OhioBWC - Basics: (Policy library) - File

Policy and Procedure Name:	Credentialing Requirements of Providers of Vocational Rehabilitation Services
Policy #:	VR-03-03
Code/Rule Reference:	O.A.C. 4123-6-02.2
Effective Date:	07/01/21
Approved:	Deborah Kroninger, Chief of Medical Operations
Origin:	Vocational Rehabilitation Policy
Supersedes:	Policy # VR-03-03, effective 08/20/18
History:	Previous versions of this policy are available upon request

I. POLICY PURPOSE

The purpose of this policy is to define BWC’s credentialing requirements for providers of vocational rehabilitation services.

II. APPLICABILITY

This policy applies to the:

· BWC disability management coordinators (DMCs);

· Managed care organization (MCO) staff involved in the coordination and management of the vocational rehabilitation program; and

· Vocational rehabilitation providers.

III. DEFINITIONS

See Vocational Rehabilitation Definitions.

IV. POLICY

A. Vocational Rehabilitation Case Manager (VRCM)

1. It is the policy of BWC that a VRCM must possess one of the following:

a. Certification for American Board of Vocational Experts (ABVE);

b. Occupational Health Nursing (COHN);

c. Certified Rehabilitation Counselor (CRC);

d. Certified Disability Management Specialist (CDMS);

e. Certified Vocational Evaluator (CVE);

f. Certified Rehabilitation Nurse (CRRN); or

g. Certified Case Manager (CCM).

2. Vocational rehabilitation case management services provided to the injured worker (IW) in a vocational rehabilitation plan shall be in accordance with the Ohio Revised Code, the Ohio Administrative Code, and BWC vocational rehabilitation policies and procedures.

B. Vocational Rehabilitation Case Manager Intern

1. It is the policy of BWC that vocational rehabilitation case management services may be provided by a BWC certified intern under the supervision of a properly credentialed VRCM.

2. To become a BWC certified intern the intern must:

a. Qualify to take one of the examinations required to become credentialed as a VRCM; and

b. Enroll with BWC as an intern using the Provider Enrollment and Certification (MEDCO-13) form.

i. Upon submission of the MEDCO-13, the intern will receive communication from the BWC detailing the additional documentation that must be submitted.

ii. BWC certification of an intern shall be for a period of four years, at which time BWC will terminate the intern’s provider number.

iii. BWC will not recertify an intern for any additional time-period beyond the initial four years.

3. The intern must receive his or her provider number prior to the provision of any services.

4. Fees for interns are reimbursed by BWC at 85% of the rate associated with the applicable service codes, except for mileage, which is paid at the full rate.

5. The MCO vocational rehabilitation program coordinator or other MCO staff member with equivalent credentials shall review all plans submitted by a vocational rehabilitation case manager intern.

6. Once the intern has acquired the required credentials for certification as a vocational rehabilitation case manager, the intern must re-apply with BWC for certification as a VRCM to receive full fee reimbursement and provide services beyond the four year intern enrollment.

C. MCO Vocational Rehabilitation Program Coordinator

1. It is the policy of BWC that a vocational rehabilitation program coordinator hired by an MCO on or after January 1, 2007:

a. Has one of the following certifications:

i. American Board of Vocational Experts (ABVE);

ii. Occupational Health Nursing (COHN);

iii. Certified Rehabilitation Counselor (CRC);

iv. Certified Disability Management Specialist (CDMS);

v. Certified Vocational Evaluator (CVE);

vi. Certified Rehabilitation Nurse (CRRN); or

vii. Certified Case Manager (CCM); and

b. Meets the standards for a case manager supervisor as required by the American Accreditation HealthCare Commission (also known as “URAC”); and

c. Has at least one year of field vocational rehabilitation case management experience.

2. The MCO is responsible for ensuring the vocational rehabilitation program coordinator:

a. Is trained and proficient in:

i. The BWC vocational rehabilitation program policies as contained in the MCO Policy Reference Guide (MPRG); and

ii. The applicable procedures contained in BWC’s Provider Billing and Reimbursement Manual (BRM); and

b. That the vocational rehabilitation program coordinator attends all BWC training sessions for the program coordinators.

3. The MCOs shall submit to the BWC MCO Business Unit:

a. The vocational rehabilitation program coordinator’s name, contact information and resume or curriculum vitae documenting compliance with the certification and experience requirements; and

b. Any change to this information within two business days of when the change becomes effective.

