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OhioBWC - Basics: (Policy library) - File

Policy and Procedure Name:

Special Vocational Rehabilitation Plan Types

Policy #:

VR-19-01

Code/Rule Reference:

R.C. 4121.61

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 special vocational rehabilitation plan types 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 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.

 

II. APPLICABILITY

 

This policy applies to the:

·         BWC disability management coordinators (DMCs);

·         MCO staff involved in the coordination and management of the vocational rehabilitation program; and

·         Vocational rehabilitation case managers (VRCMs) assigned by the MCO.

 

III. DEFINITIONS

 

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

 

IV. POLICY

 

It is 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:

·         Plans developed by a vocational rehabilitation case management intern (hereinafter, intern);

·         Plans that require an extension of reimbursable service guidelines;

·         Plans involving rehabilitation injury claims;

·         Plans requiring interpreter services;

·         Plans using return to work incentive services;

·         Plans that include service codes that  have no established fees for the identified service (i.e., services paid “by report”); and

·         Plans developed in collaboration with the Opportunities for Ohioans with Disabilities (OOD) agency.

 

V. PROCEDURE

 

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 rehabilitation plan.

 

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 Intern:

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 Interpreter Services

1.    The initial staffing regarding the need for interpreter services must include the DMC and the MCO designee.

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 information.

 

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 incentive services.

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 repairs

ii.     W0648 Physical reconditioning-unsupervised

iii.    W0663 Job modifications

iv.   W0665 Tools/equipment

v.    W0674 Child/dependent Care

vi.   W0690 Training-books, supplies and testing

vii.  W0691 Remedial training

viii. W0692 Short-term training-up to one year

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 further information.

 

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 shall:

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.

2.    Throughout implementation of the vocational rehabilitation plan, the MCO shall reference OOD’s IPE to ensure coordination and appropriate payment of services.

 


 

Vocational 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 request”.

 

When requesting vocational rehabilitation policy review of a retrospective or RAW Service By Report code, please be sure to include the following:

 

Date of the request:

IW Name:

Claim Number:

Servicing Provider Name:

Service Code:

Dates of Service:

Amount Billed:

Amount MCO authorizes:

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.1@bwc.state.oh.us). 

 


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