Skip Navigation Links.
Online Support available
Monday through Friday
7:30 a.m. - 5:30 p.m.
Click here to get help!
OhioBWC - Basics: (Policy library) - File

InfoStation Document

Home and Vehicle Modifications

The BWC Catastrophic Nurse Advocate (CNA) identifies a need for home or vehicle modification.  The CNA will address all home and vehicle modification requests for all claims regardless if the equipment being requested is for a catastrophic claim and will issue a determination.  The CNA will work closely with the MCO case manager and the necessary vendors to insure coordination of the services.

 

If the MCO receives a request for home and/or vehicle modification(s), the MCO shall respond to the provider and injured worker in writing, according to C-9 processing timeframes, that the request is being forwarded to the specific CNA assigned to the service office where the claim is located.  If the MCO receives a request for other services/supplies on the same C-9, the MCO shall review and respond to the non-home and vehicle modification services request within the C-9 processing timeframes.

 

The BWC Catastrophic Nurse Advocate is the primary authorization source for home and vehicle evaluations and modifications.

§  In situations where the MCO receives a request for authorization of home or vehicle modifications, the MCO should immediately notify the BWC CNA.

§  Reimbursement of home and vehicle modification services is made by either BWC or the MCO depending upon specific service and provider type.

§  Actual home and vehicle modifications are performed by a vendor, billed with a specific W code and paid by BWC.

§  Other services provided by a vendor require W codes for billing.  These services are paid by BWC. Exception:  Scooter/wheelchair lift and installation (W4000) including anchoring the lift to the vehicle or attachment of a hitch is authorized and paid by the MCO. An installation that requires additional vehicle modification requires review/authorization by BWC.

§  Services billed by out-patient hospital require the use of revenue codes with appropriate CPT codes and are paid by the MCO.

§  Services billed by in-patient hospital require revenue codes only and are paid by the MCO.

 

The following list outlines specific billing, coding, and reimbursement information:

 

Description of Service

Provider Type

HCPCS/CPT  Code

Revenue

Code

Fee

Billing form

Bill To

Driving evaluation PT, OT or certified driving instructor

Non-facility

W0500 

NA

By report (BR)

C-19 or HCFA 1500

BWC

Driving evaluation OT

Facility Outpatient

97003

OT

Hospital's outpatient reimbursement rate*

UB-92

MCO

Driving evaluation PT

Facility Outpatient

97001

PT

Hospital's outpatient reimbursement rate*

UB-92

MCO

Driving instruction for modified vehicle- PT, OT or certified driving instructor

Non-facility

W0549

NA

By Report (BR)

C-19 or HCFA-1500

BWC

Driving instruction for modified vehicle PT

Facility Outpatient

97535

PT

Hospital's outpatient reimbursement rate*

UB-92

MCO

Driving instruction for modified vehicle OT

Facility Outpatient

97535

OT

Hospital's outpatient reimbursement rate*

UB-92

MCO

PT/OT evaluation  for home/vehicle modification

Non-facility

W0678

NA

By Report (BR)

C-19 or HCPCS 1500

BWC

PT evaluation for home/vehicle modification

 

Facility Inpatient

NA

 

PT

Hospital's inpatient reimbursement rate*

UB-92

 

MCO

OT evaluation for home/vehicle modification

Facility Inpatient

 

NA

 

OT

Hospital's inpatient reimbursement rate*

 

UB-92

MCO

Home Modification

(includes permanent ramp)

 Vendor

W0675

NA

By Report

(BR)

C-19 or HCPCS 1500

BWC

Vehicle Modifications

Vendor

W0679

NA

By Report

(BR)

C-19 or HCPCS 1500

BWC

Home and Vehicle Modification Repairs

Vendor

W0677

NA

By Report

(BR)

C-19 or HCPCS 1500

BWC

Portable Ramp Rental  or Purchase

Vendor

W0676

NA

By Report

(BR)

C-19 or HCPCS 1500

BWC

Lift, vehicle, 3-4 wheeled chair with manual swing

Vendor

W4000

NA

$1,800

C-19 or HCPCS 1500

MCO

Lift, vehicle, 3-4 wheeled chair with motorized swing

Vendor

W4001

NA

$2,750

C-19 or HCPCS 1500

MCO

 

* For dates of service Oct. 1, 2005 through Sept. 30, 2006, the reimbursement methodology for calculating hospital reimbursement to the hospital’s cost-to-charge ratio plus 12%, not to exceed 70%, for inpatient services and the cost-to-charge ratio plus 16%, not to exceed 60%, for outpatient services.  Hospitals located in Ohio that do not report cost-to-charge ratios and out of state hospitals will be paid at 66% of allowed billed charges for inpatient services and 56% of allowed billed charges for outpatient services, which is the median cost-to-charge ratio plus the applicable inpatient and outpatient percentage. 

