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OhioBWC - Basics: (Policy library) - File

Policy Name:

Transitional Work Developer; Transitional Work Grant & Transitional Work Bonus

Policy #:

MP- 20-1   

Code/Rule Reference:

OAC 4123-17-55, 4123-6-01, 4123-6-02.2.   Employer Policies EP-20-01 (Transitional Work Grants) and EP-20-02 (Transitional Work Performance Bonus)

Effective Date:

06/01/15

Approved:

John Annarino, Chief Medical and Health Officer (Signature on file)

Origin:

Medical Policy

Supersedes:

All Medical policies, directives or memos regarding Transitional Work Grant & Bonus Program that predate the effective date of this policy.

History:

Rev 06/01/15; New 05/30/14

Review date:

06/01/20

 

 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure appropriate evaluation and approval of transitional work plans, ensure appropriate reimbursement for services provided by transitional work developers, and monitor participating employer utilization of transitional work plans for bonus payment calculation.

 

This policy complements the Transitional Work Grants Policy and the Transitional Work Performance Bonus Policy developed by BWC Employer Services. 

 

II. APPLICABILITY

 

This policy applies to BWC staff, Transitional Work Developers, Managed Care Organizations (MCOs) and Employers taking part in the Transitional Work Grant Program or the Transitional Work Performance Bonus Program.

 

III. DEFINITIONS

 

Eligible Employer – an employer that has met the BWC Employer Management eligibility criteria for participation in the Grant Program or Bonus Program.

 

Implementation Funds – funds remaining in the employer’s Grant Program account after initial reimbursement for transitional work plan development.  Implementation funds may be used to assist utilizing the transitional work plan with the first claim under the plan, provide transitional work plan program improvements, update a job analysis or add additional job analyses, or provide employer training relating to the transitional work plan.

 

Transitional Work (TW) – a work-site program that provides an individualized interim step in the recovery of an injured worker with job restrictions resulting from the allowed conditions in a claim.  Developed in conjunction with the employer and the injured worker, or with others as needed, including, but not limited to the collective bargaining agent (where applicable), the physician of record, rehabilitation professionals, and the managed care organization, a transitional work program assists the injured worker in progressively performing the duties of a targeted job.  OAC 4123-17-55(A)(5)

 

Transitional Work Developer (Developer) – the provider who develops the employer’s transitional work grant plan.  OAC 4123-17-55(A)(5)

 

Transitional Work Plan (TW Plan) – a plan with the following components: corporate analysis, employer-employee relations, policies and procedures, job analysis and program evaluation. 

 

Transitional Work Bonus Program (Bonus Program) – Employers with a transitional work plan may receive a back-end discount for using their TW plan to return injured workers back to work.  A BWC incentive is provided to qualified employers who return an injured worker to work quickly and safely after an injury through utilization of the employer’s transitional work plan.

 

Transitional Work Grant Program (Grant Program) – BWC funds provided to qualified employers used to reimburse a percentage of the cost of development of a customized transitional work plan in the workplace. 

 

IV. POLICY

A.    Grant Program

1.    It is the policy of BWC that:

a.    Once BWC has approved an employer to participate in the Grant Program, the employer has 2 years from the date of application to complete development of a TW Plan and to complete reimbursement. Refer to the Employer Services Transitional Work Grant Policy, Policy # EP-20-01, for details.

b.    Only developers meeting BWC eligibility requirements set forth in this policy shall develop TW Plans for the Grant Program.  Employers may request assistance locating a developer by checking the appropriate box on the Transitional Work Grant (TWG-1) application.

c.    BWC’s TW Unit shall review TW Plans submitted by employers and shall notify employers of Grant Program approval or denial following review of the TW Plan. 

i.      Per the Employer Services Policy, BWC may approve an associated policy number for grant monies based on corporate organization if the associated policy number submits an application and meets all Grant Program eligibility requirements under its own policy number.

ii.     If multiple policy numbers are involved, BWC will work with the employer and developer to develop a TW Plan at the corporate level.

d.    BWC will reimburse employers for TW Plan development costs based on reimbursement guidelines set forth in this policy.

e.    Grievances:

i.      An employer may file a grievance with the TW Unit if:

a)      The TW Unit denied the Grant Program application based on the TW Plan submitted; or

b)      The employer disputes the TW Unit reimbursement for TW Plan development costs. 

ii.     The TW Unit grievance decision shall be final.

f.     Employer requests, documentation and grievances shall be submitted via:

i.      Email to TWSupport@bwc.state.oh.us (the preferred method of submission);

ii.     Facsimile to:  614-621-5758; or

iii.    Mailed to:  Transition Work Unit, BWC, 30 West Spring Street, L-21, Columbus, Ohio  43215.

