Self-Managed Care Reference Manual October 2014

Transcription

1 Self-Managed Care Reference Manual October 2014 Phone: (604) or (Local 7787) Produced by: Health Care Services 1

2 Contents 1.0 DESCRIPTION OF SERVICES Self-Managed Care Program Medical Criteria Business Criteria Self-Managed Care Reference Manual Evaluation Criteria SERVICE DETAILS / NURSING ASSESSMENT EXPECTATIONS AND RESPONSIBILITIES SETTING YOURSELF UP AS AN EMPLOYER RECRUITING QUALIFIED CAREGIVERS STAFF AND REPORTING REQUIREMENTS PAYROLL DEDUCTION AND BUSINESS REQUIRMENTS INVOICING AND FINANCIAL REQUIREMENTS Invoicing Start-up Costs Submitting Invoices Submitting Monthly Reconciliation Reports Surplus Care Plan Funds In The Event Of Your Death Records and Audit Rights CARE PLAN COST AND SERVICES Care Plan Costs Caregiver Wages Additional Professional Services CONFLICT OF INTEREST COMPLIANCE WITH REQUIREMENTS WHAT DO I HAVE TO SUBMIT? WORKSAFEBC CONTACT INFORMATION APPENDICES APPENDIX A: SELF-MANAGED CARE FEE SCHEDULE APPENDIX B: SELF-MANAGED CARE - CARE PLAN COST WORKSHEET APPENDIX C: SELF-MANAGED CARE - INVOICE APPENDIX D: SELF-MANAGED CARE MONTHLY RECONCILIATION REPORT APPENDIX E: SELF-MANAGED CARE - QUARTERLY PROGRESS REPORT APPENDIX F: SELF-MANAGED CARE SIGN IN/OUT SHEET

3 1.0 DESCRIPTION OF SERVICES 1.1 Self-Managed Care Program Self-Managed Care is designed for Injured Workers who have met criteria set by WorkSafeBC in accordance with the Agreement, Reference Manual, and Application document, (the Self- Managed Care Program ). This Program allows the Injured Worker, ( You ), to manage your own care in your own residence. Admission into the Self-Managed Care Program is discretionary to WorkSafeBC. Not all applicants may be approved for admission to the Self-Managed Care Program. WorkSafeBC may change the manner of care provided and/or terminate the Agreement, at any time, if WorkSafeBC deems that you have not been provided with an adequate or appropriate level of care pursuant to the Agreement. 1.2 Medical Criteria You have a compensable condition that requires a significant amount of daily care; You have no other health concerns that would contraindicate participation (e.g. compensable or non-compensable); You must be able to communicate with others to direct your own care; You must have the cognitive capacity to direct your own care; and You have ensured that care services will be provided by qualified care providers who are skilled in managing your unique care needs. 1.3 Business Criteria You must be able to effectively communicate your ongoing business requirements; You must be capable of managing the financial and organizational demands of employing an individual (or multiple individuals); You must possess the capacity to complete all required forms as agreed in the Agreement and possess the ability to submit these forms in a timely manner. You will have access to a telephone or in order to communicate with WorkSafeBC regarding your care; You must have an established bank account that is designated only for administering selfmanaged care funds that is separate from your personal finances; Within thirty (30) business days of signing the Agreement, you agree to provide evidence of: a. Compliance with insurance requirements; b. Registration with WorkSafeBC; c. Business license requirements, where applicable; d. The name and contact information of your independent bookkeeper; and e. A back-up staffing plan. 1.4 Self-Managed Care Reference Manual The Self-Managed Care Reference Manual may be updated during the duration of the Agreement through written revisions and/or Information Bulletins sent out by WorkSafeBC. These revisions and Bulletins become part of the Manual and Service terms. Revisions and Information Bulletins will inform you about any procedural changes or changes that may affect provision of services. 3

