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OhioBWC - Basics: (Policy library) - File

Assignment of VRCM

Policy and Procedure Name:

Assignment of the Vocational Rehabilitation Case Manager

Policy #:

VR-01-01

Code/Rule Reference:

O.A.C. 4123-18-01

Effective Date:

10/10/16

Approved:

Deborah Kroninger, Chief of Medical Operations (Signature on file)

Origin:

Vocational Rehabilitation Policy

Supersedes:

All vocational rehabilitation policies, procedures, directives and memos regarding the assignment of the vocational rehabilitation case manager that predate the effective date of this policy and procedure.

History:

New

Review date:

10/10/19

 

 

I. Policy Purpose

 

The purpose of this policy is to ensure that:

·         The injured worker (IW) has a choice in the selection of a vocational rehabilitation case manager (VRCM);

·         The VRCM is promptly assigned; and

·         The VRCM is provided with, or can otherwise obtain, the information necessary to fulfill his or her responsibilities.

 

II. Applicability

 

This policy applies to the:

·         BWC disability management coordinators (DMC);

·         Managed care organization (MCO) staff involved in the coordination and management of the vocational rehabilitation program; and

·         VRCMs assigned by the MCO.

 

III. Definitions

 

See “Vocational Rehabilitation Definitions” in Chapter 4 of the MCO Policy Reference Guide.

 

IV. 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 choice.

 

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.

 

V. Procedure

 

A.    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.

1.    If the IW or the IW’s attorney of record (AOR) has previously indicated a choice of provider, the MCO shall confirm this choice.

2.    If no previous choice has been made by the IW, the MCO shall discuss with the IW available providers and agree on a selection.

 

B.    The MCO may close the vocational rehabilitation case, consistent with the Vocational Rehabilitation Case Closure policy, prior to assigning a VRCM if:

1.    The IW does not respond within 10 business days of the latest documented contact attempts from the MCO; or

2.    The MCO finds the IW is clearly not feasible for services; or

3.    The IW does not wish to participate.

 

C.   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 the VRCM.

1.    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.

2.    The MCO shall notify the DMC by email of the VRCM assignment and provider number. The date of the email becomes the assignment date.

 

D.   Once a VRCM has been assigned, the MCO shall forward to the VRCM a referral packet containing the following information, as applicable, to the VRCM:

1.    Claim demographics

a.    Claim number;

b.    Allowed conditions (narrative and ICD code);

c.    Date of injury (DOI);

d.    Last date worked;

e.    Occupation;

f.     Date of birth;

g.    Average weekly wage;

h.    Full weekly wage;

i.      Temporary total rate; and

2.    Claim documents

a.    First Report of an Injury, Occupational Disease or Death (FROI);

b.    Most recent Request for Temporary total Compensation (C-84);

c.    Most recent Physician’s Report of Work Ability (MEDCO-14);

d.    Most recent Mental Health Notes Summary (Non-Psychotherapy Note) (MEDCO-16), if applicable; and

e.    Most recent independent medical examination to determine the extent of disability;

f.     Job description(s) the IW held on the date of injury and/or the most recent job;

g.    Vocational rehabilitation screening tool;

h.    Complexity Factors Reporting Form (an electronic blank EXCEL format);

i.      All vocational rehabilitation initial assessments;

j.      All vocational rehabilitation closure reports; and

k.    All vocational evaluations and functional capacity exams;

3.    Complete contact information for each of the following (e.g., cell phone, fax number, email address):

a.    IW;

b.    AOR or other authorized representative, if applicable;

c.    DMC;

d.    MCO name and contact at MCO;

e.    Physician of record (POR) and contact at POR’s office;

f.     Employer of record (EOR) name and contact at EOR; and

g.    EOR third party administrator (TPA) name and contact at TPA if applicable.

4.    Vocational rehabilitation information

a.    The date the MCO is forwarding the referral packet to the VRCM;

b.    The date of referral, name of the person who initiated the referral and the reason for the referral;

c.    The basis for IW’s eligibility determination; and

d.    The basis for IW’s initial feasibility determination.

 

E.    The VRCM shall promptly review the referral packet and request any missing information from the MCO.


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