and Procedure Name:
Vocational Rehabilitation Plan Types
Kroninger, Chief of Medical Operations (Signature on file)
Rehabilitation policies, procedures, directives and memos regarding special
vocational rehabilitation plan types that predate the effective date of this
policy and procedure.
purpose of this policy is to ensure that in addition to appropriate managed
care organization (MCO) authorization, the disability management coordinator
(DMC) also authorizes special types of vocational rehabilitation plans prior to
the implementation of services.
policy applies to the:
disability management coordinators (DMCs);
staff involved in the coordination and management of the vocational
rehabilitation program; and
rehabilitation case managers (VRCMs) assigned by the MCO.
“Vocational Rehabilitation Definitions” in Chapter 4 of the MCO Policy
the policy of BWC to ensure the appropriateness of the following types of vocational
rehabilitation plans by requiring the DMC, in addition to the MCO, to authorize
the plans prior to implementation:
developed by a vocational rehabilitation case management intern (hereinafter,
that require an extension of reimbursable service guidelines;
involving rehabilitation injury claims;
requiring interpreter services;
using return to work incentive services;
that include service codes that have no established fees for the identified
service (i.e., services paid “by report”); and
developed in collaboration with the Opportunities for Ohioans with Disabilities
A. The VRCM shall notify
the MCO and the DMC when a vocational rehabilitation plan includes services or
otherwise meets the criteria of a special vocational rehabilitation plan type.
B. The VRCM shall not
implement services until the DMC has authorized, via email, the vocational
C. The DMC’s
authorization shall not replace appropriate authorization by the MCO, as
required by the applicable policy (i.e., Initial Assessment and Initial
Assessment Plan, Comprehensive Vocational Rehabilitation Plan and Progress
Reports and Job Retention Plan and Implementation).
D. Plans Developed by an
1. The DMC shall be
notified of the assignment of an intern at the time of assignment or transfer.
2. Prior to submitting a
vocational rehabilitation plan, the intern shall staff the plan with the DMC.
E. Extension of
Reimbursable Service Guidelines
1. The DMC, VRCM and MCO
shall staff vocational rehabilitation plans that include a service that exceeds
the service code limit or exceeds the fee schedule.
2. The DMC shall enter a
claim note indicating approval or denial of the service.
F. Rehabilitation Injury
Claims: The initial staffing of a rehabilitation injury claim shall include the
DMC and the MCO.
G. Plans Requiring
1. The initial staffing
regarding the need for interpreter services must include the DMC and the MCO
2. Once the VRCM is assigned,
the VRCM shall staff the case with the DMC prior to developing the vocational
rehabilitation plan and any amendments.
3. The DMC shall be
responsible for arranging and authorizing interpreter services at critical
junctures in the rehabilitation case, as necessary, based on on-going
communication with the MCO and assigned VRCM.
4. The DMC shall
reference the Interpreter Services policy and procedure for additional
H. Plans Using RTW
Incentive Services - Employer Incentive Contract (EIC), Gradual RTW, Work
Trial, Job Modifications, On the Job Training, and Tools and Equipment:
1. The DMC shall verify
that negotiated services comply with the requirements for return to work
2. See the Provider
Billing Reimbursement Manual (PBRM) for further information.
I. Plans with Services
Paid “By Report”
1. When including a “By
Report” code in a vocational rehabilitation plan, the VRCM shall:
a. Research the service
that is needed and the available provider for that service;
b. Document in the
vocational rehabilitation plan narrative the justification for the service and
the associated costs; and
c. Include the service
and cost of the service on the plan grid.
d. “By Report” codes
include the following:
i. W0647 Automobile
ii. W0648 Physical
iii. W0663 Job
iv. W0665 Tools/equipment
v. W0674 Child/dependent
vi. W0690 Training-books,
supplies and testing
vii. W0691 Remedial
viii. W0692 Short-term training-up to one
ix. W0694 Long term
training –over one year
2. The VRCM shall staff
the proposed service and costs with the DMC and document the outcome of the
staffing in the narrative of the vocational rehabilitation plan.
3. The DMC shall enter a
note in the claim summarizing the staffing with the VRCM and indicating DMC
support or lack of support for the service.
4. When the DMC receives
an MCO-approved authorization request with a “By Report” code from the MCO, the
DMC shall enter a rehabilitation note titled “BR code [insert appropriate code]
approval”. The note shall indicate:
a. That the service code
listed on the plan is correct;
b. The date range for
the services from the plan grid;
c. The DMC’s
authorization of the code and fee; and
d. That the code will be
payable when the MCO receives all required reports and billing documents
showing services were completed.
e. See the PBRM for
J. Plans Developed in
Coordination with the Opportunities for Ohioans with Disabilities (OOD) Agency
1. When the IW will be
receiving vocational rehabilitation services through BWC and OOD, the VRCM
a. Collaborate with OOD
in the development of each agency’s vocational rehabilitation plan, including reaching
agreement on the specific services for which each agency will be responsible;
b. Prepare the final
vocational rehabilitation plan for BWC;
c. Submit the plan to
the MCO and DMC with a copy of OOD’s Individualized Plan for Employment (IPE),
reflecting the services each agency is providing;
d. Staff the vocational
rehabilitation plan with the MCO and DMC.
implementation of the vocational rehabilitation plan, the MCO shall reference OOD’s
IPE to ensure coordination and appropriate payment of services.
Rehabilitation By Report Code Template
This is the preferred
template for requesting review of BR codes for Vocational Rehabilitation,
rather than using the Medical Policy BR/NC Code Template.
Note: If there is
already a BR Code Wxxx DMC Approval note for the service requested and
the amount authorized in the DMC note is greater than the amount of
payment the MCO is authorizing, you would simply ask to have the claim placed
on review and send the date of the DMC BR Code note to MBA with your request.
If there is already a
BR Code Wxxx DMC Approval note for the service requested and the amount
authorized in the DMC note is less than the amount of payment the MCO is
authorizing, you will need to complete the template below and include the MCO’s
explanation of its approval of the greater amount. This information would be
part of “Please explain any special conditions that apply to the current
vocational rehabilitation policy review of a retrospective or RAW Service By
Report code, please be sure to include the following:
Date of the request:
Dates of Service:
CIN #: (If the
service has already been billed this should also be included.)
Date the MCO
authorizes the plan:
Location of the
authorization: (original plan or plan amendment)
Please explain any
special conditions that apply to the current request for a “by report” note.
These requests should
be submitted to the Rehab Policy Mailbox (Policy.R.email@example.com).