Policy and Procedure Name:
|
Special Vocational Rehabilitation Plan Types
|
Policy #:
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VR-19-01
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Code/Rule Reference:
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R.C. 4121.61
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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-19-01, effective 08/20/18
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History:
|
Previous versions of this policy are available upon
request
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I. POLICY PURPOSE
The purpose of this policy is to ensure that vocational
rehabilitation plans that contain certain special plan types are properly managed
and facilitated.
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.
IV. POLICY
It is the policy of BWC to ensure that when the following
services are contained in a vocational rehabilitation plan, they are properly
managed and processed:
- Plans that require an extension of
reimbursable service guidelines;
- Plans that include payment of services above fee schedule;
- Plans that include service codes that have no established
fees for the identified service (i.e., services paid “by report”);
- Plans involving rehabilitation injury claims;
- Plans requiring interpreter services;
- Plans using return to work incentive services; and
- Plans developed in collaboration with the Opportunities
for Ohioans with Disabilities (OOD) agency.
V. PROCEDURE
A. Extension
of Reimbursable Service Limits
1. The MCO
shall ensure that service limits defined as ‘maximum’ in the Vocational
Rehabilitation Provider Fee Schedule are not exceeded.
2. Service
limits defined as ‘up to’ in the Vocational Rehabilitation Provider Fee
Schedule may be exceeded, with justification, as follows:
a. When the
VRCM identifies a need to extend a service which will exceed the ‘up to’
service code limit, the VRCM shall include:
i. The
justification of the service in the progress report or in the narrative of the
vocational rehabilitation plan, whichever is applicable; and
ii. The
adjusted costs and weeks on the authorization request or plan grid, whichever
is applicable.
b. The MCO
shall:
i. Review
the submitted documentation; and
ii. Enter
a claim note titled, “Service Limit WXXX Decision”, indicating approval or
denial of the extension of the service code limit. The note shall include:
a) The
service code and description of service,
b) The
justification of the decision, and
c) A
description of any extension approved.
B. Payment
of Services Above Fee Schedule for Out-of-State Providers: The MCO shall
process a request for payment of out-of-state vocational rehabilitation
services above fee schedule consistent with the procedures in the Pricing
Override Process policy and procedure, except, rather than
describing how the Miller criteria are met, the MCO shall describe the
vocational necessity of the request.
C. Plans
with Services Paid “By Report”
1. “By
Report” codes include the following:
a. W0647
Automobile repairs;
b. W0648
Physical reconditioning-unsupervised;
c. W0663
Job modifications;
d. W0665
Tools/equipment;
e. W0674
Child/dependent care;
f. W0690
Training-books, supplies and testing;
g. W0691
Remedial training;
h. W0692
Short-term training;
i. W0694
Long term training;
j. Z0600
Vocational rehabilitation program non-claimant reimbursement travel;
k. Z0601
Vocational rehabilitation program non-claimant reimbursement meals; and
l. Z0602
Vocational rehabilitation program non-claimant reimbursement lodging.
2. When
including a “By Report” code in a vocational rehabilitation plan, the VRCM
shall follow the processes detailed in Chapter 3 of BWC’s Provider
Billing and Reimbursement Manual (BRM).
3. The MCO
shall process these services consistent with the procedures in the Pricing
Override Process policy and procedure, except, instead of
including describing how Miller criteria are met, the MCO shall provide
a description of why the vocational rehabilitation service is necessary.
D. Rehabilitation
Injury Claims:
1. The DMC,
the MCO, and the VRCM from the source claim shall staff the claim and determine
if the new injury impacts the IW’s participation in vocational rehabilitation
services and whether vocational rehabilitation services will:
a. Continue
as originally approved;
b. Be
interrupted temporarily using a medical interrupt; or
c. Be
closed. If the decision is to close, the DMC shall determine if a medical hold
is appropriate.
2. If, at any
point after closure of the vocational rehabilitation case in the source claim,
vocational rehabilitation services are requested, the DMC shall determine:
a. Which
claim (source or new) has the more significant barriers to return to work; and
b. In which
claim the vocational rehabilitation case will be addressed.
E. Interpreter
Services
1. The MCO or
VRCM shall notify the DMC of any plan that will require interpreter services.
2. The DMC
shall be responsible for identifying and authorizing interpreter services
consistent with the Interpreter
and Translation Services policy and procedure, and communicating this
information to the VRCM.
3. The VRCM
shall be responsible for scheduling the interpreter at critical junctures in
the vocational rehabilitation process.
F. RTW
Incentive Services: The VRCM shall refer to Chapter 3 of the BRM for
information related to:
1. Employer
Incentive Contracts (EIC);
2. Gradual
RTW;
3. Job
Modifications;
4. On the Job
Training; and
5. Tools and
Equipment.
G. Plans
Developed in Coordination with OOD
1. When the
IW will be receiving vocational rehabilitation services through both 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. Staff the
vocational rehabilitation plan with the MCO;
c. Prepare
the final BWC vocational rehabilitation plan; and
d. Submit the
plan to the MCO with a copy of OOD’s Individualized Plan for Employment (IPE),
reflecting the services each agency is providing.
2. The MCO
shall:
a. Notify the
DMC to update the case with joint plan status upon plan approval; and
b. Reference OOD’s
IPE to ensure coordination and appropriate payment of services throughout
implementation of the vocational rehabilitation plan.