EEOICPA
Home Care Guide

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If you worked at Oak Ridge — K-25, Y-12, X-10 — or another covered facility, and the U.S. Department of Labor has accepted a condition on your claim, you have medical benefits. You may also have a benefits card in your wallet.

This guide walks through what happens between “I have benefits” and “someone is helping me at home.” It takes about ten minutes to read. We are a home care agency, so we are not a neutral party, and you should keep that in mind. But everything in here comes from the Department of Labor’s own published materials, and we would rather you understand the process and then decide — including deciding to use someone else — than agree to something you do not understand.

What EEOICPA is, in plain language

The Energy Employees Occupational Illness Compensation Program Act — EEOICPA — became law in October 2000. It compensates people who got sick from working at nuclear weapons facilities, and it pays for medical care related to those illnesses. It has two parts.

Part B took effect July 31, 2001. It covers current and former employees of the Department of Energy, its predecessor agencies, and certain vendors, contractors, and subcontractors who were diagnosed with radiogenic cancer, chronic beryllium disease, beryllium sensitivity, or chronic silicosis as a result of exposure to radiation, beryllium, or silica at a covered facility. It also covers people (or their survivors) awarded benefits by the Department of Justice under Section 5 of the Radiation Exposure Compensation Act.

Part E was added October 28, 2004. It covers Department of Energy contractor and subcontractor employees, their eligible survivors, and uranium miners, millers, and ore transporters, for any occupational illness causally linked to toxic exposure in the DOE or mining work environment.

Survivors can be eligible under both parts.

The two words that control everything: “accepted condition”

An accepted condition is a diagnosed medical condition that the Department of Labor’s Division of Energy Employees Occupational Illness Compensation — DEEOIC — has formally accepted as resulting from work-related toxic exposure.

This matters more than any other single fact in this guide, because the program pays for medical care for accepted conditions only. DOL’s published guidance is explicit: it pays for care that is medically necessary to treat DEEOIC-accepted conditions, and you remain responsible for costs of care unrelated to your accepted illness — that would be billed to private insurance, Medicare, Medicaid, or to you.

There is a wrinkle worth knowing. If a new problem develops because of an accepted condition — DOL calls this a consequential illness — the program cannot pay for care for it until you file a specific claim for that illness and it is accepted too. It is not automatic.

Having benefits is not the same as having approval

When DOL issues a final decision awarding medical benefits for an accepted condition, it mails a medical benefits letter explaining your benefits. That letter includes a claim form — Form EE-17A — for home health care, nursing home, or assisted living benefits.

That letter is worth keeping, and worth reading. But for home care it is the start of a process, not the approval at the end of one.

What having accepted conditions means: the program will pay enrolled providers for medically necessary care related to those conditions.

What it does not mean: it does not pre-approve any particular service, at any particular level, for any particular number of hours. And for home care specifically, it does not approve anything yet.

Why that letter does not authorize home care

DOL groups home care with nursing homes, assisted living, and hospice under one heading: Home and Residential Health Care, or HRHC. And HRHC has its own gate.

There is a practical warning attached to that. DOL notes that if you receive care without pre-approval and later seek reimbursement, you may not be fully reimbursed if you paid more than the program’s allowable fee-schedule rates. In other words, starting care first and sorting out paperwork later can leave someone holding a bill.

So the sequence is: accepted condition → medical need → your physician documents it → DOL reviews and authorizes → care is provided and billed.

Two different kinds of help

People use “home care” to mean two quite different things, and the program treats them separately. Knowing which one is being discussed will save you a great deal of confusion.

Help with activities of daily living — provided by what DOL calls assistive health care personnel: home health aides, personal care attendants, or certified nursing assistants. These are non-skilled roles, trained and in many states licensed or certified, providing personal care in the home as prescribed by a physician. DOL describes activities of daily living as the everyday tasks required for self-care and independent living: bathing, dressing, transferring, using the toilet, continence, and eating. Mobility within the household and meal preparation are also included in DOL’s description of this level of help.

Skilled nursing — provided by licensed nurses (RN or LPN). DOL’s examples include assessing your medical condition, administering prescription medications, dressing wounds, administering intravenous medications, and other services appropriate to that level of credential.

There are other categories too: home therapeutic services (physical, occupational, speech, or respiratory therapy at home when you are medically unable to travel), and targeted case management, which coordinates multiple types of care.

How home care actually gets authorized

Here is the real sequence, with the paperwork named.

1. Step 1 — You file Form EE-17A.
   You, or a properly designated authorized representative, complete and sign Form EE-17A, Claim for Home Health Care, Nursing Home, or Assisted Living Benefits, and return it to DOL. On it you check which of the three benefits you are claiming, and you name the physician who will be responsible for medically managing your home care. DOL’s current form is dated July 2024 and notes that this physician must be an M.D. or a D.O. You can file it by mail to the London, Kentucky address, or upload it through DOL’s Energy Document Portal at eclaimant.dol.gov. Form EE-17A is not required for renewals — only to start.

