Occupational Rehabilitation Services

Transcription

1 OR Fee Schedule Occupational Rehabilitation Services January 15 This Schedule must be read in conjunction with the Schedule Service Delivery Principles & Requirements and the contents of the online claims manual. The information contained in this OR Fee Schedule and the OR Schedule Service Delivery Principles & Requirements replaces prior information and guidance released by WorkSafe (Victoria). Effective as at 27 January 2015, WorkSafe will pay up to a maximum amount for the following categories of the service: Work RC200 Initial Report Work) An assessment to determine what B@W services may be needed to facilitate return to work with the pre-injury employer. The OR consultant: Contacts the agent, worker and employer within 3 working days from receipt of the OR Approval Form (the agent is contacted first) Completes the small & medium employer checklist with the employer on new claims (within the first few weeks of claim acceptance) Submits the Initial Report to the agent 2 working days prior to the scheduled RTW Case Conference Participates in a RTW Case Conference with the agent within 10 working days from receipt of the OR Approval Form. If additional time is required for small & medium employer checklist coaching, OR providers may utilise RC715. Recommendations for retraining may be included in this report with prior agent approval for RC770. Applicable across multiple OR services RC250 RTW (return to work) Index Incentive To claim the RTW Index Incentive the OR provider must be able to demonstrate that: For OR services for RTW pre injury employer The worker had no RTW when OR commenced (or ceased work subsequent to OR commencement) and is at work on the RTW Index Measurement Date. $ $300 WSV1636/01/01.15

2 For OR services for RTW new employer RC889 must have been achieved as a prerequisite and the worker is at work on the RTW Index Measurement Date. Explanatory note The RTW Index Measurement Date is 182 calendar days post Agent Received Date for any RTW (less than or equal to 100% pre injury hours), where the Agent Received Data is counted as Day 0. If the Measurement Date is on a weekend, public holiday or non-working day in a partial RTW Plan and there is a RTW coded for working days following the Measurement Date with no full weekly payments (ACCtion payment type codes 1 and 3) paid, then the worker is deemed to be working.i.e. if RTW Index is achieved for the agent, then it is also achieved for the OR provider. Agents will provide the Agent / Insurer Received Date on OR Approval Forms, which enables OR providers to calculate the RTW Index measurement date. Original Employer Services RC700 Initial Report (Original Employer Services) (Primary physical injury) An assessment to determine what OES services may be needed to facilitate return to work with the pre-injury employer. The OR consultant: Contacts the agent, worker and employer within 3 working days from receipt of the OR Approval Form (the agent is contacted first) Submits the Initial Report to the agent within 15 working days from receipt of the OR Approval Form, unless an alternative submission date is agreed with the agent. Recommendations for retraining may be included in an Initial Report, with prior agent approval for RC770. Initial Report on additional occasion An Initial Report might be requested by an agent when referring to OES on an additional occasion. Examples of when an agent may request an additional Initial Report include where a prior Initial Report did not result in an OR commencement, a prior OES service had ceased, or the worker has had surgery resulting in a change of capacity/restrictions An Initial Report completed on an additional occasion is not expected to require the same level of engagement or time as any previous Initial Report as this is an update or review of work previously completed by the OR provider. Therefore the fee should be negotiated between the agent and OR provider up to the RC700 maximum. (Additional or repeat Initial Reports negotiated to this maximum) 2

3 RC756 RC701 RC705 RC710 RC715 Initial Report (WSS) (Workplace Support Services for primary mental injury claims) An assessment to determine whether OES services may be needed to facilitate return to work with the pre-injury employer, for primary mental injury claims. A WSS approved OR consultant must be assigned to deliver this service. The OR consultant: Contacts the agent, worker and employer within 3 working days from receipt of the OR Approval Form (the agent is contacted first) Submits the Initial Report to the agent within 15 working days from receipt of the OR Approval Form, unless an alternative submission date is agreed with the agent. Various circumstances could lead an agent or OR consultant to negotiate an alternative submission date, for example an earlier date may enable inclusion of the Initial Report in agent case conferencing or a later submission date may enable the consultant to include feedback from the treating health practitioner. Recommendations for retraining may be included in this report with prior agent approval for RC770. Guidance on Initial Report on additional occasion under RC700 applies for RC756 also. Progress Report Submitted every six weeks starting from the date of the Initial Report submission. 6 Month Progress Report Submitted six months after the date of the Initial Report submission. 12 Month Progress Report Submitted twelve months after the date of the Initial Report submission. OR Services Services delivered as per recommendations in the Initial Report aimed at facilitating return to work with the pre-injury employer. Work fitness services may also be delivered under this item number. Refer to content on work fitness services in the Schedule Service Delivery Principles & Requirements document. $ (Additional or repeat Initial Reports negotiated to this maximum) $99.21 fixed amount $ $

