Original Notice.

Preproposal statement of inquiry was filed as WSR 00-05-002.

Title of Rule: New chapter 296-19A WAC, Vocational rehabilitation; new section WAC 296-15-500 What vocational rehabilitation reports are required for self-insured employers? and new section WAC 296-15-510 What is the process used for vocational rehabilitation with regard to self-insured employers?

Purpose: Chapter 296-19A WAC will replace chapter 296-18A WAC as the regulatory basis for vocational rehabilitation for industrial insurance. New sections WAC 296-15-500 and 296-15-510 will move regulations applicable to vocational services provided in the self-insured arena to the self-insured chapter.

Statutory Authority for Adoption: RCW 51.04.020, 51.04.030, 51.32.095, 51.36.100, 51.36.110.

Summary: Chapter 296-19A WAC will:

•	Spell out additional detail on provider qualifications, billing processes, and L&I auditing.
•	Explain more clearly the department's expectations of what services will be provided for each type of vocational referral, what reports to the department must contain, and when they will be submitted.
•	Address how providers are to be held accountable for the services they deliver (corrective actions and performance measurement).

Reasons Supporting Proposal: In 1998-99, the Department of Labor and Industries (L&I) conducted a study of its vocational purchasing practices. Based on the recommendation of the department's project consultant, William M. Mercer, Inc., L&I concluded that its current purchasing method of contracting with private sector vocational providers should be discontinued and the requirements of the contract should be placed in WAC. At roughly the same time, the Joint Legislative Audit and Review Committee (JLARC) authorized a performance audit of the department's workers' compensation activities. One of the recommendations from the JLARC team (21A) directed the department to "move toward higher standards of private vocational rehabilitation providers." In addition, other program improvements recommended both by JLARC and Mercer warrant significant changes to the current vocational rehabilitation chapter 296-18A WAC. Without rule changes, L&I will be unable to implement many of the changes needed to improve its vocational purchasing practices.

Name of Agency Personnel Responsible for Drafting: Blake Maresh, Senior Health Policy Analyst, Tumwater, Washington, (360) 902-6564; Implementation and Enforcement: Linda Murphy, Program Manager, Tumwater, Washington, (360) 902-6699 and Jody Moran, Program Manager, Tumwater, Washington, (360) 902-4300.

Name of Proponent: Department of Labor and Industries, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: Chapter 296-19A WAC will:

•	Spell out additional detail on provider qualifications, billing processes, and L&I auditing.
•	Explain more clearly the department's expectations of what services will be provided for each type of vocational referral, what reports to the department must contain, and when they must be submitted.
•	Address how providers are to be held accountable for the services they deliver (corrective actions and performance measurement).

The anticipated effects of replacing chapter 296-18A WAC with chapter 296-19A WAC include:

•	More efficient service delivery through more detailed billing requirements.
•	More highly qualified vocational providers delivering better quality service to injured workers.
•	More consistent application of the rules through better, more consistent definitions and easier to understand language.
•	Increased level of provider accountability for services rendered.

Proposal Changes the Following Existing Rules: The current proposal strikes and replaces the existing WAC chapter on vocational rehabilitation, chapter 296-18A WAC. The new chapter will be chapter 296-19A WAC, Vocational rehabilitation. The new chapter makes several changes to existing rules.

•	It organizes the rules more clearly, places the rules in clear rule writing format, and defines terms used in the rules more clearly and consistently.
•	As stated above, because vocational purchasing has traditionally occurred through contracts between the department and vocational rehabilitation firms, many requirements previously in contract must now be placed in WAC.
•	To clarify the parallels and distinctions between vocational providers and medical providers, some applicable WACs from L&I's Medical Aid Rules are included in this proposal. In some cases, these WACs have been modified slightly to better suit the vocational provider community.
•	The proposal also moves two WAC sections from chapter 296-18A WAC to chapter 296-15 WAC. This is because chapter 296-15 [296-18A] WAC pertains to self-insurers, as does chapter 296-15 [296-18A] WAC.

A small business economic impact statement has been prepared under chapter 19.85 RCW.

L&I's proposal makes several changes to existing rules:

•	It organizes the rules more clearly, places the rules in clear rule writing format, and defines terms used in the rules more clearly and consistently.
•	As stated above, because vocational purchasing has traditionally occurred through contracts between the department and vocational rehabilitation firms, many requirements previously in contract must now be placed in WAC.
•	To clarify the parallels and distinctions between vocational providers and medical providers, some applicable WACs from L&I's Medical Aid Rules are included in this proposal. In some cases, these WACs have been modified slightly to better suit the vocational provider community.
•	The proposed rules spell out additional detail on provider qualifications, billing processes, and L&I auditing. The proposed rules explain more clearly the department's expectations of what services will be provided for each type of vocational referral, what reports to the department will contain, and when they will be submitted. They also address how providers are to be held accountable for the services they deliver (sanctions and performance measurement).

Proposed Changes to Billing Requirements: Currently, providers are not required to itemize bills to the department by specific date of service, units of service, or individual counselor or intern. This prevents the department from being able to track costs of services by individual VRC or vocational intern. Through the issuance of individual provider ID numbers, L&I is proposing more detailed billing requirements that will allow it to perform analysis and do performance measurement on vocational professionals delivering services.

In the future, bills submitted to the department must include the following information:

•	Worker's name;
•	Worker's claim number;
•	Vocational referral number;
•	Dates of service;
•	Place of service;
•	Type of service;
•	Appropriate procedure code(s);
•	Description of service;
•	Charge;
•	Units of service;
•	Total bill charge;
•	The name and the department assigned provider ID of the counselor or intern rendering the services;
•	The provider ID of the payee;
•	Date of billing;
•	Submission of supporting documentation required under other sections of this chapter.

There are several possible implications of L&I establishing more detailed billing requirements. Vocational rehabilitation firms and counselors billing the department will need to make sure that they are maintaining the appropriate records to satisfy L&I's billing needs. Further, it may be necessary for some vocational providers who electronically bill L&I to make modifications to their information systems. Finally, some larger vocational firms may also need to engage in training of administrative and professional staff with regard to the new requirements of L&I bills.

Proposed Minimum Qualifications Changes: The proposed WACs make changes that increase the qualifications that must be met to obtain a provider number with the department and be eligible to receive referrals and be reimbursed for providing vocational services to industrially injured/occupationally ill workers.

