Operational Guidelines. Vocational Rehabilitation Services

Transcription

1 Operational Guidelines Vocational Rehabilitation Services January 2012

2 Table of Contents 1 Introduction Purpose of this guidance document Background Purpose of vocational rehabilitation Service principles Service outcomes Service overview and high level design Service categories Overview diagram Relationships and communication Useful contact information Commencing services Client eligibility Service Delivery and Referral process Service requirements Certifying practitioners Supplier records Stand Alone Workplace Assessment Stay at Work Services Lead Supplier Co-ordination Work Readiness Services Job Placement service Sustained Employment Outcome payment Quality requirements Concurrent services Performance measurement, reporting and monitoring Key performance indicators and service monitoring

3 6.2 Supplier reporting to ACC Payment and Invoicing Electronic invoicing Purchase orders Pricing schedule explanation Timing of invoicing and payments Use of ACC logo Glossary Appendix case vignettes Case example, Stay at Work, Level Case example, Stay at Work, Level Case example, Stay at Work, Level Case example, Stay at Work, Level 4 Service Case example, Work Readiness Level Case example, Work Readiness, Level Case example, Job Brokerage

4 1 Introduction 1.1 Purpose of this guidance document These guidelines are designed to assist suppliers in implementing the requirements of the vocational rehabilitation (VR) Service Schedule. If there is a conflict or inconsistency between these operational guidelines and the Service Schedule, the Service Schedule takes precedence. If a supplier is in doubt as to the delivery of a service, please refer to the service schedule and not the operational guidelines. It is envisaged this document will be updated from time to time. 2 Background 2.1 Purpose of vocational rehabilitation The purpose of VR services is to help a client to maintain employment, obtain employment or regain or acquire vocational independence following an injury (Accident Compensation Act 2001 S80). VR services take into account the requirements of the Accident Compensation Act 2001 (the Act) and follow principles that are consistent with ACC s wider claims management systems and international best practice. 2.2 Service principles The services are based on the following areas of interest and principles for vocational rehabilitation: Area of interest Guiding principles and requirements Overarching strategy Recovery is best achieved at work Employers have a key role Early intervention leads to faster recovery Identification and removal of barriers to return to work is essential To meet a client s needs may require working with several stakeholders Solutions based on partnerships collaboration and communication Outcomes based service Minimise fragmentation of service delivery Suppliers positively represent ACC when dealing with clients, employers and other parties Claims management system requirements Rapid triage and streaming of client to the right level of claims management service delivery model Effective communication with all stakeholders including client, employer and GP Fast, high quality decision making and rapid/early referral (into correct bands) for vocational rehabilitation intervention Holistic claim management integrated approach to all of client s rehabilitation needs Ongoing risk assessment and management Timely and outcome focused claim management Claims management has capabilities, tools and training required Performance monitoring and management Clear accountabilities for ACC staff and vocational rehabilitation providers/suppliers Outcome, timeliness and cost measures in place for both claims managers and vocational rehabilitation suppliers E-support to monitor outcomes, allow analysis and provide feedback Benchmarking and regular performance feedback provided 4

5 Area of interest Guiding principles and requirements Pricing and payment framework Supplier market and procurement approach Performance management against outcomes Relationship with providers that engages over priorities, comparative results, areas for improvement and strategic direction Promotes provider/supplier accountability for achievement of milestones and return to work outcomes Promotes service solutions/provision tailored to individual client needs Encourages and rewards good performance Reduces and manages risks of under or over servicing Promotes capability development and innovation End to end procurement process Optimal number of suppliers: o Balancing needs for geographic cover, financial sustainability, and closer ACC-supplier relationships. o Who are able to meet clients needs and agreed outcome objectives consistent with the service strategy Both suppliers and claims managers have a role to play in ensuring that the services are delivered in accordance with these principles. 2.3 Service outcomes The outcomes sought under the service are focused on maintaining employment or alternative employment options shown in the figure below: Figure 1: ACC goals for vocational rehabilitation outcomes Same job, same employer Modified job, same employer New job, same employer Priority Similar job, new employer Modified job, new employer Work ready, vocationally independent New job, new employer Maximum employment participation 3 Service overview and high level design 3.1 Service categories VR services are based on the following service categories: Stand alone workplace assessment Stay at Work service to support clients in returning to their pre-injury job Work Readiness service to support clients in becoming ready to get a job Job Placement service to support clients to find employment where: o o they are assessed through the IOA/IMA process as immediately capable of working in specific suitable employment, and ready to target those occupations or they are assessed as vocationally independent 5

