OhioBWC - Basics: (Policy library) - File

Policy and Procedure Name:	Transitional Work Grants
Policy #:	MP-20-01
Code/Rule Reference:	Ohio Administrative Code (OAC) 4123-17-55, 4123-6-01, 4123-6-02.2
Effective Date:	07/01/24
Approved:	Meredith Cameron, Chief of Medical Operations
Origin:	Medical Policy
Supersedes:	Policy # MP-20-01, effective 08/25/21
History:	Previous versions of this policy are available upon request

Table of Contents

II. APPLICABILITY

III. DEFINITIONS

Eligible Employer

Implementation Funds

Transitional Work (TW)

Transitional Work Developer (Developer)

Transitional Work Grant Program (Grant Program)

Transitional Work Plan (TW Plan)

IV. POLICY

A. Grant Program Eligibility

B. Grant Program Application Submission and Evaluation

C. Transitional Work Plan Reimbursement and Implementation Funds

D. Transitional Work Developer Eligibility

V. PROCEDURE

A. Standard Claim File Documentation

B. Grant Program Application Submission and Assignment

C. Transitional Work Plan Look-up

D. Transitional Work Application Approval and Denial

E. Corporate Programs

F. Monitoring TW Applications

G. Transitional Work Plan Review and Verification

H. Transitional Work Plan Reimbursement and Implementation Funds

I. Auditing Process of the TW Plan Review by the TMS

J. Transitional Work Developer Review

K. MCO Responsibilities

L. Complaints

Appendix A: BWCWeb TW Plan Look-Up Categories

Appendix B: TW Plan Review Criteria

Appendix C: Grant Program Employer Reimbursements

I. POLICY PURPOSE

The purpose of this policy is to ensure appropriate evaluation and approval of transitional work plans and ensure appropriate reimbursement for services provided by transitional work developers.

II. APPLICABILITY

This policy applies to BWC staff, Transitional Work Developers, Managed Care Organizations (MCOs) and employers taking part in the Transitional Work Grant Program.

III. DEFINITIONS

Eligible Employer: An employer that has met the BWC Employer Services eligibility criteria for participation in the Grant Program, as outlined in OAC 4123-17-55.

Implementation Funds: Funds remaining in the employer’s Grant Program account after initial reimbursement for transitional work plan development.

Transitional Work (TW): Pursuant to OAC 4123-6-01, a work-site program that provides an individualized interim step in the recovery of an injured worker with job restrictions resulting from the allowed conditions in a claim. Developed in conjunction with the employer and the injured worker, or with others as needed, including, but not limited to the collective bargaining agent (where applicable), the physician of record, rehabilitation professionals, and the managed care organization, a transitional work program assists the injured worker in progressively performing the duties of a targeted job.

Transitional Work Developer (Developer): The provider who develops the employer’s Transitional Work Grant plan.

Transitional Work Grant Program (Grant Program): A BWC program in which funds are provided to qualified employers to be used to reimburse up to the maximum award for the cost of development of a customized transitional work plan in the workplace.

Transitional Work Plan (TW Plan): A plan with the following components: corporate analysis, employer-employee relations, policies and procedures, job analysis, and program evaluation.

IV. POLICY

A. Grant Program Eligibility

1. It is the policy of BWC to provide employers who meet the criteria set forth by BWC with financial support, in the form of a grant, for developing a transitional work plan (TW plan).

2. Eligibility criteria are detailed in OAC 4123-17-55.

B. Grant Program Application Submission and Evaluation

1. Employers interested in the Grant Program must make application to BWC.

a. Employers may utilize BWC’s website to complete the Application for Transitional Work Grant Program (TWG-1) online; or

b. Print the TWG-1 and complete, sign, and submit it according to the directions on the form.

2. Employers may submit supporting documentation via:

a. E-mail to: TWSupport@bwc.ohio.gov (the preferred method of submission); or

b. Fax to: (614) 621-5758.

3. BWC will process, review, and evaluate all applications and notify the employer of a decision.

4. Upon approval, the employer has one year from the date of application to develop and submit a TW plan.

5. An employer that has multiple policy numbers must disclose all policy numbers associated with the business to BWC on the application.

C. Transitional Work Plan Reimbursement and Implementation Funds

1. Employers are reimbursed at 100%, up to the employer’s approved grant maximum.

2. Grant Program caps are based on the number of employees reported on the employer’s last payroll report to BWC.

a. Grant caps are:

i. 11-49 employees: up to $3,700;

ii. 50-199 employees: up to $6,800;

iii. 200+ employees: $8,200.

b. If the employer did not report a number of employees on the last payroll report, the number must be entered when completing the online application before the application is processed. If the number is incorrect, it may be updated when completing the online or paper application.