4 You are responsible for maintaining the Reference Manual, incorporating any updates and communications from WorkSafeBC, and informing all personnel. 1.5 Evaluation Criteria Eligibility for the Self-Managed Care Program may be withheld or denied if any of the following apply. Please note that each will be assessed on an individual basis. You have filed for bankruptcy within the last 36 months (to be assessed on an individual basis); You are actively abusing drugs and/or alcohol (illicit, and/or prescription) and this abuse is seen to place yourself or your caregivers at risk of harm; You exhibit current acute psychotic symptoms or other severe psychological dysfunction; that place yourself or a caregiver at risk of harm; You have a history of sexually inappropriate behavior, violence or harassment towards caregivers which places yourself or the caregiver at risk of harm (to be assessed on an individual basis); You have a criminal record; You have been convicted of a criminal offence within the last ten (10) years; You demonstrate an inability to manage your care needs and arrange for the hiring and support of suitable staff; You have a prior history of fraudulent use of WorkSafeBC funds or equipment; Your home environment places yourself and your caregivers at risk of physical harm; You have a history of non-compliant behavior while participating in other WorkSafeBC Sponsored Programs/Services; You do not have the cognitive ability to direct your own care independently; You have a history of physical or verbally abusive behavior; You are not or have not been current with the legislative requirements of the CRA (Canada Revenue Agency) while receiving funds for Self-Managed Care in a previous contract term; Other care options made available by WorkSafeBC are more appropriate and available to you as deemed by WorkSafeBC; Or any other relevant circumstances or criteria deemed inappropriate by WorkSafeBC. 2.0 SERVICE DETAILS / NURSING ASSESSMENT WorkSafeBC will determine service requirements. Health Care Services shall set a monthly rate based on the level of care required, as indicated in the current Nursing Assessment Report. The Nursing Assessment Report outlines the Injured Worker s medical needs and establishes both the level of care and the hours of care to be provided pursuant to the Self Managed Care Program. Representatives from WorkSafeBC will conduct a site visit to meet with the Injured Worker and to confirm the level of care required and that the per diems are appropriate. Nursing Assessment A Nursing Assessment determines the care requirements of an individual in their own environment (the Care Services ) and will include: Identification of necessary services; Identification of safety concerns; A review of Injured Worker s current status; Interventions required due to physical, psychological and behavioral deficits; 4

5 Description of individual goals of care with anticipated timelines; and Development of a Care Plan specific to the goals of the Care Services. Care Plan (RN) A Care Plan is developed by a registered nurse in collaboration with other health care professionals and the Injured Worker and provides written direction to the care givers setting out how the Care Services are to be implemented. The Care Plan shall include, but not be limited to the following: Clearly defined aspects of care; (level of dependence, frequency, and duration of associated activities/tasks); Specific instructions about how to provide the care including interventions required to address psychological and behavioral concerns; Reporting guidelines and instructions; Review and revision of the Care Plan on a regular basis; and Instructions in the event of an emergency. A copy of a current Care Plan must be available to the care givers in the Injured Worker s home at all times. 3.0 EXPECTATIONS AND RESPONSIBILITIES Your Responsibilities You understand and confirm that you have the legal capacity to enter into the Agreement and accept the terms and responsibilities as defined in the Self-Managed Care Reference Manual; You understand the funds from WorkSafeBC are only for your approved Care Services as outlined in the Care Plan Costs of the Agreement. You agree to be financially accountable to WorkSafeBC for those funds and to only use the funds for these purposes; You must immediately notify your WorkSafeBC Case Manager when there is a change in your condition or circumstances that might result in a change to your care; You shall comply with the provisions of all Provincial and Federal legislation, laws, statutes, orders, and directives and municipal by-laws in the province in which you are situate; You must notify Health Care Services and/or your Case Manager thirty (30) days in advance of a change of residence; In the event that your change of residence will be outside of Canada, the Agreement may be terminated at the discretion of WorkSafeBC and other care options may be explored; Neither you nor your employees are a servant, employee or agent of WorkSafeBC; You cannot transfer any of your responsibilities or rights either directly or indirectly under the Agreement (for example by hiring a company or an individual to take over your contract); You shall not use WorkSafeBC s name as a reference without obtaining written permission from WorkSafeBC; You understand that any record sent by WorkSafeBC relating to your Self Managed Care Program is subject to the Freedom of Information and Protection of Privacy Act R.S.B.C c. 165 ( FIPPA ); 5