6 3.2 Overview diagram The following diagram depicts the services and their outcomes. Service Level Service & Timeframe Outcome Max Stay at Work Level 1 Service for clients 2 with simple rehab needs to return to preinjury employment or temporarily modified weeks job with their current employer Stay at Work Services Stay at Work Level 2 Service for clients with risk factors or barriers to achieving Max 6 an early return to work who requires weeks rehab to return to pre-injury employment or modified job with their current employer may require an integrated multidisciplinary team Same Job, Same Employer or Modified Job, Same Employer OR New Job, Same Employer or Maximum Employment Participation Stay at Work Level 3 Service as for Max 6 Level 2 service where a client requires weeks more extensive services within the same timeframe likely to require an integrated multidisciplinary team Stay at Work Level 4 - Tailored Service for clients with complex rehab needs with multiple risk factors & barriers to achieve an early return to work. Service elements & timeframes negotiated will require an integrated multidisciplinary team (each client case is individually costed) Neg Injured worker requires vocational rehabilitation Work Readiness Services Work Readiness Level 1 Service for clients who require rehab to reach a state of work readiness where the client is not Max 8 expected to return to their pre-injury job or weeks where the client cannot maintain their current employment as a result of their injury likely to require an integrated multidisciplinary team Work Readiness Level 2 Service as for Level 1 service where a client requires more extensive services within the same timeframe will require an integrated multidisciplinary team Max 8 weeks Work Ready and vocationally independent OR New Job, new employer or Maximum Employment Participation Work Readiness Level 3 - Tailored Service for clients with complex rehab needs with multiple risk factors & barriers who will require an integrated multidisciplinary team (each client case is individually costed) Neg Stand alone workplace assessment undertaken at client s workplace to gather information about pre-injury job but client does not need a SAW Service Job Placement Services Job Brokerage Services for clients without employment who are work ready with transferable skills Job Search Services for clients without employment who have been referred following a vocational independence assessment Max 6 weeks Max 10 weeks Similar Job, New Employer or Modified Job New Employer or New Job, New Employer 6

7 3.3 Relationships and communication Relationship expectations The rehabilitation partnership between the supplier and the claims manager is one of the most important tools for ensuring the client s rehabilitation outcomes are met. The client s rehabilitation will be enhanced by the supplier and claims manager working and communicating together in a coordinated way. To be effective this relationship needs to be based on mutual respect, open communication, and clear performance expectations. There is an expectation that: suppliers and ACC staff will work together to rehabilitate the client both parties will respect each other s area of expertise suppliers are experts in the rehabilitation of injured clients and are responsible for achieving the service outcome for the client within the context of VR services (as defined in the service schedule) claims managers are expert at managing the complex mix of rehabilitation, entitlements, and compliance relating to claims and monitoring outcomes ACC is responsible for funding rehabilitation services to the extent that they are costeffective, and likely to achieve the rehabilitation outcome The supplier will nominate a person to have contact with ACC. This person will: keep ACC informed of any issues with providing assessments or treatment raise any issues with the service and suggest solutions ensure all services are carried out in accordance with the service schedule represent the supplier in service performance discussions inform ACC promptly when any contact details change 3.4 Useful contact information The following people can be contacted for any questions about the contracting process: Provider Helpline, ph: or medfees@acc.co.nz. Relationship and Performance Manager for your region (contact the Provider Helpline to obtain contact details). Contracts Administrator and Health Procurement Facilitator, ph: or health.procurement@acc.co.nz. 4 Commencing services 4.1 Client eligibility Clients are eligible for VR services if: 7

8 They are eligible to receive weekly compensation 1 ; and They are determined by ACC as requiring a vocational rehabilitation service in order to achieve a specific agreed outcome (see Figure 1) The services are likely to be cost-effective 4.2 Service Delivery and Referral process Service Delivery Most clients return to work quickly and require no assistance or only a short term minor intervention such as arranging temporary adjusted duties with an employer to ensure a safe return to work. Where a short no touch intervention is required, this is supported by the Short Term Claims Centre. Clients requiring vocational rehabilitation are streamed based on the ACC Claims Management Service Delivery Model. Risk factors are assessed and where there are clients with: No significant risk factors requiring case management and an early intervention service is required, the client will be managed by the Short Term Claims Centre Few barriers or flags to returning to work and no significant risk preventing a return to work, the client will be managed by the Short Term Claims Centre (age of claim less than 70 days) or Branch (age of claim more than 70 days) Significant barriers to rehabilitation and return to work the client will be managed by the Branch Long term vocational rehabilitation needs, serious injury or sensitive claims, these will be managed through the respective specialised claims management offices Deciding on the client outcome and time frame Vocational rehabilitation services will be provided with urgency and intensity in order to achieve optimal rehabilitation outcomes. This relies on ACC assigning clients into the correct level of service at the earliest opportunity. As part of their rehabilitation planning process, claims managers will gather information and make a determination regarding the outcomes expected for the client, the complexity of the client s need for VR services and the expected duration of work incapacity. The ACC claims manager is responsible for working with the client to determine and agree the outcome objective under one of the four service categories. The determination of which service category that will be pursued i.e. Stand Alone Work place Assessment, Stay at Work, Work Readiness or Job Placement, will be guided by the client s medical certificate and obligations under the legislation and collation of relevant information. The claims manager then develops a plan 2 with the client and identifies whether or not VR services are needed in order to achieve the desired outcome. Copies of this plan should be sent to the client s GP and their employer (if applicable) to inform them of the proposed rehabilitation. 1 The AC Act also provides for VR services to be supplied to clients who are likely, unless they have VR services, to be entitled to weekly compensation. 2 This can be a formal individual rehabilitation plan as required by the AC Act or it can be an informal plan agreed with the client and documented as part of the claim record (e.g. an action plan). Work readiness and job placement service level decisions are a process set out in legislation, based on the results of the IOA/IMA, and the claims manager s followup with the client in agreeing the formal Individual Rehabilitation Plan (IRP). 8

