficient number of providers within reasonable proximity to each work site of the employing agency4 7,e7 ,evaluations ,the ,,mcn shall1 using a provider assessment system-- 7i7 regularly evaluate each provider providing services to an employing agency through the ,,mcn for performance and cost-effectiveness2 and 7ii7 if appropriate1 remove a provider from the ,,mcn or exclude the provider from providing services through the ,,mcn to the employing agency4 7,f7 ,annual reports ,the ,,mcn shall1 on an annual basis1 submit to the head of the employing agency a report containing information in relation to the preceding calendar year1 including information on the following3 7i7 ,cost savings1 as compared to estimated costs the agency would pay if the agency did not have a contract with the ,,mcn4 7ii7 ,an assessment of the performance of each provider furnished through the ,,mcn4 7iii7 ,anonymized data on outcomes of employees who were treated by a provider furnished through the ,,mcn4 7,g7 ,information for reviews ,the ,,mcn shall provide the review board established pursuant to paragraph 7#e7 such information as the board determines necessary to carry out the duties of the board under such paragraph1 including1 if requested1 information needed for the board to carry out subparagraph 7,d7 of such paragraph4 7#d7 ,treatment protocols ,the ,secretary of ,labor shall establish standardized treatment protocols for employees based on the best practices of the healthcare industry4 7#e7 ,review board 7,a7 ,in general ,not later than #bgj days after the effective date under section #c7;c7 of the ,,feca ,modernization and ,cost ,containment ,act of #bjbf1 the ,secretary of ,labor shall establish a review board4 7,b7 ,membership ,the board established pursuant to subparagraph 7,a7 shall be selected by the ,secretary of ,labor and shall be composed of #af members as follows3 7i7 #b representatives of the ,secretary of ,labor who are from the ,office of ,workers ,compensation ,programs4 7ii7 #a representative of the ,secretary of ,labor who is not from such ,office4 7iii7 #a representative of the head of another agency4 7iv7 #b representatives of employees4 7v7 #b representatives from ,m,c,ns who have contracted with ,federal agencies4 7vi7 #e representatives of providers who have contracted with ,m,c,ns described in clause 7v74 7,c7 ,duties ,the duties of the ,board shall be to-- 7i7 monitor-- 7,i7 ,m,c,ns to ensure compliance with standardized treatment protocols established pursuant to paragraph 7#d72 7,,ii7 rate negotiations2 and 7,,iii7 the performance of providers furnished through ,m,c,ns2 and 7ii7 suggest improvements to the ,secretary4 7,d7 ,optional review of geographic accessibility ,the ,board may ensure ,m,c,ns comply with paragraph 7#c77;,e74 7#f7 ,fraud prevention ,the ,secretary of ,labor may contract with entities to monitor claims and flag potentially fraudulent claims for further review using predictive analytics tools 7which may include the use of artificial intelligence 7as defined in section #idja7c7 of title #ae1 ,united ,states ,code77 to1 based on historical claim patterns and medical inconsistencies1 identify potentially fraudulent claims4 7d7 ,managed care network2 ,,mcn defined ,in this section1 the terms managed care network and ,,mcn mean a network of providers that furnishes services1 appliances1 and supplies prescribed or recommended by a qualified physician as described under subsection 7a74 4 7c7 ,effective ,date ,the amendments made by this section shall take effect #a year after the date of enactment of this ,act4 #d4 ,regulatory authority 7a7 ,in general ,not later than #f months after the date of enactment of this ,act1 the ,secretary of ,labor shall issue such regulations as are necessary to carry out the purposes of this ,act4 7b7 ,transition plan ,not later than #a year after the date of enactment of this ,act1 the head of each ,federal agency shall submit to the ,secretary a plan describing how the agency will transition to the use of managed care networks pursuant to the amendments made by section #c of this ,act to section #hajc of title #e1 ,united ,states ,code4 #e4 ,,gao review ,not later than #f months after the end of the #e-year period beginning on the date that is #a year after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit a report to ,congress on the effect1 during such #e-year period1 of the amendments made by section #c of this ,act to section #hajc of title #e1 ,united ,states ,code1 including the effect1 in relation to administration of such section1 on-- 7#a7 costs2 7#b7 fraud reduction2 and 7#c7 administrative efficiency4