6 You must ensure all records, including payments issued and received, are in compliance with the terms and conditions of the Agreement; You must keep accounting records, together with supporting documents, invoices, and other materials for a period of seven (7) years after the Agreement expires; You agree to indemnify WorkSafeBC, its employees, directors, officers and agents responsible from any and all claims, demands, actions and costs whatsoever that may occur directly or indirectly from an action or oversight from your employees, servants or agents in the performance of the Self-Managed Care Program. Your Responsibilities as an Employer These guidelines identify the major areas of your responsibilities when managing your Self- Managed Care Program. When you manage your own care you assume the responsibilities of an employer. As the employer your responsibilities include but are not limited: To recruit caregivers and ensure they are qualified and possess the appropriate skills, abilities and basic qualifications as required by the Agreement; To ensure the safety of you and your family, WorkSafeBC recommends that you have all of your caregivers go through the Criminal Record Check (CRC) process. The caregiver would undergo a Police CRC conducted by the RCMP detachment or local police service. The onus is on the caregiver to determine which organization conducts their CRC. They can find information regarding the process with the RCMP at: WorkSafeBC will reimburse you for any funds incurred for CRC processes. Please ensure you keep copies of all receipts. If you need assistance with the procedures, we could assign a social worker to help guide you; To administer payroll, employer/employee deductions through the management of an independent bookkeeper; To submit required reports as per timelines specified herein to WorkSafeBC; To submit required invoices as per timelines specified herein to WorkSafeBC; To comply with the provisions of all Provincial and Federal legislation, regulations, orders and directives in the Province of British Columbia (or the province where the Injured Worker resides and the Services are conducted) and the Municipal by-laws in the Injured Worker s municipality as they apply to the Services; To be registered and be in good standing with WorkSafeBC Assessments; To provide a safe, sanitary and healthy work environment for employees. The work environment shall have procedures to address situations in the event of fire and other natural disasters. To ensure caregivers record their shifts on the Sign In/Out form. The form is available in the Appendix. This form does not need to be submitted to WorkSafeBC, but must be available for review if requested. Standards of Conduct WorkSafeBC has a Standards of Conduct Policy and a Personal Harassment Policy. The Injured Worker and all of the Injured Worker s employees and/or agents shall familiarize themselves with these and abide by the policies. The two (2) policies are available for viewing at the WorkSafeBC website: under Bid Opportunities; Purchasing Policies and Terms. If WorkSafeBC determines you have demonstrated behavior and/or conduct that is not appropriate as an employer for the self-management of your Care Services, WorkSafeBC may terminate the Agreement and your participation in the Self-Managed Care Program immediately as set out in Section 11.0 Termination of the Agreement. 6

7 WorkSafeBC Responsibilities WorkSafeBC will assess and determine if you are appropriate for the Self-Managed Care Services Program; A WorkSafeBC Quality Assurance Supervisor will provide an education session for you regarding the expectation and requirements of you under the Self-Managed Care Agreement and the Reference Manual; WorkSafeBC will obtain a Nursing Assessment; A WorkSafeBC Case Manager in consultation with various team members will review and approve the recommendations of the Nursing Assessment; WorkSafeBC will monitor and ensure the quality of care; WorkSafeBC may review your care requirements annually and/or initiate a new Nursing Assessment at any time as required; When WorkSafeBC receives the signed Agreement, a WorkSafeBC Quality Assurance Supervisor will contact you to discuss the contract and process. A representative from WorkSafeBC may visit you to address the following concerns: o Staffing; o Reporting Issues; o Care; o Your concerns; o Monthly care plan updates; o Concerns presented by the family doctor, caregivers or nurse advisors. WorkSafeBC shall have the right to terminate your Self-Managed Care Program for the occurrence of any of the events listed under Section 12.0 Termination in the Agreement. 4.0 SETTING YOURSELF UP AS AN EMPLOYER Onestop Business Registry The BC government offers OneStop Business Registry where you can register your company name, apply for a municipal business licenses, register for tax and payroll deductions with the Canadian Revenue Agency (CRA), etc. You can access OneStop Business Registry visiting their website at Once you have completed registration through OneStop Business Registry, you can register with WorkSafeBC Assessments. WorkSafeBC does not guarantee that OneStop Business Registry will provide all the business requirements under the Agreement. WorkSafeBC Assessment Registration and Clearance Letter As a condition of your participation in the Self-Managed Care Program, and as an employer, you shall be registered and maintain good standing with the Assessment Department of WorkSafeBC during the Trial Period and/or Term of the Agreement and any subsequent renewals. How Do I Report My Payroll And Make My Payments To WorkSafeBC? 7

8 The quickest and easiest ways are to report and pay online from your computer, or by calling our automated phone system at or How Do I Get a Clearance Letter? You can request a clearance letter online from WorkSafeBC at and they are available free of charge. How Can I Get More Information? Call our Employer Service Centre at (604) or 1 (888) during regular business hours. Separate Business Bank Account You must have a separate business bank account for funds provided pursuant to the Self- Managed Care Program. This business bank account is for the sole and exclusive use of paying your Self-Managed Care costs amounts. This account cannot be used for personal transactions. If funds are not required for your Care Services, you shall refund the funds to WorkSafeBC. Payroll and Bookkeeping Services When operating as an employer, you need to set-up and maintain an orderly record and accounting system as required by law. You must obtain the services of a qualified, non armslength accounting and/or bookkeeping service to maintain your accounting, invoicing, payroll and bookkeeping. Reasonable fees for this service are reimbursed to a maximum of $250 per month (at the sole discretion of WorkSafeBC s Health Care Services). In the event that the Injured Worker chooses to do their bookkeeping, the Bookkeeping fee is not payable. In addition, you must provide WorkSafeBC a copy of your receipts for accounting/bookkeeping services upon the request of WorkSafeBC. As an employer or payer, you are responsible for paying deductions and submissions to the Canada Revenue Agency ( CRA ). It is recommended you consult with an accountant or bookkeeper for information and assistance. The accounting and/or bookkeeping service expectations include, but may not be limited to: Payroll deductions; Accounts payable and receivable; Calculation and submission of any applicable taxes; WorkSafeBC assessment remittances; Monthly Reconciliation Reports, including o Monthly bank reconciliation o Submission of monthly payroll summary reports detailing the actual amounts paid; o Submission of monthly bank statements; Submission of T4 slips to employees; Submission of copies of cancelled cheques for wages paid to caregivers to WorkSafeBC, upon request; Submission of invoices related to your Self-Managed Care to WorkSafeBC; Submission of a copy of year-end T4 Summaries to WorkSafeBC; Submission of a copy of your E-PD7A, Statement of Account for Current Source Deductions to WorkSafeBC; and, Completion of Record of Employment upon termination of employee. 8