9 Where the claims manager decides that a VR service is required to achieve the desired outcome the claims manager determines the level of service required based on the information available to them regarding the barriers to RTW and the duration and intensity of effort required for their rehabilitation. Services are not designed for clients to move through the process multiple times or receive any form of extension to the service pathway chosen 3. For example a client who should be referred to a SAW level 2 service (see table below) should not first be referred for a SAW level 1 service. All services beyond level 1 are inclusive of the lower level services Making the referral Once it has been determined which service category and service level a client needs to achieve their outcome, the claims manager makes a referral for the identified services by: Selecting an appropriate supplier from the list of available suppliers in the client s region. The following factors are taken into account: o o o o The geographic location of the client and supplier Any known associations between the client s employer and the supplier, e.g. where an employer may engage the services of a supplier for work-related injuries Any specific skills or competencies required by the client, e.g. cultural needs, experience with specific types of claim e.g. sensitive claims, traumatic brain injury The track record of the supplier in achieving results for similar types of client Contacting the supplier to ascertain capacity to accept a referral (often this can be by telephone or ) this is optional Making the referral in writing on the appropriate template and completing all relevant information. The referral will provide details of any specific service elements that the claims manager may have identified as being required for the client s rehabilitation needs and, if relevant, supporting documentation outlining this need. For example, literacy or computer skills or development of a Tailored Plan Supplier acceptance of the referral The supplier is responsible for: Checking their capacity to provide the service in the required time frame Checking that the referral information is complete and contains all relevant information if not, returning it to the claims manager Notifying the claims manager of their acceptance of the referral or otherwise within one working day of receiving the referral. Note all referrals are expected to be accepted unless the supplier can demonstrate that they don t have capacity, there is insufficient information or there is a conflict of interest. For accepted referrals, making an initial appointment with the client 3 Services should be provided with urgency and intensity. Maximum time periods are specified within the service schedule. The claims manager may agree to extend service durations in exceptional circumstances dependent upon individual client needs. 9

10 4.2.5 What if the supplier doesn t agree with the expected outcome, timeframe or level? If, following receipt of the referral, the supplier concludes from information available that the expected outcome and/or timeframe is not achievable they should make a request to the claims manager to reconsider. Such a request should include: What the supplier considers should be the client outcome, timeframe or level; Information that supports their opinion (this may be information provided with the referral or new information identified at the initial or subsequent appointments). Such requests must be made prior to completion of the referred service. Within two working days of receiving such a request the claims manager will advise whether or not they agree with the request. If they agree to change the expected outcome, timeframe or level the claims manager advises the supplier and amends the referral details and amends the previous purchase order by deleting the original service item code and replacing with the new code. The frequency and outcomes of such requests will be monitored. If the supplier is not satisfied with the claims manager s decision relating to such a request they may: Escalate their request to the claims manager s supervisor Decline the referral where an agreement has not been reached (within two working days as to the services required) What if the service needs to go on hold for a period? Some clients who commence a service may need to have the service suspended for a period of time due to factors such as a need for treatment that cannot be delivered concurrently or a change in social circumstance that makes it impracticable to continue with rehabilitation for a short period of time (e.g. bereavement). Where this is the case the claims manager has the ability to agree extended time frames for a client and amend the purchase order time period accordingly. Services cannot be put on hold for longer than 12 weeks from date of referral acceptance 4. Where services have been placed on hold, this is inclusive within the package price. Suppliers are unable to invoice for services until the service has been completed Confirmation of Service Plan The claims manager will confirm the receipt of the service plan developed by the supplier by contacting the supplier within 2 working days to: Indicate they have seen and agree with the plan, or Indicate that they need to discuss the plan further with the supplier. It is important that the commencement of services outlined in the service plan is not delayed. Therefore, the supplier should start delivering services as soon as possible and should not wait on confirmation of agreement from a claims manager before commencing services other than for any costed elements that are paid as a fee for service within Stay at Work Level 4 services or Work Readiness Level 3 services. 4 Note that an extension of services is by exception. It would be highly irregular for a service to be put on hold for its maximum possible duration. 10

