Policy and Procedure Name:
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Initial Assessment and Assessment Plan
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Policy #:
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VR-09-01
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Code/Rule Reference:
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O.A.C.
4123-18-02; O.A.C.
4123-18-04; O.A.C.
4123-18-05
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Effective Date:
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07/01/21
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Approved:
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Deborah Kroninger, Chief of Medical Operations
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Origin:
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Vocational Rehabilitation Policy
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Supersedes:
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Policy # VR-09-01, effective 08/20/18
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History:
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Previous versions of this policy are available upon
request
|
The purpose of this policy is to ensure that a thorough
initial assessment is completed, including an initial assessment report and an
assessment plan, when needed.
This policy applies to the:
- BWC disability management coordinators (DMCs);
- Managed care organization (MCO) staff involved in the
coordination and management of the vocational rehabilitation program; and
- Vocational rehabilitation case managers (VRCMs) assigned
by the MCO.
See Vocational
Rehabilitation Definitions.
It is the policy of BWC that a thorough initial assessment
will be conducted to develop information and make recommendations to best serve
the vocational needs of the injured worker (IW).
A. Initial
Assessment Contacts
1. The VRCM shall
contact the IW, the employer of record (EOR), the physician of record (POR),
and the MCO. The VRCM may contact other people, as needed, who may provide
information related to the IW’s vocational needs.
a. The VRCM shall
use all contacts as a means of establishing a good working relationship that
will aid in the sharing of information and generally contribute to the IW’s
successful vocational outcome.
b. Before
contacting the POR or any other provider, the VRCM shall ensure that the IW has
signed a proper authorization to release information to the VRCM.
c. The VRCM
shall document each initial contact on the Vocational
Rehabilitation Initial Assessment Report (RH-42). Documentation must
include:
i. The
time and date of each initial contact;
ii. The name
of the person contacted; and
iii. A summary of the
information received.
d. If, for any
reason, a required initial contact cannot be made, the VRCM shall clearly
document on the RH-42:
i. All
attempts at establishing initial contact (i.e., the VRCM made several initial
contact attempts); or
ii. The reason
contact is not possible (e.g., the EOR is out of business).
2. IW Contact
a. The VRCM shall
contact the IW within five calendar days of case assignment to schedule a
face-to-face initial interview.
b. During this
interview, the VRCM is responsible for gathering any information relevant to
the initial assessment not already in the referral documents, including but not
limited to:
i. The
IW’s hard copy signature on the Rehabilitation
Agreement (RH-1) acknowledging the IW’s interest in vocational
rehabilitation services;
ii. Any
medication usage, prescribed or over-the-counter, frequency, dose and
prescribing source;
iii. Demographics
(e.g., age, marital status, number of dependents, transportation issues);
iv. Education;
v. Employment
history (e.g., previous employment, job descriptions, reasons for leaving any
prior employment, union affiliations, military service);
vi. Legal considerations
(e.g., arrests, convictions, pending legal matters, non-citizen work status);
vii. Medical concerns (e.g.,
abilities and limitations, unrelated medical or mental conditions, medical
insurance);
viii. Financial disincentives (e.g.,
other financial benefits, other household income);
ix. BWC Information (e.g.,
any previous claims, pending hearings); and
x. Vocational
rehabilitation participation information (e.g., any previous vocational
rehabilitation including participation through other agencies).
3. EOR Contact
a. The VRCM shall,
whenever reasonably possible, visit the EOR or current employer’s worksite and
meet with the employer representative responsible for decisions regarding the
IW’s work status.
b. If a visit to
the employer is not reasonably possible, the VRCM shall make telephone contact.
c. The VRCM
shall:
i. View
and/or obtain a detailed description of the work environment and job tasks
performed by the IW in order to determine if job modifications or alternative
jobs may be available to the IW;
ii. Discuss
opportunities for transitional work, return to work (RTW), and/or other
services with the employer representative; and
iii. Obtain
information about the IW’s work strengths.
4. POR Contact
a. The VRCM shall
make contact with the POR, preferably in person.
b. The VRCM shall
obtain from the POR any documentation of:
i. The
IW’s current physical restrictions related to the allowed conditions;
ii. Current
medications; and
iii. Any needed
prescription for plan services.
c. The VRCM
shall discuss with the POR:
i. The
IW’s medication usage and specifically how this may impact the IW’s ability to
perform specific work tasks (e.g., operate machinery, drive);
ii. The IW’s
restrictions as they relate to the IW’s targeted job goal, using the job description
or job analysis;
iii. The RTW options
available through the employer, including transitional work or other early RTW
services; and
iv. The IW’s ability to
participate in vocational rehabilitation services.
