|
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
BWC Employer Policy EP-20-01 (Transitional
Work Grants)
|
|
Effective Date:
|
01/14/2020
|
|
Approved:
|
Deborah Kroninger, Chief of Medical Operations
|
|
Origin:
|
Medical Policy
|
|
Supersedes:
|
All Medical policies, directives or memos regarding Transitional
Work Grant & Bonus Program that predate the effective date of this
policy.
|
|
History:
|
Available upon request
|
Transitional Work Grants Table of Contents
I. POLICY
PURPOSE
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 Review and Verification
D. Transitional
Work Plan Reimbursement and Implementation Funds
E. Auditing
Process of the TW Plan Review by the TMS
F. Transitional
Work Developer Review
G. MCO
Responsibilities
H. Complaints
Appendix A:
BWCWeb TW Plan Look-Up Categories
Appendix B:
TW Plan Review Criteria
Appendix C:
Grant Program Employer Reimbursements
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.
This policy and procedure complements BWC’s Transitional
Work Grants Employer Policy.
This policy applies to BWC staff, Transitional Work
Developers, Managed Care Organizations (MCOs) and employers taking part in the
Transitional Work Grant Program.
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 a percentage
of 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.
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 one-time grant, for developing a transitional work plan
(TW plan).
2. Eligibility
criteria are detailed in BWC’s Employer Services Transitional
Work Grants policy.
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 form
and complete, sign, and submit the TWG-1, according to the directions on the
form.
2. Employers
may submit supporting documentation via:
a. E-mail to:
TWSupport@bwc.state.oh.us
(the preferred method of submission);
b. Fax to: (614)
621-5758; or
c. Mail
to: BWC Transitional Work Unit, 30 West Spring Street, L-20, Columbus, Ohio
43215.
3. BWC shall
process, review, and evaluate all applications and notify the employer of a
decision.
4. Upon
approval, the employer has two years from the date of application to develop
and submit a TW plan.
5. Information
regarding employers with multiple policy numbers, as well as additional
application requirements are detailed in BWC’s Employer Services Transitional
Work Grants policy.
1. Employers
are reimbursed at a 3:1 match up to the amount of the grant award.
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 $2900;
ii. 50-199
employees: up to $5200;
iii. 200+
employees: $6300.
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 employers seventy-five percent (75%) of the final, total
out-of-pocket cost 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. $200
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
shall not exceed the amount of the employer’s grant award.
4. Implementation
fund reimbursement is subject to the 3:1 match until the balance remaining is
$200. At $200, the 3:1 match is not applied and the remaining balance may be
paid for services.
5. Complaints
a. An employer
may file a complaint with the 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.
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 shall :
a.
Meet the minimum credentials designated in OAC 4123-6-02.2 for one of the following provider
types:
i. Vocational/Medical
Case Manager;
ii. Occupational
Therapist; or
iii. Physical
Therapist
b. Complete a
Transitional
Work Developers Application (TWD-115) available on BWC’s website;
and
c. Complete
BWC-sponsored transitional work development training prior to delivering
transitional work programs.
3. Transitional
work developers shall complete a Transitional
Work Reaccreditation Application (TWD-116) and participate in a
BWC sponsored transitional work webinar every two years.
a. If
accredited between 2001 and 2006, the developer shall take a BWC-sponsored
refresher course for the current Grant Program.
b. Failure to
complete the training and retain accreditation shall result in denial of the TW
plan submitted by the employer.
4. If accredited
by BWC, developers shall be added to the Transitional Work Developer list on
BWC’s website.
The list includes the transitional work developer’s:
a. Name;
b. Service
areas;
c. Business
address;
d. E-mail
address; and
e. Phone
number.
5. Developers
that BWC determines do not meet requirements may file a grievance with the TW
Unit.
a. The TW
Unit shall investigate, and its decision shall be final.
b. Developer
applications and grievances shall be submitted via:
i. E-mail
to: TWSupport@bwc.state.oh.us
(the preferred method of submission);
ii. Facsimile
to: 614-621-5758; or
iii. Mail to: Transitional
Work Unit, BWC, 30 West Spring Street, L-20, Columbus, Ohio 43215.
