Policy and Procedure Name:
|
Assignment and Reassignment of the Vocational
Rehabilitation Case Manager
|
Policy #:
|
VR-01-01
|
Code/Rule Reference:
|
O.A.C. 4123-18-01; O.A.C. 4123-6-06.2
|
Effective Date:
|
07/01/21
|
Approved:
|
Deborah Kroninger, Chief of Medical Operations
|
Origin:
|
Vocational Rehabilitation Policy
|
Supersedes:
|
Policy # VR-01-01, effective 10/07/19
|
History:
|
Previous versions of this policy are available upon
request
|
I. POLICY PURPOSE
The purpose of this policy is to ensure that:
·
The injured worker (IW) has a choice in the selection of a
vocational rehabilitation case manager (VRCM);
·
The VRCM is promptly assigned;
·
The VRCM is provided with, or can otherwise obtain, the
information necessary to fulfill their responsibilities; and
·
A VRCM is effectively reassigned, as appropriate.
II. APPLICABILITY
This policy applies to the:
·
BWC disability management coordinators (DMC);
·
Managed care organization (MCO) staff involved in the
coordination and management of the vocational rehabilitation program; and
·
VRCMs assigned by the MCO.
III. DEFINITIONS
See Vocational Rehabilitation Definitions.
IV. POLICY
A. It
is the policy of BWC to ensure the IW is provided information regarding the
provision of vocational rehabilitation services and has the opportunity to
select a VRCM of their choosing.
B. It
is the policy of BWC to ensure the prompt assignment of a VRCM and that the
VRCM is provided with all relevant information necessary for vocational
rehabilitation planning and service delivery to the IW.
C. It
is the policy of BWC that the MCO may reassign a VRCM when there are
extraordinary circumstances justifying such a reassignment.
V. PROCEDURE
A. Assigning
a VRCM
1.
After a BWC order has been issued approving the IW’s participation in
vocational rehabilitation, the MCO shall assign the VRCM as discussed with the
IW during the referral process (See the Referrals, Eligibility and Feasibility policy
and procedure for more information).
a. Assignment
of the VRCM shall occur within three business days:
i. From
the conclusion of the appeal period; or
ii. Of
receipt of waiver for the appeal period by all parties to the claim.
b. If the
IW’s choice of providers was not verified during the MCO’s initial review of
feasibility, the MCO shall contact the IW and determine the IW’s preferred
provider within three business days of when the order becomes final.
i. If
the MCO is unable to speak with the IW, the MCO shall send a letter to the IW
requesting that the IW contact the MCO; and
ii. If
the IW does not respond to the MCO within 10 calendar days from the date the
letter was mailed to identify their choice of provider, the MCO may assign a
VRCM.
2.
If an Industrial Commission (IC) order grants the IW’s participation in
vocational rehabilitation:
a. The MCO
shall reconfirm with the IW or attorney of record (AOR) the IW’s choice of
provider; or
b. If no
previous provider choice has been discussed with the IW, the MCO shall follow
the process in V.A.1.b of this procedure.
c. It
is the responsibility of the VRCM to decline an assignment if he or she is not
reasonably able to provide appropriate and timely services.
d. The MCO
shall notify the DMC by email of the VRCM assignment and provider number. The
date of the email becomes the assignment date.
3.
Once a VRCM has been assigned, the MCO shall forward to the VRCM a
referral packet containing the following information, as applicable:
a. Claim
demographics
i. Claim
number;
ii. Allowed
conditions (narrative and ICD code);
iii. Date of
injury (DOI);
iv. Last date
worked;
v. Occupation;
vi. Date of birth;
vii. Average weekly wage;
viii. Full weekly wage; and
ix. Temporary total
rate.