4 RC717 RC720 RC730 RC740 RC741 RTW Assistance If an OR provider forms the view while completing a Work Report that a RTW in preinjury or suitable employment can be achieved without RC715 OR services then they contact the agent to seek approval of RC717 RTW Assistance. However if agent contact cannot be established then an OR provider may proceed to provide this service on the understanding that the RTW will be achieved at the same time that the report is completed although the actual date of the RTW may be later than the report date. An OR provider should include in the Initial Report sufficient information to substantiate how an OR provider resolved any identified actual or perceived barriers to RTW and achieved a RTW. RC717 is automatically approved in connection with a referral for an RC756 service. Incentive for partial RTW An Incentive paid for any return to work less than 100% pre-injury hours, for workers who were not at work at OES commencement. Placement Report 100% PIH achieved Submitted within 10 working days of the worker achieving 100% pre-injury hours, after OES commencement. 100% pre-injury hours must first be sustained for at least 5 working days. 13 week sustainability date Day 1 of 100% PIH becomes Day 1 of the 13 week sustainability period. 13 Week Sustainability Incentive (Where OES commenced less than 50 calendar days after the Agent Received Date) A Sustainability Report is submitted within 10 working days of the 13 week sustainability date being achieved when the date of the OR Approval Form is less than 50 calendar days after the Agent Received Date for the claim and the worker was receiving weekly payments at OES commencement and has remained at work on 100% PIH with no more than 5 working days off work 1 in the 13 week sustainable RTW period. See also RC750 below. 13 Week Sustainability Incentive (Where OES commenced on or after 50 calendar days after the Agent Received Date). A Sustainability Report is submitted with an invoice for RC741 within 10 working days of the 13 week sustainability date being achieved when the date of the OR Approval Form is equal to or more than 50 calendar days after the Agent Received Date for the claim and the worker was receiving weekly payments at OES commencement and has remained at work on 100% PIH with no more than 5 working days1 off work in the 13 week sustainable RTW period. See also RC750 below. (capped at 1.5 hours) $82.58 fixed amount $ $ $ In calculating the 5 working days where the worker may be absent from work due to their compensable injury, a part day is counted as 1 day. 4

5 RC742 RC750 RC764 RC765 RC Week Sustainability Incentive (Incentive for primary mental injury claims as indicated on the OR Approval Form& for WSS cases) A Sustainability Report is submitted with an invoice for RC742 within 10 working days of the 13 week sustainability date being achieved when the OR Approval Form identifies the claim as a primary mental injury claim, the worker was receiving weekly payments at OES commencement and has remained at work on 100% PIH with no more than 5 working days off work in the 13 week sustainable RTW period. See also RC750 below. Incentive Pre-Injury Duties (PID) or Productive Duties (PD) Achieved Worker receiving weekly payments at OES commencement The invoice for RC740 or RC741 or RC742 may also include RC750when a worker has remained at work on 100% PIH with no more than 5 working days off work in the 13 week sustainable RTW period and at the 13 week sustainable RTW date the worker is working in pre injury duties or productive duties. Worker at work PIH at OES commencement Alternatively a Sustainability Report is submitted with an invoice for RC750 within 10 working days of the 13 week sustainability date being achieved when a worker has remained at work on 100% PIH and subsequently returned to pre injury duties or productive duties for at least 4 weeks in the 13 week sustainable RTW period. No other incentive is payable in this circumstance. Suspension Report Submitted within 10 working days of the agent agreeing that OES services should be suspended. Suspension should be considered when a worker will have no CWC for a period between 4 and 13 weeks. Cessation Report Submitted within 10 working days of the agent agreeing or requesting that OES services should cease. Cessation should be considered when a worker will have no CWC or has had no CWC for a period greater than 13 weeks. Retraining or Redeployment Report An assessment of retraining options for a worker who requires new or different competencies in order to RTW or remain at work with their pre injury employer. Course enrolment is a part of this service, once agent approved. The report should identify at least two training courses suitable to where the worker resides and details including the cost, duration, provider name and location, the competency title (e.g. Cert IV in Workplace Training), confirm the worker has any training prerequisites and is capable of completing the course. The OR provider must attempt to engage the worker s treating health practitioner when completing this service. $1, $ $99.21 $ $ (Negotiated to this maximum) 5