Vocational Rehabilitation Counselor (VRC): VRCs applying for a provider number with the department effective on or after September 1, 2000, must meet the following minimum qualifications:

CDMS = Certified Disability Management Specialist

ABVE = American Board of Vocational Experts

VRCs registered with the department prior to September 1, 2000, will be required to apply for a provider number and will be given four years from September 1, 2000, to meet the above requirements.

Vocational Rehabilitation Counselor/Supervisor: In order to supervise interns providing vocational services to industrially injured/occupationally ill workers beginning on or after September 1, 2000, the VRC/supervisor must provide proof of three years full-time experience working with Washington state injured workers when applying for a provider number. VRC/supervisors registered with the department prior to September 1, 2000, will be required to apply for a provider number and will be given four years from September 1, 2000, to meet the above requirements.

Forensic Services: In order to provide forensic services to the department on claims other than those for which the VRC provided the vocational rehabilitation services, a VRC must provide proof of three years full-time experience working with Washington state industrially injured or ill workers when applying for a provider number.

Vocational Rehabilitation Interns (interns): Interns applying for a provider number with the department on or after September 1, 2000, must meet the following minimum qualifications:

Comparison of L&I and NARPPS Qualifications Proposals: The National Association of Rehabilitation Professionals in the Private Sector (NARPPS) Washington chapter submitted recommendations to the department for VRC qualifications. The primary differences between the NARPPS and department proposed qualifications are:

Industry Survey to Assess Cost of Compliance: To assess the financial impact of the proposed amendments to chapter 296-307 WAC, the agency conducted a mail cost survey. A total of one hundred thirty surveys were sent to vocational rehabilitation service providers that provide service to residents of Washington state. The survey contained information regarding the proposed changes to the vocational rehabilitation rules focusing particularly on the minimum qualification and billing requirements. Recipients were asked to supply information on the number of VRCs, VRC supervisors and VRC interns at their company, and what fractions of VRC and VRC interns met the proposed educational requirements. Survey recipients were also asked to estimate the cost of meeting the proposed minimum qualification and billing requirements.

A total of sixty surveys were returned for a response rate of 46%, which represents six hundred thirty-six people that work in the vocational rehabilitation industry. Of this number, fifty-five survey responses were from small businesses and five were from large business establishments. Note that four of the five large businesses reported total VRC employment in the forty to fifty range; the department assumed that with part-time workers and support staff that these businesses would exceed the fifty employee threshold.

Analysis of Survey Cost Data: The survey data was compiled and analyzed in an Excel spreadsheet. Summary data on the fraction of VR employees that currently meet the minimum qualification (option A or B) and billing requirements is presented in Table 4 below.

For this study, just under three fifths of VRC workers were employed at small business establishments. The survey results indicate that about half of the VRCs currently meet the proposed minimum qualification requirements, slightly less than one third of VRC interns meet the requirements and approximately half of the VRC businesses meet the proposed billing requirements. Overall, VR businesses responded that they would cover about 40% of the training and educational costs for VRCs to meet the minimum qualification requirements.

In the survey additional information was collected regarding the sources of a particular VR firms work (state, federal, self-insured, other). Correlation coefficients between fraction of VRCs and VRC interns meeting the minimum qualifications and the sources of work were determined. The correlation coefficients are presented in Table 5 below.

The negative correlation coefficients of -0.248 and -0.273 between the fraction of state fund work and fraction of VRCs and VRC interns meeting the minimum qualifications suggests that VR business doing state fund work tend to have workers with lower qualifications. The positive correlation coefficients of 0.513 and 0.200 between nonstate fund work and fraction VRCs and VRC interns meeting the minimum qualifications suggests that those VR businesses in which nonstate fund work is a large fraction of the total work, have more highly qualified workers. The results of this correlation analysis seem to lend credence to anecdotal information from the vocational provider community. That is, self-insurers, who will typically pay more for vocational rehabilitation services than does the department, are able to attract more highly qualified and experienced providers to give self-insured referrals priority over state fund referrals. It follows, then, that less experienced counselors and interns typically work on state fund referrals.

Procedure for Dealing with Data Outliers: Costs to meet the proposed minimum training and experience qualifications and billing requirements were determined for small and large business entities. While data was generally used as reported, a few respondents may have misinterpreted the questions, based their responses on incorrect assumptions, or responded in a strategic manner, thus giving unrealistically high cost numbers. Based on the departments' own internal vocational rehabilitation expertise, more reasonable lower, middle and upper bound costs estimates for the minimum qualifications and billing were developed. These estimates were used to replace the extreme survey cost estimates and are shown in Table 6 below. The lower bound minimum qualification estimate was based on the following assumptions:

1. VRC or intern has degree, which meet credential requirements,

2. Cost of credential is $290,

3. Cost of supervision is $3,000 (60 hours at $50/hour).

The upper bound minimum qualification estimate was based on the following assumptions:

1. VRC or intern needs 5 courses to meet credential requirement,

2. Cost of credential is $290,

3. Cost of supervision is $3,000 (60 hours at $50/hour),

4. Costs of course work $4,000.

The middle estimate is centered between the lower and upper bounds. Upper, middle and lower bound estimates were also prepared for outliers involving the costing of the billing requirements. Basic billing software can be obtained for about $300 dollars from Crabtree Consulting and $1,000 from Berg Infosytems. A supplementary cost was added to the $1,000 sited above for customizing efforts or consulting fees that might be incurred to make the software fully functional. An allowance was also made for additional recurring costs in the billing process. Because a large VR business might need to buy multiple versions of the billing software, costs for the large VR businesses were assumed to be twice the costs for small VR businesses: See Table 6 below.

Impacted Industries and Involvement of Small Business in Rule Development (RCW 19.85.040(2)): The proposed rule changes impact businesses that provide vocational rehabilitation services for injured workers: SIC 833. The affected businesses have had an opportunity to comment through extensive stakeholder mailings and survey, and VTSG (Vocational Technical Stakeholder Group) meetings. They will continue to have an opportunity to comment during the hearing and public commenting process.

Conclusion: The survey results presented in the previous section reveal anticipated compliance costs that impose a more than minor impact on the vocational rehabilitation industry. The results above indicate that on a per employee basis annualized compliance costs for small vocational rehabilitation businesses will be only half those for large businesses. Therefore, I conclude that the anticipated compliance costs for the proposed changes to chapter 296-19A WAC will not have a disproportionate financial impact on small businesses. Based upon the fact that the proposed rules will not have a disproportionate financial impact on small businesses, the department has not taken steps to reduce the costs of the rule on small businesses as required by RCW 19.85.030(3).