 

With a target date of Nov. 1, 2006, the bureau's fees for inpatient hospital services shall be equal to 115 percent of the applicable diagnosis related group (DRG) reimbursement rate for the inpatient hospital service under the Medicare program.

 

Home Modification

 

Objective for Home Modification

BWC’s objective is to maintain the injured worker in a home environment and to avoid prolonged or repeated hospitalizations.  Home modifications will be made in order to overcome a need for hospitalization, nursing home placement, special nursing, or caregiver services, substantially improve the mobility of the injure worker, or promote a return to work.   Each case is considered on an individual basis. Priority will be given to the provision of 2 accessible entryways into the IW residence, modification of one bathroom, and modification of one bedroom.  All injured workers should be advised that the home modification benefit should be considered after they have determined post injury that they will occupy the residence on a long term basis.  Often injured workers will buy, build or move post injury to a different residence after their injury stabilizes.

 

Scope

BWC will reimburse home modifications specifically needed by the IW due to physical limitations due to the result of allowed claim conditions.

 

A.   BWC will authorize home modifications on a one-time basis only.  An exception would be for a ramp, which must be replaced if deterioration has occurred.

 

B.   Home modifications will be limited to the interior of a residence with exception of ramps, lifts, and platforms necessary for accessing and exiting the home.  The residence to be modified must be owned by the injured worker or a member of the injured worker’s immediate family.  BWC does not modify any property other than privately owned property.  If renting, the injured worker can have limited modifications (i.e., grab bars, portable ramps, etc.) upon the written approval from the property owner. It is recommended that modification equipment for rental units be transferable, if possible.  Any amount put into rentals may be deducted from future home modification requests.  If the injured worker moves, he/she is responsible for costs involved with transferring any modification equipment to the new residence.  BWC will not reimburse dismantling of constructed ramps.

 

C.   BWC will not authorize construction for room additions, except where two contractors advise the home is not modifiable due to the total size of the home.  If the existing home is not modifiable, construction of a room addition will be considered.  The injured worker may be responsible for paying a portion of the cost of construction in certain circumstances.  If modifications are recommended by the home evaluator and they are not medically necessary, BWC will not pay for the modification. BWC will educate evaluators regarding the scope of the BWC home modification policy.

 

D.   Home improvements which are of general utility, and are not of direct medical benefit to the injured worker (i.e., carpeting, roof repair, central air conditioning), are not covered modifications.

 

E.   Specific home modification guidelines are:

 

1.    Bathroom – Only one bathroom will be modified.  Bathroom modifications may include installing a roll-in shower, a roll under sink, a handicap toilet, single style vanity/medicine cabinet, etc.  A bathroom may need to be added to a bedroom, or an existing room may need to be remodeled for accessibility.  Two (2) rough scale drawings (current situation and proposed modification) must be submitted for approval.  Built-in whirlpool baths and Jacuzzis/hot tubs/spas are not approved.

 

2.    Kitchen – BWC may approve limited kitchen modifications for injured workers who are living alone.  If the injured worker has no live-in caregivers, modifications may include, but are not limited to,  handicap cabinets, and  roll-under sink.  If the injured worker has a live-in caregiver, pays for caregiver services, or IW has long term home health care services needs , BWC will approve widening a doorway for access into a kitchen, but will deny other kitchen modifications.

 

3.    Elevator or stair-lift – A stair-lift can be approved for an injured worker on an individual case-by-case basis, for example, in cases where the injured worker is unable to climb stairs and bathroom facilities are on the second floor.  A stair-lift is less expensive than alternative modifications and provides accessibility.  If an injured worker receives a stair-lift, a second manual wheelchair may be approved.  It may be less expensive to provide a first floor bathroom rather than to install an elevator if the residence structure will not accommodate a stair-lift.  Elevators should only be approved when there are no other alternatives.