3. BWC will reimburse the employer for out-of-pocket costs, up to the maximum as noted in IV.C.2, the employer paid to the Transitional Work Developer (developer) for covered services, after any discounts, rebates, or other cost or price adjustments offered by the developer are applied, subject to the following limitations:

a. The maximum rate per service is:

i. $200 per hour for developer labor;

ii. $350 per job analysis.

b. Developer hours or number of job analyses per employer are not limited;

c. Ineligible or unnecessary costs are not reimbursable and include, but are not limited to:

i. Costs associated with a developer’s preparing and submitting a proposal to an employer;

ii. Travel and lodging expenses;

iii. Costs associated with development of a TW plan by a non BWC-accredited developer.

d. Reimbursement will not exceed the amount of the employer’s grant award.

4. Implementation fund reimbursement is paid at 100% until the employer’s grant funds are exhausted or the funds expire as set forth in Section IV.C.5. of this policy.

5. Grant awards expire five years from the date of the mailing of the notice of approval of the grant. Upon expiration of the grant, the remaining grant funds that were awarded but unspent are returned to BWC, and the employer can reapply.

6. Complaints

a. An employer may file a complaint with the Transitional Work Unit (TW Unit) if the TW Unit denied the TW plan submitted; or

b. The employer disputes the TW Unit reimbursement for TW plan development costs.

D. Transitional Work Developer Eligibility

1. It is the policy of BWC to require TW plans submitted as part of the Grant Program to be developed by an eligible BWC-accredited developer.

2. To be found eligible, prospective developers must:

a. Meet the minimum credentials designated in OAC 4123-6-02.2 for one of the following provider types listed in OAC 4123-17-55:

i. Vocational Rehabilitation Case Manager;

ii. Occupational Therapist; or

iii. Physical Therapist

b. Complete and submit to BWC a Transitional Work Developers Application (TWD-115); and

c. Complete BWC-sponsored transitional work development training prior to delivering transitional work programs.

3. Developers must complete and submit to BWC a Transitional Work Reaccreditation Application (TWD-116) and participate in a BWC sponsored transitional work webinar every two years.

4. If a developer does not have active BWC accreditation, BWC will not reimburse the employer for TW plans submitted by that developer.

5. If accredited by BWC, developers will be added to the Transitional Work Developer list on BWC’s website. The list includes the developer’s:

a. Name;

b. Service areas;

c. Business address;

d. E-mail address;

e. Phone number;

f. Accreditation number;

g. Class date; and

h. Expiration date.

6. Developers that BWC determines do not meet requirements may file a grievance with the TW Unit.

a. The TW Unit will investigate, and its decision will be final.

b. Developer applications and grievances will be submitted via:

i. E-mail to: TWSupport@bwc.ohio.gov (the preferred method of submission); or

ii. Fax to: 614-621-5758.

V. PROCEDURE

A. Standard Claim File Documentation

1. BWC staff will refer to the Standard Claim File Documentation and Altered Documents policy and procedure for claim note requirements; and

2. Will follow any other specific instructions for claim notes included in this procedure.

B. Grant Program Application Submission and Assignment

1. Upon receipt of a paper application from an employer for participation in the Grant Program, the TW Unit will ensure that the paper application is entered online into BWC’s website.

2. Applications submitted online do not require action by BWC’s TW Unit prior to systematic eligibility processing.

3. The employer’s application must be signed by the chief executive officer, owner or designated management representative, certifying the employer will comply with all program reauirements.

4. An employer that has multiple policy numbers must disclose all policy numbers associated with the business to BWC on the application.

C. Transitional Work Plan Look-up

1. If the criteria detailed in OAC 4123-17-55 are met, the system automatically creates a TW Plan Look-Up shell on BWCWeb.

a. The created TW Plan Look-Up notes the following:

i. Program Type (Grant Program);

ii. Application date;

iii. Application status will show “Approved” (because the application passed BWC Employer Services’ criteria);

iv. Plan status will initially be “Expected”, which means that BWC is expecting a TW plan from the Grant Program applicant.

b. Employers with multiple policy numbers must have separate TW Plan Look-Up shells for each policy number.

c. See Appendix A for detailed TW Plan Look-Up categories and descriptions.