9 Business License Requirement A business license is generally not required for you to hire support workers. However it is your responsibility to check with your municipality to confirm regulations in your area. In the event that you do not maintain a valid business license where required during the Trial Period or during the Term of the Self-Managed Care Program as set out in the Agreement WorkSafeBC may, at its sole discretion, terminate the Self-Managed Care Program. Insurance (Household and Tenant) During the Trial Period and/or Term of the Self-Managed Care Program you are required to maintain homeowner or tenant insurance including liability coverage. It is suggested that you contact your insurance agency or agent directly to discuss appropriate insurance coverage. Such insurance shall include blanket coverage for contractual liability and 3 rd Party liability. Be sure to advise the insurance agent that you are/will register with WorkSafeBC, which covers workrelated injuries. WorkSafeBC is not responsible for the payment of homeowner or tenant insurance. 5.0 RECRUITING QUALIFIED CAREGIVERS As an employer, it is your responsibility to review the qualifications of all caregivers and ensure that each individual caregiver is able to provide the care you require. Examples of qualified caregivers may include: Licensed Practical Nurse ( LPN ): licensed and in good standing with the College of Licensed Practical Nurses of BC. Community Health Worker ( CHW ): may also be known as Residential Care Aide, Personal Care Attendant, Registered Care Attendant, Home Support Worker, or Nurse s Aide. A CHW works under the direction and supervision of a RN or LPN and has completed an appropriate training program supplemented with on-the-job training. You must ensure that all CHWs are qualified to perform the Services they are assigned. Qualifications of Caregivers Caregivers must possess any combination of the following: a) A certificate from a recognized care aide program; and/or b) Have extensive work experience providing care to individuals with similar care needs to the worker outlined in the Agreement and demonstrates the skills and abilities required to provide your care. If you are uncertain about the suitability of a potential caregiver you may request the assistance of WorkSafeBC to determine appropriate levels of work experience and/or skills and abilities of caregivers. All caregivers must possess and maintain current CPR and First Aid certification. All caregivers must have a clean criminal record. This can be confirmed by an RCMP certified criminal record check. 9

10 Non arms-length caregivers are prohibited. Non arms-length caregivers are defined as parties who have shared or are too closely related to be seen as completely independent (e.g. the parties have familial ties, are in a common law relationship or long standing relationship). Qualification Review During the term of the Self-Managed Care Program, the Injured Worker shall ensure that his/her employees providing Services have the qualifications, experience, skills and appropriate licenses. WorkSafeBC reserves the right to undertake a review to confirm the professional credentials of any person providing the Care Services at any time during the Trial Period and/or Term of the Agreement. If WorkSafeBC determines that any person providing Care Services does not possess the qualifications required, WorkSafeBC shall immediately notify you and you shall immediately replace that person or persons with qualified staff to provide Care Services. If the Injured Worker does not ensure that all persons providing Care Services are qualified, WorkSafeBC may terminate the Agreement for cause without notice if WorkSafeBC is of the opinion the Injured Worker s health is at immediate risk. Advertisement to Recruit Caregivers Where you need to advertise to recruit caregivers, fees for this service may be reimbursed to a maximum value of $ per year. Submission of invoice and receipt are required for reimbursement. 6.0 STAFF AND REPORTING REQUIREMENTS As an employer, you are responsible for hiring, directing, scheduling, supervising and terminating your employees. Reasons for termination could include failing to provide proper care as outlined in the Nursing Assessment. When you terminate caregivers you will be required to provide notice advising of their termination, and you are responsible for the preparation and submission of all required documentation as per CRA guidelines. Staff Complement and Scheduling You are responsible to ensure adequate staffing to avoid incurring overtime. Note that WorkSafeBC will not pay overtime costs that result from staffing or scheduling issues. A staffing schedule is based upon the recommendations of the Nursing Assessment and must meet BC employment standards. Back-Up Staffing Plan You must develop an adequate complement of staff to meet your care needs in all situations (i.e. if your caregiver goes on vacation, becomes ill or requires unplanned leave). You must ensure that you receive proper care if the regular caregiver is unable to provide care. This back-up plan must meet the requirements set out in the Nursing Assessment. All training of back-up caregivers is your responsibility. 10