6 RC799 OES Provider Travel Travel for the purposes of delivering OES services at the injury workplace or for attending a GP RTW Case Conference. The cost of Provider Travel is calculated from the provider s nearest location to the injury workplace. New Employer Services RC800 Vocational Report An assessment to determine what NES services may be needed to facilitate return to work with a new employer. Report to be submitted within 15 working days from receipt of the OR Approval Form. RC805 Subsequent Vocational Report An assessment to determine what NES services may be needed to facilitate return to work with a new employer. RC810 RC830 Subsequent Vocational Reports are not expected to require the same level of engagement or time as the first Vocational Report as it is an update or review of work previously completed by an OR provider. Report to be submitted within 15 working days from receipt of the OR Approval Form. NES Workplace Report An assessment is conducted as soon as advice is received that the worker is due to commence a new job unless the worker says they do not want the OR provider to visit the workplace as the new employer does not know they have had a claim. Where an eligible employer wishes to access WISE, then the OR provider conducting a workplace assessment should also assist the employer complete the WISE payment paperwork. Report to be submitted within 10 working days of the worker commencing a new job. Work fitness services may also be delivered under this item number. Refer to content on work fitness services in the Schedule Service Delivery Principles & Requirements document. Retraining Report An assessment of retraining options for a worker who requires new or different competencies in order to complete on the open labour market. Course enrolment is a part of this service, once agent approved. The OR provider may determine the format of the report and may include recommendations in the Vocational Report or Job Seeking Plans. The report/ recommendations should identify at least two training courses suitable to where the worker resides and details including: The cost, duration, provider name and location The competency title (e.g. Cert IV in Workplace Training) $ $ (Negotiated to this maximum) 6

7 RC831 RC840 RC880 RC881 Whether the worker has any training prerequisites and is capable of completing the course Information on the course relevance to obtaining new employment. Report submitted within 15 working days of the agent approving the service. Training Course Monitoring Enables contact to the worker and training course provider to monitor course progress. Vocational Counselling Enables continued job seeking support to a worker who is due to complete a 26 Week NES or 12 Week NES Refresher service, where the worker is expected to secure new employment with this assistance. A request for this service should be made to the agent prior to the 26 Week NES or 12 Week NES Refresher completion. A Vocational Counselling Report is submitted no later than 2 months after the service commenced and should inform the agent about progress made towards addressing ongoing RTW barriers and achieving a sustainable RTW. If Vocational Counselling was commenced because a RTW was not achieved during a 26 Week NES or 12 Week NES Refresher then the report should also demonstrate the progress against agreed actions included in the Future activities section of the Worker Independent Job Seeker Plan or contents of the NES 12 Week Refresher Plan. Recommendations to continue Vocational Counselling beyond 2 months must be agreed with the agent prior to the first 2 months of the service concluding. Week 1 Job Seeker Plan RC880, RC881, RC883 and RC882 are applicable during a 26 week NES job seeking service. A Week 1 NES Job Seeker Plan is submitted reflecting the agreed actions for the first 8 weeks consistent with the NES service expectations and demonstrating job brokerage and WISE promotion actions. Upon securing alternative employment during a 26 week NES job seeking service, the OR provider submits a Placement Report and an NES Workplace Assessment report (if completed) with an invoice for RC889 and RC810 respectively. Week 8 Job Seeker Plan RC880, RC881, RC883 and RC882 are applicable during a 26 week NES job seeking service. A Week 8 NES Job Seeker Plan is submitted summarising the information collected by the OR provider, information on the worker s CWC, any actual or perceived barriers to RTW, and restating the prioritised suitable employment options. The Plan must be consistent with NES service expectations and demonstrate job brokerage and WISE promotion actions. (hours negotiated with agent) Agent approved up to 2 hrs per month for 2 months at $ (paid in advance on agent approval of the service) $