2. Upon creation of the TW Plan Look-Up shell, the system will automatically assign the application to the Technical Medical Specialist (TMS). The TW Unit may reassign applications to another TMS based on workload/vacation schedules.

D. Transitional Work Application Approval and Denial

1. Upon BWC’s approval to participate in the Grant Program, the employer has one year from the date of application to develop and submit a TW plan.

2. Employers may request assistance locating a BWC-accredited developer by checking the appropriate box on the TWG-1.

a. BWC will supply the employer with three BWC accredited transitional work developer names that may be based on the employer’s location, the employer’s managed care organizations, or third party administrator.

b. The employer will interview and select their developer.

3. BWC will notify the employer of grant approval and the maximum amount of the grant prior to the expenditure by the employer.

4. If an employer applies for a grant and meets eligibility criteria, but funding is not available, BWC will notify the employer that:

a. The employer does not need to reapply for the grant;

b. Upon availability of funds, BWC will process the employer’s application; and

c. When funding is available, BWC will reevaluate the employer to determine if the employer continues to meet all eligibility requirements for a transitional work grant.

5. If the employer does not otherwise qualify to participate in the Grant Program according to 4123-17-55:

a. BWC will notify employers whose transitional work grant applications are denied.

b. Upon request by the employer, BWC may assist employers in developing and/or updating a TW plan.

i. BWC assistance in developing and/or updating a TW plan may include, but is not limited to:

a) Providing templates for the TW plan development;

b) Conducting workshops to train employers;

c) Phone and/or on-site consultation at BWC’s discretion;

d) Generic job analysis; and

e) Assistance implementing existing grant plans or programs.

ii. Employers are not eligible for reimbursement relating to BWC assistance to the employer.

c. An employer that BWC determines to be ineligible may reapply for a grant when eligibility is met.

E. Corporate Programs

1. If multiple policy numbers are involved, BWC will work with the employer and transitional work developer to develop a program at the corporate level.

2. The employer under the associated policy numbers, must submit an application for each associated company.

3. BWC may approve associated policy numbers for grant monies based on the corporate organization and the amount of grant money needed to complete a corporate program.

4. The Transitional Work Developer will work with the employer to determine how the employer’s companies interact in order to determine which corporate scenario applies.

a. Corporate Scenarios:

i. Employer with one policy number:

a) One policy, multiple companies, different industry types;

b) One policy, multiple companies, one department is unionized; and

c) One policy, multiple locations, same industry.

ii. Employer with multiple policy numbers:

a) Multiple policies with the same location;

b) Multiple policies with the same industry type;

c) Multiple policies with unrelated industry types; and

d) Multiple policies with different locations.

b. Transitional Work Developers must staff corporate plans with the TW Unit.

5. Multiple policies and companies which do not share resources or transitional work contact may develop separate plans.

F. Monitoring TW Applications

1. On an ongoing basis, the TW Unit will monitor grant applications approaching six months and one year from application approval without a TW plan submitted and communicate with the employer to determine interest in the program.

a. The TW Unit will create a report from the TW Plan Look-up by filtering for:

i. Program Type: Grant;

ii. Plan Status: Expected; and

iii. Application dates greater than six months.

b. For application dates greater than six months and at 12 months, the TW Unit will:

i. E-mail the employers on this report to determine if they are still interested in developing a plan, and if so, whether they require assistance in selecting a developer;

ii. Note on the report the date the e-mail was sent and the employer’s response;

iii. If the employer indicates they would like to opt-out, send an e-mail to the TW Unit manager, who will remove the employer’s policy from the TW Grant screen on BWC Rates and Payments (R&P).

a) This action will systematically update the Application Status on the TW Plan Look-Up to “Denied”, and the Application date to the date of this decision.

b) The TW Unit manager may also reactivate the application status in R&P upon notification by the employer that they want to participate in the Grant Program.

iv. If the employer indicates they are in the process of developing a transitional work plan and needs longer than one year from the application date to complete the plan, make note of the extension approval on the report so that the employer’s policy will remain active in the TW Grant screen in BWC’s R&P.

2. For application dates at 12 months with no reply, the TW Unit will:

a. E-mail the employers on this report to inform them that they are being removed from the Grant Program;

b. Note on the report the date the e-mail was sent; and

c. Notify the TW Unit manager, who will follow the procedure in Section V.F.1.b.iii above to remove the employer’s application from the system.

