and Procedure Name:
Management Follow-Up Services
Kroninger, Chief of Medical Operations (Signature on file)
vocational rehabilitation policies, procedures, directives and memos
regarding case management follow-up services that predate the effective date
of this policy and procedure.
purpose of this policy is to ensure the requirements for providing follow-up
vocational rehabilitation services are clearly detailed.
policy applies to the:
disability management coordinators (DMC);
care organization (MCO) staff involved in the coordination and management of
the vocational rehabilitation program; and
rehabilitation case managers (VRCM) assigned by the MCO.
“Vocational Rehabilitation Definitions” in Chapter 4 of the MCO 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
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.”