8 RC883 RC882 RC884 RC885 RC889 Upon securing alternative employment during a 26 week NES job seeking service, the OR provider submits a Placement Report and an NES Workplace Assessment report (if completed) with an invoice for RC889 and RC810 respectively. Week 16 Job Seeker Plan RC880, RC881, RC883 and RC882 are applicable during a 26 week NES job seeking service. A Week 16 NES Job Seeker Plan is submitted summarising the information collected by the OR provider, information on the worker s CWC, any actual or perceived barriers to RTW, and restating the prioritised suitable employment options. The Plan must be consistent with NES service expectations and demonstrate job brokerage and WISE promotion actions. Upon securing alternative employment during a 26 week NES job seeking service, the OR provider submits a Placement Report and an NES Workplace Assessment report (if completed) with an invoice for RC889 and RC810 respectively. Worker Independent Job Seeker Plan RC880, RC881, RC883 and RC882 are applicable during a 26 week NES job seeking service. An NES Job Seeker Plan is submitted summarising the information collected by the OR provider, information on the worker s CWC, any actual or perceived barriers to RTW, and restating the prioritised suitable employment options. The Plan should inform the agent about the progress towards addressing ongoing RTW barriers and explain why a sustainable RTW was not achieved. Upon securing alternative employment during a 26 week NES job seeking service, the OR provider submits a Placement Report and an NES Workplace Assessment report (if completed) with an invoice for RC889 and RC810 respectively. 12 Week NES Refresher Vocational Report An assessment to establish job options in preparation for a 12 Week NES Refresher job seeking program. The intended recommendations of the report must be discussed with the agent prior to finalising the report. Report to be submitted within 15 working days from receipt of the OR Referral form. 12 Week NES Refresher Plan This service commences on the date the RC884 report is submitted. NES Placement Report Submitted when a worker achieves RTW during a 26 Week or 12 Week NES service / refresher. $ $ $ $1, $

9 RC890 RC891 RC892 RC893 Incentive weekly payments < 52 weeks & no payments at 13 weeks sustainable RTW Invoiced when at the NES commencement date the worker was receiving weekly payments but less than 52 weeks of weekly payments had been received AND no weekly payment was payable at the 13 week sustainable RTW date. Note, NES incentives cannot be paid by an agent unless an NES Placement Report has been first submitted. Incentive weekly payments < 52 weeks &< 50% payments at 13 weeks sustainable RTW Invoiced when at the NES commencement date the worker had received less than 52 weeks of weekly payments AND: A. No weekly payments were payable at that date or at the 13 week sustainable RTW date, OR B. Weekly payments were payable at that date and the 13 week sustainable RTW date but the amount is 50% less than the amount paid at the NES commencement date. Alternatively, an OR provider invoices for this item when the worker return to work within the injury employer after the NES commencement date and the OR provider delivering the NES is not the OR provider who provided OES to the worker previously. Note, NES incentives cannot be paid by an agent unless an NES Placement Report has been first submitted. Weekly payments > 52 weeks & no payments at 13 weeks sustainable RTW Invoiced when at the NES commencement date the worker was receiving weekly payments and more than 52 weeks of weekly payments had been received AND no weekly payment was payable at the 13 week sustainable RTW date. Note, NES incentives cannot be paid by an agent unless an NES Placement Report has been first submitted. Weekly payments > 52 weeks &< 50% payments at 13 weeks sustainable RTW Invoiced when at the NES commencement date the worker had received more than 52 weeks of weekly payments AND: A. No weekly payments were payable at that date or at the 13 week sustainable RTW date, OR B. Weekly payments were payable at that date and the 13 week sustainable RTW date but the amount is 50% less than the amount paid at the NES commencement date. Note, NES incentives cannot be paid by an agent unless an NES Placement Report has been first submitted. $4, $2, $6, $3,