 

4.    Garage/Garage Door Opener/Carport – Garages and garage door openers are generally not reimbursable.  In limited cases such as quadriplegia, BWC  may consider payment  for a carport or raising a pre-existing garage door and a garage door opener. 

 

5.    Driveway/Sidewalk – BWC does not widen driveways to allow injured workers to drive up and get out of a vehicle.  BWC may approve paving of an area of a driveway or sidewalk for providing an operable surface for a scooter or wheelchair. 

 

6.    Air conditioning/Air purifying systems – Upon receipt of a request for air conditioning or air purification system, a physician review of the claim file may be completed to determine medical necessity.  Pulmonary function studies are considered when the injured worker has an occupational disease affecting the cardiovascular or respiratory system.  Quadriplegics may require a room air conditioner for body temperature consistency. If an injured worker desires central air conditioning for the entire home, BWC will reimburse the percentage of cost for air conditioning for the IW’s room only. BWC will authorize a room air conditioning unit. BWC does not reimburse central air conditioning for the whole house. Air purifiers should be the portable type. Only claims allowed for pulmonary conditions, quadriplegia and burns qualify for air conditioners and only claims with pulmonary conditions for air purifiers.

 

7.    Ceiling installed lift tracking mechanism – The injured worker must ensure that the home structure can accommodate this equipment. 

 

8.    Handicap accessible home – If the injured worker chooses to purchase a new handicap accessible home, BWC will reimburse limited amounts for items such as a special shower, widened doorways, ramps, etc.  An itemized list of handicapped accessories should be obtained from the builder and submitted for review and authorization prior to purchase.  Reimbursement will be made after the house is built and the injured worker furnishes a copy of the deed/closure documentation showing ownership.


F.    Non-Covered Services include:

§  Swimming pools of any type

§  Hot tubs portable, freestanding or installed

§  Spas portable, freestanding  or installed

§  Whirlpool baths portable,  freestanding  or installed*

§  Jacuzzis portable, freestanding or installed

§  Central air conditioning or air-purification systems

§  Dismantling of constructed ramp

§  Removal, dismantling or transfer of home modifications

§  Reimbursement of routine maintenance contracts

§  Home improvements which are of general utility, and are not of direct medical benefit to the injured worker (i.e., carpeting, roof repair)

 

*Note:  A portable whirlpool device that is placed in the IW’s tub can be approved/reimbursed by the MCO as DME  if medically necessary and related to the allowed claim condition..

 

Procedure for Processing the Home Modification Request

A.   The MCO will forward the request to BWC’s CNA upon receipt of a home modification request. 

 

B.   CNA will send a to the injured worker detailing the procedure to be followed for home modifications along with informational sheet.

 

C.   The MCO will submit medical evidence including diagnosis, functional limitations; support personnel/services required for the care of the injured worker; physician of record documentation to the BWC CNA. The CNA will obtain a physician file review if indicated.

 

D.   BWC’s CNA will review the medical evidence to determine medical necessity and relatedness to the allowed conditions.  All requests must be in writing.

 

E.   If modifications are indicated, the BWC CNA will contact an occupational therapist or physical therapist home evaluator to perform a detailed assessment of the home.  These evaluators are paid via the outpatient PT or OT codes of the hospital or through a home health agency.  If it’s a catastrophic claim, it may be done prior to discharge as a routine procedure of the inpatient facility.  Services provided in a facility must be billed with the revenue codes for occupational therapy or physical therapy with  the corresponding CPT code for an occupational therapy evaluation or physical therapy evaluation. For  non-hospital billing, a home evaluation must be billed with W0678 (Home Modification) in MIIS on. The therapist, if possible, should be informed of BWC scope of modifications, and sketches requested.  Two rough scale drawings for the modification (current situation and proposed modification) will be supplied to BWC upon request.

 

F.    BWC’s CNA gathers the following information from the IW:

1.    A copy of the deed showing ownership of the home, whether owned by the injured worker or immediate family;

2.    A letter from the landlord granting permission to do limited modification if the home is rented;

3.    Two rough scale drawings (current situation and proposed situation); and

4.    Two bids including labor and materials.

 

G.   The IW is responsible for obtaining bids for home modification. BWC does not provide contractors.

1.    All contractors chosen to bid are the responsibility of the injured worker

2.    The injured worker must supply the following items: a copy of the deed of the property and two bids which include labor and materials with cost breakdown.