5. MCO Contact: The
VRCM shall contact the MCO to:
a. Obtain any
recent information received in the claim, especially any recent treatment
requests and their status;
b. Obtain feedback
regarding vocational rehabilitation services for the IW;
c. Obtain
assistance with gathering information from medical providers or the EOR, if
needed; and
d. Staff current
strategy and recommendations.
6. Attorney of
Record (AOR) Contact: The VRCM shall contact the AOR, if applicable, to:
a. Update the AOR
on the status of the initial assessment and recommendations;
b. Provide contact information;
c. Obtain AOR
input; and
d. Enlist AOR
assistance with the IW, if necessary.
B. Complexity
Factors: Throughout the initial assessment phase, the VRCM shall use the Complexity
Factors Reporting Form to record any barriers or issues that impact the IW’s
RTW.
C. The
Initial Assessment Report (RH-42)
1. Job Retention
Services
a. The VRCM is not
required to complete an RH-42 for job retention services.
b. After completing
all initial contacts, the VRCM shall proceed directly to completing a job
retention plan (see the Job
Retention Plan Development and Implementation policy and procedure for
further information).
2. In all other
cases, the VRCM shall complete an RH-42. When completing the RH-42, the VRCM
shall:
a. Ensure all
information is reasonably based and that any subjective inferences are
substantiated with an objective behavioral description;
b. Summarize and
document the current vocational factors identified by the VRCM;
c. Identify
current vocational barriers and strengths;
d. Identify
additional vocational questions, if any; and
e. Include a
recommendation for:
i. Case
closure; or
ii. Development
of an assessment plan to answer any identified questions and/or obtain
additional information; or
iii. Development of a
comprehensive vocational plan.
f. Hard
copy sign the RH-42.
3. Within 21 calendar
days of assignment, the VRCM shall submit to the MCO:
a. Any releases hard
copy signed by the IW;
b. The RH-1; and
c. The
completed RH-42.
4. If the RH-42
cannot be completed within the 21-day timeframe, the VRCM shall submit to the
MCO:
a. A written
justification for the delay;
b. The current
status; and
c. The
projected submission date.
5. Upon receipt of
the RH-42, the MCO shall confirm the VRCM has included all of the required
information.
6. Requesting a
Corrected RH-42
a. The MCO may
request a corrected RH-42 from the VRCM when:
i. There
is information missing from the RH-42 that was available to the VRCM at the
time the RH-42 was completed; or
ii. The RH-42
contains an error (e.g., incorrect claim number, misspelled name, incorrect
diagnosis).
b. A corrected
RH-42 is not needed when:
i. The
MCO requires additional clarifying information; or
ii. The VRCM
obtains additional relevant information following the submission of the RH-42.
c. In cases
where the VRCM is not required to submit additional information on a corrected
RH-42, the VRCM shall utilize other appropriate means to communicate this
information to the MCO (e.g., progress report, e-mail).
D. Assessment
Plan
1. The VRCM and MCO
shall staff assessment plan recommendations required by the Vocational
Rehabilitation Plan Review and Decision policy and procedure.
2. When the VRCM
identifies the need for an assessment plan, they shall develop and submit the
plan using the Vocational
Rehabilitation Assessment Plan form (RH-43) within seven calendar days
of submission of the RH-42.
3. When preparing
the RH-43, the VRCM shall:
a. Ensure all
sections of the RH-43 are complete;
b. Describe the
specific questions to be answered by the services;
c. Identify
and justify the services needed;
d. Complete the
service grid; and
e. Complete plan of
service approvals, which includes:
i. The hard
copy signature of the VRCM that prepared the RH-43 and the date; and
ii. Verification
of verbal approval by the IW.
a) The VRCM shall
obtain an updated verbal approval from the IW anytime there is a substantive
change to the RH-43 (e.g., job goal changes, adding or removing a service).
b) The VRCM is not
required to receive an updated verbal approval from the IW if the RH-43 is
being corrected for clerical errors (e.g., date corrections).