b. Claim
documents
i. First
Report of an Injury, Occupational Disease or Death (FROI);
ii. Most
recent Request for Temporary Total Compensation (C-84);
iii. Most
recent Physician’s Report of Work Ability (MEDCO-14);
iv. Most recent Mental
Health Notes Summary (Non-Psychotherapy Note) (MEDCO-16), if applicable;
v. Most
recent extent of disability independent medical examination;
vi. A written job
description(s) the IW held on the date of injury and/or the most recent job;
vii. Vocational
rehabilitation screening tool;
viii. Complexity Factors Reporting Form
(an electronic blank EXCEL format);
ix. All vocational
rehabilitation initial assessments;
x. All
vocational rehabilitation closure reports; and
xi. All vocational
evaluations and functional capacity exams;
c. Complete
contact information for each of the following (e.g., cell phone, fax number,
email address):
i. IW;
ii. AOR
or other authorized representative, if applicable;
iii. DMC;
iv. MCO name and
contact at MCO;
v. Physician
of record (POR) and contact at POR’s office;
vi. Employer of record
(EOR) name and contact at EOR; and
vii. EOR third party
administrator (TPA) name and contact at TPA if applicable.
d. Vocational
rehabilitation information
i. The
date the MCO is forwarding the referral packet to the VRCM;
ii. The
date of referral, name of the person who initiated the referral and the reason
for the referral;
iii. The basis
for IW’s eligibility determination; and
iv. The basis for
IW’s initial feasibility determination.
4.
The VRCM shall promptly review the referral packet and request any
missing information from the MCO.
B. Reassigning
a VRCM
1.
Any request for reassignment of the VRCM, from whatever source, shall be
addressed by the MCO.
a. The DMC or
any other BWC staff shall forward any request for VRCM reassignment, from
whatever source, to the MCO.
b. The MCO
may also initiate a VRCM reassignment.
2.
The MCO may reassign the VRCM when extraordinary circumstances exist
that justify the reassignment. Examples of extraordinary circumstances may
include, but are not limited to:
a. The IW
moving to a different area;
b. The IW threatening
the VRCM;
c. The
VRCM being unavailable for two or more weeks; or
d. The VRCM
failing to meet or maintain certification as required by the Credentialing Requirements of Providers of Vocational
Rehabilitation Services policy and O.A.C. 4123-6-06.2.
3.
If the VRCM reassignment is initiated by the MCO and is not at the
request of the IW or the VRCM, the MCO may consult with the DMC and/or the BWC
Rehabilitation Policy Unit as necessary, prior to reassigning.
4.
The IW retains choice in the selection of a VRCM and the MCO shall
ensure the IW is in agreement with the new VRCM assignment.
5.
The MCO shall enter a claim note describing the reason for reassignment
of the VRCM.
6.
Within five days of receiving notice of VRCM reassignment, the current
VRCM shall prepare and provide to the MCO a transfer summary report. This
report shall include:
a. The
current job goal;
b. IW
restrictions;
c. The
EOR contact information;
d. Training
and/or job placement status, as applicable; and
e. All
services that have been completed, to date.
7.
Within five days of assignment to the new VRCM, the MCO shall provide
the VRCM:
a. The
transfer report;
b. An updated
referral packet containing the information described in section IV.A.2, as
applicable; and
c. Any
vocational rehabilitation plans completed since the date of referral.
8.
The newly assigned VRCM shall review the referral packet, transfer
report and any additional documentation. The VRCM shall take appropriate steps,
based on where the IW is in the vocational rehabilitation process and
consistent with the applicable policy and procedure.
a. If an
assessment plan or a job retention plan has been prepared and/or begun, the
VRCM shall prepare an amended plan.
i. The
VRCM may amend the plan to reflect new or changed services; or
ii. At a
minimum, the VRCM shall provide an amended plan reflecting the new VRCM
assignment with no change in services.
b. If a
comprehensive vocational rehabilitation plan has begun, the VRCM shall:
i. Prepare
and submit an amended plan if there is a significant change in the job goal or
the VRCM identifies a significant new barrier and/or service needed; or
ii. If
there is no need to amend the plan, prepare and submit a progress report and Authorization Request for Vocational Rehabilitation Plan
(RH-45).
C. Managing
Cases Outside the Ohio Region
1.
When the IW does not live in the Ohio region, the MCO shall:
a. Assign a
VRCM that the IW is in agreement with and who is in close proximity to the IW (the
IW retains choice in the selection of a VRCM); and
b. Ensure the
VRCM is BWC certified or at a minimum becomes enrolled to provide services
under the direction of the Ohio MCO.
2.
The MCO shall only approve payment for vocational rehabilitation case
management services provided by the assigned VRCM.