and Procedure Name:
Assessment and Assessment Plan
4123-18-02; O.A.C. 4123-18-04; O.A.C. 4123-18-05
Kroninger, Chief of Medical Operations
#VR-09-01, effective 10/10/16
purpose of this policy is to ensure that a thorough initial assessment is
completed, including an initial assessment report and an assessment plan, when
policy applies to the:
disability management coordinators (DMCs);
care organization (MCO) staff involved in the coordination and management of
the vocational rehabilitation program; and
rehabilitation case managers (VRCMs) assigned by the MCO.
“Vocational Rehabilitation Definitions” in Chapter 4 of the MCO Policy
It is the
policy of BWC that a thorough initial assessment will be conducted to develop
information and make recommendations to best serve the vocational needs of the injured
A. Initial Assessment Contacts
1. The VRCM shall contact
the IW, the employer of record (EOR), the physician of record (POR), and the
MCO. The VRCM may contact other people, as needed, who may provide information
related to the IW’s vocational needs.
a. The VRCM shall use all
contacts as a means of establishing a good working relationship that will aid
in the sharing of information and generally contribute to the IW’s successful
b. The VRCM shall ensure
that a proper authorization to release information is signed by the IW before
contacting the POR or any other provider.
c. The VRCM shall document
the time and date of each contact or attempted contact, the name of the person
contacted and the information received.
d. If, for any reason, a
required contact cannot be made (e.g., the EOR is out of business), the VRCM
shall clearly document the circumstances.
2. IW Contact – The VRCM
shall contact the IW within five (5) days of case assignment to schedule a
face-to-face initial interview. The VRCM shall gather the following information
and/or documents, if not already in the vocational documents, during this
interview (not an exhaustive list):
a. The IW’s hard copy
signature on the Rehabilitation Agreement (RH-1) acknowledging the IW’s
interest in vocational rehabilitation services;
b. Any medication usage,
prescribed or over-the-counter, frequency, dose and prescribing source;
c. Demographics (e.g.,
age, marital status, number of dependents, transportation issues);
e. Employment history (e.g.,
previous employment, job descriptions, reasons for leaving any prior
employment, union affiliations, military service);
f. Legal considerations (e.g.,
arrests, convictions, pending legal matters, non-citizen work status);
g. Medical concerns (e.g.,
abilities and limitations, unrelated medical or mental conditions, medical
h. Financial disincentives
(e.g., other financial benefits, other household income);
i. BWC Information (e.g.,
any previous claims, pending hearings); and
rehabilitation participation information (e.g., any previous vocational
rehabilitation including participation through other agencies).
3. Employer Contact
a. The VRCM shall,
whenever reasonably possible, visit the EOR or current employer’s worksite and
meet with the employer representative responsible for decisions regarding the
IW’s work status.
b. If a visit to the
employer is not reasonably possible, the VRCM shall make telephone contact.
c. The VRCM shall:
i. View and/or obtain a
detailed description of the work environment and job tasks performed by the IW
in order to determine if job modifications or alternative jobs may be available
to the IW;
ii. Discuss opportunities
for transitional work, RTW and/or other services with the employer
iii. Obtain information
about the IW’s work strengths.
4. POR Contact – The POR
shall be contacted, preferably in person.
a. The VRCM shall obtain
from the POR any documentation of:
i. The IW’s current
physical restrictions related to the allowed conditions;
ii. Current medications;
iii. Any needed prescription
for plan services.
b. The VRCM shall discuss
with the POR:
i. The IW’s medication
usage and specifically how this may impact the IW’s ability to perform specific
work tasks (e.g., operate machinery, drive);
ii. The IW’s restrictions
as they relate to the IW’s targeted job goal, using the job description or job
iii. The RTW options
available through the employer, including transitional work or other early RTW
iv. The IW’s ability to
participate in vocational rehabilitation services.
5. MCO Contact – The VRCM
shall contact the MCO to:
a. Obtain any recent
information received in the claim, especially any recent treatment requests and
b. Obtain feedback
regarding vocational rehabilitation services for the IW;
c. Obtain assistance with
gathering information from medical providers or the EOR, if needed; and
d. Staff current strategy
6. Attorney of Record
(AOR) Contact – The VRCM shall contact the AOR, if applicable, to:
a. Update the AOR on the status
of the initial assessment and recommendations;
b. Provide contact
c. Obtain AOR input; and
d. Enlist AOR assistance
with the IW, if necessary.
B. Complexity Factors:
Throughout the initial assessment phase, the VRCM shall begin identifying the
barriers and issues that create complexity in the case and noting these issues
on the Complexity Factors Reporting Form.
C. The Initial Assessment
1. Job Retention: The VRCM
is not required to complete an initial assessment report for job retention
services. The VRCM will proceed directly to a job retention plan (See the Job
Retention Plan Development and Implementation policy and procedure for
2. Except for job
retention services, the VRCM shall, within twenty-one (21) days of an
assignment, complete and submit to the MCO an initial assessment report using
the Vocational Rehabilitation Initial Assessment Report (RH-42). The
a. Summarize and document
the current vocational factors identified by the VRCM;
b. Identify vocational
barriers and strengths;
c. Identify additional
vocational questions, if any; and
d. Include a
i. Case closure; or
ii. Development of an
assessment plan to answer any identified questions and/or obtain additional
iii. Development of a
comprehensive vocational plan.