11 5 Service requirements This section expands on the service requirements listed in the service schedule. 5.1 Certifying practitioners The supplier will liaise with the general practitioner or certifying practitioner to gain approval for: The Service Plan and confirm this clearance with the claims manager. Any proposed functional rehabilitation programme not covered by the current medical certificate before the client undertakes this. Any work trial or simulated work activities not covered by the current medical certificate before the client undertakes these. Refer to Work Readiness Work Trial clearance for GP and Certifying Practitioners section of this guidance document for more detailed information. 5.2 Supplier records The supplier is required to maintain their own records of client progress which represent a running record and are in addition to ACC reporting requirements. These records are to be made available to ACC upon request. The situations where records are likely to be requested are when: Further information is required by ACC for example, for a medical case review or vocational independence decision ACC has conflicting information and would like to review a supplier s source documents. 5.3 Stand Alone Workplace Assessment A Stand Alone Workplace assessment may be requested when the client does not require any other vocational rehabilitation service but the claims manager needs detailed information about the client s pre-injury job or workplace and work task requirements to assist them with onward decision making. It is not used to determine the entry requirements or level of a Stay at Work service. The workplace assessment is a process of conducting an on-site work place evaluation in order to document the range of employment tasks and activities and must be conducted at the pre-injury workplace of the client. The client is not required to be present at the assessment, but should have been advised by the claims manager that this assessment is to take place and can request to be present, but as an observer only. The assessment should be conducted using objective assessment tools and processes as far as possible and be conducted in a safe manner. The supplier will supply a report to the claims manager on a standard reporting template in the timeframe outlined in the referral. Information sought in regard to the assessment includes: The nature and type of the business; description of job tasks and corresponding physical demands for those tasks Classification of the activity of those physical demands - Never, Occasional; Frequent, Constant. Other activities (and the Classification of Activity where it applies) and any applicable information that may be relevant to those activities, for example : o Driving: whether it is long distance; public responsibility driving; type of licence; day or night work etc 11

12 o Cognitive activities: whether the role requires an ability to remember; focus and sustain attention; concentration; undertake structured work activities; undertake mentally demanding tasks ; requires multi-tasking; ability to divide one s attention; solve problems; control emotions; work autonomously; handle pressure of work or public demands, etc o Sensory activities: whether the role requires manually operating equipment at speed; fine hand/eye co-ordination; balance, etc o Psychosocial factors such as working alone and/or in isolated or rural area, etc o Cultural factors such as language barriers, etc. o Features of the Workplace environment indoors, outdoors, noisy, chemical exposure, etc. o Equipment required to be used or worn o Any additional information requested by ACC. On receipt of the report the claims manager will review it to ensure that it is complete and informative. If further information is required the claims manager will communicate this to the supplier within 2 working days of receipt of the report. The claims manager is responsible for forwarding the assessment to the client and obtaining confirmation that it is an accurate record of their work place and job tasks. 5.4 Stay at Work Services Stay at Work Level 1 The Stay at Work level 1 service is for those clients who require simple vocational support and will require: workplace visit negotiation or liaison with the employer/gp for an early return to work and whose return to work is expected to be within 2 weeks from the date of referral. The supplier is expected to: complete an initial face to face interview with the client within 2 working days of receiving the referral at the client s workplace liaise with the certifying medical practitioner and the employer and obtain agreement to a simple return to work (RTW) plan (including a partial RTW) that is consistent with the referral return to work date and medical certifier requirements identify the functional requirements of the client s work, and their current and expected functional limitations. Identify the obstacles or barriers currently preventing recovery at work in some capacity. Promote actions to address those obstacles or barriers so that recovery at work can begin provide a return to work plan on the Stay at Work Level 1 template to the claims manager within 2 working days of referral acceptance identify any additional support the client may need to support early RTW and report this to the claims manager keep the claims manager informed where progress is not as expected any non-compliance must be reported immediately provide a brief written completion report to the claims manager within two working days of completion of the service using a standard ACC template. The completion report should also 12