2.    BWC may assist employers in developing and/or updating a TW Plan if requested.  Employers are not eligible for reimbursement relating to BWC assistance to the employer. 

a.    BWC may assist in the following circumstances:

i.      Employer is eligible to participate in the Bonus Program and does not have a TW Plan or needs assistance updating an existing TW Plan;

ii.     Employer has multiple policy numbers approved to participate in the Grant Program and needs assistance developing a corporate level TW Plan;

iii.    Employer was denied participation in the Grant Program because the employer reported fewer than 11 employees on its last payroll report to BWC; or

iv.   Employer previously received a grant from BWC for development of a TW Plan and needs assistance updating the TW Plan.

b.    BWC assistance in developing and/or updating a TW Plan may include but is not limited to:

i.      Providing templates for the TW Plan development;

ii.     Conducting workshops to train employers;

iii.    Phone and/or on-site consultation at BWC’s discretion;

iv.   Generic job analysis; and/or

v.    Assistance implementing existing grant plans or programs.

3.    Transitional Work Developer Eligibility.  Eligible developers shall be added to the Transitional Work Developer list on bwc.ohio.gov.  The list includes the transitional work developer’s name, service areas, business address, email and phone number. 

a.    Developers shall meet all of  the following requirements to be eligible:

i.      Be certified to participate in the Health Partnership Program as a vocational rehabilitation case manager, a licensed occupational therapist or a licensed physical therapist.

ii.     Complete a Transitional Work Developer Application (TWD-115 Form), available on bwc.ohio.gov, and meet the criteria set forth in the application.  Applicants unable to meet the experience criteria set forth in the application may still be eligible to participate if they:

a)      Provide  evidence of verified experience in developing transitional work programs or verified mentoring experience with a  developer of transitional work services; or

b)      Request via email to TWSupport@bwc.state.oh.us that the Transitional Work Unit (TW Unit) provide names of developers that may be willing to provide guidance and/or mentoring.  The TW Unit does not guarantee that the developer will provide mentoring experience.

iii.    Complete a BWC sponsored transitional work training program prior to delivering a TW Plan (if accredited between 2001 and 2006, the developer shall take a BWC sponsored refresher course for the current Grant and Bonus Program).

b.    Failure to complete the training shall result in denial of the TW plan submitted by the employer.

c.    Developers that BWC determines do not meet requirements, except the provider certification requirement that shall be addressed by the Provider Credentialing Unit, may file a grievance with the TW Unit.  The TW Unit shall investigate and its decision shall be final.

d.    Developer applications and grievances shall be submitted via:

i.      Email to: TWSupport@bwc.state.oh.us (the preferred method of submission);

ii.     Facsimile to:  614-621-5758; or

iii.    Mailed to:  Transition Work Unit, BWC, 30 West Spring Street, L-21, Columbus, Ohio  43215.

4.    Transitional Work Plan Review.  TW Plans shall be reviewed based on criteria set forth in Appendix A to this policy.  Review criteria include corporate description, management and employee relations, policies and procedures, job analysis and evaluation and auditing process.

5.    Employer Reimbursement. 

a.    Reimbursement is a 3:1 match up to the amount of the grant award.  Grant Program caps are based on the number of employees reported on the employer’s last payroll report to BWC.  If the employer did not report a number on the last payroll report, the number may be updated in the BWC web when completing the online application.  Grant Caps are:

i.      11-49 employees – up to $2900;

ii.     50-199 employees - $5200;

iii.    200+ employees - $6300. 

b.    BWC will reimburse employers seventy-five percent (75%) of the final, total out-of-pocket cost the employer paid to the developer for covered services, after any discounts, rebates, or other cost or price adjustments offered by the developer are applied, subject to the following limitations:

i.      The maximum rate per service is:

a)    $200 per hour for TW developer labor;

b)    $200 per job analysis;

ii.     Developer hours or number of job analyses per employer are not limited;

iii.    Ineligible or unnecessary costs are not reimbursable and include but are not limited to:

a)    Costs associated with a developer’s preparing and submitting a proposal to an employer;

b)    Travel and lodging expenses;

c)    Costs associated with development of a TW Plan by a non-BWC approved developer;

iv.   Reimbursement shall not exceed the amount of the employer’s grant award.

c.    Employers may obtain reimbursement for TW Plan development costs after all of the following occur:

i.      The employer submits the developer’s TW Plan to BWC;

ii.     BWC approves the TW Plan;

iii.    The employer pays the developer; and

iv.   The employer submits the following forms (available at bwc.ohio.gov) and documentation to BWC:

a)    Transitional Work Grant Reimbursement Request Form (Form  TWG-2);

b)    BWC Service Invoice;

c)    BWC Transitional Work Agreement (Form TWG-3);

d)    Developer invoice to employer; and

e)    Employer proof of payment to the developer.  Acceptable proof of payment includes:

i)      Cancelled check that has been redacted of all confidential employer information;

ii)     Credit card statement that has been redacted of all confidential employer information; or

iii)    PayPal verification.

d.    Implementation fund reimbursement is subject to the 3-to-1 match until the balance remaining is $200.  At $200, the remaining balance may be paid for services.  To obtain implementation fund reimbursement (if available), an  employer shall submit to BWC the following documentation:

i.      Description of the service provided;

ii.     Invoice from the developer for services provided; and

iii.    Verification of payment for service provided.

e.    BWC shall cancel checks disbursed and not cashed within 90 days or checks returned undelivered.