Please contact Greg Nothstein if you have further questions regarding this analysis, (360) 902-6805.

A copy of the statement may be obtained by writing to Department of Labor and Industries, ATTN: Greg Nothstein, Economic Analyst, P.O. Box 44001, Olympia, WA 98504-4001, phone (360) 902-6805, fax (360) 902-4202.

RCW 34.05.328 applies to this rule adoption. Chapter 296-19A WAC constitutes significant legislative rules of the Department of Labor and Industries and will make significant amendments to the department's vocational rehabilitation regulatory program.

Hearing Location: Everett L&I Service Location, 729 100th Street S.E., Everett, WA 99208-3727, on June 14, 2000, at 1:30-4:30 p.m.; at the Tumwater L&I Service Location, 7273 Linderson Way S.W., Tumwater, WA 98501, on June 7, 2000, at 1:30-4:30 p.m.; and at the Spokane L&I Service Location, 901 North Monroe Street, Suite 100, Spokane, WA 99201-2149, on June 13, 2000, at 9 a.m.-noon.

Assistance for Persons with Disabilities: Contact Blake Maresh, by June 1, 2000, (360) 902-6564.

Submit Written Comments to: Blake Maresh, Senior Health Policy Analyst, fax (360) 902-4249, by June 21, 2000.

Date of Intended Adoption: July 22, 2000.

May 3, 2000

Gary Moore

Director

OTS-3889.4

(1) What does it mean to say an injured worker is employable?

(a) "Employable" means having the skills and training that are commonly and currently necessary in the labor market to be gainfully employed on a reasonably continuous basis when considering the worker's:

(i) The worker's age, education, and experience;

(ii) The worker's preexisting physical and mental limitations; and

(iii) The physical and mental limitations caused, at least in part, by the worker's industrial injury or occupational disease.

(b) Physical and/or mental conditions that arose after the industrial injury/occupational disease that were not caused or aggravated by the industrial injury/occupational disease are not considered in determining whether the worker is employable under the Industrial Insurance Act.

(c) If there are no physical or mental limitations caused by the worker's industrial injury/occupational disease, the worker cannot be found unemployable under the Industrial Insurance Act.

(2) What are vocational rehabilitation services? Vocational rehabilitation services are those provided by a vocational rehabilitation provider and include, but are not limited to, the following:

(a) Gathering industrially injured or ill workers' work and/or education histories and physical capacities information;

(b) Assessing industrially injured or ill workers' employability;

(c) Developing, documenting, and writing vocational plans;

(d) Monitoring injured workers' progress during training;

(e) Writing progress reports;

(f) Analyzing and documenting the transferable skills of the injured worker and writing transferable skills analyses;

(g) Performing occupational research;

(h) Conducting labor market surveys and writing labor market survey reports;

(i) Conducting and writing job analyses;

(j) Communicating with industrially injured or ill workers, employers, physicians and others;

(k) Developing job modifications and work site modifications, as well as prejob accommodations, and writing reports for this work; and

(l) All work done to obtain any job with any employer for injured workers referred for vocational rehabilitation services.

(3) What is a vocational rehabilitation provider (provider)? A provider is any person, firm, partnership, corporation, or other entity that provides vocational rehabilitation services to industrially injured or ill workers. A provider must meet the qualifications listed in WAC 296-19A-210.

(4) What is an injured worker's labor market? It is the area in which a worker would seek gainful employment. The labor market must be within a reasonable commuting distance and be consistent with the industrially injured or ill worker's physical and mental capacities.

When a worker:	Then the department:
•Relocates to a labor market other than at the time of injury and •Returns to work and •Suffers an aggravation of the work-related condition.	Uses the labor market where the industrially injured or ill worker worked at the time of the aggravation. This applies whether the department closed and reopened the claim or whether the claim remained open during the period of aggravation.
•Relocates after the industrial injury/illness or aggravation and •Now lives in a labor market with more employment opportunities than where the industrially injured or ill worker worked at the time of injury.	Uses the industrially injured or ill worker's current labor market. For example, an industrially injured or ill worker was injured in Forks but after the injury, moves to Tacoma. Provider would use Tacoma as the industrially injured or ill worker's labor market.
•Relocates to a labor market other than at the time of injury or onset of illness and •The industrial injury or occupational disease was a proximate cause of the move.	Uses the injured or ill worker's current labor market. For example, an industrially injured or ill worker moves to a drier climate due to an accepted asthma condition. Provider would use the labor market in the drier climate.

(5) What is a labor market survey (LMS)? It is a survey of employers in an industrially injured or ill worker's labor market to obtain specific information (such as physical demands and qualifications) related to job possibilities.

(6) What is a job analysis? It is a description of the knowledge, skills, abilities, and physical requirements necessary for a worker to perform a job.

(7) What is a transferable skill? Transferable skills are any combination of learned behavior, education, training, work traits, and work-related skills that can be readily applied by the worker. They are skills that are interchangeable among different jobs and workplaces. Nonwork-related talents or skills that are both demonstrated and applicable may also be considered.

(8) What is a transferable skills analysis? It is a systematic study of the transferable skill or skills a worker has to see if that skill set makes him/her employable.

(9) What are job modifications? Job modifications are adjustments or alterations made to the way a job is performed to accommodate the restrictions imposed by an industrial injury or occupational disease. Job modifications are used when an employer-employee relationship exists, and they may include worksite adjustment; job restructuring; and/or tools, equipment or appliances.

(10) What are prejob accommodations? Prejob accommodations are adjustments or alterations made to the way a job is performed to accommodate the restrictions imposed by an industrial injury or occupational disease. Accommodations are used when an industrially injured or ill worker is engaged in a vocational plan or in a job search, and they may include tools, equipment or appliances.

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The department may, in its discretion, authorize vocational rehabilitation services that are necessary and likely to make the worker employable. In exercising its discretion the department considers, but is not limited to:

(1) Whether the worker took advantage of and utilized vocational rehabilitation services offered in this or other claims;

(2) The worker's ability and willingness to participate in and benefit from vocational services; and

(3) The likelihood that the worker will be employable after the vocational services are completed.