13 outline if there is any follow-up required by ACC. For example, if the client has returned to partial pre-injury duties on pre-injury hours i.e. there are one or two normal job tasks that they are unable to perform at this stage of their recovery e.g. lifting a particularly heavy object, but there is an expectation that they will be able to resume undertaking these tasks when they have fully recovered and a timeframe has been stated for resuming these full pre-injury work tasks enter information into an electronic database (or other reporting system) to record for each client the results achieved and services provided The claims manager will: acknowledge receipt of the return to work service plan within two working days of receipt and contact the supplier to discuss any suggested changes to the plan where appropriate arrange any additional support, e.g. transport, that is agreed as necessary to support the client s return to work maintain contact with the client and the supplier as appropriate Stay at Work levels 2 and 3 The Stay at Work levels 2 and 3 are for those clients that require: ongoing vocational support due to identified risk and barriers functional or vocational rehabilitation or job modification employment maintenance support or training or a combination of both; and whose return to work is expected to be within 6 weeks from the date of referral Note: Stay at Work Level 3 clients are expected to require a more extensive combination of function and/or vocational rehabilitation delivered by a multidisciplinary team. The supplier is expected to: Prepare a service plan using the Stay at Work Level 2 and 3 template that lists activities to be undertaken and timeframes to achieve the outcome specified in the referral. Provide all of the services described in section above. Provide any of the following services that may be required or requested for level 2 or 3 clients such as: o Additional vocational rehabilitation that may include further workplace visits and more extensive monitoring, modification of the workplace or job tasks, fitting or trialling equipment. o Rehabilitation services to address functional or psychosocial barriers to RTW such as low level pain issues and related fatigue, a physical reactivation programme to increase their general fitness and contact with other treatment providers e.g. physiotherapists to ensure treatment aligns with the RTW plan. o Job maintenance activities, where the client is not fit for selected duties or there are no other duties available and the client is at risk of disengaging from their employment, such as supporting the maintenance of contact with their employer and colleagues and could also include engaging in alternative work tasks such as working alongside colleagues, attending staff meetings; staff social activities o Obtaining agreement of the medical practitioner to any proposed functional rehabilitation programme before undertaking it and liaising with the treatment provider on progress, where applicable. 13

14 o Attendance at case conferences where required by the claims manager Report progress to the claims manager at the mid-point of the programme or more frequently if there are exceptions. Provide a brief written Completion Report to the claims manager within two working days of completion of the service using a standard ACC template o This report should also outline if there is any follow-up required by ACC. For example: if client has returned to Partial pre-injury duties on pre-injury hours i.e. there are one or two normal job tasks that they are unable to perform at this stage of their recovery e.g. lifting a particularly heavy object, but there is an expectation that they will be able to resume undertaking these tasks when they have fully recovered and a timeframe for resuming these full pre-injury work tasks. if there is any reason the client has not been able to return to work and any recommendations e.g. Functional capacity evaluation or medical assessment etc. Enter information into an electronic database or other reporting system to record for each client the results achieved and services provided. The claims manager is expected to: Undertake responsibilities listed in section above Review progress reports and provide any necessary feedback to the supplier Arrange any case conferences considered necessary Stay at Work Level 4 Tailored with or without Lead Supplier services The Stay at Work Level 4 (Tailored) service is for those clients who are not expected to return to work within the usual timeframes of the lower levels of the Stay at Work services due to a number of risk factors or barriers. These clients may also require other services, not normally provided within those lower level services, which are tailored to achieve the client s individual outcome and to meet any unique identified needs. The length of service is dependent on the needs and services and timeframes for achieving the client s specific vocational rehabilitation outcome. Tailored services are planned and managed through a collaborative process between the claims manager, the certifying medical practitioner, the supplier and other suppliers. The claims manager will work with the client and their certifying medical practitioner to develop and agree the client s Individual Rehabilitation Plan. The claims manager will then determine which services are required to meet the client s needs and outline these in the referral. Options for a referral for a Stay at Work Level 4 (tailored) service are: A Stay at Work Level 4 service without any additional fee for service components that is used for a client requiring an extended period of vocational rehabilitation past 12 weeks from the date of referral acceptance by the supplier (i.e. a slower programme of rehabilitation but not more services). A Stay at Work Level 4 service with additional services required that will be paid on a fee for service basis including where there may be additional hours to ensure liaison and monitoring of the progress of any activities the client may be undertaking or may be engaging in within the SAW return to work plan that extends the duration of services e.g. attending community funded computer courses. 14

