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OhioBWC - Basics: (Policy library) - File

Policy and Procedure Name:

Case Management Follow-Up Services

Policy #:

VR-03-01

Code/Rule Reference:

O.A.C. 4123-18-08

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 case management follow-up services 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 the requirements for providing follow-up vocational rehabilitation services are clearly detailed.

 

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

·         Vocational rehabilitation case managers (VRCM) 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 provide follow-up services to an IW that has returned to work as the result of participating in a comprehensive vocational rehabilitation plan.

 

B.    BWC will only reimburse for follow-up services when the IW returns to work as a result of the vocational rehabilitation plan, whether or not the plan was completed.

 

C.   It is the policy of BWC that follow-up services may be provided, as needed, when the return to work occurs during pre-plan or during an assessment plan, or following a job retention plan.

 

V. PROCEDURES

 

A.    The VRCM shall provide follow-up services in a comprehensive plan for as long as needed, but for not less than 30 calendar days after an IW returns to work. Follow-up services may be provided concurrent with other services (e.g., on the job training, gradual return to work).

 

B.    If the VRCM determines that post-return-to-work services are needed beyond 30 calendar days after the IW returns to work:

1.    The VRCM shall include a justification in the narrative section of the Vocational Rehabilitation Progress Report (RH-46); and

2.    The time shall be submitted on the Authorization Request for Vocational Rehabilitation Plan (RH-45).

 

C.   If the VRCM determines that follow-up services are appropriate following a return to work, during assessment plan or a job retention plan, the VRCM shall amend the assessment or job retention plan and provide justification.

 

D.   The VRCM shall instruct the IW who is returning to work to immediately contact the VRCM concerning any problems that might affect maintaining employment. The VRCM shall take prompt action to resolve such issues.

 

E.    If employment is not maintained during the follow-up period the VRCM, the MCO and the DMC shall staff the case to determine plan direction.

 

F.    The DMC shall ensure the IW is aware of provisions for living maintenance wage loss if the IW appears eligible. (See the Living Maintenance Wage Loss policy).

 

G.   For additional information regarding case management follow-up services and outcome payments refer to the “Provider Billing and Reimbursement Manual.”


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