11 Change in Your Condition You must notify your Case Manager at WorkSafeBC immediately in the event there is a change in your condition or circumstances that results in a need to substantially revise the Care Plan. This is especially relevant if your care needs are exceeding the care capabilities of the caregivers. In the event that your care needs have changed, WorkSafeBC will either request a new nursing assessment and/or conduct a visit as required to assess your needs. If You Are Hospitalized If you are hospitalized, it is your responsibility to ensure: Your WorkSafeBC Case Manager is notified immediately; and Caregivers are immediately notified of your absence. Upon admission into a hospital, WorkSafeBC will not pay your caregivers to provide your care as it is expected that care will be provided by hospital staff. If You Go On Vacation When you decide to go on vacation, WorkSafeBC will continue to fund the approved Care Services as outlined in the Care Plan Costs, Schedule A. If the caregiver is traveling with you, you are responsible to pay for any associated travel expenses. Caregiver overtime is not payable while you are on vacation. Submission of Care Reports You must complete and fax a quarterly care plan report using the Self-Managed Care Quarterly Progress Report template (83W133) as attached in the Appendix. Quarterly care reports must be received on or before the last calendar day of March, June, September and December as indicated on the report, regardless of any change in your condition. Forms must be type written and faxed to (604) or toll-free 1 (888) Incident Reports You must report, verbally and in writing, to the WorkSafeBC Program Manager of Health Care Services, any physical or psychological trauma sustained by or any complaints relating to service reported by the Injured Worker. The incident or trauma must be reported within twenty-four (24) hours of the Contractor becoming aware of it having occurred and a written progress report (83W133) must be submitted to the WorkSafeBC within seven (7) days. 7.0 PAYROLL DEDUCTION AND BUSINESS REQUIRMENTS You have a number of business responsibilities as an employer. As an employer, you must: Have a Business Number from the Canada Revenue Agency business accounts; Determine and submit payroll deductions including income tax, Canada Pension Plan ( CPP ) contributions, and Employment Insurance ( EI ) premiums from amounts you pay to your employees; Determine and submit taxes as applicable; Determine and submit the employer s portion of CPP contributions and EI premiums that you have to pay throughout the year on your employees' behalf; 11

12 Report and submit all of these amounts to CRA as required by CRA guidelines (either by the end of February of the following calendar year or earlier as determined by CRA). For more information, contact Canada Revenue Agency toll-free at: 1 (800) or on the Web at You can obtain an Employer s Kit from the CRA by calling tollfree: 1 (800) ; Fax a copy of the E-PD7A, Statement of Account for Current Source Deductions to (604) or toll-free 1 (888) either monthly or quarterly as determined by CRA; and, Fax a copy of the T4 summary to WorkSafeBC at (604) or toll-free 1 (888) by the end of February of each year. Please clearly write the code 83W6 on the bottom left hand corner of each page. In addition, you agree to provide WorkSafeBC a copy of your assessment notice from the Canada Revenue Agency, upon request from WorkSafeBC. 8.0 INVOICING AND FINANCIAL REQUIREMENTS 8.1 Invoicing You must submit invoices to WorkSafeBC for the payment of wages and benefits for the person(s) providing care in accordance with the Care Plan Cost. The following costs are included in the WorkSafeBC Care Plan Costs: Care services; Payroll deduction requirements; WorkSafeBC assessment fees; and, Bank charges associated in the set-up and maintenance of the bank account used exclusively for the payment of care costs under the Agreement. The WorkSafeBC Care Plan Costs are for the cost of your care. WorkSafeBC will not pay any extra invoices for care in addition to the Care Plan Costs (i.e., Postage/stationary, mileage). You shall not charge interest on accounts and no interest shall be payable in respect of those invoices. Invoices and Reports are to be submitted for authorized Services only. The Case Manager does not have the authority to deviate from the Care Plan Costs and the Agreement. No additional charges shall be invoiced to WorkSafeBC except under Sc. 9.0 of the Self-Managed Care Reference Manual, Care Plan Costs and Services, Additional Professional Services. Should you be admitted to a hospital, or be unable to receive Care Services for any other reason, then you shall notify WorkSafeBC and suspend invoicing. 8.2 Start-up Costs Upon execution of the AGREEMENT for the Self-Managed Care program, you must immediately submit an invoice for the Service Start Up Costs which should equate to 150% of your monthly Care Plan Costs. These funds will serve as a buffer to cover the timing difference between the month end invoice and reimbursement by WorkSafeBC and in the event of any missed or 12