15 A Stay at Work Level 4 service with or without additional services paid under a fee for service and a referral for the supplier to act as a Lead Supplier (Refer section 5.5.Lead Supplier Co-ordination) Development of the SAW Level 4, Tailored Plan The supplier will work collaboratively with the claims manager to agree the content of the tailored return to work plan as it applies to them as a supplier (including where the supplier is a lead supplier). This Tailored Plan should be developed and completed within 4 working days of the receipt of the referral. This will include specifying the additional services with timeframes and any fee for service costs that require approval by the claims manager including additional services and /or time required for lead supplier co-ordination. The Stay at Work Level 4 Tailored Plan will be completed using the ACC template and includes: other services that are reasonable and necessary relevant rationale, goals and activities related to those other services appropriate monitoring, milestones/ progress dates dates outcomes are to be achieved and measures of achievement any client specific activities linked to goal achievement any other service supports or activities that may be required e.g. case conferences any Lead Supplier Co-ordination to be undertaken, including the services to be co-ordinated, methods of co-ordination and frequency of progress reports/updates costing sheet that outlining any hours and costs (that are additional to those that are inclusive within a Stay at Work service package price) The supplier will: submit the Tailored Plan (on the standard ACC template) to the claims manager for approval ensure that services are delivered in a co-ordinated way within the optimum timeframe to achieve the outcome report progress to the claims manager as agreed in the Tailored Plan for Other Services and/or as a Lead Supplier SAW Level 4 Services Progress Reporting The supplier will submit Progress Reports for Stay at Work Level 4 services to the claims manager in the agreed timeframes and should outline: an overview of progress goals and outcomes achieved including any partial or full return to work any activities completed any new issues or barriers that have emerged The minimum progress reporting requirement is the mid-point of services, however, it is expected that more frequent progress reporting will be required for tailored services. This is outlined in the tailored plan to ensure ACC and the supplier have shared expectations around reporting. If the supplier is a Lead Supplier the progress report should also include any comments about the coordination of other services to date SAW Level 4 Plan Outcome Report. The supplier will submit a Service Outcome Report on the Stay at Work level 4 Tailored Plan Completion Report and submit it to the claims manager 2 working days after the service has been completed. The Service Outcome report will outline: 15

16 services provided goals and outcomes achieved whether the client has achieved the outcome of a full return to work in the same job and hours with the same employer as prior to injury and an explanation should this not be achieved general comments and whether there is any follow-up action required by ACC If the supplier is a Lead Supplier the report should also include any comments about the co-ordination that has been completed Other services for SAW Level 4 clients The supplier is responsible for the range of other services required within the tailored return to work plan. This may include contracting or subcontracting others to provide the range of services that are usually outside Stay at Work services but have been requested or agreed to by the claims manager to facilitate the client s vocational rehabilitation outcome. These additional services are designed to meet the client s unique identified needs and may include, for example: dietary support and/or advice cultural support social support Note: These services cannot include ACC contracted services. Those services that are normally provided by ACC contracted providers must be facilitated through the Claims Manager in the usual assessment and approval process. Consideration must also be given to whether the other services being considered for inclusion in a tailored service are of a type that can be provided under ACC legislation. There is no fee for service payable for clients who do not attend an appointment under the allowable fee for service billing. It is also important to consider community services that can provide free training/up-skilling for clients that they can complete independently as part of their Tailored Plan e.g. free community computer courses, literacy courses. 5.5 Lead Supplier Co-ordination The supplier of Stay at Work Level 4 services or Work Readiness Level 3 services may be appointed as a Lead Supplier where the claims manager may consider it is appropriate that the supplier is responsible for liaising between other ACC contracted suppliers and co-ordinating communication so that all parties are aware of the client s progress through their vocational rehabilitation. Communication by the Lead Supplier with other ACC contracted suppliers will include phone calls, s and or case conferences. Only those services that have been identified by the claims managers as relevant to and that may impact on the vocational outcome are to be included in the lead supplier arrangement. For example, a home help contracted service may not be relevant to the vocational rehabilitation supplier whereas a pain service may be. Note: The Lead Supplier is not responsible for co-ordinating the other suppliers contracted services themselves and their contractual obligations such as reports to ACC. These remain the responsibility of the other supplier. Case conferences need to be approved by the claims manager as part of the tailored plan. Case conferences attended by the VR supplier are usually inclusive within the package price and not a fee for service. Where extended timeframes for provision of services are required, then a fee for service may be applicable for additional case conferences. ACC will pay ACC contracted suppliers for their time when case conferencing. A Lead Supplier status finishes when the vocational rehabilitation service is complete, or when the claims manager determines the coordination service is no longer required. 16