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All parties will have the following responsibilities in assisting the injured worker to become employable at gainful employment:

(1) The attending physician shall maintain open communication with the industrially injured or ill worker's assigned vocational rehabilitation counselor and the referral source. The attending physician shall respond to any requests for information in a timely fashion and will do all that is possible to expedite the vocational rehabilitation process, including making an estimate of physical capacities or restrictions. The attending physician may review the vocational plan, and if the attending physician feels that the injured worker is not physically capable of carrying out the plan, or the plan is unnecessary, based on current medical findings, shall notify the referral source immediately of this opinion with the reasons for that opinion.

(2) The claims unit within the department shall:

(a) Notify the employer of the referral to a vocational rehabilitation provider;

(b) Send the employer a copy of the closing report; and

(c) Give written notice to an injured worker if a complaint of noncooperation has been made.

(3) The employer shall assist the vocational rehabilitation counselor in any way necessary to collect data regarding the former gainful employment of the injured worker. Further, the employer will assist the vocational rehabilitation counselor and attending physician to determine whether or not a modified job could be made available for employment of the injured worker.

(4) The injured worker shall cooperate with all reasonable requests from all responsible individuals in determining disability, developing and implementing the rehabilitation process. Should the injured worker fail to be cooperative, the sanctions as set out in RCW 51.32.110 shall be applied.

(5) In assisting the injured worker to become employable at gainful employment, the provider is to follow the priorities as set out in RCW 51.32.095 and the requirements as set out in this chapter.

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All vocational services must be preauthorized by the referral source. The referral source may make one or more of the following type of referrals: Early intervention; ability to work assessment ("AWA" or "assessment"); plan; and forensic services. Each referral is a separate authorization for vocational rehabilitation services. For example, when a vocational rehabilitation provider receives a referral for early intervention services, the provider may only provide the authorized early intervention services. No other services are authorized until the referral source makes another referral to the vocational rehabilitation provider.

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Early intervention services are intended to help an industrially injured or ill worker return to work, or continue to work, for the employer of injury or the current employer. These services include, but are not limited to, the following:

(1) Discussing early return to work options with the employer, worker, and attending physician;

(2) Identifying return to work goals and barriers that may interfere with or prevent the industrially injured or ill worker from returning or continuing to work;

(3) Assisting employers with offers of employment;

(4) Planning and working with the referral source on necessary job modifications and prejob accommodations;

(5) Performing on-site and telephone job analyses; and

(6) Assessing the industrially injured or ill worker's need for preferred worker status and obtaining a preferred worker card for the worker, if appropriate.

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(1) Progress reports. The vocational rehabilitation provider must submit a written progress report to the department every thirty days from the date of the referral. The progress report must include the following:

(a) List of dates and summarized results of all contacts the provider had with the industrially injured or ill worker and employer of injury or current employer;

(b) Summary of all actions taken in the past thirty days, including progress on previously recommended actions;

(c) Identification and analysis of any barriers preventing completion of the referral; and

(d) Description of the specific actions the provider intends to take and the expected time frame to complete those actions.

(2) Closing reports. The provider must always submit an early intervention closing report at the conclusion of services. In the report the provider must include:

(a) Description of the industrially injured or ill worker's work history in detail:

(b) Summary of the industrially injured or ill worker's education, training, licenses, and certificates;

(c) A job analysis for the job of injury and any other return to work options;

(d) Description of the worker's medical status and physical capacities;

(e) The date the worker returned to work and the monthly salary or wage;

(f) Indication of which return to work priority relates to the situation;

(g) Documentation that no return to work options exist with the employer of injury or current employer, if applicable.

(3) The provider must notify the department orally and in writing within two working days after learning of an unsuccessful return to work by the injured worker.

(4) The provider must notify the department orally and in writing within two working days after learning of a return to work by the injured worker.

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(1) An AWA is a written report used by the department to determine if an industrially injured or ill worker should receive vocational rehabilitation services. The AWA must include an evaluation of the industrially injured or ill worker's:

(a) Age, education and experience;

(b) Applicable transferable skills;

(c) Preexisting physical and mental conditions and the effect of those conditions on the worker's employability;

(d) Physical and mental conditions proximately caused by the worker's industrial injury or occupational disease and the effect of those conditions on the worker's employability;

(e) Wage at the time of injury;

(f) Work pattern;

(g) Significant barriers to employment;

(h) Applicable labor market; and

(i) Complete work history, in addition to information about education level, courses or transcripts, licenses, certifications or registrations that the worker may have obtained in the past.

(2) The AWA must also include one of the following recommendations:

(a) Able to work: The injured worker is employable at gainful employment. The report must include:

(i) Whether the worker is employable with the employer of injury or current employer, or if not, a list of job possibilities for which the worker is qualified;

(ii) A job analysis; and

(iii) Labor market information supporting the provider's recommendation;

(b) Further services appropriate: Vocational rehabilitation services are necessary and likely to enable the injured worker to become employable at gainful employment. The report must include:

(i) An analysis demonstrating why the worker is unlikely to return to work without vocational service;

(ii) The specific return to work possibilities investigated and the reasons why they were ruled out; and

(iii) Labor market information supporting the provider's recommendations; or

(c) Further services not appropriate: The injured worker is not likely to benefit from vocational services. The report must include:

(i) An analysis explaining why vocational services are not appropriate;

(ii) Any barriers that will interfere with the worker's return to work or make it unlikely the worker will benefit from vocational services;

(iii) If appropriate, labor market information supporting the provider's recommendations.

(3) The provider must immediately notify the department in writing if the worker is medically released to work without restrictions. The provider must attach documentation showing the worker was medically released to work without restrictions. The provider should not perform any other work on the AWA without the prior authorization of the referral source.

(4) The provider must immediately inform the department orally and in writing if the worker has returned to work. This report must include:

(a) A description of the job the worker returned to;

(b) The name of the employer;

(c) The date that the worker returned to work;

(d) The worker's monthly wages.

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The provider must submit a written progress report every thirty days from the date of the referral. The written progress report must include:

(1) A detailed explanation why the AWA was not completed as of the date of the report;

(2) A summary of all activities taken in the past thirty days, including progress on previously recommended actions;

(3) Identification and analysis of any barriers preventing completion of the referral; and

(4) A description of the specific actions the provider intends to take and the expected time frame to complete those actions.