13 delayed payments invoiced for your Self-Managed Care program. Invoice using Fee Code Submitting Invoices You must complete and fax your invoice at the end of each month for actual services rendered using the Invoice Form template (83W134) as attached in the Appendix. The invoice is also available at under Forms; Health care providers; Self-Managed Care Services. Invoices must be submitted with all the mandatory fields completed as indicated on the invoice form (83W134). All invoices shall be issued and paid for in Canadian (CDN) funds. WorkSafeBC may return invoices containing discrepancies or errors, noting areas for correction. If the defect is minor, WorkSafeBC may correct the invoice. The Injured Worker may not be paid until an invoice which complies with the terms as set out in the Agreement and the Self-Managed Care Reference Manual is received or the invoice has been corrected by WorkSafeBC. If invoicing for advertising expense, include Fee Code and total amount on the invoice. A copy of the receipt must be included. All invoices and supporting documents must be faxed to (604) or toll-free 1 (888) WorkSafeBC may change the invoicing procedures at any time during the initial six (6) month period and/or Term of the Agreement. WorkSafeBC shall provide written notice to the Injured Worker regarding any changes. 8.4 Submitting Monthly Reconciliation Reports Self Managed Care Monthly Reconciliation Reports, reflecting all disbursements and receipts completed in the previous month, must be submitted by the 15 th calendar day of the following month accompanied by a bank reconciliation. For example, the report for June needs to be submitted by the July 15th. Bank statements and payroll summary sheets detailing the actual amounts paid must accompany the monthly reconciliation report. Please clearly write the code 83W6 on the bottom left hand corner of each page of your bank statement. Monthly reconciliation reports must be faxed using the WorkSafeBC template as attached in the Appendix Self-Managed Care (SMC) Monthly Reconciliation Report Form (83W6). The form is also available at under Forms; Health care providers; Self- Managed Care Services. Monthly reconciliation reports and supporting documents must be faxed to (604) or toll-free 1 (888)

14 8.5 Surplus Care Plan Funds If financial reporting reveals that the Care Plan funds have accrued a surplus in the designated account, the surplus may be reviewed at any time and refunded to WorkSafeBC. WorkSafeBC will collaborate with you to assess why a surplus exists. WorkSafeBC may: Conduct a review of your care plan costs and/or nursing assessment; and/or Conduct a financial audit which may result in a change to the Care Plan requirements; and/or Arrange to meet with you to discuss the matter. The payments normally made by WorkSafeBC for future care may be reduced by the amount of the surplus. 8.6 In The Event Of Your Death In the event of your death, WorkSafeBC may recover any surplus care plan funds that exist after all employer disbursements are paid for services rendered. 8.7 Records and Audit Rights You, the Injured Worker, shall maintain all records and books concerning the Care Services provided and fees invoiced pursuant to the Self-Managed Care Program, together with all relevant documents and materials, for the duration of the Self-Managed Care Program and for seven (7) years following the completion or termination of the Self-Managed Care Program. When requested by WorkSafeBC, the Injured Worker shall make available all books and records, together with the supporting or underlying documents and materials, to WorkSafeBC for inspection, audit, or reproduction by its employees and/or subcontractors or authorized representatives, during normal business hours at the Injured Worker s office or place of business. The Injured Worker shall not charge any fee for the cost of reproduction of records required under the Agreement. WorkSafeBC may, at any time during the initial six (6) month trial period and/or Term of the Self-Managed Care Program, audit all the Injured Worker s accounting records and books concerning Care Services provided pursuant to the Self-Managed Care Program including any and all documents and other materials, in whatever form they may be kept, upon which the accounting records and invoices are based. 9.0 CARE PLAN COST AND SERVICES 9.1 Care Plan Costs WorkSafeBC shall establish your Care Plan Costs based on the Nursing Assessment and current health care requirements of your compensable injury. The payment of wages and benefits for the person(s) providing care services are your responsibility and are based upon the Care Plan Costs. Benefits for your caregivers have been calculated into the care plan costs. These benefits include compensation for vacation and supplement in lieu of benefits and must be paid to your caregivers. 14