 

B.    Bonus Program

1.    Per the Employer Services Transitional Work Performance Bonus policy, EP-20-02, in addition to meeting Employer Services eligibility criteria, employers are required to submit documentation evidencing a developed and implemented TW Plan. 

a.    Bonus Program employer applicants not utilizing the current Grant Program shall submit written documentation to the TW Unit that includes but is not limited to:

i.      Executive summary describing the TW Plan signed by a corporate officer;

ii.     Copy of the employer’s TW Plan.   

b.    An employer approved to participate in the Bonus Program is not required to submit TW Plan documentation with subsequent bonus period applications if there has been no lapse in Bonus Program participation, and the employer continues to meet Employer Services eligibility criteria.

2.    Documentation shall be submitted prior to the bonus period cutoff date set forth in Employer Services Transitional Work Performance Bonus policy, EP-20-02, for inclusion in the current bonus period. 

a.    Employers failing to timely submit documentation shall be denied and not be considered for the current bonus payment period.  

b.    Documentation shall be submitted via:

i.      Email to: TWSupport@bwc.state.oh.us (the preferred method of submission);

ii.     Facsimile to:  614-621-5758; or

iii.    Mail to:  Transition Work Unit, BWC, 30 West Spring Street, L-21, Columbus, Ohio  43215.

c.    BWC shall review submitted documentation and may contact the employer by phone or email to offer assistance, including, but not limited to: 

iv.   Recommendations for improving or enhancing the TW Plan;

v.    Strategies and suggestions for implementing transitional work and light duty successfully;

vi.   Informational assistance including:

a)    BWC job templates;

b)    BWC services to support transitional work such as job modifications, job analyses and vocational rehabilitation; and/or

c)    Process for submitting Transitional Work Offer and Acceptance Forms (TWB-2).

d.    An employer that has its application for the transitional work bonus denied, or that disagrees with BWC’s performance bonus determination, may file an appeal to BWC’s Adjudicating Committee pursuant to Ohio Revised Code 4123.291 and OAC 4123-14-06.  Employer appeals filed due to transitional work plan issues (e.g., employer believes it did not get appropriate credit for a return to work) will be addressed by the TW Unit.

 

C.   MCO Responsibilities for the Bonus Program

 

1.    Gathering and transmitting return to work information;

2.    Reviewing and updating return to work information; and

3.    Assisting employers in the collection of required forms.

 

 

 

 

 

 


 

 

Appendix A- Transitional Work Grant & Transitional Work Bonus Policy

 

Review of transitional work plans shall be based on the following criteria:

 

1.    Corporate Description Criteria:  In reviewing the corporate description developed by the developer, BWC shall consider whether the developer reviewed/addressed the following areas:

a.    Corporate description with analysis of the following:

i.      Current organizational status;

ii.     Corporate demographic information relating to:

a)    Number of employees;

b)    Industry type;

c)    Job classifications;

d)    Union positions, if applicable;

e)    Multiple business locations, if any;

f)     Related companies and associated policy numbers, if any;

g)    Managed Care Organization (MCO);

h)    Third Party Administrator (TPA), if applicable;

iii.    On-site interviews with employer-owners, supervisors, team leaders, union representatives, if applicable, and employees;

b.    Review of current corporate policies with recommendations for improvement in the following areas:

i.      Accident reporting;

ii.     Modified duty program;

iii.    Dispute procedures;

iv.   Return to work policies;

v.    Americans with Disabilities Act policies;

vi.   Training policies;

vii.  Safety policies;

c.    Transitional work grant plan objectives;

d.    Barriers to transitional work plan implementation.

 

2.    Management and Employee Relations Criteria: Formation of a Transitional Work/Safety Committee with participation by:

a.    Management;

b.    Union, if applicable; and

c.    Labor.

 

3.    Policies and Procedures Criteria:  A developer may use BWC’s policy and procedure templates or customize them to meet the needs of the employer but is not permitted to charge for the use of BWC templates or forms.  BWC shall consider whether the developer identified:

a.    A company transitional work coordinator;

b.    Employer mission statement;

c.    Eligibility, entry, extension and exit guidelines;

d.    Timeframes for implementation;

e.    Dispute resolution policy;

f.     Americans with Disabilities Act compliance and accommodation at alternate work sites, if applicable;

g.    Multilingual and multicultural needs;

h.    Interpreter Services offered or required;

i.      Training plan including training for the company transitional work coordinator, management, supervisors and employees. At a minimum, the following educational requirements must be met:

i.      Written policies that are discussed with employees prior to program initiation;

ii.     Written course materials relating to the program provided to employees with the opportunity to review and comment or ask questions regarding the program and policies;

iii.    A method to document employee knowledge and understanding of the program;

iv.   Provision for employee education within six (6) weeks of employment; and

v.    Provision for refresher courses with educational materials on a yearly basis to all employees.  The refresher course may be incorporated with annual safety training.