3. The MCO shall ensure
that the initial assessment report is provided on the current form and
submitted within 21 days of assignment.
4. If the report cannot be
completed within the 21-day timeframe, the VRCM shall submit to the MCO a
written justification for the delay, the current status and the projected
submission date for the report.
5. The MCO shall confirm
a. The initial assessment
report is reasonably based and that any subjective inferences are substantiated
with an objective behavioral description;
authorizations for the release of information were signed by the IW before the
VRCM contacted the POR and any other providers;
c. The VRCM submits the
initial assessment report before any plan services are authorized or delivered;
d. The Rehabilitation
Agreement (RH-1) and the authorization for release of information are
submitted no later than the submission of the initial assessment report.
D. Assessment Plan
1. The VRCM and MCO shall
staff any recommendation for an assessment plan.
2. Within 28 days of assignment
and upon agreement of the MCO, the VRCM shall develop and submit the assessment
plan, using the BWC form Vocational Rehabilitation Assessment Plan
3. The VRCM shall ensure
all sections of the RH-43 are complete.
4. The VRCM shall:
a. Describe in detail each
b. The rationale for that
c. The specific questions
to be answered by the service, as applicable.
5. The VRCM may include in
the assessment plan, as appropriate, the following reimbursable services and
activities (not an exhaustive list):
a. Vocational evaluation;
b. Evaluation of
functional and physical capacity;
d. Evaluation by a
physical medicine and rehabilitation physician;
f. Work conditioning
g. Vocational screening;
h. Situational assessment;
i. Career counseling;
j. Informational interviews;
k. Pre-test for GED;
l. Job analysis;
m. Ergonomic study;
n. Transferable skills
analysis (this may be conducted by the VRCM during the initial assessment);
o. Labor market survey;
rehabilitation case management for assessment and plan development (W3000-W3040);
q. Travel; and
r. Other services as
authorized by the MCO.
6. The following are not
appropriate services for an assessment plan:
a. Employment services;
b. Work adjustment;
c. Actual training;
f. Job modifications; and
g. The provision of tools
7. The MCO shall refer to
the Special Plan Types policy
and procedure for information on:
a. Plans that require an
extension of reimbursable service guidelines;
b. Plans that include
payment of services above fee schedule;
c. Plans that include service
codes that have no established fees for the identified service (i.e., services
paid “by report”);
d. Plans involving
rehabilitation injury claims;
e. Plans requiring
interpreter services; and
f. Plans developed in
collaboration with the Opportunities for Ohioans with Disabilities (OOD)
9. The VRCM shall design
the assessment plan to be completed within 28 days.
10. The MCO shall review
the assessment plan and, if in agreement, the VRCM shall proceed with services.
11. If unusual
circumstances exist and the VRCM determines that additional assessments are
g. The VRCM shall submit
an amended assessment plan with justification for the additional services to
h. The MCO shall review
and approve or disapprove the amended assessment plan.
12. Signature Requirements
a. On an RH-43 (both the
original assessment plan and an amended assessment plan), the MCO shall require
a hard copy signature from the:
ii. MCO; and
iii. The IW within thirty
b. When the VRCM initially
receives verbal approval from the IW, the VRCM shall:
i. Initial and date the
appropriate “Plan of service approval” section, which serves to attest the verbal
approval was received from the IW awaiting the approval of the MCO; and
ii. Within 30 days of the assessment
plan start date, obtain and submit the IW’s hard copy signature to the MCO.
c. The MCO shall not
accept an email- generated (i.e., typed) signature as a hard copy signature.
The MCO shall accept a scanned document sent via fax or email which reflects a
hard copy signature.
E. Living Maintenance (LM)
1. The DMC shall evaluate
and facilitate, when appropriate, payment of LM to the IW during the IW’s
participation in an assessment plan.
2. LM shall start on the
first day of the IW’s participation in the assessment plan and continue
throughout the period the IW is participating in the assessment plan.
3. The IW may continue to
receive LM for up to 14 days following completion of the assessment plan if a
comprehensive vocational rehabilitation plan is being developed.
4. If further information
is required, the DMC shall refer to the Living Maintenance Compensation policy and procedure.
1. Within seven days of
the IW’s completion of active services in an assessment plan, the VRCM shall
complete a written employability recommendation to the MCO. (This step occurs
during the time allotted on the assessment plan for comprehensive plan
2. The employability
recommendation shall summarize and integrate results from all the assessments
completed and outline vocational rehabilitation service options including:
a. The type of assessment;
b. The provider; and
c. Recommendations as to
whether the IW is a viable candidate at this time for participation in a
comprehensive vocational rehabilitation plan for purposes of RTW.
i. If the VRCM determines
that the IW is not a viable candidate and therefore not feasible for vocational
rehabilitation services, the MCO shall follow the procedures for case closure (See
the Vocational Rehabilitation Case Closure policy and procedure).
ii. If the VRCM determines
the IW is a viable candidate, the VRCM shall outline the service options and
staff the recommendations with the MCO and otherwise follow the Comprehensive
Vocational Rehabilitation Plan and Progress Reports policy and procedure.
F. Reopened Cases
1. Cases closed during or
after the assessment plan may only be reopened with justification of
significant changes in the IW’s circumstances.
2. If a comprehensive
vocational rehabilitation plan is reopened within two months of closure due to
a rescinded closure or claim transfer, another initial assessment is not