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Policy and Procedure Name:
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Case Management Follow-Up Services
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Policy #:
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VR-03-01
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Code/Rule Reference:
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O.A.C.
4123-18-08
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Effective Date:
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07/01/21
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Approved:
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Deborah Kroninger, Chief of Medical Operations
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Origin:
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Vocational Rehabilitation Policy
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Supersedes:
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Policy # VR-03-01, effective 08/20/18
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History:
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Previous versions of this policy are available upon
request
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I. POLICY PURPOSE
The purpose of this policy is to ensure the requirements for
providing follow-up vocational rehabilitation services are clearly detailed.
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
·
Vocational rehabilitation case managers (VRCM) assigned by the
MCO.
III. DEFINITIONS
See Vocational Rehabilitation Definitions.
IV. POLICY
A. When
an IW has retuned to work as a result of participating in a comprehensive
vocational rehabilitation plan, it is the policy of BWC to provide follow-up
services for a minimum of 30 days after the IW returns to work.
1.
The length of follow-up is determined by the needs of the IW to achieve
stability on the job.
2.
Follow-up services may be provided concurrent with other services (e.g.,
on the job training, gradual return to work), provided the return to work
employer is paying part of the IW’s wages.
B. Follow-up
services may be provided, as needed, when the return to work occurs during an
assessment plan, or following a job retention plan. No concurrent services
shall occur when follow-up occurs in conjunction with these plans.
C. If
the IW returns to work prior to the start of any vocational rehabilitation
plan, the case may remain open for up to two weeks to monitor the IW’s
stability on the job.
V. PROCEDURE
A. Case
Management Follow-Up Services in Comprehensive Plans
1.
When the IW returns to work, the VRCM shall submit the following to the
MCO for follow-up and any other needed return to work services:
a. Authorization
Request for Vocational Rehabilitation Plan (RH-45); and
b. Vocational
Rehabilitation Progress Report (RH-46), justifying the need for
services.
2.
If the VRCM determines that additional follow-up time is needed beyond
the initial period requested, the VRCM shall submit a new RH-45 and RH-46 to
the MCO.
B. If,
during an assessment plan or job retention plan, the VRCM determines that
follow-up services are appropriate to ensure the IW’s stability on the job, the
VRCM shall amend the assessment or job retention plan and provide
justification.
C. Upon
the IW’s return to work, the VRCM shall instruct the IW to immediately contact
the VRCM concerning any problems that might affect maintaining employment. The
VRCM shall take prompt action to resolve such issues.
D. If,
during the follow-up period, employment is not maintained, the VRCM and the MCO
shall staff the case to determine plan direction.
E. The
DMC shall ensure the IW is aware of provisions for living maintenance wage loss
if the IW appears eligible. (See the Living
Maintenance Wage Loss policy).