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Vocational plan development services are authorized to obtain the vocational provider's assistance in producing a vocational plan for an industrially injured or ill worker. The provider will work with the industrially injured or ill worker in the development of the plan. Covered services include, but are not limited to, the following:

(1) Vocational counseling;

(2) Identifying training needs, resources, and expenses;

(3) Coordinating with medical providers to obtain physical capacities and restrictions information and release to participate in a vocational plan; and

(4) Vocational testing.

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(1) Progress reports. The vocational rehabilitation provider must submit a written progress report to the department every thirty days from the date of the referral. The progress report must include the following:

(a) Description of the return to work goals explored, accepted or ruled out;

(b) Review of the return to work priorities being addressed;

(c) Summary of all actions taken in the past thirty days, including progress on previously recommended actions;

(d) Identification and analysis of any barriers preventing completion of the referral; and

(e) Description of the specific actions the provider intends to take and the expected time frame to complete those actions.

(2) Vocational plan. The provider must address the return to work priorities listed in RCW 51.32.095(2) in the plan and explain why each preceding priority would not help the industrially injured or ill worker return to work. The vocational plan must also include the following information:

(a) An assessment of the industrially injured or ill worker's skills and abilities considering the industrially injured or ill worker's physical capacities and mental status, aptitudes and transferable skills gained through prior work experience, education, training and avocation;

(b) The services necessary to enable the industrially injured or ill worker to become employable in the labor market;

(c) Labor market survey supportive of the industrially injured or ill worker's employability upon plan completion;

(d) Documentation of the time and costs required for completion of the plan;

(e) A direct comparison of the industrially injured or ill worker's skills, both existing and those to be acquired through the plan, with potential types of employment to demonstrate a likelihood of plan success;

(f) A medically approved job analysis for the proposed retraining job goal;

(g) Any other information that may significantly affect the plan; and

(h) An agreement signed by the provider and industrially injured or ill worker that:

(i) Acknowledges that the provider and the industrially injured or ill worker have reviewed, understand and agree to the vocational plan; and

(ii) Sets forth the provider's and industrially injured or ill worker's responsibilities for the successful implementation and completion of the vocational plan.

The provider must use a form approved by, or substantially similar to a form used by, the department in order to document this agreement.

(3) Closing report. If the provider has to stop plan development before reaching a vocational goal, submit a plan development closing report. The report must include:

(a) A list of the reasons the provider cannot proceed with vocational plan development activities; and

(b) Supporting documentation, such as: Goals researched, job analyses developed, and/or labor market research conducted.

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Vocational plan implementation and monitoring services are those services a vocational rehabilitation provider provides to assist an industrially injured or ill worker to successfully complete a vocational plan. These services may include, but are not limited to, the following:

(1) Maintain sufficient contact with the industrially injured or ill worker, trainer and medical providers to make sure the worker is successfully progressing in the vocational plan;

(2) Confirm that the industrially injured or ill worker has received all necessary equipment and supplies;

(3) Contact the industrially injured or ill worker and trainer at least every thirty days to identify potential problems;

(4) Notify the department if the plan needs to be interrupted;

(5) Notify the department when the industrially injured or ill worker completes the plan;

(6) Monitor the industrially injured or ill worker's progress and resolve any problems that might arise;

(7) Document the industrially injured or ill worker's acquisition of skills; and

(8) Notify the department if the plan needs to be terminated.

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(1) Progress reports. The vocational rehabilitation provider must submit a written progress report to the department every thirty days from the date of the referral. The progress report must include the following:

(a) Review of the industrially injured or ill worker's compliance with the vocational plan;

(b) A list of the dates the provider contacted the industrially injured or ill worker and training site;

(c) Description of the skills the worker has acquired so far and a comparison with the vocational plan;

(d) Summary of all actions taken in the past thirty days, including progress on previously recommended actions;

(e) Identification and analysis of any barriers preventing completion of the referral;

(f) Statement of whether the industrially injured or ill worker will complete the plan by the target plan end date.

(2) Closing report. If the industrially injured or ill worker successfully completes the vocational plan, the closing report, at a minimum, must contain the following information:

(a) An assessment of the industrially injured or ill worker's employability status at the time of closure;

(b) An assessment of the skills acquired by the industrially injured or ill worker as compared to the vocational plan;

(c) A statement as to whether or not the industrially injured or ill worker has returned to gainful employment; and

(d) The barriers, if any, to the industrially injured or ill worker's return to gainful employment.

(3) If the industrially injured or ill worker does not successfully complete the vocational plan, the closing report, at a minimum, must contain the following information:

(a) Explain why the vocational plan cannot be completed;

(b) Assess the industrially injured or ill worker's employability status at the time the plan stopped;

(c) Assess what skills the industrially injured or ill worker acquired and compare them to the vocational plan;

(d) Indicate whether or not the industrially injured or ill worker has returned to work. If so, list the job title, employer, and monthly salary; and

(e) Describe any remaining barriers that may keep the industrially injured or ill worker from returning to work.

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Vocational forensic services are authorized to obtain the vocational provider's assistance in reviewing the claim file and making recommendations to resolve vocational issues.

(1) The recommendations may include, but are not limited to:

(a) Vocational services are not appropriate. The vocational provider will provide the rationale for the recommendation.

(b) Vocational services are appropriate. The vocational provider will provide specific suggestions for the type of vocational services recommended.

(c) Able to work.

(d) Further clarification of medical or vocational issues is needed. The vocational provider will identify issues impacting the vocational process and requiring clarification.

(2) Covered services include, but are not limited to:

(a) Reviewing medical and vocational records;

(b) Identifying barriers to employment and possibilities for resolving the barriers;

(c) Coordinating with providers to obtain physical, mental and vocational capacities and restrictions;

(d) Identifying training needs and resources.

Vocational recommendations must follow department guidelines and have supporting documentation attached.

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(1) The following information must be included in a labor market survey:

(a) The specific job title surveyed:

(b) If the provider completes a LMS on a referral, include a summary;

(c) Indicate in the summary whether the industrially injured or ill worker has the physical and mental/cognitive capacities to perform the job, based on either the industrially injured or ill worker's attending physician or the preponderance of medical information; and

(d) The LMS must list all employer contacts, positive and negative.

(2) A positive labor market exists if one of the following circumstances is present:

(a) If the provider performs a LMS to assess the industrially injured or ill worker's employability, it is considered positive if the LMS shows enough jobs to conclude the worker's lack of employment is not the consequence of his/her industrial injury; or

(b) If the provider performs a LMS for a vocational plan, it is considered positive if the LMS shows the proposed job goal exists in sufficient number to reasonably conclude that the worker will be employable at successful plan completion.

