Current through all regulations passed and filed through September 16, 2024
(A) When surplus funds are used, the managed
care organization (MCO)
will ensure that a vocational rehabilitation case
management provider contacts the injured worker and prepares a written
vocational rehabilitation assessment plan, comprehensive vocational
rehabilitation plan, or job retention plan for the injured worker's
acknowledgment and approval. The vocational rehabilitation case management
provider
will, where practical, consult with the injured
worker's employer, the physician of record, and others considered appropriate.
A vocational rehabilitation assessment plan may be prepared prior to the
individualized written comprehensive vocational rehabilitation plan. The
assessment plan may be up to four weeks in length, during which time the
injured worker will be actively engaged in career exploration and assessment
activities.
(B) Each written
vocational rehabilitation assessment plan
will include,
at a minimum, the following information:
(1)
The evaluation questions to be answered by the assessment;
(2) The types of services
needed to complete the assessment, including:
(a) The estimated costs for the
services;
(b) The estimated length
of time
needed to complete the services;
(c) The provider for the services;
(3) The estimated length of time
needed to complete the assessment.
(C) Each written comprehensive
vocational rehabilitation plan
will include, at a minimum, the following
information:
(1) Identification of the injured
worker's return to work goals and barriers to employment;
(2) The types of services
needed;
(3) The estimated costs;
(4) The estimated length of time
needed to attain the goals of the plan;
(5) An explanation of the specific strategies
that will be employed to assist the injured worker in returning to work. The
MCO
will
document that the return to work goal is addressed following the hierarchy of
return to work objectives set forth in rule
4123-18-02 of the Administrative
Code.
(6) The method of evaluating
services.
(D) Each
written job retention plan
will include the following information:
(1) The problems to be addressed by the
plan;
(2) The specific services
necessary for the injured worker to maintain current employment;
(3) The estimated costs for the
services;
(4) The estimated length
of time
needed to complete the services;
(5) The provider for the services.
(E) The MCO
will
oversee the development and implementation of the vocational rehabilitation
assessment plan, comprehensive vocational rehabilitation plan, or job retention
plan by the assigned vocational rehabilitation case management provider. Once a
comprehensive vocational rehabilitation plan is initiated, the MCO
will
approve a change in the assigned vocational rehabilitation case management
provider only for extraordinary circumstances.
(F) The MCO, in conjunction with the bureau,
will
close an injured worker's vocational rehabilitation assessment plan,
comprehensive vocational rehabilitation plan, or job retention plan for the
following reasons:
(1) The injured worker has
completed a vocational rehabilitation assessment plan and it is determined
further vocational rehabilitation services are not needed;
(2) The injured worker has failed to fulfill
the responsibilities outlined in the vocational rehabilitation assessment plan,
comprehensive vocational rehabilitation plan, or job retention plan;
(3) The injured worker is unable to attain
the goals of the vocational rehabilitation assessment plan, comprehensive
vocational rehabilitation plan, or job retention plan;
(4) The injured worker has refused, without
good cause, to accept an offer of employment within the vocational goal of the
comprehensive vocational rehabilitation plan;
(5) The injured worker is no longer
living;
(6) The injured worker does
not agree with the MCO's or bureau's decision to approve or deny specific
vocational rehabilitation assessment plan, comprehensive vocational
rehabilitation plan, or job retention plan services; or
(7) The claim is subsequently disallowed by
an order of the industrial commission, its district or staff hearing officers,
or by an order of the court;
(8)
The claim is settled (medical and/or indemnity);
(9) The injured worker has completed a
comprehensive vocational rehabilitation plan;
(10) The injured worker has completed a job
retention plan;
(11) The injured
worker is determined to be no longer feasible for vocational rehabilitation
services as defined in rule
4123-18-03 of the Administrative
Code.
(G) Appeals
regarding vocational rehabilitation plan closure
are governed
by the alternative dispute resolution process provided for in rule
4123-6-16 of the Administrative
Code.