4. Assessment
services may include the following services and activities:
a. Vocational
evaluation;
b. Evaluation of
functional and physical capacity;
c. Multi-disciplinary
evaluation;
d. Evaluation by a
physical medicine and rehabilitation physician;
e. Psychological
evaluation;
f. Work
conditioning evaluation;
g. Vocational
screening;
h. Situational
assessment;
i. Career
counseling;
j. Informational
interviews;
k. Pre-test
for GED;
l. Job
analysis;
m. Ergonomic study;
n. Transferable
skills analysis (this may be conducted by the VRCM during the initial
assessment);
o. Labor market
survey;
p. Vocational
rehabilitation case management for assessment and plan development
(W3000-W3040);
q. Travel; and
r. Other
services as authorized by the MCO.
5. The following
are not appropriate services for an assessment plan:
a. Employment
services;
b. Work adjustment;
c. Actual
training;
d.
Therapy;
e. Conditioning;
f. Job
modifications; and
g. The provision of
tools and equipment.
6. Refer to the Special
Vocational Rehabilitation Plan Types policy and procedure for
information on plans:
a. That require an
extension of reimbursable service guidelines;
b. That include
payment of services above fee schedule;
c. That
include service codes that have no established fees for the identified service
(i.e., services paid “by report”);
d. Involving
rehabilitation injury claims;
e. Requiring
interpreter services; and
f. Developed
in collaboration with the Opportunities for Ohioans with Disabilities (OOD)
agency.
7. If the VRCM
cannot submit the RH-43 to the MCO within seven calendar days of RH-42
submission, the VRCM shall provide to the MCO:
a. A written
justification for the delay;
b. The current
status; and
c. The
projected submission date.
8. The MCO shall
review the RH-43 in accordance with the Vocational
Rehabilitation Plan Review and Decision policy and procedure.
9. The VRCM shall
obtain and submit to the MCO a hard copy signature on the RH-43 from the IW
within 30 days of the start of plan services.
E. Assessment
Plan Amendments
1. If unusual
circumstances exist and the VRCM determines that additional assessments are
needed, the VRCM shall submit an amended assessment plan with justification for
the additional services to the MCO so that it is received by the DMC no later
than three business days prior to the end of the previous assessment plan. This
will ensure there is no interruption in the IW’s LM payment.
2. The MCO shall
review the amended RH-43 in accordance with the Vocational
Rehabilitation Plan Review and Decision policy and procedure.
F. Living
Maintenance (LM)
1. The DMC shall
evaluate and facilitate, when appropriate, payment of LM to the IW during the
IW’s participation in an assessment plan.
2. LM shall start
on the first day of the IW’s participation in the assessment plan and continue
throughout the period the IW is participating in the assessment plan.
3. The IW may
continue to receive LM for up to 14 days following completion of the assessment
plan if a comprehensive vocational rehabilitation plan is being developed.
4. If further
information is required, refer to the Living
Maintenance Compensation policy and procedure.
1. Within seven
days of the IW’s completion of active services in an assessment plan, the VRCM
shall make a recommendation to the MCO as to whether the IW is a viable
candidate for participation in a comprehensive vocational rehabilitation plan
for purposes of RTW.
2. If the VRCM
determines the IW is a viable candidate, the VRCM shall:
a. Staff with the
MCO their employability recommendations, if required by the Vocational
Rehabilitation Plan Review and Decision policy and procedure;
b. Detail the
recommendations on the comprehensive plan; and
c. Follow the
Comprehensive
Vocational Rehabilitation Plan and Progress Reports policy and
procedure.
3. If the VRCM
determines that the IW is not a viable candidate and therefore not feasible for
vocational rehabilitation services,the VRCM shall present their recommendation to
the MCO.
a. If the MCO
agrees with the VRCM’s recommendation, the MCO and VRCM shall follow the Vocational
Rehabilitation Case Closure policy and procedure.
b. If the MCO
disagrees with the VRCM’s recommendation, the MCO and VRCM shall discuss
alternatives to case closure, including but not limited to:
i. Additional
assessments;
ii. Additional
documentation; or
iii. With the IW’s
agreement, VRCM reassignment, following the Assignment
and Reassignment of the Vocational Rehabilitation Case Manager policy
and procedure.
H. Reopened Cases
1. Cases closed
during or after the assessment plan may only be reopened with justification of
significant changes in the IW’s circumstances.
2. If a
comprehensive vocational rehabilitation plan is reopened within two months of
closure due to a rescinded closure or claim transfer, another initial
assessment is not necessary.