3.    The IW may request a list of previous providers used in a home modification project from the nurse handling the case, but BWC does not give any preference or referrals to these providers.

 

H.   Any contractor submitting a bid for home modifications should have a license and/or             permit             appropriate for the work being done in the jurisdiction in which it is being done. 

1.    The contractor should be insured for general contracting service and  be bonded

2.    The contractor must have workers’ compensation coverage (unless he/she is an independent contractor).  A copy of the liability insurance is to be maintained in the file

3.    The contractor must conform to existing building codes for residential property.

 

I.      After extent of modification is determined, BWC’s CNA will update V3 notes or the prior authorization screen on V3.

1.    The CNA will issue an  letter for modifications to all parties of the claim, MCO and service provider. This letter should contain a sentence informing the contractor that BWC expects license and/or permits appropriate to be obtained as required by the governing ordinances of the modification address.  This letter will give instructions regarding the appeal process stating:  “Should the injured worker or employer or their representative disagree with the decision, they may file a Motion (Form C-86) within 14 days with BWC requesting a hearing at the I.C.  Any new evidence they wish to have reviewed should be included with the Motion.”

2.    The CNA must obtain a physician review prior to sending for IC hearing, if an IW files a motion (C-86) regarding full or partial denial of home modifications.

3.    The CSS will forward the C-86 to the Industrial Commission for determination.

4.    The CNA will send the provider an enrollment application (if the provider is not currently enrolled with BWC), billing instructions and a

5.    If an initial payment is required by the contractor for home modifications, it can be made at the beginning of the project.

§  BWC’s CNA negotiates the approved amount of the initial and subsequent payments with the provider. The initial payment should not exceed the estimated cost of materials for construction and should be not be more than 30-40 per cent of the total cost of the modification.

§  CNA will send the C-19 and an for home modifications to the provider.

§  The CNA will notify the IW that upon completion of the modifications the certification agreement must be signed by the injured worker, service provider, and a witness, and must be received prior to release of payment.  The injured worker’s signature verifies that the IW is satisfied with the work performed and that BWC (the third party payer) has no additional liability with the modifications.

§  Upon receipt of the signed Certification Agreement and C-19, BWC’s CNA places the authorization number on the C-19 for any modifications that exceed $1,000, writes FORCE 375 EDIT and forwards the bill to BWC Medical Billing and Adjustments for processing in MIIS.

§  CNA will update V3 notes and image the letter of denial and physician review to the claim file.

 

J.    BWC reserves the right to inspect the modified home to ensure that all modifications authorized by BWC were completed prior to release of payment for the             modifications.

 

K.   BWC will reimburse for reasonable home modification repairs.  The repairs must be prior authorized by BWC’s CNA.  Home modification repairs or vehicle modification repairs may be billed using HCPCS code W0677.  BWC does not reimburse maintenance contracts.

 

Vehicle  Modifications

Objectives for Vehicle Modification

BWC’s objective is to provide medically necessary cost-effective vehicle modifications related to the allowed claim conditions to enable the injured worker to be safely transported in a motor vehicle and/or safely operate a motor vehicle if physically capable.

 

Scope

A. BWC will limit reimbursement of modifications/equipment specifically needed by the IW due to limitations resulting from allowed claim conditions. BWC’s fee cap for home modifications be established at $40,000.

 

Any home modification amount over $40,000 should be referred by BWC’s CNA to the Administrator of the Bureau of Workers’ Compensation.

 

The Rehabilitation Services Commission may be considered as a possible source of funding per the Cooperative Agreement between Ohio Rehabilitation Services Commission and the Ohio Bureau of Workers’ Compensation, State Fiscal Years 2003-2005.  The Rehabilitation form RH 20  is needed to make a referral. If RSC requirements are met and the referral is accepted within one month, RSC will manage the home and vehicle modification for those injured workers according to the policies of RSC.  If RSC does not accept the referral within one month of receipt of documentation, BWC CNA will be responsible for home or vehicle modification following the BWC guidelines for home or vehicle modification.  Although the funding for services accepted by RSC is covered by the Cooperative Agreement, it is possible that RSC might negotiate some of the fees before accepting the referral. 

 

1.    A vehicle modification will be considered by the CNA no more frequently than once every five (5) years.  A more frequent or additional modification to the vehicle may  be considered only if medical documentation supports a change in the injured worker’s medical condition and justifies the need.