G. Transitional Work Plan Review and Verification

1. TW Unit staff will utilize the following programs during the review process:

a. BWCWeb: Location of TW Plan Look-Up for the Grant Program and Bonus Program.

b. Access: Location of Grant Program transitional work grant (TWG) checklist created by the TW Unit (the link to the TWG checklist on Access is located on SharePoint).

c. Universal Document System (UDS): Depository for TW plan documents, e-mails and correspondence received and sent out by the TW Unit and TMS.

2. On an ongoing basis, the TW Unit will:

a. Review the TWSupport@bwc.ohio.gov e-mail box at least twice daily;

b. Send out all correspondence relating to TW plan review and reimbursement decisions;

c. Verify that submitted TW plans were developed by an approved developer listed on BWC’s website;

d. Process all TW plan documentation received;

i. Upload documents received to UDS indexed by employer risk/policy number with a document type selected. Available document types are as follows:

a) “TWGrant”: Existing and new Grant Program documents; developer reimbursement documents;

b) “TWG-1”: Grant Program applications;

c) “Correspond”: Letters and correspondence to employers;

d) “TWB-1” if submitted: TW Bonus program application. Also notify the TW Unit manager via e-mail that the application is in the TW Support e-mail box.

ii. Ensure that a “TWG Checklist” (checklist) exists in the Access database for the employer risk/policy number noted on the submitted document(s). If no checklist exists, create the checklist so that the TMS will have a template in which to input their TW plan reviews;

iii. Provide notice to the assigned TMS that TW plan documentation has been received.

e. Upload all e-mail correspondence to and from the employer to the TW Support folder.

3. Upon notification of TW plan document receipt, the TMS will:

a. Update the TW Plan Look-Up and the TWG checklist:

i. Enter the TW plan receipt date;

ii. Update the plan status from “Expected” to “In Process”.

b. Review TW plan documentation (located in the UDS system) using the criteria detailed in Appendix B of this policy to determine if review criteria are met; and

c. If TW plan documentation is missing, incomplete, or does not meet required plan criteria:

i. Update TW Plan Look-Up status to “Pended”;

ii. Update the TWG checklist:

a) Enter the plan pending date;

b) Update the plan decision status to “Pending”;

c) Under the Pending section:

i) Click the pending checkbox;

ii) Enter the pending date;

iii) Click the checkbox to indicate the reason the plan was pended; and

iv) Enter additional comments as needed.

d) E-mail or call the employer’s TW developer to identify the needed information;

e) Save the e-mail to UDS, if applicable; and

f) If there is no response from the developer within three business days, the TMS will:

i) Phone or e-mail TW coordinator again;

ii) Save the e-mail to UDS; and

iii) Enter notes in comments section of the checklist, reflecting the TMS’s attempts to contact the developer.

iii. Staff with TW Unit manager if, after following the steps detailed above, TW plan information continues to be missing or incomplete or the TW plan does not meet required plan criteria.

iv. If missing documentation is received, follow the steps in section D.3.d. of this policy.

v. If, after discussing with the TW Unit Manager, the decision is to deny the TW plan:

a) Update the TW Plan Look-Up status to “Denied”;

b) Update the TWG checklist:

i) Enter plan decision date;

ii) Update plan decision status to “Denied”;

iii) Document the denial reason in the comments section.

c) Send an e-mail to the TW Unit Management Analyst with the policy number and policy name, noting that it is denied.

d. If the TW plan documentation meets review criteria, conduct a telephone interview with the employer’s TW coordinator:

i. Verify the employer has the information in the Employer Telephone Interview section of the TWG checklist;

ii. If a Bonus Program application (TWB-1) has not been previously submitted for all related policies:

a) Inform the employer of the program benefits and requirements; and

b) Request a TWB-1 for each policy; and

c) Supply the employer with a link and/or e-mail copy of the TWB-1.

e. Document TW plan documentation review and employer telephone interview findings in the TWG checklist.

i. Click on the checkboxes and enter information to indicate the presence of the required information;

ii. Enter the date of phone interview;

iii. Name of person interviewed; and

iv. Enter comments as needed.

f. If, after TW plan documentation review and employer telephone interview, the TMS determines that all TW plan requirements are met:

i. Update the TW Plan Look-Up plan status to “Approved.”

ii. Update the TWG checklist:

a) Change the plan decision status to “Approved;”

b) Enter the plan decision date;

c) Enter the approval date.

4. Send an e-mail to the TW Unit Management Analyst with the policy number and policy name, noting that it is ready for approval and billing. The TW Unit Management Analyst transfers the record from the TWG checklist to the Transitional WorkGRANTS Reimbursement database.