15 9.2 Caregiver Wages The following is the salary grid to be used for caregiver wages. All new staff must start at Step 1. Annual wage increases may be provided upon written request to Purchasing Services at with a subject header of Self Managed Care Wage Increase. Wage increases can only be given to those caregivers who have been employed for a minimum of 365 days at the current step. Requests for caregiver increases must be received by December 1 st to be effective January 1 st of the following year, outlining the caregivers and current wages (step). Step Step Step Step Step Step Step Please note that the Salary Grid may be revised intermittently for cost of living and inflation adjustments at the sole discretion of WorkSafeBC. 9.3 Additional Professional Services If other professional services are required (e.g. Wound/Ostomy Nurse, Physiotherapist, Occupational Therapist, Speech Therapist, or Respiratory Therapist), please contact your Case Manager as WorkSafeBC has networks of contracted providers for these services CONFLICT OF INTEREST The Injured Worker shall ensure that Care Services are provided without any conflict of interest, including but not limited to the following: a) Non arms-length employees; b) The hiring or retention of WorkSafeBC employees; c) Distribution of promotional material while conducting WorkSafeBC business; d) Providing advocacy services to Injured Workers against WorkSafeBC COMPLIANCE WITH REQUIREMENTS If you do not comply with the reporting and communication requirements, it will impact your future participation in any Self-Managed Care Program. If you do not meet the requirements, WorkSafeBC will use an escalation process where WorkSafeBC may choose to: a) Contact you to review the situation and discuss future actions required; and/or b) Meet with you and a WorkSafeBC Quality Assurance Supervisor, Program Manager and/or other WorkSafeBC representatives to review the situation and discuss future actions required; and/or c) Where WorkSafeBC determines that you do not comply with the requirements breach of the performance standards, WorkSafeBC may terminate this AGREEMENT pursuant to Clause 11.0 Termination. 15

16 12.0 WHAT DO I HAVE TO SUBMIT? MONTHLY What Forms? Invoice Form Monthly Reconciliation Report Form E-PD7A Statement of Account for Current Source Deductions (copy) Self-Managed Care ( SMC ) Quarterly Update When Do I Submit It? Last day of every month 15th day of the following month Monthly or quarterly as determined by CRA March 31, June 30, September 30, December 31 How Do I Submit It? Form # Fax to (604) or toll-free 1 (888) Fax to (604) or toll-free 1 (888) Fax to (604) or toll-free 1 (888) Fax to (604) or toll-free 1 (888) W134 83W6 Write 83W6 on the bottom left corner of each page 83W133 * Forms may be downloaded at under Forms; Health Care Providers. ANNUALLY What Forms? Copy of T4 Summary Clearance Letter from WorkSafeBC When Do I Submit It? By end of February of EVERY year How Do I Submit It? 1. Clearly write 83W6 on bottom left hand corner of each page. 2. Fax to (604) or toll-free 1 (888) WORKSAFEBC CONTACT INFORMATION Please ensure on your fax correspondence to WorkSafeBC, that each page includes your name, claim number and/or contract number. 1. Health Care Services: Questions regarding contract process, forms or reports, clinical questions and service quality issues should be sent to the Quality Assurance Supervisor or Program Manager. Phone: (604) or Toll free: 1 (866) extension General Contract Notices: Change in licensing requirements and notices, fax to Purchasing Services at (604) Questions regarding your contract terms and conditions, 16

17 contact the Senior Purchasing Officer. Phone: (604) or Toll free: 1 (888) extension Board Officer or Case Manager: Questions regarding your entitlement or related questions, please contact your Case Manager. 4. Assessment Registration: Questions regarding registration letters, registration status or clearance letters. Phone: (604) or Toll Free: 1 (888) or On-line: Information may be found on WorkSafeBC website Click on Insurance tab. 17

18 APPENDICES APPENDIX A: SELF-MANAGED CARE FEE SCHEDULE FEE SCHEDULE: SELF-MANAGED CARE SERVICES Type of Service Care Plan Cost Start-up Costs Advertising Expense Accounting/ Bookkeeping Expense Fee codes Use as indicated on Monthly Care Plan Worksheet Business Rules FEES EFFECTIVE March 1, 2012 Maximum monthly rate based on the Nursing Assessment and current health care requirements of your compensable injury. All inclusive of wages and benefits of person(s) providing the Care Services, Payroll Deductions, and WorkSafeBC assessment fees. Billable upon submission of the Monthly Reconciliation Report and Invoice to WorkSafeBC. Billable at the end of each month for ACTUAL services provided. Payroll summary sheets detailing the actual amounts paid must be submitted with the monthly financial Reconciliation report. Not billable for any additional charges in excess of the Care Plan Costs Billable only once per executed SMC AGREEMENT Billable immediately after execution of AGREEMENT Serves as a buffer in the event of any missed or delayed payments invoiced for your Self Managed Care program Billable for advertisement to recruit caregivers Maximum reimbursement up to $ Billable only with submission of invoice and receipt Billable only once per year Billable for qualified, non armslength accounting and/or bookkeeping service. As per AGREEMENT 150% of Monthly Care Plan Cost As invoiced, up to maximum $ annually As invoiced, up to a reasonable maximum of $250 per month (at the sole 18