 

2.    BWC will modify one vehicle only.  The same vehicle will be modified for the lifetime of vehicle.  If an injured worker owns more than one vehicle, he/she is responsible for modification of any additional vehicles.

 

3.    The IW must undergo a driving evaluation if the vehicle is to be driven by the IW.  BWC may require a second driving evaluation if there is a change in the injured worker’s condition.

 

4.    BWC will limit reimbursement to modification/ equipment specifically needed by the IW.  BWC will not authorize luxury items.  However, since quadriplegics cannot regulate their own body temperature and the atmosphere must be kept at a steady temperature, BWC may approve rear air conditioning and rear heat.

 

5.    BWC may authorize vehicle modifications for injured workers who utilize manual wheelchairs.  Objective medical documentation must support the request.

 

6.    BWC may authorize hand controls or left foot gas pedal for injured workers who utilize canes, crutches, or prostheses for mobility if objective medical documentation supports the need and driving evaluation recommends.

 

7.    BWC will not pay for purchase of the vehicle to be modified.

 

8.    The injured worker may apply for a Lump Sum Advancement to finance the vehicle.  The CNA will refer to procedures for Lump Sum Advancement in Infostation and refer the IW to Customer Service Specialist.

 

9.    BWC may authorize manual wheelchair carriers (car topper) for paraplegics who can transfer.

 

10. BWC may authorize modifications for allowed conditions requiring a power wheelchair for mobility, or when the transfer of the injured worker is impossible to accomplish independently.

 

11. BWC will reimburse for reasonable vehicle modification repairs, not routine maintenance of modified vehicles.

§  The IW is responsible for a yearly maintenance on lifts or mechanical parts.  

§  Repairs of $250 or less do not require prior authorization by the BWC CNA.

§  Repairs with an estimated cost greater than $250 require authorization by BWC’s CNA in advance unless done in emergency situation.

 

12. Vehicle or home modification repairs may be billed using HCPCS code W0677.

 

13. The MCOs authorize and pay for Scooter lifts, using code W4000.   Requests for authorization of scooter lifts for scooters authorized by the MCO should be referred to the MCO for review and processing.

 

B. Specific vehicle modifications guidelines include

1.    The injured worker or injured worker’s family must own the vehicle.  If the injured worker leases the vehicle, approval to modify the vehicle must be obtained from the leasing company before authorization of modifications can be granted.

 

2.    The injured worker is responsible for researching the appropriateness of a vehicle for the recommended modification. See for document listing vehicles that can be modified.

 

3.    Vehicles must have modifiable features (i.e., power steering, power brakes, and automatic transmission) and must be provided by the injured worker.

 

4.    BWC does not convert vehicles from standard shift to automatic transmissions.

 

5.    All vehicles must meet the Ohio Vehicle Safety codes.

 

6.    Used vehicles may be subject to inspection by the Ohio State Highway Patrol (or similar agency if the injured worker resides out of state).

 

7.    Some car manufacturers offer rebates if their vehicle is purchased for modification.  The amount of the manufacturer’s rebate provided to the injured worker for purchase of a vehicle to be modified will be deducted from the BWC authorized cost for the modifications.

 

8.    The IW is responsible for obtaining a comprehensive evaluation of the vehicle to be modified from a certified mechanic if the condition of the vehicle is in doubt. 

 

9.    BWC has the right to deny modifications if it is determined that the vehicle is not safe or is not in good working condition.  Factors such as age of vehicle and mileage will be considered.

 

10. Injured workers are responsible for insuring the vehicle and modification equipment.  BWC will not be held liable for accidents caused by faulty equipment nor will BWC replace equipment damaged in a motor vehicle accident.  BWC does not replace stolen equipment.

 

11. In cases where the injured worker purchases a used vehicle which was modified by a previous owner, BWC will consider reimbursement for the modification equipment only if BWC did not originally pay for the modifications. 

 

12. When trading in a modified vehicle for a newer vehicle, the IW is responsible for arranging the transfer of equipment such as spinner knob, hand controls, EZ locks and power seats from the current modified vehicle to the newly purchased vehicle after such equipment has been determined  by the vehicle modification provider to be suitable for transfer.