17 The Lead Supplier is only responsible for the communication with these suppliers to ensure that all parties involved with the client are focused on the same outcome. In addition, any progress, lack of progress, barriers or needs can be identified in a timely way and managed to ensure a smooth and co-ordinated delivery of the client s vocationally relevant rehabilitation to ensure a return to independence. The claims manager is responsible for notifying the client s other service suppliers that there will be communication between them and the client s vocational supplier. 5.6 Work Readiness Services Determining work readiness Work ready means the client has capacity to obtain employment, or has regained or acquired vocational independence. Work readiness has a corresponding meaning. Documented evidence of the identification of barriers, activities addressing the barriers and of the client s response demonstrating work readiness is pivotal for this group of services. Currently, there is no standardised programme to facilitate work readiness. ACC would like to encourage suppliers to take a systematic, well documented approach to determining what rehabilitation is required to facilitate this goal. In the context of work readiness under vocational rehabilitation services, ACC needs to see how rehabilitation needs were identified (referring to the Initial Occupational Assessment (IOA), Initial Medical Assessment (IMA), individual rehabilitation plan and any additional assessments, client interview or clinical information). ACC needs to be able to see that activities undertaken address the rehabilitation needs and that barriers that emerge during rehabilitation are given appropriate attention and mitigated. In documenting the progress of the rehabilitation activities, the suppliers must show how barriers have been addressed and how work readiness is demonstrated. Some injury conditions for example leave clients with pain, psychological vulnerability and fatigability or suboptimal stamina. Rehabilitation therefore frequently involves helping clients to adjust, optimise stamina and manage ongoing symptoms. Suppliers should show how rehabilitation has facilitated the adjustment of these clients to be able to undertake work and complete a working week while managing residual symptoms. Similarly, rehabilitation to address loss of confidence in skill sets or the need to update skills should always be documented. In every instance, achieving work readiness requires motivating and engaging with the client and where barriers to motivation are encountered, the supplier must show how these have been addressed. Note that the goal of the work readiness service is to ensure the client achieves work readiness. If a client achieves employment while receiving the work readiness service, an incentive payment to the supplier may be applicable if conditions of the service schedule are met. Suggested additional reading on the topic of work readiness: Bootes, K., & Chapparo, C. J. (2002). Cognitive and behavioural assessment of people with traumatic brain injury in the work place: Occupational therapists' perspectives. Work, 19, Franche, R.-L., Corbiere, M., Lee, H., Breslin, F. C., & Hepburn, C. G. (2007). The Readiness for Return to Work (RRTW) scale: Development and Validation of a Self-reported Staging Scale in Lost-time Claimants with Musculoskeletal Disorders. Journal of Occupational Rehabilitation, 17, 22. Innes, E., & Straker, L. (2002). Strategies used when conducting work-related assessments. Work, 19,

18 McPherson, K., et. Al (2009). Supports Needed for Return to Work: Testing a New Measure of Work-ability. AUT University, Auckland. Unpublished Report, Rosenberg, H., & Tesolowski, D. G. (1982). Assessment of Critical Vocational Behaviors. Career Development for Exceptional Individuals, 5(1), Serra, C., Rodriguez, M. C., Delclos, G. L., Plana, M., Gómez López, L. I., & Benavides, F. G. (2007). Criteria and methods used for the assessment of fitness for work: a systematic review. Occupational and Environmental Medicine, 64(5), Stergiou-Kita, M., Rappolt, S., Kirsh, B., & Shaw, L. (2009). Evaluating work readiness following acquired brain injury: Building a shared understanding. Canadian Journal of Occupational Therapy, 76(4), Strong, S., et al. (2004). Functional assessment of injured workers: A profile of assessor practices. The Canadian Journal of Occupational Therapy, 71(1), Work Readiness Level 1 and Level 2 Work Readiness level 1 and 2 services are for those client who have been identified as requiring rehabilitation to become work ready when it has been established, following appropriate recovery time and rehabilitation, that they are not able to return to their pre-injury job or cannot maintain their current job, but it is expected that they will achieve this work ready outcome in 8 weeks from the date of referral. Work Readiness service clients will have undertaken an Initial Occupational Assessment (IOA) and Initial Medical Assessment (IMA) that has identified sustainable work types that are appropriate and suitable for the client, including where some upskilling may be required. Note: Work Readiness Level 2 clients are expected to require a more extensive combination of function and/or vocational rehabilitation delivered by a multidisciplinary team. The supplier is expected to prepare a work readiness service plan that lists activities to be undertaken and timeframes to achieve the outcome specified in the referral, within 2 working days of receipt of the referral. The plan needs to be consistent with referral information including the Individual Rehabilitation Plan, IOA and IMA. It will include goals, activities and incremental steps to support the outcome within the expected timeframe where the supplier will be expected to: Obtain agreement of the medical practitioner not covered by the current medical certificate to any proposed functional rehabilitation programme before undertaking it. Attend case conferences where required by the claims manager Ensure that services are delivered in a co-ordinated way within the optimum timeframe to achieve the outcome. Report progress to the claims manager at the mid-point and end of the programme or more frequently if there are exceptions using the Work Ready Level 1 / 2 report. Reports should clearly document how the client is progressing with work trials, motivation, compliance, any barriers or issues identified that are likely to impact on the vocational independence process etc. The claims manager will: Acknowledge receipt of the work readiness plan within two working days of receipt of the plan and contact the supplier to discuss and negotiate changes to the plan where appropriate Purchase any additional support, e.g. equipment, that is agreed as necessary to support the work readiness programme Review progress reports and provide any necessary feedback to the supplier Arrange any case conferences considered necessary. 18