5. The TW Unit will e-mail an approval or denial letter (as appropriate) to the employer within five business days of the TMS updating TW Plan Look-Up status to “Approved” or “Denied.” Approval letters inform employers of required reimbursement documentation.

H. Transitional Work Plan Reimbursement and Implementation Funds

1. Employers may obtain reimbursement for TW plan development costs after all the following occur:

a. The employer submits the developer’s TW plan to the TW Unit;

b. BWC approves the TW plan;

c. The employer pays the developer; and

d. The employer submits the following forms (available on BWC’s website) and documentation to BWC:

i. BWC Transitional Work Grant Reimbursement Request Form (TWG-2);

ii. BWC Service Invoice;

iii. BWC Transitional Work Agreement (TWG-3);

iv. Developer invoice to employer; and

v. Employer proof of payment to the developer. Acceptable proof of payment includes:

a) Developer’s receipt showing proof of payment from the employer

b) Cancelled check that has been redacted of all confidential employer information;

c) Credit card statement that has been redacted of all confidential employer information; or

d) Electronic payment method.

2. If the employer does not exhausted all the funding BWC approved, the remaining funds are referred to as implementation funds. The implementation funds may be used to purchase additional services for implementation and improvement of the their plan.

3. The employer may subsequently submit for reimbursement of four transitional work services until the employer’s individual grant limit is reached or up to five years, as long as BWC has Transitional Work Grant funding available.

4. The reimbursement is at 100% until the remaining balance is $0.

5. The implememtation services include:

a. Update to, or additional job analysis;

b. Plan improvement;

c. Just-in-time consultation to assist employer with an injured worker in transitional work; and

d. Training of management, supervisors, and workers.

6. To obtain implementation fund reimbursement (if available), an employer will submit to the TW Unit the following documentation:

a. Description of the service provided;

b. Invoice from the developer for services provided; and

c. Verification of payment for service provided.

7. Upon receipt of documentation, the TW Unit will review submitted documentation and take the following actions:

a. Upload the documents into UDS. If an employer submits a check or credit card statement that does not have confidential information redacted, redact confidential employer information prior to uploading the document.

b. Utilize the Transitional WorkGRANTS Reimbursement database checklist to ensure all required documentation was received and input invoice information.

i. If all required documentation is submitted and payment is for allowed expenses, the TW Unit will process the payment.

ii. If all required documentation is not submitted, the TW Unit will pend payment authorization and contact the employer via e-mail noting additional documentation required for processing.

iii. If the request is for a non-allowed expense(s), deny the non-allowed reimbursement request and contact employer via e-mail noting the non-allowed expense(s).

iv. If the employer’s grant funds have expired, e-mail the employer and instruct them to submit a new application to obtain reimbursement.

a) If the employer reapplies and meets the eligibility criteria detailed in OAC 4123-17-55, the reimbursement will be processed using the funds from the new grant.

b) If the employer does not reapply or is now ineligible to receive a grant:

i) The payment will be denied; and

ii) The TW Unit will inform the employer of the denial via e-mail.

8. TW Unit staff will utilize R&P for payment processing as follows:

a. Two individuals will be responsible for processing reimbursement requests (a “creator” and a payment “approver”). The creator and approver cannot be the same person

i. The back-up for the creator is the TW Unit Management Analyst.

ii. The back-up for the approver is the manager in Benefits Payable.

b. The creator will:

i. Create an invoice in R&P for the employer; and

ii. Enter invoice information into the system.

c. Prior to processing reimbursements, the approver will:

i. Review the five reimbursement forms and documents referenced above in UDS for accuracy and appropriateness of payment under OAC 4123-17-55(C)(5)-(7);

ii. Assure the employer’s confidential personal information (CPI) is redacted by reviewing the five reimbursement documents put together by the creator and imaged in Policy UDS prior to approval of the payment invoice in Rates & Payments; and

iii. Approve payment of invoice in R&P. Approval authorizes BWC Benefits Payable to create a check and reimburse the employer. The approver will staff all payment concerns with creator.

d. See Appendix B for specific payment processing steps.

e. Following approval, the TW Unit will send a payment letter to the employer noting amount to be reimbursed and amount of funds remaining in the grant award.

i. Checks disbursed but not cashed after 90 days will be cancelled. If contacted by the employer, the TW Unit and BWC Benefits Payable staff will work together to issue a replacement check.

ii. Checks returned undelivered will be cancelled by BWC Benefits Payable. The TW Unit and BWC Benefits Payable will work together to determine the appropriate address so that a replacement check can be issued.