 

C. Driving Evaluation Requirements:

BWC requires a signed physician prescription or completed C-9 requesting a driving evaluation or vehicle modifications.  When an initial vehicle modification to allow the injured worker to drive is requested, the injured worker must have a driving evaluation before modifications are authorized.  A Certified Driver Rehabilitation Specialist Educator for the Disabled will determine driving eligibility and will prescribe the required equipment.  Estimates obtained by the injured worker must be for the equipment that is prescribed by the driving instructor.

 

1.    The injured worker must be trained in the proper operation of the vehicle by a Certified Driver Rehabilitation Specialist for the Disabled, who confirms the injured worker has received training and is physically capable of driving a modified vehicle on public streets.  BWC wants to ensure that the injured worker and public safety are a priority at all times.

 

2.    BWC CNA will require driving lessons when recommended by the driving evaluator.  BWC’s CNA will authorize driving lessons. See Description of Service table for coding, billing  and fee issues.  Follow up driving lessons may be recommended after IW modification completed. 

 

Procedure for Processing the Vehicle Modifications Request

A.   The request for the vehicle modification is received by the MCO and forwarded to BWC’s CNA.

 

1.    BWC’s CNA will review the claim file and the medical information from the MCO to verify the medical necessity in relation to the allowed condition(s).  BWC’s CNA will start a reference file on the injured worker’s requested modifications.

 

2.    CNA will send a letter to the injured worker detailing the procedure for vehicle modification along with or  .

 

3.    The following documentation is required for requests for vehicle modification:

 

a.    A physician prescription or BWC Form C-9 from the POR for vehicle modifications and driving evaluation and training (if needed), stating medical necessity and the relationship to the allowed condition.

 

b.    A copy of the title showing ownership of the vehicle and a Vehicle Identification Number.

 

c.    Written approval from the leasing company to modify the vehicle, if the vehicle is leased

 

d.    Completed driving evaluation for initial modifications

 

e.    Two bids if the estimate is over $1,000

 

4.    The following documentation is required for requests for used vehicle modifications:

a.    Copy of title or bill of sale signed by seller and buyer showing payment for the vehicle and vehicle identification number. (VIN)

 

b.    List of all modification equipment currently on the vehicle

 

c.    Year and condition of vehicle and modifications with original and depreciated costs of the equipment

 

d.    Physician C-9 or prescription requesting driving evaluation indicating medically necessary equipment for allowed condition(s) unless previously in file

 

e.    A vehicle inspection may be required depending on age and condition of vehicle.

 

5.    For initial vehicle modification requests, BWC’s CNA schedules a driving evaluation. A rehabilitation or physical therapy department at a teaching hospital may be contacted to obtain the name of a Certified Driving Rehabilitation Specialist Educator for the Disabled (may also search http://www.aded.net).  An Occupational Therapy (OT)  or Physical Therapy (PT) revenue center  code with the  corresponding CPT code for OT or PT evaluation must  be used by hospitals billing outpatient for a  driving evaluation. The CNA must advise the  MCO to pay bill for the driving evaluation when received in Cambridge.    For non-hospital billing, a driving evaluator must bill with W0500 (Driving Evaluation) in MIIS on C19

 

6.    After completion of the evaluation, the driving educator will forward results to BWC’s CNA.  BWC’s CNA will authorize driving lessons when needed.  When the driving instructor determines that the injured worker is able to drive the vehicle in a safe manner, he supplies the injured worker a copy of an on-road exam.

 

7.    The CNA makes a determination for vehicle modifications upon receipt of the bids and proof of driver license restriction. Medical necessity denial must have a physician review.

·         The CNA generates an authorization or denial letter on V3 (or offline if update capabilities are not available) and sends the letter/copy to the injured worker, service provider, injured worker’s representative, employer, employer representative, MCO and to imaging in the claim file.

·         If the request is denied, the letter should state that the injured worker may appeal to the Industrial Commission by sending a C86 motion to the Service Office requesting a hearing at the IC.  The request will be forwarded to the Industrial Commission for determination.

·         BWC’s CNA updates V3 notes and have the adhoc letter of denial and physician review of denial imaged to the claim file.  

 

8.    When the modification is authorized, the CNA sends the authorization letter, a Certification Agreement and BWC Service Invoice C-19 to the service provider The Certification Agreement must be signed by the injured worker, service provider, and a witness prior to payment of the bill.