j.      Community resources and contact list provided by the developer including formal agreements with preferred community providers to provide services to the employees, a community resource list with contact names, phone and fax numbers.  A different community resource directory shall be developed for different locations and for workers in remote locations, if applicable.  Community resources  include:

i.      Physicians and physician groups in the area;

ii.     Urgent care centers and emergency departments;

iii.    Occupational medicine and physical medicine specialists;

iv.   Rehabilitation providers on-site and at clinics;

v.    Case managers and vocational rehabilitation managers.   

k.    Roles and responsibilities of the following:

i.      Managed care organization and third party administrator, if applicable;

ii.     Physician;

iii.    On-site providers;

iv.   Injured worker;

v.    BWC;

vi.   Employer-transitional work coordinator; and

vii.  Vocational rehabilitation professionals.

 

4.    Job Analysis Criteria:  A job analysis examining different jobs and collecting measurements while the job is being performed. A job analysis may utilize the BWC’s job analysis templates but the job analysis must be customized to meet the needs of the employer.  In reviewing the job analysis developed by the developer, BWC shall consider if the following criteria are met:

a.    A job analysis may only be performed by a BWC certified:

i.      Occupational Therapist;

ii.     Physical Therapist;

iii.    Certified Professional Ergonomist (CPE);

iv.   Certified Human Factors Professional (CHFP);

v.    Associate Ergonomics Professional (AEP);

vi.   Associate Human Factors Professional (AHFP);

vii.  Certified Ergonomics Associate (CEA);

viii. Certified Safety professional (CSP) with “Ergonomics Specialist” designation;

ix.   Certified Industrial Ergonomist (CIE);

x.    Assistive Technology Practitioner (ATP); or

xi.   Rehabilitation Engineering Technologist (RET).

b.    At a minimum, the job analysis shall include the following:

i.      The job title and summary description;

ii.     Essential functions of the job divided into work tasks with a description of the physical demands of required tasks analyzed at the job site with the worker’s input including frequency, duration, and postures and the use of devices to measure force;

iii.    Equipment or tools used in the job performance of each work task;

iv.   Working environment and conditions of the job including knowledge, skill and experience generally required to perform the job.

c.    Repeat job analysis are prohibited unless a component of the job analysis is customized for a particular part of the job.

d.    All job analysis must be signed and dated by the actual servicing provider and must specify his/her credentials.

e.    All job analysis shall be submitted to BWC for use by claims and rehabilitation staff.

 

5.    Evaluation and Auditing Process Criteria:  Evaluation and auditing measures the effectiveness of the Grant Program and/or Bonus Program from both the employer and employee perspective. Any of the following outcome-measures may be addressed:

a.    Bonus Program calculations indicating successful utilization of the TW plan in returning injured workers to work;

b.    Workers’ Compensation savings analysis supplied by BWC Employer Services;

c.    Reports supplied to the company by the MCO or TPA;

d.    Productivity measurements;

e.    Worker and management satisfaction.

 


 

Procedure Name:

Procedure for Transitional Work Developer; Transitional Work Grant & Transitional Work Bonus

Procedure #:

MP- 20-01.PR1   

Policy # Reference:

MP-20-01

Effective Date:

06/01/15

Approved:

John Annarino, Chief Medical and Health Officer (Signature on file)

Supersedes:

All Medical procedures, directives or memos regarding Transitional Work Grant & Bonus Program that predate the effective date of this procedure.

History:

Rev 06/01/15; New 05/30/14

Review date:

06/01/20

 

 

II.    BWC staff shall refer to the Standard Claim File Documentation policy and procedure for claim-note requirements and shall follow any other specific instructions included in this procedure.

 

III.   Transitional Work Developer Review

A.    The Transitional Work Unit (TW Unit) shall review Transitional Work Developer (Developer) applications (Form TWD-115). Upon receipt of Form TWD-115,  the TW Unit shall determine if the applicant:

1.    Is  certified in the Health Partnership Program (HPP) as one of the following provider types designated in O.A.C. 4123-6-02.2:

a.    Vocational rehabilitation case manager;

b.    Occupational therapist;

c.    Physical therapist.

2.    Has sufficient experience in transitional work development.

 

B.    TW Unit staff shall notify applicants meeting developer requirements of required training via email.

 

C.   TW Unit staff shall add the developer’s name, service areas, business address, email and phone number to the BWC Certified Transitional Work Developer list on bwc.ohio.gov following completion of a BWC-sponsored training program noted in II.B.

 

D.   TW Unit staff shall refer, via email, applicants not currently enrolled in HPP to the Provider Enrollment and Certification (Medco-13) form on bwc.ohio.gov.