9. The TW Unit will monitor for employers eligible for reimbursement that have not submitted a reimbursement request.

a. If a reimbursement request has not been submitted, the TW Unit may send an e-mail reminder to the employer monthly or more frequently, as needed.

b. The TW Unit may solicit the assistance of the employer’s developer to obtain the five reimbursement documents from the employer.

10. See Appendix C for specific payment processing steps.

11. The TW Unit manager will investigate and respond to employer-submitted grievances relating to TW plan development and implementation cost reimbursement.

a. The TW Unit manager will send a written response by e-mail within 10 business days of receipt of a grievance.

b. If additional time is required to investigate a grievance, the TW Unit manager will notify grievant by e-mail of the date by which a decision will be made.

c. The TW Unit’s grievance decision will be final.

I. Auditing Process of the TW Plan Review by the TMS

1. The TW Unit manager will conduct an audit of plan reviews by the TMS to assure transitional work plans are reviewed according to the review criteria for the program.

a. The TW Unit manager will take a stratified random sampling of all TW plans submitted on a semi-annual basis (January 1 and July 1).

b. The sample size will be 10% based on the total population of plans reviewed by the TMS in the prior six months. If the population is less than 10 policies, all the policies will be audited.

2. If needed, an interim data audit and report will be conducted to determine if the metrics are appropriate.

3. The TW Unit manager will gather and analyze the data for the population of the TWG plans that were reviewed for the final report.

4. The TW Unit manager will create a final executive summary and corrective action plan, if needed, and present it to the Deputy Chief of Operations.

5. The TW Unit manager will send outcome reports to the TMS. In the event there are problems identified, the TW Unit manager will conduct one-on-one education with the TMS. One-on-one education includes:

a. E-mail documentation sent to the TMS by e-mail when there are minor errors identified; or

b. In-person corrective action when there are major errors identified. The in-person corrective action will be documented for comparison during the next auditing period.

6. The TW Unit manager will conduct an audit of timeframes to ensure that plan review is completed timely.

a. The timeframe from plan receipt date to date of approval is five days.

b. The exception to this timeframe is when the plan is pended for additional information or inability to contact employer for interview. In these cases, the plan is pended with follow-up to completion.

J. Transitional Work Developer Review

1. The TW Unit will review the Transitional Work Developer's Application (TWD-115). Upon receipt of the TWD-115, the TW Unit will determine if the applicant:

a. Meets the minimum credentials designated in OAC 4123-6-02.2 for one of the following provider types:

i. Vocational rehabilitation case manager;

ii. Occupational therapist; or

iii. Physical therapist.

b. Completes a TWD-115 and attends a BWC-sponsored transitional work developer orientation training class prior to delivering transitional work programs and in at least two-year intervals.

2. The TW Unit will notify applicants meeting developer requirements of required training by e-mail.

3. The BWC-accredited transitional work developer must complete a Transitional Work Developer Reaccreditation Application (TWD-116) and participate in a BWC webinar training at two-year intervals to remain on the BWC Accredited Transitional Work Developer list.

4. The TW Unit staff will add the developer’s name, service areas, business address, e-mail, and phone number to the BWC Accredited Transitional Work Developer list on bwc.ohio.gov following completion of a BWC-sponsored training program noted in OAC 4123-6-02.2.

5. The TW Unit will consult with the TW Unit manager if a determination is made that the applicant does not meet the criteria. If after consultation, the decision is to deny the applicant, staff will send an e-mail to the applicant.

6. If an applicant files a grievance for the denial, the TW Unit manager will investigate and respond to the grievance.

a. The TW Unit manager will send a written response via e-mail within 10 business days of receipt of the grievance.

b. If additional time is required to investigate the grievance, the TW Unit manager will notify the grievant by e-mail of the date by which a decision will be issued.

c. The TW Unit grievance decision will be final.

K. MCO Responsibilities

1. The MCO will identify employers needing a transitional work grant plan;

2. Encourage the employer to apply to BWC for a TWG; and

3. Assist the employer in hiring an eligible BWC-accredited developer.

L. Complaints

1. The TW Unit manager will investigate and respond to complaints relating to TW plan decisions and implementation cost reimbursement.

2. The TW Unit manager must provide an e-mailed response to the complainant within 10 business days of the receipt of the complaint.

3. If additional time is required to fully investigate the complaint, the TW Unit manager will notify the complainant by e-mail of the date by which a decision will be made.

