4123-6-19 Remain at work program.

 

 

 

4123-6-19                    Remain at work program.

 

 

 

(A)   The bureau shall take measures and make expenditures, as it deems necessary, to aid injured workers who have sustained compensable injuries or contracted occupational diseases to remain at work.

 

(B)  Remain at work services.

 

(1)  An injured worker is eligible to participate in a remain at work program when:

 

(a)     The injury results in a medical only claim which is certified by the employer or is allowed pursuant to a bureau or industrial commission order; and,

 

(b)    It is documented by the employer, the injured worker or physician of record that the injured worker is experiencing problems that are work-related and result from the allowed conditions in the claim.

 

(2)     Services provided shall be charged to the employer's risk. If the claim is subsequently disallowed, the bureau will not be responsible for remain at work services that were provided.

 

(3) The MCO shall determine the need for remain at work services.

 

(C)  Scope of remain at work services.

 

(1) Referrals for remain at work.

 

(a) Any one can refer an injured worker for remain at work services.

 

(b) The MCO shall determine the need for remain at work services.

 

(c) An injured worker's participation in remain at work services is voluntary.

 

(2)(1) Services provided in a remain at work program.

 

(a)    The MCO shall submit to the bureau a final report at the completion of services within five business days of final services.

 

(b) The  provider  shall  staff  the  claim  with  the  MCO  and  bureau  at  the initiation of remain at work services.

 

(c)(b) Remain at work services may include ergonomic study, functional capacity        evaluation,           job            analysis,                 physical         therapy               (on             site),

 

 

occupational therapy (on site), physical reconditioning, transitional work, gradual return to work, on the job training, job modification, tools and equipment, and remain at work case management.

(d)(c) The bureau will not reimburse an employer for remain at work services that are provided by the employer (e.g., transitional work, on the job training, gradual return to work).

(3)(2) Remain at work services shall cease upon the occurrence of any of the following:

(a)   A bureau, industrial commission or court order subsequently disallowing the claim.

(b)   The claim changes to a lost time claim, with the exception of those cases in which the claim becomes lost time due to an award pursuant to division (A) of section 4123.57 of the Revised Code with eight or more days of lost time due to a work related injury.

(i)   A claim receiving an award under division (A) of section 4123.57 of the Revised Code may continue in the services already authorized; however, no additional services shall be authorized under the remain at work program that changes to a lost time claim with eight or more days of lost time due to a work related injury may be referred for vocational rehabilitation services as provided under Chapter 4123-18 of the Administrative Code.

(ii) The injured worker may be referred for vocational rehabilitation services as provided under Chapter 4123-18 of the Administrative Code.

(c)   The effective date of lump sum settlement.

(4)(3) Audit ofThe bureau may audit the MCO's remain at work program.

(a) The bureau may audit the MCO's remain at work program on a regular basis.

(b) The following issues will be audited: notification process, eligibility criteria, forty five day staffing, completion reports, documentation of services, and services charged to proper fund.

Effective:                                                     07/01/2012

R.C. 119.032 review dates:                         12/30/2011 and 07/01/2017

CERTIFIED ELECTRONICALLY

Certification

03/26/2012

Date

Promulgated Under:                           119.03

Statutory Authority:                           4121.12, 4121.121, 4121.30, 4121.31, 4121.44,

4121.441, 4123.05, 4123.66

Rule Amplifies:                                  4121.121, 4121.44, 4121.441, 4123.66

Prior Effective Dates:                         10/26/04, 3/1/09, 1/1/01, 2/14/05