 

E.    TW Unit staff shall consult with the TW Unit manager if a determination is made that the applicant does not meet the experience criteria. If after consultation, the decision is to deny the applicant, staff shall send an email to the applicant with a list of developers that the applicant may contact to request mentoring to develop transitional work plans.

 

F.    If an applicant files a grievance for the denial, the TW Unit shall investigate and respond to the grievance.

1.    The TW Unit shall:

a.    Send a written response via email within 10 business days of receipt of the grievance.

b.    If additional time is required to investigate the grievance, the TW Unit shall notify the grievant via email of the date by which it will issue a decision.  

2.    The TW Unit grievance decision shall be final.

 

IV.  Grant and Bonus Program Evaluation Tools; TW Unit and Disability Management Coordinator (DMC) Roles and Responsibilities

A.    Employers submit Transitional Work Grant Program (Grant Program) and Transitional Work Bonus Program (Bonus Program) applications online, via fax or by mail.  The TW Unit is responsible for ensuring the paper applications are entered online into bwc.ohio.gov.    

 

B.    If Employer Services (ES) underwriting criteria are met, the system automatically creates a “TW Plan Look-Up” shell on BWCWeb.  See Appendix A for detailed Plan Look-Up categories. 

1.    The created TW Plan Look-Up notes the following:

a.    Type of application:  Grant Program or Bonus Program;

b.    Application Date;

c.    Application status:

i.      If the application is for the Grant Program, the application status is “Approved” (because the application passed ES underwriting criteria).

ii.     If the application is for the Bonus Program, the application status is “Received” (the application cannot be “Approved“ until the DMC completes verification and ES runs a final eligibility screening for the assigned bonus period).

d.    TW Plan Status.  Plan Status will note “Expected.”  Expected means:

i.      BWC is expecting a TW plan from the Grant Program applicant; or

ii.     BWC is expecting documentation confirming a TW plan from the Bonus Program applicant.

2.    The system automatically assigns applications on a rotating basis to a DMC from the service office to which the employer’s policy number is assigned.

a.    Injury Management Supervisors in each service office are authorized to re-assign an application based on workload/vacation schedules.

b.    TW Unit staff are authorized to re-assign applications.

c.    Employers with multiple policy numbers have a separate TW Plan Look-Up shell for each policy number.

i.      The TW Unit shall assign employers with multiple TW Plan Look-Up shells to one DMC. 

ii.     DMCs shall notify the TW Unit via email if the DMC finds an employer with multiple TW Plan Look-up shells assigned to different DMCs. 

 

C.   TW Unit and DMC staff:

1.    Work together to:

a.    Review and approve Grant Program TW plans;

b.    Verify Bonus Program TW plan documentation.

2.    Utilize the following programs during the review process:

a.    BWCWeb – location of TW Plan Look-Up for the Grant Program and Bonus Program. 

b.    SharePoint – location of Grant Program transitional work checklist created by TW Unit.

c.    Universal Document System (UDS) –depository for TW plan documents, emails and correspondence received and sent out by TW Unit and DMC.

d.    Claims Management System – links approved (Grant Program) or verified (Bonus Program) TW plan to employer claims.  The TW Unit utilizes this system to monitor Bonus Program employers.

 

V.    Grant Program TW Plan Review

A.    The TW Unit shall:  

1.    Process all TW plan documentation received via email, fax or mail and send out all correspondence relating to TW plan review and reimbursement decisions.

2.    Review the TWSupport@bwc.state.oh.us email box at least twice daily.

3.    Verify that submitted TW plans were developed by an approved transitional developer listed on bwc.ohio.gov.

4.    Scan documents received and sent out to UDS indexed by employer risk/policy number with a document type selected. Following are available document types:

a.    “TWSuppInfo”- Bonus Program documents;

b.    “TWGrant”- existing  and new Grant Program documents; developer reimbursement documents;

c.     “TWB-1”- Bonus Program applications;

d.    “TWG-1” – Grant Program applications;

e.    “Correspond”- letters and correspondence to employers.

5.    Make sure a “TWG Checklist” (Checklist) exists in SharePoint for the employer risk/policy number noted on the submitted document(s).  If no Checklist exists, TW Unit staff shall create the Checklist so that the DMC will have a “shell” in which to input their TW plan reviews.

6.    Access BWCWeb TW Plan Look-up Grant Program to:

a.    Insert the TW plan receipt date;

b.    Update the TW Plan Status from “Expected” to “In Process.” Changing the plan status to “In Process” gives notice to the DMC to begin TW plan review.