19 5.6.3 Work Readiness Level 3 Tailored with or without Lead Supplier services Work Readiness Level 3 services are for those clients who have been identified as requiring rehabilitation to become work ready when it has been established, following appropriate recovery time and rehabilitation, that they are not able to return to their pre-injury job or cannot maintain their current job, but it is not expected that they will achieve this work ready outcome in 8 weeks from the date of referral and may require more unique client-centred services to achieve their outcome. These clients may also require other services, not normally provided within those lower level services, which are tailored to achieve the client s individual outcome and to meet any unique identified needs. The length of service is dependent on the needs and services and timeframes for achieving the client s specific vocational rehabilitation outcome. Tailored services are planned and managed through a collaborative process between the claims manager, the certifying medical practitioner, the supplier and other suppliers. The claims manager will work with the client and their certifying medical practitioner to develop and agree the client s Individual Rehabilitation Plan. The claims manager will then determine which services are required to meet the client s needs and outline these in the referral. Options for a referral for a Stay at Work Level 4 (tailored) service are: A Work Readiness Level 3 service without any additional fee for service components that is used for a client requiring an extended period of vocational rehabilitation past 12 weeks from the date of referral acceptance by the supplier (i.e. a slower programme of rehabilitation but not more services). A Work Readiness Level 3 service with additional services required that will be paid on a fee for service basis including where there may be additional hours to ensure liaison and monitoring of the progress of any activities the client may be undertaking or may be engaging in within the work readiness service plan that extends the duration of services e.g. attending community funded computer courses. A Work Readiness Level 3 service with or without additional services paid under a fee for service and a referral for the supplier to act as a Lead Supplier (Refer section 5.5 Lead Supplier Co-ordination) Other services for Work Readiness clients A client may require other services, not normally contained within a Work Readiness programme, to facilitate the successful completion of the programme. These additional services are tailored to achieve the client s individual outcome and to meet their unique identified needs and may include, for example: dietary support and/or advice cultural support specific client job training or skill development e.g. operating Eftpos; customer service skills social support additional services not usually available through vocational rehabilitation but are claims manager directed and negotiated and considered necessary to assist achieve the vocational outcome (e.g. programme delivered by a sports physiologist or extensive gym based programme). Other types of services may also include those for clients who have been assessed as unlikely to achieve vocational independence or have been assessed as having not achieved vocational independence, but who may be referred with an outcome objective of maximum employment participation, and could include the following: Voluntary work programmes (where this is a step towards employment participation, rather than a final outcome) 19

20 Job Clubs (selected clients participate in facilitated group work to learn return to work strategies) Work Readiness Tailored Plan The Work Readiness Level 3 Services Tailored Plan is completed using an ACC template and details: a summary of the client s injury, work situation, objectives and any service components any issues, goals and actions proposed Work Readiness RTW Plan other Services that are reasonable and necessary if a work trial is planned and how this relates to the job options identified in the IOA/IMA if any work trial details have been sent to GP to obtain clearance to undertake work trial any additional job options identified that were not in the IOA/IMA relevant rationale, goals and activities related to those other services appropriate monitoring, milestones/ progress dates dates outcomes are to be achieved and measures of achievement any client specific activities linked to goal achievement any other service supports or activities that may be required e.g. case conferences any Lead Supplier Co-ordination to be undertaken, including the services to be coordinated, methods of co-ordination and frequency of progress reports/updates a Tailored Plan costs sheet that outlines any hours and costs (that are additional to those that are inclusive within a Work Readiness service) for the other services and/or Lead Supplier co-ordination. The supplier will: submit the Tailored Plan to the claims manager for approval within 4 working days from date of referral ensure that services are delivered in a co-ordinated way within the optimum timeframe to achieve the outcome report progress to the claims manager as agreed in the Tailored Plan for other services and/or as a Lead Supplier Work Readiness Level 3 Progress Reporting The supplier will submit Progress Reports for Stay at Work Level 4 services to the claims manager in the agreed timeframes and should outline: an overview of progress goals and outcomes achieved including any partial or full return to work any activities completed any new issues or barriers that have emerged If the supplier is a Lead Supplier the progress report should also include any comments about the co-ordination of other services to date Work Readiness Level 3 Outcome Report The supplier will submit Service Outcome Report to the claims manager 2 working days after the service completion. The Service Outcome report will outline: services provided goals and outcomes achieved any activities completed by the provider and/or client 20