4. If the complaint relates to actions taken by BWC Employer Services:

a. The TW Unit manager will:

i. Forward the complaint to BWC Employer Services; and

ii. Notify the complainant by e-mail of such action.

b. BWC Employer Services will process complaints in the manner outlined in BWC’s Employer Services General Employer Complaint Policy policy.

5. All decisions of the TW Unit will be final.

Appendix A: BWCWeb TW Plan Look-Up Categories

BWC Web TW Plan Look-up contains the following categories:

· Policy Number: Employer’s risk/policy number

· Plan Status: Status of transitional work plan. Plan status categories include:

o Expected: BWC is expecting a transitional work plan;

o In Process: TMS has received a plan and initiated review;

o Pended: TMS has reviewed transitional work plan, items are missing, and the plan is on hold awaiting additional information;

o Approved: TMS has approved transitional work plan;

o Denied: TWG 1 application is denied;

o Not Needed: Employer notified BWC that they wish to opt-out of the Grant or Bonus program;

o Remediatin [sic]: No longer utilized. Prior to 9/1/2018 it was a placeholder category created because Grant and Bonus shells were linked. Utilized when an employer submits both a Grant Program and Bonus Program application that pass BWC Employer Services’ initial screening criteria and the Grant Program TW plan review has not yet been completed.

· Plan Status Effective Date: Date any plan status above is changed;

· Plan Receipt Date: Date transitional work plan was received by BWC;

· Program Type: Grant or Bonus based on online application type *;

· Application Status: Status of Bonus or Grant Application from BWC Employer Services *;

· Application Date: Receipt date of Bonus or Grant application from employer*;

· Program Year Begin Date: Only applies to Bonus Program. Updated by Employer Services with Bonus Program begin date after R&P runs policy eligibility *.

· TW Unit Assigned: As of 9/21/2018, auto-assigned to the TMS when online application is submitted. Can be reassigned to other TW Unit staff as needed.

· Action: Tool to input actions into BWCWeb.

(*) TW Unit staff cannot update these fields.

Appendix B: TW Plan Review Criteria

Reviews of TW plans will be based on the following criteria:

Corporate Description Criteria: In reviewing the corporate description developed by the developer, BWC will consider whether the developer reviewed/addressed the following areas:

· Corporate description with analysis of the following:

o Current organizational status;

o Corporate demographic information relating to:

· Number of employees;

· Industry type;

· Job classifications;

· Union positions, if applicable;

· Multiple business locations, if any;

· Related companies and associated policy numbers, if any;

· Managed Care Organization (MCO);

· Third Party Administrator (TPA), if applicable;

o On-site interviews with employer-owners, supervisors, team leaders, union representatives, if applicable, and employees;

· Review of current corporate policies with recommendations for improvement in the following areas:

o Accident reporting;

o Modified duty program;

o Dispute procedures;

o Return to work policies;

o Americans with Disabilities Act policies;

o Training policies; and

o Safety policies.

· Transitional work grant plan objectives; and

· Barriers to transitional work plan implementation.

Management and Employee Relations Criteria: Formation of a Transitional Work/Safety Committee with participation by:

· Management;

· Union, if applicable; and

· Labor.

Policies and Procedures Criteria: A developer may use BWC’s policy and procedure templates or customize them to meet the needs of the employer but is not permitted to charge for the use of BWC templates or forms. BWC will consider whether the developer identified:

· A company transitional work coordinator;

· Employer mission statement;

· Eligibility, entry, extension and exit guidelines;

· Timeframes for implementation;

· Dispute resolution policy;

· Americans with Disabilities Act compliance and accommodation at alternate work sites, if applicable;

· Multilingual and multicultural needs;

· Interpreter Services offered or required;

· Training plan including training for the company transitional work coordinator, management, supervisors and employees. At a minimum, the following educational requirements must be met:

o Written policies that are discussed with employees prior to program initiation;

o Written course materials relating to the program provided to employees with the opportunity to review and comment or ask questions regarding the program and policies;

o A method to document employee knowledge and understanding of the program;

o Provision for employee education within six (6) weeks of employment; and

o Provision for refresher courses with educational materials on a yearly basis to all employees. The refresher course may be incorporated with annual safety training.

· Community resources and contact list provided by the developer including formal agreements with preferred community providers to provide services to the employees, a community resource list with contact names, phone and fax numbers. A different community resource directory will be developed for separate locations and for workers in remote locations, if applicable. Community resources include:

o Physicians and physician groups in the area;

o Urgent care centers and emergency departments;

o Occupational medicine and physical medicine specialists;

o Rehabilitation providers on-site and at clinics; and

o Case managers and vocational rehabilitation managers.