7.    Email notice to the assigned DMC that documentation has been received. 

8.    Monitor BWCWeb to ensure:

a.    DMC processing of submitted documentation:

i.      If, within five business days of the TW Work Unit updating BWCWeb Plan Status to “In Process” there is no change in the plan status, the TW Unit shall send an email to the assigned DMC noting that paperwork was scanned into UDS and no action has been taken with respect to the plan status.

ii.     If BWCWeb Plan Status remains in “Pended” status for 30 days following the DMC updating the plan status to “Pended,” the TW Unit shall send an email to the assigned DMC noting the plan status remains pended (a plan status is pended if the DMC needs additional information).

b.    Transfer of Checklist information into the Transitional WorkGRANTS Reimbursement database.  An “Approved” plan status alerts the TW Unit staff to transfer Checklist information into the database used to determine employer reimbursement.

c.    Timely mailing of Grant Program correspondence following DMC TW plan review. The TW Unit shall email an approval or denial letter (as appropriate) to the employer within five business days of the DMC updating BWCWeb Plan Status to “Approved” or “Denied.” Approval letters shall inform employers of required reimbursement documentation.

9.    Investigate and respond to grievances relating to TW plan decisions.

a.    A written response shall be sent via email within 10 business days of receipt of grievance.

b.    If the grievance relates to actions taken by ES, the TW Unit shall forward the grievance to ES and notify the grievant via email letter of such action.

c.    If additional time is required to investigate the grievance, the TW Unit shall notify the grievant via email of the date by which a decision will be made.  

d.    The TW Unit’s grievance decision shall be final.

10.  Upload the policy numbers of employers approved/denied for the Grant Program to the appropriate MCO Portal along with denial rationale.

 

B.    DMCs shall:

1.    Review the BWCWeb database daily to determine assigned workload and status of assigned employer TW plans.

2.    Within five business days following notice by the TW Unit of document receipt:

a.    Review TW plan documentation (located in the UDS system) utilizing the Checklist to determine if review criteria are met; and

b.    Update BWCWeb Grant Program Plan Status. 

If unable to timely complete a review and update Plan Status, the DMC shall email the TW Unit to notify of delay so that the TW Unit may reassign the application.

3.    If the DMC determines that the TW plan meets review criteria, the DMC shall:

a.    Update BWCWeb Grant Program Plan Status to “Approved.” (TW Plan approval automatically updates the claims management system to reflect the presence of an approved TW program for that employer’s claims).

b.    The DMC shall then review BWCWeb to determine if the employer submitted a Bonus Program application.

i.      If a Bonus Program application has not been received for the present bonus period, the DMC shall:

a)    Contact the employer’s TW coordinator via email or telephone and request submission of an online Bonus Program application;

b)    Monitor BWCWeb for the submission of a Bonus Program application by the employer; and

c)    If/when the BWCWeb notes a BWC ES approved Bonus Program application; the DMC shall update the Bonus Program Plan Status to “Approved.”

ii.     If a Bonus Program application has been received for the present bonus period, the DMC shall update the BWCWeb Bonus Program Plan Status to “Approved” in addition to updating the BWCWeb Grant Program Plan Status.

4.    If TW plan information is missing or incomplete or does not meet required plan criteria, the DMC shall:

a.    Update BWCWeb Grant Program Plan Status to “Pended” and take the following actions:

i.      Determine what is needed;

ii.     Prepare questions (using SharePoint template) addressed to the employer’s TW coordinator;

iii.    Call employer’s TW coordinator to discuss what is needed;

iv.   Email the questions to employer’s TW coordinator confirming the conversation (if applicable) or requesting information (if unable to contact TW coordinator).  The email shall include the following information:

a)    Timeframe for receipt of information if the DMC is confirming information provided by employer’s TW coordinator over the phone;

b)    Timeframe for response to DMC’s request if no conversation with employer’s TW coordinator occurred.

v.    Save the email to UDS.  

vi.   If there is no response from the employer following the first phone call or no response to the email within three business days of sending, the DMC shall:

a)    Place another call to employer’s TW coordinator;

b)    Send a second email letter, save the email to UDS; and

c)    Place written notes in comments section of Checklist reflecting DMC’s attempts to contact employer.

b.    Staff with TW Unit Manager if, after following the steps set forth in IV.B.4.a., TW plan information continues to be missing or incomplete or the TW plan does not meet required plan criteria.  The TW Unit shall contact the developer to assist in obtaining information.

c.    If the decision is to deny the TW plan, the DMC shall note the denial reason in the Checklist and update the BWCWeb Grant Program Plan Status to “Denied.”  The TW Unit shall then send an email “denial” letter to the employer’s TW coordinator and save the letter to UDS.

 

VI.  Grant Program TW Plan Reimbursement/Implementation Funds 

A.    Employers submit reimbursement requests to the TW Unit for Grant Program TW plan development costs and implementation funds. 

 

B.    Upon receipt of documentation, the TW Unit shall:

1.    Scan the documents into UDS.  If an employer submits a check or credit card statement that does not have confidential information redacted, TW Unit staff shall redact confidential employer information prior to scanning the document.  

2.    Utilize the Transitional WorkGRANTS Reimbursement database checklist to ensure all required documentation was received and input invoice information.