(3) The labor market survey report must include:

(a) The specific job title surveyed;

(b) All specific employer contacts, including their firm names, phone numbers, contact name and job title;

(c) Physical and mental/cognitive demands of the job in relation to the industrially injured or ill worker's physical and mental/cognitive capacities;

(d) Minimum hiring requirements and the skills and training commonly and currently necessary to be gainfully employed in the job;

(e) Work patterns;

(f) Number of positions per job title;

(g) Wage;

(h) Date of last hire;

(i) Number of current openings; and

(j) A summary of the labor market survey results and whether the survey is positive or negative for the recommended occupation or proposed vocational goal.

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When completing a job analysis, the vocational provider must:

(1) Include identifying information on each page. This information includes the worker's name and claim number, date of the job analysis, and job title and DOT/O*NET number;

(2) Note where the provider completed the job analysis. If the analysis is done on-site, include the employer name and employer contact person with phone number;

(3) List the tools and equipment required to do the job;

(4) Evaluate and describe the knowledge, skills and abilities required to perform the job;

(5) Evaluate and describe the physical demands and their frequency required to perform the job. This must include demands for sitting, standing, lifting, etc. The vocational provider should pay special attention to any job duties and physical demands that may be affected by the industrially injured or ill worker's condition;

(6) Describe any environmental hazards encountered on the job;

(7) Describe possible modifications to the job for employer job offers or job modifications;

(8) A section for medical approval, signature, and comments; and

(9) The signature of the author and date completed.

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As provided for in section 13, chapter 63, Laws of 1982 (RCW 51.32.250), the supervisor or supervisor's designee in his or her discretion may pay job modification costs. This payment is intended to be a cooperative participation with the employer and funds shall be taken from the appropriate account within the second injury fund.

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An amount not to exceed five thousand dollars from the department is available per worker per modification. The employer may add to this amount with its own contribution.

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(1) An employer requesting job modification assistance must submit to the department a job modification assistance application.

(2) The job modification assistance application shall include, but not be limited to:

(a) A document supporting the need for job modification;

(b) A description of the job modification; and

(c) An itemized account of each expense to be incurred in the job modification. Job modification assistance applications shall be submitted on a form prescribed by the department.

(3) The supervisor or supervisor's designee shall accept, reject or modify the job modification application within thirty days of receipt. Notification of the supervisor's acceptance, rejection, or modification shall be in writing.

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Provider community commentary, expert opinion and best practices suggest that there is a correlation between a higher quality level of vocational services and higher qualifications of vocational providers. To ensure the provision of the highest possible quality of vocational rehabilitation services, the department adopts the following qualification requirements:

(1) Vocational rehabilitation counselor (VRC).

(a) VRCs not registered with the department and applying for a provider number with the department effective on or after September 1, 2000, must meet the following minimum qualifications:

Education Masters Degree	Experience 1 year full-time industrial insurance experience	Certification and CRC or CDMS or ABVE
OR
Bachelors Degree	2 years full-time industrial insurance experience	and CRC or CDMS

CRC = Certified Rehabilitation Counselor

CDMS = Certified Disability Management Specialist

ABVE = American Board of Vocational Experts

(b) VRCs registered with the department prior to September 1, 2000, will be required to apply for a provider number and will be given four years from September 1, 2000, to meet the above requirements.

(2) VRC supervisor.

(a) In order to supervise interns providing vocational services to industrially injured or ill workers beginning on or after September 1, 2000, the VRC/supervisor must provide proof of three years full-time experience working with Washington state injured workers.

(b) Supervisors registered with the department prior to September 1, 2000, will be required to apply for a provider number and will be given four years from September 1, 2000, to meet all VRC/supervisor requirements.

(3) Forensic services -- In order to provide forensic services to the department on claims other than those for which the VRC provided the vocational rehabilitation services, a VRC must provide proof of three years full-time experience working with Washington state industrially injured or ill workers.

(4) Intern.

(a) Interns not registered with the department and applying for a provider number with the department on or after September 1, 2000, must meet the following minimum qualifications:

Degree	Internship Length
Masters Degree in field acceptable to CRC or CDMS or ABVE	Equal to required experience to obtain CRC or CDMS or ABVE certification including at least 1 year working with industrially injured or ill workers.
OR
Bachelors Degree in field acceptable by CDMS	Equal to required experience to obtain CDMS certification including at least 2 years working with industrially injured or ill workers.

(b) Interns must obtain one of the required VRC certifications within one year of completing their required internship.

(c) Interns registered with the department prior to September 1, 2000, will be required to apply for a provider number with the department and may work as an intern an additional four years from September 1, 2000, if necessary, to meet the new VRC requirements.

(5) Providers registered with the department prior to September 1, 2000, who do not meet the above qualification requirements within the four-year period will no longer be eligible to provide vocational services to industrially injured or ill workers and the department will terminate their provider number(s).

(6) Business requirements.

(a) Any provider who elects to operate as a vocational firm, partnership, corporation, or other entity must comply with all federal and state laws, regulations and other requirements with regard to business operations.

(b) Any provider who elects to operate as a vocational firm, partnership, corporation, or other entity must be covered by general liability insurance, automobile liability insurance, errors and omission/malpractice insurance, and industrial insurance if required by Title 51 RCW.

(c) Any provider who elects to operate as a vocational firm, partnership, corporation, or other entity must have services and facilities that provide injured workers a private and professionally suitable location in which to discuss vocational services issues.

(d) Any provider who elects to operate as a vocational firm, partnership, corporation or other entity must have telephone-answering capability during regular business hours, Monday through Friday.

(e) Any provider who elects to operate as a vocational firm, partnership, corporation or other entity must maintain equipment that can utilize the department's remote access system for transmitting vocational referrals.

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No. Only qualified vocational rehabilitation providers will be given provider numbers.

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The department audits providers to:

(1) Ensure that the provider is providing services conforming to accepted standards of service;

(2) Ensure compliance with the Revised Code of Washington, the Washington Administrative Code, and department policies governing vocational rehabilitation services.

