Justification

Justification

No material/Non-substantive Change Request

“Authorization request form and Certification/Letter of Medical Necessity for Compounded Drugs”

(CA-26)

The Office of Workers’ Compensation Programs (OWCP) is the primary agency responsible for the administration of the Federal Employees’ Compensation Act (FECA) and the Energy Employees Occupational Illness Compensation Program Act of 2000, as amended (EEOICPA). Both the FECA program and the EEOICPA program cover pharmaceuticals and may request prior authorization for such.

OWCP’s request is to allow physicians prescribing compounded drugs for claimants covered under the FECA and the EEOICPA the opportunity to request prior authorization. This request does not increase the prior burden assessment previously submitted for the CA-26 form.

OWCP requests the following changes to the CA-26 form:

Page 1: “Division of Federal Employees’ Compensation” to be deleted.

• This change would indicate that the form is not exclusively for the FECA program.

Page 3: Under number 2: “9-digit number” to be deleted.

• This change in the instructions would reduce confusion as the EEOICPA program does not have a 9-digit case number.

Page 3: Under number 20: “14,400” to be changed to “68,000”.

• This change in the instructions updates the number of International Statistical Classification of Diseases and Related Health Problems 10^th Revision (ICD-10) codes currently in use in the medical field today.

Page 4: Room “S3524” to be changed to “S3229”.

• This change in the instructions updates the room number location under the public burden statement.

Page 4: The privacy act statement to be updated to include the EEOICPA program.

• This change in the instructions would indicate that the form is not exclusively for the FECA program.

Page 5: “DFEC” to be deleted in three areas under the notice statement.

• This change in the instructions would indicate that the form is not exclusively for the FECA program.