3.    Review submitted documentation and take one of the following actions:

a.    If all required documentation is submitted and payment is for allowed expenses, the TW Unit shall process the payment;

b.    If all required documentation is not submitted, pend payment authorization and contact employer via email noting additional documentation required for processing; or

c.    If request is for a non-allowed expense(s), deny the non-allowed reimbursement request and contact employer via email noting the non-allowed expense(s).  

 

C.   TW Unit staff shall utilize the Rates & Payments TW Grant Reimbursement System (R&P Program) for payment processing as follows:

1.    Two individuals shall be responsible for processing reimbursement requests (a “Creator” and a payment “Approver”). The creator and approver cannot be the same person.  See Appendix B for specific payment processing steps.

2.    The creator shall:

a.    Create an invoice in the R&P Program for employer; and

b.    Enter invoice information into the system.

3.    The approver shall:

a.    Review payment request input by creator for accuracy and appropriateness of payment; and

b.    Approve payment of invoice.  Approval authorizes BWC Benefits Payable to create a check and reimburse the employer. The approver shall staff all payment concerns with creator. 

4.    Following approval, the TW Unit shall send a payment letter to the employer noting amount to be reimbursed and amount of funds remaining in grant award.

a.    Checks disbursed but not cashed after 90 days shall be cancelled by commission.  If contacted by the employer, the TW Unit and BWC Benefits Payable staff shall work together to issue a replacement check.

b.    Checks returned undelivered shall be cancelled by BWC Benefits Payable.  The TW Unit and BWC Benefits Payable shall work together to determine the appropriate address so that a replacement check can be issued.

 

D.   The TW Unit shall monitor for employers eligible for reimbursement that have not submitted a reimbursement request.  If a reimbursement request has not been submitted, the TW Unit may send an email reminder to the employer.

 

E.    The TW Unit shall investigate and respond to employer-submitted grievances relating to TW plan development and implementation cost reimbursement.

1.    A written response shall be sent via email within 10 business days of receipt of a grievance.

2.    If additional time is required to investigate a grievance, the TW Unit shall notify grievant via email of the date by which a decision will be made. 

3.    The TW Unit’s grievance decision shall be final. 

 

VII. Bonus Program TW Plan Verification

A.    The TW Unit shall:

1.    Review the TWSupport@bwc.state.oh.us email box at least twice daily.

2.    Process all TW Plan documentation received via email, fax or mail.

3.    Scan to UDS all emails and documents received and sent out by the TW Unit.

4.    Access  BWCWeb TW Plan Look-Up Bonus Program to:

a.    Insert plan documentation receipt date;

b.    Update Plan Status from “Expected” to “In Process.”  Changing plan status to “In Process” gives notice to the DMC to verify plan documents. 

5.    Monitor BWCWeb to ensure DMC processing of submitted documentation.  If, within five business days of TW Work Unit updating Plan Status to “In Process,” there is no change in Plan Status, the TW Unit shall send an email to assigned DMC noting that paperwork was scanned into UDS and no action has been taken with respect to Plan Status.

6.    Upload the following TW plan reports to the appropriate MCO Portal for use by MCOs:

a.    At the close of the bonus application period (as set forth in the ES policy), a report noting policy numbers of employers approved to participate in the Bonus Program;

b.    A weekly Transitional Work Bonus Claims Participation report with an update of all claims for employers approved to participate in the Bonus Program.

7.    Investigate and respond to appeals to BWC’s Adjudicating Committee pursuant to Ohio Revised Code 4123.291 and OAC 4123-14-06 relating to transitional work plan documentation timeliness, DMC review decisions and employer appeals relating to return to work credit. 

 

B.    DMCs shall:

1.    Monitor BWCWeb daily to determine assigned workload and status of assigned employer TW plans.

2.    Review and verify TW plan documentation (located in the UDS system) within five business days following notice by the TW Unit of document receipt.  TW plan verification may be demonstrated through submission of:

a.    Executive summary describing the TW Plan signed by a corporate officer;

b.    Copy of the employer’s TW Plan.

3.    Following review and verification, update the BWCWeb Bonus Program TW Plan Status to “Approved.” If the employer risk/policy number has an “Approved” Grant Program application and a Grant Program Plan Status that is not in “Approved” status, the DMC shall update the Bonus Program TW Plan Status to “Remeditin” [sic].

a.    Updating the Bonus Program grant status to “Remeditin” [sic] causes the system to change the Grant Program TW Plan Status to “Remeditin” [sic] which the system recognizes as “Expected.”

b.    The DMC may contact the employer to determine if the employer wants to continue with the Grant Program application.

c.    The system recognizes a Bonus Program TW plan in “Remeditin” [sic] status as “Approved” when Employer Services runs a final eligibility screening for the assigned bonus period.

4.    Monitor BWCWeb Bonus Program application status for assigned employer policy/risk numbers.

a.    If an assigned employer’s Bonus application is in “Received” status and the DMC has not been notified by the TW Unit that documentation has been received, the DMC shall contact the employer and request documentation submission prior to the Employer Service cutoff date for inclusion in the current the bonus period (See Employer Services policy EP-20-02).

b.    If the employer does not timely submit documentation, the DMC shall update BWCWeb Bonus Program TW Plan Status to “Denied.”  (The Bonus application will be denied at the time Employer Services runs a final eligibility screening for the assigned bonus period and the employer will be notified of the denial by Employer Services).