2. Step 2 — You see that physician in person.
   A treating physician must conduct a face-to-face physical examination. The timing requirement is specific: the examination must have occurred within 60 days of the date of the Letter of Medical Necessity. Not a phone call, not a portal message — an in-person exam.

3. Step 3 — Your physician completes Form EE-17B and writes a Letter of Medical Necessity.
   DOL mails Form EE-17B, Physician’s Certification of Medical Necessity, to the physician you named, along with a letter explaining the process. Your physician has two options: complete the EE-17B and attach a Letter of Medical Necessity, or check a box requesting that the home care provider you have designated perform an in-home assessment first, to help the physician decide what is needed. If your physician asks for the assessment, DOL authorizes your designated provider to do it, the provider’s findings go back to the physician, and the physician then writes the letter.

   Two details people trip over: the Letter of Medical Necessity cannot be signed by a nurse practitioner or a physician assistant — an evaluation from an NP or PA has to be certified by a physician. And the EE-17B, like the EE-17A, is not required for renewals.

4. Step 4 — DOL reviews the letter.
   The Letter of Medical Necessity has to do real work. Per DOL’s requirements it must cover:

   • Type of care — and why it is needed in the home rather than at a clinic or a facility
   • Level of care — skilled nursing, assistive personnel, therapy, and so on
   • Frequency — how often each level of service will be performed
   • Duration — how many hours or minutes per visit, at that frequency (for example: an aide four hours a day, five days a week; or a nurse two hours a day, three days a week)
   • Period — for how long the care is required
   • Conditions requiring care — each accepted condition and the care prescribed for it, with physician notes, measurements, observations, and test results supporting the need, and an attempt to separate needs caused by accepted conditions from needs caused by conditions that are not covered
   • Evidence of the recent face-to-face examination

   A DEEOIC Medical Benefits Examiner reviews it, sometimes with advice from a DEEOIC nurse consultant, to decide whether the care requested is consistent with the medical evidence.

5. Step 5 — DOL issues an authorization, or does not.
   If the evidence supports it, DOL issues a written authorization describing the type, level, frequency, and duration of care approved for billing. Copies go to you, to the home care provider you identified, and to the prescribing physician. Under DOL’s current Procedure Manual, home health care, assisted living, or nursing home care may be authorized for up to 12 months, or a shorter period if that is what the medical evidence supports.

One exception worth knowing: emergencies. If you need immediate care at home after a hospital discharge, or your condition suddenly changes, an emergency authorization is possible. It runs through DOL’s Bill Processing Agent, requires an emergency care order from your treating physician or a physician-signed hospital discharge order, and is granted in 30-day increments for no more than 90 days total. It is a bridge, not a substitute for the regular process.

You choose your provider

This is the part we most want you to know, and the part we hear the most misinformation about.

Two related facts:

No agency is DOL-approved, and no agency is endorsed by DOL. Asked whether it endorses or certifies home care providers, DOL’s answer is “No. We do not endorse or sponsor any HRHC provider or any other entity providing medical services.” If an agency tells you it is DOL-approved, a government partner, or your assigned provider, that is not how the program works.

Enrollment is a different thing from endorsement. Providers can enroll with the program so DOL pays them directly under its fee schedule. That is an administrative step, not a seal of approval. You can check whether a provider is enrolled at owcpmed.dol.gov/portal/provider/search, and you can ask the provider directly. If a provider is not enrolled, you can pay out of pocket and seek reimbursement using Form OWCP-915, though you may not recover amounts above DOL’s allowable rates.

12 questions to ask any home care agency

Ask us these. Ask anyone else these. Compare the answers.

1. Are you enrolled with the EEOICPA program, and will you bill the Department of Labor directly?
2. What exactly do you provide — help with activities of daily living, skilled nursing, or both?
3. Do you provide both of those at my address, or only one?
4. Who employs the caregivers — you, or a staffing agency? Are they background-checked, bonded, and insured?
5. What happens when my regular caregiver is sick or quits? How often do shifts go unfilled, and who calls me?
6. What is your role in the authorization process, and what is my physician’s role?
7. Will you explain the process to my doctor’s office if they have not done this before?
8. What do you need from me, and when — and what will you not ask me for?
9. How will you keep my family informed, and who do I call with a problem at 9pm?
10. What happens as my authorization approaches its expiration date? Will you remind me?
11. If my needs change, how does that get handled — and who decides?
12. If I want to switch agencies, what happens, and will you make it difficult?

Where to get help that isn’t from an agency

Program website: dol.gov/agencies/owcp/energy  ·  Document portal: eclaimant.dol.gov

If you’d like to talk it through

You do not need to call anyone to use this guide. It is yours, and it is complete.

But if you have questions about your own situation — what is available in your county, how the paperwork tends to go in practice, what to ask your physician — we are happy to talk. It is a short conversation, there is no cost, and nothing is decided on it.