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The department has the authority to:

(1) Conduct audits of a provider, either for cause or at random;

(2) Conduct audits at a provider's place of business; (3) Conduct audits away from a provider's place of business, using copies of all files and records supplied by the provider;

(4) Require a provider to submit legible copies of all files and records requested for audit;

(5) Inspect and audit all of the provider's vocational rehabilitation files and records relating to services delivered under Title 51 RCW;

(6) Inspect and audit a provider's documentation supporting charges billed for vocational rehabilitation services delivered.

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The department must give at least forty-eight hours written notice to a provider before starting an audit.

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The department may order corrective action(s) when it determines that a provider is not in compliance with department statute, rule, or written department policy. Possible corrective actions include, but are not limited to:

(1) Submission and implementation of a written corrective action by the provider showing how the provider will come into compliance;

(2) Recoupment of payments, plus interest, made to the provider;

(3) Requirement that the provider satisfactorily complete remedial education courses and/or other educational or training programs;

(4) Suspension or termination of the provider's ability to receive payment for vocational services rendered to industrially injured or ill workers under the Industrial Insurance Act;

(5) Rejection of a provider's application to provide vocational services to industrially injured or ill workers under the Industrial Insurance Act;

(6) Denial or rejection of a request for payment submitted by or on behalf of the provider;

(7) Placement of the provider on prepayment review status requiring the submission of supporting documents prior to payment.

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(1) Reasons the department can order corrective actions against a vocational provider include, but are not limited to, the following:

(a) Commission of an act involving moral turpitude, dishonesty, or corruption relating to the provision of vocational services whether the act constitutes a crime or not;

(b) Misrepresentation or concealment of a material fact in obtaining registration or reinstatement of registration, a provider number, or in response to any request for information about service delivery made by the department;

(c) Provision of vocational services without being a registered vocational rehabilitation counselor/intern;

(d) Use of persons who are not registered vocational rehabilitation counselors/interns to deliver vocational services;

(e) Operation of a vocational firm, partnership, corporation, or other entity in violation of the business requirements set forth in RCW, WAC, or written department policy;

(f) Use of false, fraudulent, or misleading advertising;

(g) Commission of any incompetent or negligent action which presents the significant risk of resulting in harm to an industrially injured or ill worker, the referral source, or an employer;

(h) Submission of a false or misleading report or document as part of delivering vocational services;

(i) Failure to supervise a vocational intern in accordance with RCW, WAC, or written department policy;

(j) Failure to comply with any order issued by the department;

(k) Disclosure of confidential information on vocational services to a person who is not entitled to it;

(l) Charges an industrially injured or ill worker or employer a fee for delivering vocational services on a referral from the referral source; and

(m) Bills an industrially injured or ill worker or state fund employer for providing services under the Industrial Insurance Act.

(2) The department can take corrective action(s) for other violations of RCW, WAC, or written department policy not specifically mentioned above.

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The department must make referrals for vocational services based on the vocational rehabilitation provider's performance. The performance measurement factors for vocational providers will include, but not be limited to:

(1) Cost for services delivered;

(2) Length of time taken to provide the services;

(3) The outcome of the vocational services;

(4) Complexity of cases referred; and

(5) Whether the vocational services conformed with department rules and accepted standards of good practice.

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Based on WAC 296-19A-280, the department will generate periodic performance ratings for vocational providers. The performance ratings will be the method used for making referrals from the department to vocational providers based on quality and effectiveness.

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(1) Several situations exist in which a vocational provider may not have a performance rating with the department or may not have sufficient experience with Washington industrially injured or ill workers covered by the department to establish a performance rating.

(2) Provider community commentary, expert opinion and best practices suggest that there is a correlation between a higher level of vocational services and higher qualifications of vocational providers. Based upon this information, the department concludes that referrals to providers who satisfy these minimum qualification criteria set forth in WAC 296-19A-210 (1)(a) and (2)(a), but who do not have a performance rating with the department, may be appropriate. The department will ensure that these providers are complying with department statutes, rules, and policies and furnishing a high level of service through close and continued monitoring. The department may consider making referrals to vocational providers, on a trial basis, for whom the department does not have performance rating data, under the following circumstances:

(a) The provider fulfills the qualification requirements set forth in WAC 296-19A-210 (1)(a), (2)(a); and

(b) The department may consider making referrals sufficient to develop a reliable performance rating.

(3) If the department elects to refer and monitor a limited number of cases to the provider(s) in order to evaluate a provider's performance and develop performance rating, the department makes no guarantee of future referrals to the provider.

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The department or self-insured employer refers industrially injured or ill workers for vocational rehabilitation services at their sole discretion. No provider is entitled to referrals from the referral source.

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The rendering of vocational services to a worker who comes under the jurisdiction of the department constitutes acceptance of the provisions of Title 51 RCW, the department's rules and policies, and the department's fee schedule.

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All providers must apply for and receive a provider number from the department in order to bill the department and get paid for providing vocational services to industrially injured or ill workers. More detailed billing instructions for vocational services are available from the department.

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The following services are considered overhead and the department or self-insured employer will not pay for these services:

(1) Administrative and supervisory salaries and related personnel expenses;

(2) Office rent;

(3) Depreciation;

(4) Equipment purchase and rental;

(5) Telephone expenses including long distance phone call charges;

(6) Postage;

(7) Shipping;

(8) Expendable supplies;

(9) Printing costs;

(10) Copier costs;

(11) Printing of fiche and department electronic files;

(12) Maintenance and repair;

(13) Taxes;

(14) Automobile costs and maintenance;

(15) Insurance;

(16) Dues and subscriptions;

(17) Vacation, sick leave, and other expenses of a similar nature;

(18) Internal staffing time;

(19) Filing of material in case files;

(20) Setting up files;

(21) Activities associated with reports other than composing or dictating original draft of the report (e.g., editing, filing, distribution, revising, typing, and mailing);

(22) Generating and keeping internal recordkeeping forms;

(23) Time spent on any administrative and clerical activity, including typing, copying, mailing, distributing, filing, payroll, recordkeeping, delivering mail, picking up mail;

(24) Activities associated with counselor training, general discussion regarding office procedures, internal case file reviews by supervisors, meetings, and seminars;

(25) Unanswered phone calls; and

(26) Any other item or service not specifically identified and separately billable.