· Roles and responsibilities of the following:

o Managed care organization and third-party administrator, if applicable;

o Physician;

o On-site providers;

o Injured worker;

o BWC;

o Employer-transitional work coordinator; and

o Vocational rehabilitation professionals.

Job Analysis Criteria: A job analysis examining different jobs and collecting measurements while the job is being performed. A job analysis may utilize the BWC’s job analysis template, but the job analysis must be customized to meet the needs of the employer. In reviewing the job analysis developed by the developer, BWC will consider if the following criteria are met:

· A job analysis may only be performed by a BWC-certified:

o Occupational Therapist;

o Physical Therapist;

o Certified Professional Ergonomist (CPE);

o Certified Human Factors Professional (CHFP);

o Associate Ergonomics Professional (AEP);

o Associate Human Factors Professional (AHFP);

o Certified Ergonomics Associate (CEA);

o Certified Safety Professional (CSP) with “Ergonomics Specialist” designation;

o Certified Industrial Ergonomist (CIE);

o Assistive Technology Practitioner (ATP); or

o Rehabilitation Engineering Technologist (RET).

· At a minimum, the job analysis will include the following:

o The job title and summary description;

o Essential functions of the job divided into work tasks with a description of the physical demands of required tasks analyzed at the job site with the worker’s input including frequency, duration, and postures and the use of devices to measure force;

o Equipment or tools used in the job performance of each work task;

o Working environment and conditions of the job including knowledge, skill and experience generally required to perform the job.

· Repeat job analyses are prohibited unless a component of the job analysis is customized for a particular part of the job.

· All job analyses must be signed and dated by the actual servicing provider and must specify his/her credentials.

· All job analyses will be submitted to BWC for use by claims and rehabilitation staff.

Evaluation and Auditing Process Criteria: Evaluation and auditing measures the effectiveness of the Grant Program and/or Bonus Program from both the employer and employee perspective. Any of the following outcome-measures may be addressed:

· Bonus Program calculations indicating successful utilization of the TW plan in returning injured workers to work;

· Workers’ Compensation savings analysis supplied by BWC Employer Services;

· Reports supplied to the company by the MCO or TPA;

· Productivity measurements;

· Worker and management satisfaction.

Appendix C: Grant Program Employer Reimbursements

1. The creator opens the Rates and Payments program and chooses Payment Menu on TW Grant Reimbursement screen. The Employer Reimbursement menu will open. Choose “Special Payments” on the menu bar and on the drop-down menu, select “Employer Payment” then select “Employer Reimbursement” from the subsequent drop-down menu.

2. An “Employer Reimbursement – Window” will open. Enter employer’s policy number in appropriate box. If employer policy number is not noted on documentation, choose “Lookup” in top right corner of screen to find employer’s risk/policy number.

a. If employer’s TW Grant application and TW Grant plan are in “Approved” status, the “Employer Reimbursement” window will be displayed.

b. If employer’s TW Grant Plan Status is not in “Approved” status, a message will be displayed stating that the employer does not have an approved plan. No further action may be taken until TW Plan Look-up Grant Program plan status is in “Approved” Plan Status. Staff will review why the plan is not in “Approved” status.

3. At the “Employer Reimbursement” screen, the creator will click on the “create” button to create the invoice in the system on the “Payment Entry” screen (the “Payment Entry” screen provides information relating to the maximum grant allowable amount, the total grant amount paid and the remaining eligible amount). On the “Payment Entry” screen, the creator will:

a. Enter “Invoice From” and “Invoice To” information;

b. Enter Invoice Amount. The allowed amount will be calculated by the system.

c. Click the “ok” button on the screen.

4. The creator sends an e-mail to the approver with subject line stating “Invoice created for” and the policy number.

5. The approver opens the “Employer Reimbursement” screen:

a. Click on the Payment Menu;

b. Click on Special Payments;

c. Click on Employer Payments;

d. Click on Employer Reimbursement;

e. Enter the policy number;

f. Click on View;

g. Select the invoice to be paid;

h. Click on Details;

i. Compare the Employer Reimbursement - Payment Entry to the five reimbursement documents in UDS for accuracy and appropriateness of payment and assure employer CPI information is redacted;

6. The approver clicks the “Approve Invoice” button on the screen. At this point, the payment is authorized and will go through Benefits Payable batching to be paid that evening.