and Reassignment of the Vocational Rehabilitation Case Manager
Kroninger, Chief of Medical Operations
and Procedure VR-01-01, effective 10/10/16
purpose of this policy is to ensure that:
injured worker (IW) has a choice in the selection of a vocational rehabilitation
case manager (VRCM);
VRCM is promptly assigned;
VRCM is provided with, or can otherwise obtain, the information necessary to
fulfill his or her responsibilities; and
VRCM is effectively reassigned, as appropriate.
policy applies to the:
disability management coordinators (DMC);
care organization (MCO) staff involved in the coordination and management of
the vocational rehabilitation program; and
assigned by the MCO.
“Vocational Rehabilitation Definitions” in Chapter 4 of the MCO Policy
A. It is the policy of BWC
to ensure the IW is provided information regarding the provision of vocational
rehabilitation services and has the opportunity to select a VRCM of his/her
B. It is the policy of BWC
to ensure the prompt assignment of a VRCM and that the VRCM is provided with
all relevant information necessary for vocational rehabilitation planning and
service delivery to the IW.
C. It is the policy of BWC
that the MCO may reassign a VRCM when there are extraordinary circumstances justifying
such a reassignment.
A. Assigning a VRCM
1. Within three (3)
business days of the MCO’s receipt of the eligibility verification from the
DMC, the MCO shall contact the IW and verify the IW’s interest in vocational
rehabilitation. If the IW’s interest was verified within 10 business days prior
to the referral date, additional verification of interest is not required.
a. If the IW or the IW’s attorney
of record (AOR) has previously indicated a choice of provider, the MCO shall
confirm this choice.
b. If no previous choice
has been made by the IW, the MCO shall discuss with the IW available providers
and agree on a selection.
2. The MCO may close the
vocational rehabilitation case, consistent with the Vocational Rehabilitation Case
Closure policy, prior to assigning a VRCM if:
a. The IW does not respond
within 10 business days of the latest documented contact attempts from the MCO;
b. The MCO finds the IW is
clearly not feasible for services; or
c. The IW does not wish to
3. Within three (3)
business days of the verification of the IW’s interest in vocational
rehabilitation and selection of a provider, the MCO shall assign the case to
a. It is the
responsibility of the VRCM to decline an assignment if he or she is not reasonably
able to provide appropriate and timely services.
b. The MCO shall notify
the DMC by email of the VRCM assignment and provider number. The date of the
email becomes the assignment date.
4. Once a VRCM has been
assigned, the MCO shall forward to the VRCM a referral packet containing the
following information, as applicable:
a. Claim demographics
i. Claim number;
ii. Allowed conditions
(narrative and ICD code);
iii. Date of injury (DOI);
iv. Last date worked;
vi. Date of birth;
vii. Average weekly wage;
viii. Full weekly wage;
ix. Temporary total rate;
b. Claim documents
i. First Report of an
Injury, Occupational Disease or Death (FROI);
ii. Most recent Request for
Temporary Total Compensation (C-84);
iii. Most recent Physician’s
Report of Work Ability (MEDCO-14);
iv. Most recent Mental Health
Notes Summary (Non-Psychotherapy Note) (MEDCO-16), if applicable;
v. Most recent extent of
disability independent medical examination;
vi. A written job
description(s) the IW held on the date of injury and/or the most recent job;
rehabilitation screening tool;
viii. Complexity Factors Reporting Form (an electronic
blank EXCEL format);
ix. All vocational
rehabilitation initial assessments;
x. All vocational
rehabilitation closure reports; and
xi. All vocational
evaluations and functional capacity exams;
c. Complete contact information
for each of the following (e.g., cell phone, fax number, email address):
ii. AOR or other authorized
representative, if applicable;
iv. MCO name and contact at
v. Physician of record (POR)
and contact at POR’s office;
vi. Employer of record (EOR)
name and contact at EOR; and
vii. EOR third party
administrator (TPA) name and contact at TPA if applicable.
i. The date the MCO is
forwarding the referral packet to the VRCM;
ii. The date of referral,
name of the person who initiated the referral and the reason for the referral;
iii. The basis for IW’s
eligibility determination; and
iv. The basis for IW’s
initial feasibility determination.
5. The VRCM shall promptly
review the referral packet and request any missing information from the MCO.
B. Reassigning a VRCM
1. Any request for
reassignment of the VRCM, from whatever source, shall be addressed by the MCO.
a. The DMC or any other
BWC staff shall forward any request for VRCM reassignment, from whatever
source, to the MCO.
b. The MCO may also initiate
a VRCM reassignment.
2. The MCO may reassign
the VRCM when extraordinary circumstances exist that justify the reassignment.
Examples of extraordinary circumstances may include, but are not limited to:
a. The IW moving to a
b. The IW threatening the
c. The VRCM being
unavailable for two or more weeks; or
d. The VRCM failing to
meet or maintain certification as required by the Credentialing Requirements
of Providers of Vocational Rehabilitation Services policy and O.A.C. 4123-6-02.2.
3. If the VRCM
reassignment is initiated by the MCO and is not at the request of the IW or the
VRCM, the MCO may consult with the DMC and/or the BWC Rehabilitation Policy Unit
as necessary, prior to reassigning.
4. The IW retains choice
in the selection of a VRCM and the MCO shall ensure the IW is in agreement with
the new VRCM assignment.
5. The MCO shall enter a
claim note describing the reason for reassignment of the VRCM.
6. Within five (5) days of
receiving notice of VRCM reassignment, the current VRCM shall prepare and provide
to the MCO a transfer summary report. This report shall include:
a. The current job goal;
b. IW restrictions;
c. The EOR contact
d. Training and/or job
placement status, as applicable; and
e. All services that have
been completed, to date.
7. Within five (5) days of
assignment to the new VRCM, the MCO shall provide the VRCM:
a. The transfer report;
b. An updated referral
packet containing the information described in section IV.A.4, as applicable;
c. Any vocational
rehabilitation plans completed since the date of referral.
8. The newly assigned VRCM
shall review the referral packet, transfer report and any additional
documentation. The VRCM shall take appropriate steps, based on where the IW is
in the vocational rehabilitation process and consistent with the applicable
policy and procedure.
a. If an assessment plan
or a job retention plan has been prepared and/or begun, the VRCM shall prepare
an amended plan.
i. The VRCM may amend the
plan to reflect new or changed services; or
ii. At a minimum, the VRCM
shall provide an amended plan reflecting the new VRCM assignment with no change
b. If a comprehensive
vocational rehabilitation plan has begun, The VRCM shall:
i. Prepare and submit an
amended plan if there is a significant change in the job goal or the VRCM
identifies a significant new barrier and/or service needed; or
ii. If there is no need to amend
the plan, prepare and submit a progress report and Authorization Request for
Vocational Rehabilitation Plan (RH-45).
C. Managing Out-Of-State
1. When the IW does not
live in Ohio, the MCO shall:
a. Assign a VRCM the IW is
in agreement with and in close proximity to the IW (The IW retains choice in
the selection of a VRCM); and
b. Ensure the VRCM is BWC
certified or at a minimum becomes enrolled to provide services under the
direction of the Ohio MCO.
2. The MCO shall only
approve payment for services provided by the assigned out-of-state VRCM.