1. BWC staff
shall refer to the Standard
Claim File Documentation and Altered Documents policy and
procedure for claim note requirements; and
2. Shall
follow any other specific instructions for claim notes included in this
procedure.
1. Upon
receipt of a paper application (received by mail or via fax) from an employer
for participation in the Grant Program, the TW Unit Grant Coordinator (Grant
Coordinator) shall ensure that the paper application is entered online into
BWC’s website for processing by the TW Unit Technical Medical Specialist (TMS).
2. Applications
submitted online do not require action by BWC’s TW Unit prior to processing by
BWC Employer Services.
3. If the
criteria detailed in BWC’s Employer Services Transitional
Work Grants policy 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 and Plan Status:
a) Grant
Program application status will show “Approved” (because the application passed
BWC Employer Services’ criteria);
b) 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 Plan Look-Up categories and descriptions.
4. Upon
creation of the TW Plan Look-Up shell, the system will automatically assign the
application to the TMS. The Grant Coordinator may reassign applications to
another TMS based on workload/vacation schedules.
1. Upon BWC’s
approval to participate in the Grant Program, the employer has two years from
the date of application to develop and submit a TW plan.
a. Only
developers meeting BWC eligibility requirements set forth in this policy shall
develop TW plans.
b. Employers
may request assistance locating a developer by checking the appropriate box on
the TWG-1.
c. Upon
request by the employer, BWC may assist employers in developing and/or updating
a TW plan.
i. BWC
may assist if the employer:
a) Has
multiple policy numbers approved to participate in the Grant Program and needs
assistance developing a corporate level TW plan;
b) Has been denied
participation in the Grant Program because the employer reported fewer than 11
employees on its last payroll report to BWC; or
c) Previously
received a grant from BWC for development of a TW plan and needs assistance
updating the TW plan.
ii. 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.
iii. Employers
are not eligible for reimbursement relating to BWC assistance to the employer.
2. TW Unit
staff shall 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 checklist created by the TW Unit (the link
to the 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.
d. Claims
Management System: Links approved (Grant Program) TW plan to employer claims.
3.
The Grant Coordinator shall:
a. Filter and
create a report from the TW Plan Lookup for:
i. Program
Type: Grant;
ii. Plan
Status: Expected; and
iii. Application
dates lapsed at one and two years.
b. E-mail the
employer:
i. To
determine if they are still interested in developing a grant and if so, whether
they need assistance in selecting a Transitional Work Grant Developer.
ii. If
the employer responds that they would like to opt-out of the Grant Program, or
after two years of non-response:
a) The Grant
Coordinator shall notify the TW Unit Manager; and
b) The TW
Unit manager shall remove the employer’s policy from the TW Grant screen on BWC
Rates and Payments (R&P).
i) This
action will systematically update the Application Status on the TW Plan Lookup
to “Denied”, and the Application date to the date of this decision.
ii) 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.
c. Review
TW plans submitted by employers using the criteria detailed in Appendix B of this
policy;
d. Ensure the
developer continues to meet the requirements set forth in section IV.C of
this policy;
e. Review the
TWSupport@bwc.state.oh.us
e-mail box at least twice daily;
f. Process
all TW plan documentation received via e-mail, fax or mail;
g. Send out
all correspondence relating to TW plan review and reimbursement decisions;
h. Verify
that submitted TW plans were developed by an approved developer listed on BWC’s
website;
i. Scan
documents received to UDS indexed by employer risk/policy number with a
document type selected. Available document types are as follows:
i. “TWGrant”:
Existing and new Grant Program documents; developer reimbursement documents;
ii. “TWG-1”:
Grant Program applications;
iii. “Correspond”:
Letters and correspondence to employers.
j. 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.
k. Access
BWCWeb TW Plan Look-up Grant Program to:
i. Insert
the TW plan receipt date;
ii. Update
the TW Plan Status from “Expected” to “In Process”. Changing the plan status to
“In Process” gives notice to the TMS to begin TW plan review.