10 RC899 RC500 RC505 NES Provider Travel Travel for the purposes of delivering NES services when the worker is unable to travel to the OR provider s nearest location to their residence, for attending a GP RTW Case Conference, or conducting a Workplace Assessment because the worker has secured a new job. The cost of Provider Travel is calculated from and to the provider s location nearest to where the worker resides or where the new workplace is located. Note that NES Provider Travel must be pre-approved by the agent, but can proceed if response is not received from the agent within 3 working days of a request 130 Week Vocational Report An assessment to assist the agent to determine a worker s entitlement to weekly payments post the second entitlement period (i.e. to continue weekly payments after 130 weeks of weekly payments has been made). Report to be submitted within 15 working days from receipt of the OR Approval Form. There is no fixed report format. Subsequent 130 Week Vocational Report An assessment to confirm that suitable employment options identified in a prior Vocational Report remain relevant after a 26 Week NES service has been completed, to review a previous 130 Week Vocational Assessment Report or update the labour market analysis, to review previously identified employment options with the worker s THP. WorkSafe expects that this report will not require the same level of engagement or time as a 130 Week Vocational Report as this is an update or review of work previously completed by the OR provider. Therefore the fee should be negotiated between the agent and OR provider. Report to be submitted within 15 working days from receipt of the OR Approval Form. There is no fixed report format. GP RTW Case Conference RC270 GP RTW Case Conference Funding to arrange, attend, and complete an Action Plan arising from a GP RTW Case Conference. The Action Plan is submitted within 5 working days and is included with the next OR Progress Report or NES report that might be due within that 5 day timeframe. Travel may be billed in addition under RC799 or RC899. This item may be used in connection with any OR service. WISE OR PROVIDER FEES PAYMENT TYPE CODE 216 EWP200 Placement An OR provider will submit an RC889 Placement Report with an invoice for this item. (up to 4 hours maximum negotiated) (up to 2 hours maximum) $

11 EWP203 Sustainability & Action Plan An OR Provider will submit a Sustainability & Action Plan with an invoice for EWP203 if the worker remains in work for 13 weeks and the agent and OR provider can agree the criteria has been satisfied for paying a WISE sustainability fee. This fee is payable where the OR provider cannot seek a NES RTW incentive because the worker was: Not participating in a 26 Week NES, 12 Week NES Refresher, or Vocational Counselling service at the time the WISE placement was achieved, or Participating in a 26 Week NES, 12 Week NES Refresher, or Vocational Counselling service at the time the WISE placement was achieved but the weekly payments at the 13 week sustainable RTW date is greater than 50% of what was payable at the most recent NES service commencement date. $1, GST Amounts published have not taken into account that GST may apply to certain services. Where deemed appropriate by WorkSafe, an amount taking into account GST will be added to the listed amount. Invoicing All invoices are submitted within 10 working days of the respective service completion. Agent approval required before OR costs incurred Following an initial OR Approval Form signed by the agent, agent approval is required prior to continuation of services or commencement of a new/different type of service than indicated on the initial OR Approval Form. OR providers may proceed with services they recommend/request when agents have not replied within 3 working days of a request, however the OR consultant must have attempted contacting the agent by telephone about an outstanding service funding request. 11

12 Further information WorkSafe Advisory Service Phone (03) Toll-free Website vwavic.gov.au WorkSafe Agents ALLIANZ Workers Compensation (Vic) Limited Freecall: CGU Workers Compensation (Vic) Limited Freecall: Gallagher Bassett Services Workers Compensation Vic Pty Ltd Freecall: QBE Workers Compensation (Vic) Limited Freecall: Xchanging Pty Ltd Freecall: For information about the VWA in your own language, call our Talking your Language service: 12