19 Type of Service Fee codes Business Rules FEES EFFECTIVE March 1, 2012 Reasonable fees for this service are reimbursed up to a maximum of $250 per month (at the sole discretion of WorkSafeBC s Health Care Services). Copy of your receipts for accounting/ bookkeeping services are required upon the request of WorkSafeBC. discretion of WorkSafeBC s Health Care Services). 19

20 APPENDIX B: SELF-MANAGED CARE - CARE PLAN COST WORKSHEET The following Care Plan Cost Worksheet is an estimated annual cost of your care. This worksheet will also provide the following: Estimated monthly care cost; Estimated source deduction amounts from payroll; Hourly rate of employees. Care Plan Cost Monthly Amount The Care Plan Cost is an estimated amount and it is subject to change based upon your care requirements. This estimated averaged monthly amount will not match your actual monthly expenditures as you may find there is a slight shortfall in some months and overage in others months. You should have enough surplus funds to cover the months with a shortfall. Employee Hourly Rate The following is the salary grid to be used for caregiver wages. All new staff must start at Step 1. Step Step Step Step 1 Step 3 Step 5 Step Please note that the Salary Grid may be revised intermittently for cost of living and inflation adjustments at the sole discretion of WorkSafeBC. Change in Hourly Caregiver Rate Annual wage increases may be provided upon written request to Purchasing Services at Purchase@worksafebc.com with a subject header of Self Managed Care Wage Increase. Wage increases can only be given to those caregivers who have been employed for a minimum of 365 days at the current step. Requests for caregiver increases must be received by December 1 st to be effective January 1 st of the following year, outlining the caregivers and current wages (step). Annual wage increases will only be given once per year and only at the previously described timeframe. Any changes to the hourly rate must be reflected in your monthly invoice form (83W134) and in your monthly reconciliation report form (83W6) to WorkSafeBC. Note: Rates are subject to change annually: Employment Insurance ( EI ) Premiums; Canada Pension Plan ( CPP ); WorkSafeBC Assessment Insurance Premium. Statutory Holidays BC Employment Standards states there are 10 statutory holidays. WorkSafeBC has included an additional two (2) days which are Easter Monday and Boxing Day. WorkSafeBC s goal is to remain competitive in salary and benefits in the current job market. We achieve this through competitive wages, the additional statutory holidays and providing 6% in lieu of benefits and 6% vacation pay. 20

21 APPENDIX C: SELF-MANAGED CARE - INVOICE 21

22 APPENDIX D: SELF-MANAGED CARE MONTHLY RECONCILIATION REPORT This sheet is to provide you with basic information on how to complete the Monthly Reconciliation Report. This report is to be sent along with the corresponding bank statements and payroll summary sheets by the 15 th day of the following month reflecting all disbursements and receipts for the preceding month. Please check to make sure the report is complete and you have included the cheque number where indicated. Balance as per book (left hand column): Line A - Cash Balance from Last Month Report the amount as appeared on Line J of the preceding month s reconciliation report. If this is your first report, report $0. Line B WorkSafeBC Payment Received* Report the amount received from WorkSafeBC during the current month. Line C Subtotal Report the total of lines A and B. Line D Net Wages to Employees* Report the total amount paid to employees during the current month (net of employee s portion of employment insurance, Canada Pension Plan, and income tax deductions). Line E Employment Insurance Payment* Report the amount remitted to Canada Revenue Agency (CRA) for both the employer and employee portion of employment insurance on wages to employees. Line F CPP Payment* Report the amount remitted to CRA for both the employer and employee portion of CPP on wages to employees. Line G Income Tax Withheld * Report the amount remitted to CRA for income tax withheld on amounts paid to employees. Line H Other (Specify)* Report any bank charges, administration costs of self-directed home care plan, amount remitted to WorkSafeBC for employer assessment, etc. Please attach to this report a breakdown of amounts reported in this box. Line I - Total Cheques Report the total of all lines D to H. Line J Total Cash Balance for This Month 22

23 This amount should equal the bank balance as at the end of the current month. If not, please provide a listing of cheques that have not cleared the bank. *For example: The report you submit in mid-july should include payments received and made in June. Balance as per bank statement (right hand column): Line A Balance per bank statement Note the bank balance as listed on the bank statement. Line B Deposit in transit Add any deposits not yet recorded on the bank statement. Line C Outstanding cheques Subtract any cheques that have been issued but have not been debited or cleared the bank account as of the date of the bank statement Line D Adjusted bank balance Add A and B and subtract C to give this total. 23

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25 APPENDIX E: SELF-MANAGED CARE - QUARTERLY PROGRESS REPORT 25

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30 APPENDIX F: SELF-MANAGED CARE SIGN IN/OUT SHEET SELF MANAGED CARE STAFF SIGN IN/OUT SHEET Worker name: Worker claim number: Month/year: Date Caregiver Name (printed) Sign in time Sign out time Caregiver Signature 30