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

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

 

 


 

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.

 

This policy and procedure complements BWC’s Transitional Work Grants Employer Policy.

 

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 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.


 

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 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.

 

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 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.

 

C.    Transitional Work Plan Reimbursement and Implementation Funds

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. 

 

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 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.

 

V. PROCEDURE

 

A.     Standard Claim File Documentation

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.

 

B.     Grant Program Application Submission and Assignment

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.

 

C.    Transitional Work Plan Review and Verification

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.

 

D.    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)     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.

 

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

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.

 

F.     Transitional Work Developer Review

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.

 

G.    MCO Responsibilities

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.

 

H.    Complaints

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.