l. E-mail
notice to the assigned TMS that documentation has been received;
m. Upload all
e-mail correspondence to and from the employer to the TW Support folder; and
n. Monitor BWCWeb
to ensure:
i. TMS
processing of submitted documentation:
a) If, within
five business days of the TW Work Unit updating BWCWeb Plan Status to “In
Process” there is no change in the plan status, send an e-mail to the assigned TMS
noting that paperwork was scanned into UDS and no action has been taken with
respect to the plan status.
b) If BWCWeb
Plan Status remains in “Pended” status for 30 days following the TMS updating
the plan status to “Pended”, send an e-mail to the assigned TMS noting the plan
status remains pended (a plan status is pended if the TMS needs additional
information).
ii. Transfer
of checklist information into the Transitional WorkGRANTS Reimbursement
database. An “Approved” plan status alerts the Grant Coordinator to transfer checklist
information into the database used to determine employer reimbursement.
iii. Timely
mailing of Grant Program correspondence following TMS TW plan review.
a) The Grant
Coordinator shall e-mail an approval or denial letter (as appropriate) to the
employer within five business days of the TMS updating BWCWeb Plan Status to
“Approved” or “Denied.”
b) Approval
letters shall inform employers of required reimbursement documentation.
4. The TMS
shall:
a. Within
five business days following notice by the Grant Coordinator of document receipt:
i. Review
TW plan documentation (located in the UDS system) utilizing the checklist to
determine if review criteria are met; and
ii. Update
BWCWeb Grant Program Plan Status.
b. If unable
to timely complete a review and update Plan Status, e-mail the Grant Coordinator
to notify of delay so that the Grant Coordinator may reassign the application.
c. If
the TMS determines that the TW plan meets review criteria:
i. Update
BWCWeb Grant Program Plan Status to “Approved.”
ii. The TMS
shall then review BWCWeb to determine if the employer has also submitted a
Bonus Program application.
a) If a Bonus
Program application has not been received for the present bonus period, the TMS
shall:
i) Contact
the employer’s TW coordinator via e-mail or telephone and request submission of
an online Bonus Program application;
ii) Monitor
BWCWeb for the submission of a Bonus Program application by the employer; and
iii) If/when the BWC
Plan Look-up indicates a TWB-1 Bonus Program application is received, the TMS
shall update the Bonus Program Plan Status to “Approved.”
d.
If TW plan information is missing or incomplete or does not meet
required plan criteria:
i. Update
BWCWeb Grant Program Plan Status to “Pended” and take the following actions:
a) Determine
what is needed;
b) Prepare
questions (using the checklist found on Access) addressed to the employer’s TW
coordinator;
c) Call the employer’s
TW coordinator to discuss what is needed;
d) E-mail the
questions to the employer’s TW coordinator confirming the conversation (if
applicable) or requesting information (if unable to contact TW coordinator). The
e-mail shall include the following information:
i) Timeframe
for receipt of information if the TMS is confirming information provided by
employer’s TW coordinator over the phone;
ii) Timeframe
for response to TMS’s request if no conversation with employer’s TW coordinator
occurred.
e) Save the e-mail
to UDS, if applicable.
f) If
there is no response from the employer following the first phone call or no
response to the e-mail within three business days of sending, the TMS shall:
i) Place
another call to the employer’s TW coordinator;
ii) Send
a second e-mail letter and save the e-mail to UDS; and
iii) Place written
notes in comments section of the checklist, reflecting the TMS’s attempts to
contact the employer.
ii. 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. The TMS shall contact the developer to assist in
obtaining information.
iii. If the
decision is to deny the TW plan, the TMS shall note the denial reason in the checklist
and update the BWCWeb Grant Program Plan Status to “Denied.” The Grant
Coordinator shall then send an e-mail “denial” letter to the employer’s TW
coordinator and save the letter to UDS.
5. Upon
application and TW plan approval, BWC will reimburse employers for TW plan
development costs based on reimbursement guidelines set forth in this policy.
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) Cancelled
check that has been redacted of all confidential employer information;
b) Credit
card statement that has been redacted of all confidential employer information;
or
c) Electronic
payment method.
2. To obtain
implementation fund reimbursement (if available), an employer shall 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.
3. Upon
receipt of documentation, the Grant Coordinator shall review submitted
documentation and take the following actions:
a. Scan 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 scanning 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 Grant Coordinator shall process the payment.
ii. If
all required documentation is not submitted, the Grant Coordinator shall 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).
4. TW Unit
staff shall utilize R&P for payment processing as follows:
a. Two
individuals shall 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 shall:
i. Create
an invoice in R&P for the employer; and
ii. Enter
invoice information into the system.
c. The
approver shall:
i. Review
the five reimbursement forms and documents referenced above in UDS for accuracy
and appropriateness of payment;
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 shall staff all payment
concerns with creator.
d. See Appendix B for
specific payment processing steps.
e. Following
approval, the Grant Coordinator shall 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 shall be cancelled. If contacted by the
employer, the Grant Coordinator and BWC Benefits Payable staff shall work
together to issue a replacement check.
ii. Checks
returned undelivered shall be cancelled by BWC Benefits Payable. The Grant
Coordinator and BWC Benefits Payable shall work together to determine the
appropriate address so that a replacement check can be issued.
5. The Grant
Coordinator shall monitor for employers eligible for reimbursement that have
not submitted a reimbursement request.
a. If a
reimbursement request has not been submitted, the Grant Coordinator may send an
e-mail reminder to the employer monthly or more frequently, as needed.
b. The Grant Coordinator
may solicit the assistance of the employer’s transitional work developer to
obtain the five reimbursement documents from the employer.
6. See Appendix C for specific
payment processing steps.
7. The TW Unit
manager shall investigate and respond to employer-submitted grievances relating
to TW plan development and implementation cost reimbursement.
a. The TW
Unit manager shall 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 shall notify
grievant by e-mail of the date by which a decision will be made.
c. The
TW Unit’s grievance decision shall be final.
1. The TW Unit
manager shall 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 shall 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 10-20% based on the total population of plans reviewed by the TMS
in the prior six months. If the population is less than 5 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 shall gather and analyze the data for the population of the TWG plans
that were reviewed for the final report.
4. The TW
Unit manager shall create a final executive summary and corrective action plan,
if needed, and present it to the Chief of Medical and Health Programs.
5. The TW
Unit manager shall send outcome reports to the TMS. In the event there are
problems identified, the TW Unit manager shall 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 shall be documented for comparison during the next auditing
period.
6. The TW
Unit manager shall 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
without follow-up to completion.
1. The Grant
Coordinator shall review Transitional Work Developer applications (TWD-115).
Upon receipt of the TWD-115,
the Grant Coordinator shall 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 at least two-year
intervals.
2. The Grant
Coordinator shall 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 Grant
Coordinator staff shall add the developer’s name, service areas, business
address, email 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 Grant
Coordinator shall 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 shall send an email to the applicant.
6. If an
applicant files a grievance for the denial, the TW Unit manager shall
investigate and respond to the grievance.
a. The TW
Unit manager shall send a written response via email within 10 business days of
receipt of the grievance.
b. If
additional time is required to investigate the grievance, the TW Unit manager
shall notify the grievant by e-mail of the date by which it will issue a
decision.
c. The
TW Unit grievance decision shall be final.
1. The MCO
shall 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.
1. The TW
Unit manager shall 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 shall 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 shall:
i. Forward
the complaint to BWC Employer Services; and
ii. Notify
the complainant by e-mail of such action.
b. BWC Employer
Services shall process complaints in the manner outlined BWC’s Employer
Services Transitional
Work Grants policy.
5. All decisions
of the TW Unit shall 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 shall be based on the following
criteria:
Corporate Description Criteria: In reviewing the
corporate description developed by the developer, BWC shall 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 shall 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 shall be developed
for separate locations and for workers in remote locations, if applicable. Community
resources include:
o
Physicians and physician groups in the area;
·
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 shall 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 shall 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 shall 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 shall 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 shall:
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. Once the
“ok” button is clicked, the approver is able to open the “Employer
Reimbursement” screen. The approver shall:
a. Review the
five reimbursement documents for accuracy and appropriateness of payment and
assure employer CPI information is redacted;
b. Highlight
invoice information noted; and
c. Click
the “Details” button on the screen.
5. The
“Payment Entry” screen will appear, and 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.