 

C.   DMCs may contact the employer by email letter and/or phone following review of submitted documentation to offer BWC consultation services including but not limited to:

1.    Recommendations for improving or enhancing the TW plan;

2.    Strategies and suggestions for implementing transitional work and light duty successfully;

3.    Informational assistance including:

a.    BWC job templates;

b.    BWC services to support transitional work such as job modifications, job analyses and vocational rehabilitation; and/or

c.    Process for submitting Transitional Work Offer and Acceptance forms (TWB-2).

 

VIII.        Managed Care Organization (MCO) Responsibilities

A.    MCOs shall:

1.    Follow the Return to Work Data Policy;

2.    Work with employers participating in the Bonus Program to obtain a completed BWC Offer and Acceptance Form (TWB-2) if not received;

3.    Update the “Released Type” on bwc.ohio.gov no sooner than the day after sending the return to work (RTW) date; and

4.    Verify data entry accuracy of RTW dates and released type information on the Transitional Work Bonus Claims Participation weekly report posted on the MCO portal by the TW Unit.

 

B.    MCOs may:

1.    Update “Actual Job” indicators on bwc.ohio.gov;

2.    Identify the job type of actual return to work including “same job, same employer” (SJSE), “different job, same employer” (DJSE), “same job, different employer” (SJDE), or “different job, different employer” (DJDE).

 

 

 

 

 

Appendix A

BWC Web TW Plan Look-up contains the following categories:

·         Policy Number – employer’s risk/policy number

·         Plan Status – status of transitional work plan.  Plan status categories include:

o     Expected – BWC is expecting a transitional work plan;

o     In Process – a plan has been received and DMC should begin reviewing the plan;

o     Pended – DMC has reviewed transitional work plan, items are missing, and the plan is on hold awaiting additional information;

o     Approved – DMC has approved transitional work plan;

o     Denied – transitional work plan has been denied;

o     Not Needed – Employer notified BWC that Grant or Bonus application

no longer being requested or Employer Services denied Grant application because of an Attorney General balance;

o     Remedintin [sic] – “placeholder” category created because Grant and Bonus shells are “linked.”  Utilized when an employer submits both a Grant Program and Bonus Program application that pass Employer Service initial screening criteria and the Grant Program TW plan review has not yet been completed.

·         Plan Status Effective Date – date transitional work plan was approved by DMC;

·         Plan Receipt Date – date transitional work plan was received by BWC;

·         Program Type - Grant or Bonus; 

·         Application Status – status of Bonus or Grant Application from Employer Services perspective.

·         Application Date – receipt date of Bonus or Grant application from employer;

·         Program Year Begin Date – only applies to Bonus applications.  Notes what year to begin calculation for Bonus Program;

·         DMC Assigned;

·         Action – tool to input actions into BWCWeb.


 

Appendix B

1.    The creator opens the Rates and Payments program and chooses Payment Menu on TW Grant Reimbursement screen.  The Employer Reimbursement menu will open.  Choose “Special Payments” on the menu bar and on the drop-down menu, select “Employer Payment” then select “Employer Reimbursement” from the subsequent drop down menu.

2.    An “Employer Reimbursement – Window” will open.  Enter employer’s policy number in appropriate box.  If employer policy number is not noted on documentation, choose “Lookup” in top right corner of screen to find employer’s risk/policy number.

a.    If employer’s TW Grant application and TW Grant plan are in “Approved” status, the “Employer Reimbursement” window will be displayed.

b.    If employer’s TW Grant Plan Status is not in “Approved” status, a message will be displayed stating that the employer does not have an approved plan.  No further action may be taken until TW Plan Look-up Grant Program plan status is in “Approved” Plan Status.  Staff shall review why the plan is not in “Approved” status.

3.    At the “Employer Reimbursement” screen, the creator will click on the “create” button to create the invoice in the system on the “Payment Entry” screen.  (The “Payment Entry” screen provides information relating to the maximum grant allowable amount, the total grant amount paid and the remaining eligible amount).  On the “Payment Entry” screen, the creator shall:

a.    Enter “Invoice From” and “Invoice To” information;

b.    Enter Invoice Amount. The allowed amount will be calculated by the system.

c.    Click the “ok” button on the screen. 

4.    Once the “ok” button is clicked, the approver is able to open the “Employer Reimbursement” screen.  The approver shall:

a.    Review payment request for accuracy and appropriateness of payment;,

b.    Highlight invoice information noted; and

c.    Click the “Details” button on the screen. 

d.    The “Payment Entry” screen will appear and the approver clicks the “Approve Invoice” button on the screen.  At this point, the payment is authorized and will go through Benefits Payable batching to be paid that evening.

 

 


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