D. Employment Specialist

1. It is the policy of BWC that employment specialists must meet one of the following criteria:

a. Possession of one of the following certifications or accreditation:

i. Certification for American Board of Vocational Experts (ABVE);

ii. Certified Rehabilitation Counselor (CRC);

iii. Certified Case Manager (CCM);

iv. Certified Employment Support Professional (CESP);

v. Certification for Individual Placement and Support (CIPS)

vi. Global Career Development Facilitator (GCDF);

vii. Associate Certified Coach (ACC);

viii. Professional Certified Coach (PCC);

ix. Master Certified Coach (MCC);

x. Certified Disability Management Specialist (CDMS); or

xi. Commission on Accreditation of Rehabilitation Facilities (CARF) accreditation for employment and community services in job development or employment supports; or

b. Evidence of:

i. Completion of three or more courses, seminars or workshops prior to application for BWC certification, totaling a minimum of 80 hours and approved by BWC or an entity offering a certification referenced in Section IV.D.1.a, in at least two domain areas:

a) Job development, job placement and career and lifestyle development;

b) Vocational consultation and services for employers;

c) Professional roles and practices, ethics, and utilization of community resources; or

ii. BWC reimbursement to the provider for job placement, job development, job seeking skills training, job club, and/or job coaching services to IWs for dates of service on or before September 30, 2012. If the provider has been certified pursuant to this provision and the provider's certification subsequently lapses, the provider must thereafter meet the criteria in Sections IV.D.1.a or IV.D.1.b.i for certification or recertification.

2. Providers who have been certified pursuant to Section IV.D.1.b.i. or b.ii. must:

a. Complete thirty hours of continuing education, including three hours of ethics, every three years to maintain certification.

b. Complete their continuing education prior to the provider’s certification end date; and

c. Provide proof of completed continuing education upon BWC’s request.

E. Vocational Evaluator: It is the policy of BWC that to conduct a comprehensive vocational evaluation, the provider must possess one of the following:

1. Certified Rehabilitation Counselor (CRC);

2. Certified Vocational Evaluator (CVE);

3. Certification for American Board of Vocational Experts (ABVE); or

4. Licensed psychologist (Ph.D. or PsyD).

F. Remedial, Short, and Long Term Training

1. It is the policy of BWC that to conduct short or long term training, the provider must be:

a. Designated by the Ohio Board of Regents as a college or university;

b. Identified as an Ohio Adult Workforce Education (AWE) provider;

c. Granted a certificate of authorization from the Ohio Board of Career Colleges and Schools;

d. Approved by the appropriate state licensing board, department or commission for training in a specific field;

e. Certified as an eligible training provider by state and local Workforce Investment Boards (WIB) and the Ohio Department of Job and Family Services;

f. An apprenticeship provider identified as a Registered Apprenticeship by the U.S. Department of Labor or the Ohio State Apprenticeship Council;

g. A person who has achieved mastery of a particular field by certification, licensing or experience;

h. Chartered or certified by the Ohio Department of Education; or

i. Accredited by an accrediting body recognized by the U.S. Department of Education.

2. Short-term training may also be provided by:

a. An academic, business or trade school identified as an Adult Basic Literacy Education (ABLE) provider;

b. An instructor certified or licensed by the product’s developer, manufacturer or distributor;

c. A teacher certified by the State of Ohio;

d. A person employed as an instructor by an accredited college or school; or

e. A provider accredited by CARF International.

3. Remedial training may be provided by any provider listed in Section IV.F.1 or 2 above, other than the following:

a. An apprenticeship provider identified as a Registered Apprenticeship by the U.S. Department of Labor or the Ohio State Apprenticeship Council; or

b. A person who has achieved mastery of a particular field by certification, licensing or experience.

4. A provider who does not meet the applicable criteria of Section IV.F.1, 2, or 3 above but was reimbursed by BWC for remedial, short or long-term training for dates of service between September 1, 2009 and August 31, 2012 may continue to provide the same type(s) of training the provider was reimbursed for providing during this period.

G. Ergonomic Study and Ergonomic Implementation: It is the policy of BWC that to conduct an ergonomic study and ergonomic implementation, the provider must possess one of the following:

1. Occupational Therapist (OT);

2. Physical Therapist (PT);

3. Certified Professional Ergonomist (CPE);

4. Certified Human Factors Professional (CHFP);

5. Associate Ergonomics Professional (AEP);

6. Associate Human Factors Professional (AHFP);

7. Certified Ergonomics Associate (CEA);

8. Certified Safety Professional (CSP) with "Ergonomics Specialist" designation;

9. Certified Industrial Ergonomist (CIE);

10. Assistive Technology Practitioner (ATP); or

11. Rehabilitation Engineering Technologist (RET).

H. Career Counselor: It is the policy of BWC that to provide career counseling, the provider must possess one of the following:

1. Licensed Social Worker (LSW);

2. Licensed Independent Social Worker (LISW);

3. Licensed Professional Counselor (LPC);

4. Licensed Professional Clinical Counselor (LPCC);

5. Licensed Psychologist (Ph.D or PsyD);

6. Doctor of Medicine (MD);

7. Doctor of Osteopathic Medicine (DO); or

8. Certified Rehabilitation Counselor (CRC).

I. “Occupational Rehabilitation - Comprehensive” (also referred to as Work Hardening): It is the policy of BWC that to provide “Occupational Rehabilitation - Comprehensive” services, the provider must have valid CARF accreditation for Occupational Rehabilitation - Comprehensive services.

J. Transitional Work: It is the policy of BWC that to provide transitional work services, the provider must be a licensed occupational or physical therapist.

K. Job Analysis: It is the policy of BWC that to provide a job analysis, the provider must possess one of the following: