Current through 2024-38, September 18, 2024
1.
Evaluation
and Plan
A. A provider must consider
medical evidence and information received with a referral for
evaluation.
B. If a provider finds
the employee is not suitable for employment rehabilitation services, the
provider must clearly articulate the reason(s) in the evaluation.
C. If a provider finds an employee is
suitable for employment rehabilitation services, the provider must include in
the evaluation, at a minimum, the following:
i. Clearly articulated reasons the provider
believes employment rehabilitation services are warranted;
ii. A concise summary of medical records
reviewed;
iii. The source, date,
and description of the employee's current work capacity, including
restrictions;
iv. Clearly defined
vocational goals for the employee; and
v. A detailed employment rehabilitation plan,
including a clear plan for workforce re-entry, an outline of expected costs,
and the estimated length of the plan.
D. A provider must submit the evaluation of
the employee to the Executive Director or the Executive Director's designee no
later than sixty days after the referral from the Board, unless the provider
has received an extension of time from the Executive Director or the Executive
Director's designee.
2.
Plan Implementation
A. If a plan
is implemented, the provider shall submit monthly reports to the Executive
Director or the Executive Director's designee and all interested
parties.
B. The provider shall
communicate in a timely and responsive manner with the Executive Director or
the Executive Director's designee after selection and during plan
implementation.
C. Except in cases
that lump sum settle, no later than thirty days after the conclusion of the
plan, the provider must submit a final report that indicates whether the
employee has returned to work.
i. If the
employee has returned to work, the report must indicate where the employee is
working, and how the plan resulted in that particular employment.
ii. If the employee does not return to work,
the report must indicate why the plan was unsuccessful.
D. The Employment Rehabilitation Fund is not
responsible for costs incurred after a case is lump sum settled. If the
provider was not notified of the date of the lump sum settlement, then any
costs incurred after the settlement date shall be paid by the
employer/insurer.
3.
Extension and Modification Requests; Provider
The provider may request an extension or modification of a
previously approved plan. A request must include the information required in
§2(1)(C). The provider must submit a request for an extension of time or
modification to the Executive Director or the Executive Director's designee
within 30 days of the date the plan is scheduled to end.
4.
Conflict of Interest
The provider must decline any referral to conduct an
evaluation on a case for which the provider has a conflict of interest and must
notify the Executive Director or the Executive Director's designee immediately
of such conflict.
5.
Billing
A. A provider must submit
a completed Vendor Activation/Change form or other form approved by the State
Controller to receive payment for services provided to the Board.
B. A provider must submit monthly invoices
for payment of costs and services. Invoices must include, at a minimum, dates
of service, invoice number, and provider name and address.
C. Payment for costs and services included in
a plan must be made directly to providers, unless the payor and the provider
agree otherwise.