 

9.    The CNA updates the authorization on the V-3 prior auth screen using the beginning date as the day of authorization or date of service and the ending date with the estimated completion date (3 months).  The authorization number is VAN, plus authorizer’s five-digit EIN.  If unable to update authorization screen, the CNA will document the information in a V3 note and ask the assigned CSS to update the prior authorization screen in V3.

 

10. BWC reserves the right to subject the modified vehicle to inspection by an agency specified by BWC prior to release of payment.  BWC wishes to ensure that the authorized modifications are complete and function in a safe manner.

 

11. Upon receipt of the signed and completed Certification Agreement and BWC Service Invoice Form C-19, BWC’s CNA forwards the bill to the MIIS system for processing.  The bill should be marked FORCE 375 EDIT.

 

12. Following completion of modifications, the CNA updates the notes on V3 with the authorization information and  sends a copy of the original paperwork to image into the claim file.

 

13. The CNA sends an to the Bureau of Motor Vehicles giving notification that  vehicle modifications have been performed.

 

Resources

 

1.   Bureau of Vocational Rehabilitation (BVR):

BVR authorizes both home and vehicle modifications for BWC injured workers who are in a rehabilitation plan with a return to work goal.

§  Home modifications are very limited and allow for ingress to and egress from the home, bathroom modifications when necessary for someone to prepare for work, and any home modification necessary for someone who is working at home.  There is a provision to allow for electrical or plumbing work if it is necessary to install or operate a modification.

§  BVR contracts with an instate rehabilitation engineer who has the expertise to evaluate the home and to determine the appropriate modification.  When the necessary modifications are determined, contracts are put out to bid by BVR. 

§  For vehicle modifications, BVR submits bids for a consultant to determine the appropriateness of the vehicle and vehicle modifications and look at modification bids and to inspect the vehicle to determine the modification is done correctly and the driver is able to appropriately use the modification.

 

2.   Ohio Rehabilitation Services Commission (RSC)

Cooperative Agreement between Ohio Rehabilitation Services Commission (ORC)   and Ohio Bureau of Workers’ Compensation, fiscal year 2004-2005

 

This joint agreement enables each agency to fulfill its unique missions by use of BWC monies and matching federal funds.  It allows:

BWC to expand service delivery to a wider range of injured workers and facilitate a safe return to work 

RSC to meet its responsibilities in such a way that permits its monetary resource base to increase

 

Services would be provided to injured workers with catastrophic injuries, those receiving any form of compensation or those requiring rehabilitation or retraining in order to return to employment. Referrals may come from BWC, the MCO or the individual who desires vocational rehabilitation.  Each agency accepts referrals to rehabilitation from anyone and then determines client eligibility.

 

Per Ohio Administrative Code 3304-2-59, “RSC may purchase home modifications only if they are necessary to enable the consumer to engage in an acceptable employment outcome or to participate in a vocational rehabilitation service provided under an individualized plan for employment that leads to an acceptable employment outcome.”

 

Per the Cooperative Agreement between the ORC and BWCfor fiscal year 2004-2005 ORSC agrees to provide appropriate rehabilitation services to Ohio’s injured workers residing in the state and meeting ORSC’s eligibility criteria. ORSC’s priority of services identifies those individuals with significant disabilities which may include individuals with multiple disabilities as the population to receive consideration for services by ORSC counselors. Injured workers identified by BWC, who might be able to benefit fromjointly provided services or ORSC services alone, are those who fall into several distinct categories as listed in A - F below.

 

A.   A.  Those who have met BWC catastrophic guidelines, such as spinal cord injury, head injury, blindness and visual impairments, hearing impairments, severe burn injury and multiple injuries, and who will need extensive rehabilitation. This may include coordination of restorative          services and/or identification of a vocational goal.

 

B.   Those who do not meet BWC feasibility guidelines but for whom some type of employment (as yet unidentified) is anticipated, after an extended rehabilitative stage.

 

C.   Those who have a general learning ability that is extremely limited but who do have work potential under specialized circumstances.

 

D.   Those who have applied for permanent-total disability, but who have also       expressed a desire for rehabilitation, who have no vocational goal, who       need extensive vocational evaluation and whose potential for re-employment is severely limited due to physical and/or mental barriers.

 

E.   Those with severe but not permanent restrictions who have expressed a desire for rehabilitation, but whose employment options are severely limited and whose rehabilitation needs are extensive.

 

F.    Those who may need retraining or other services in order to realize the most efficient method of return to appropriate employment.

 

3.   Americans with Disabilities Association of Ohio

      This service provides technical information regarding modification needed in order to conform to requirements of the Americans with Disabilities Act.

 

Driver Education Programs

 

Driver Education Program, Medical College of Ohio, Toledo

A prescription for vehicle modification equipment is needed from a physician.  

·         An occupational therapist evaluates an injured worker to determine if he/she is capable of driving with modified equipment; what adaptive devices are needed; who can supply them; and who will reimburse for them.

·         If the evaluation is positive, the injured worker is referred to a Certified Driver Educator for the Disabled. 

·         The driver educator will evaluate the injured worker in a vehicle with adaptive equipment similar to that recommended by the occupational therapist.  Functions of the driver educator are to educate the driver about the laws regarding adaptive equipment on vehicles and do an on-road examination with the equipment.

·         The injured worker takes the on-road exam with equipment of the Department of Public Safety where a sticker appropriate for the modification is placed on the license.

 

Driver Rehabilitation Services, Ohio State University, Columbus, OH

·         The injured worker must have a valid driver’s license or permit and a doctor’s prescription asking for a driver evaluation.

·         An occupational therapy evaluation, consisting of a clinical assessment to check visual skills, cognitive skills, perceptual skills, and functional skills as related to driving is done. 

·         A simulator is used as a diagnostic tool to check reaction time and processing time. 

·         An on-the-road evaluation with whatever equipment deemed necessary is done. 

·         The driver must be tested by the Ohio Department of Public Safety.  Whatever restriction is appropriate is placed on the driver license after being tested by the Department of Public Safety. 

 

Drake Center, INC. Cincinnati, OH

·         Physician prescription for evaluation of driving/and or modifications is needed

·         A copy of current driver’s license is required

·         Driving evaluator sends letter to injured worker regarding Department of Motor Vehicle restrictions.

·         Training is authorized by BWC Managed Care Organization (MCO) or catastrophic nurse advocate (CNA)

·         Equipment is authorized by the BWC CNA

·         The information should be sent to:

Drake Center, INC.

151 West  Galbraith Rd.

Cincinnati, OH 45216-1096

Phone:  (513) 948-2798 or (513) 948-2751

Fax:  (513) 948-2550

 

Cleveland Metro

The following requirements need to be met before the driving evaluation is scheduled.

·         A copy of injured worker’s current, valid driver’s license or temporary permit (with validation stamp from the BMV)

·         Prescription from the IW’s physician stating the reason for referral as “OT for driving evaluation and rehabilitation” with IW telephone number and diagnosis (including ICD-9 code) and the doctor’s fax number

·         A brief physician’s note detailing the IW history, current medical status and list of medications.

 

The information should be sent to:

MetroHealth Medical Center

Department of Physical Medicine and Rehabilitation

2500 MetroHealth Drive

1st Floor, Rehabilitation Pavilion

Cleveland, OH 44109-1998

Attention:  Lori Thomas

FAX: (216) 778-7767

 

5.   Americans with Disabilities Association of Ohio

 This service provides technical information regarding modification needed in order to conform to requirements of the Americans with Disabilities Act.

 

6.   Ohio Department of Public Safety, Medical Department  When an individual goes through a driver’s rehabilitation program, the instructor will send a statement to the Department of Public Safety stating that an evaluation is completed and that a driver’s test is required.

§  The Department of Public Safety will send a letter to the individual, stating that he/she must have a driver’s test using the adaptive equipment.  A deadline is given for the examination to be completed. Upon completion, an appropriate sticker is placed on the license.  If this deadline is not met, the license is suspended.

 

§  If the individual does not go through drivers’ rehabilitation, the facility treating the individual might notify the Department of Public Safety.  Again, when they are aware of the situation, a letter is sent giving a deadline in which the individual must have a driver’s examination or face suspension of the driver’s license.

 

§  Some rehabilitation programs might determine that a person does not require a driver’s examination.  In this instance, a statement of driving capability is given to the individual with instructions to take the statement to the Department of Public Safety where the appropriate sticker will be placed on the license. 

 

§  BWC CNA will notify ODPS if an injured worker does not follow through with a required BVM driver’s examination  for a restricted license for any adaptive equipment.

 


Resources