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Vocational providers must maintain case notes. Case notes must:

(1) Include the first and last name of the industrially injured or ill worker being served and the worker's claim number at the top of each page;

(2) Include the first and last name of the vocational rehabilitation provider providing each service documented on each page;

(3) Be kept in a claimant file with the reports, medical information, correspondence, and other materials that they provide documentation for;

(4) Testing and other records with special confidentiality requirements may be kept in separate files;

(5) Be legible;

(6) Be in chronological order;

(7) Record the date each service was provided month month/day day/year year;

(8) Include the amount of time, recorded in tenths of an hour, required to provide each service;

(9) Describe each service sufficiently to allow the referral source to verify the reason, level, type, and outcome of each service provided and substantiate the charges billed for them.

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(1) Any bill a provider submits to the department must include the following information:

(a) Worker's name;

(b) Worker's claim number;

(c) Vocational referral number;

(d) Dates of service;

(e) Place of service;

(f) Type of service;

(g) Appropriate procedure code(s);

(h) Charge;

(i) Units of service;

(j) Total bill charge;

(k) The name and the department-assigned provider ID of the counselor or intern rendering the services;

(l) Provider number of the payee;

(m) Date of billing;

(n) Submission of any supporting documentation required under other sections of this chapter.

(2) Itemize the bills on department approved forms. A vocational rehabilitation provider may transmit the bills electronically if the provider uses department file format specifications. If the provider uses any of the electronic transfer options, the provider must follow department instructions for electronic billing.

(3) The provider must bill using procedure codes, fees, and methods provided by the department. The department will publish codes, fees, and procedures and provide this information to all vocational rehabilitation providers receiving department referrals. The department will establish fees at regular intervals.

(4) Document all billed charges and justify the type, level and extent of services in the case notes. A provider's billed charges must be consistent with the services provided. The department may reduce, deny, or recoup payment whenever case notes fail to document billed charges or services provided.

(5) It is the vocational rehabilitation provider's responsibility to make sure the charges billed are complete and accurate, even if a third party is actually performing the billing.

(6) The vocational rehabilitation provider is encouraged to bill every two weeks. The department must receive bills within one year of the date of service to be eligible for payment.

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(1) The department or self-insurer may adjust payment of charges when appropriate. The department or self-insurer must provide a written explanation of why they adjusted a billing or line item of a bill when they make any adjustment. In cases where the department is the referral source, it will not give the provider a written explanation if the department made the adjustment solely to conform to its maximum allowable fees.

(2) The department or self-insurer must receive any inquiries about a bill adjustment within ninety days from the date of payment to be considered. All provider inquiries must be in the required format.

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(1) If a provider does not receive payment or notification from the department within one hundred twenty days, he or she may rebill for services.

(2) Rebills should be identical to the original bill: Same charges, codes, and billing date.

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(1) When a vocational provider receives a payment to which that provider is not entitled, the provider must repay the excess amount, plus accrued interest, without regard to whether the excess payment occurred due to provider or department error or oversight.

(2) Interest accrues on excess payments at the rate of one percent per month or portion of a month beginning on the thirty-first day after payment was made. Where partial repayment on an excess payment is made, interest accrues on the remaining balance.

(3) The department reserves the option of either requesting the provider to remit the amount of excess payment and accrued interest to the department or offsetting excess payments and accrued interest against future payments due the provider.

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(1) A vocational rehabilitation provider must maintain adequate documentation in claimant-specific files to verify the level, type, and extent of the vocational rehabilitation services provided to and on behalf of industrially injured or ill workers.

(2) A vocational rehabilitation provider who requests payment from the referral source for vocational rehabilitation services must maintain all records necessary for the director's authorized auditors to audit the provision of services. Providers need to keep all records necessary to disclose the specific nature and extent of all services provided for an industrially injured or ill worker, along with the amounts billed to the department, for those services. Vocational providers need to securely maintain their records for at least five years from the last date of service provision.

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The purpose is to avoid delays in vocational rehabilitation services by resolving disputes between industrially injured or ill workers, employers and the referral source.

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The following parties are authorized to dispute a vocational determination made by the referral source:

(1) An industrially injured or ill worker;

(2) An employer; or

(3) The representative of an industrially injured or ill worker or employer.

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A vocational provider cannot dispute a vocational determination.

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A finding that an industrially injured or ill worker is eligible for vocational services, or a finding that he or she is ineligible for vocational services, may be disputed. An approved vocational plan may also be disputed.

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The department must receive the written dispute within twenty calendar days of the date of the vocational determination. The dispute must explain the reason(s) for the disagreement with the determination. The department may accept the dispute if it is not received within the twenty-day period if there is a demonstrated good cause for the delay.

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The vocational dispute resolution office (VDRO) consultant reviews disputes of vocational determinations and makes a recommendation to the director, who makes a final decision. Disputes should be sent to the director, in care of the VDRO.

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VDRO will review the written dispute and issue an acceptance letter, which will be sent to all parties. If the department does not accept your dispute, the letter will explain the reason(s) for the rejection. A copy of this letter, along with the written dispute, will be sent to all involved parties.

The director, at his or her sole discretion, will initiate a review of an accepted dispute to determine further action. If necessary, and at the discretion of the director, VDRO staff will contact the parties to attempt to resolve the dispute.

If the dispute is not resolved, the director in his or her sole discretion will take other action that he or she considers appropriate to protect the rights of the parties. The director will promptly inform all parties, in writing, of what action is taken.

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(1) The following section of chapter 296-19A WAC becomes effective on September 1, 2000:

WAC 296-19A-210

What are the qualifications to provide vocational rehabilitation services to industrially injured or ill workers?

(2)The following sections of chapter 296-15 WAC become effective on September 1, 2000:

(a) WAC 296-15-500

What vocational rehabilitation reports are required for self-insured employers?

(b) WAC 296-15-510

What is the process used for vocational rehabilitation with regard to self-insured employers?

(3) All remaining sections of chapter 296-19A WAC become effective on January 2, 2001.

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OTS-3887.3

NEW SECTION
WAC 296-15-500
What vocational rehabilitation reports are required for self-insured employers?

The following reports are required from the self-insurer to be sent to the self-insurance section.

(1) Self-insured rehabilitation referral.      A form submitted no later than after paying ninety continuous days of time loss after the initial filing or reopening of a claim.      If more time is necessary, an extension may be requested on this form.      The format for this form will be supplied by the department.

(2) Employability assessment report.      If a vocational referral is not being made and an extension of time is not necessary, this form must be completed and submitted to the self-insured section no later than after paying ninety continuous days of time loss after the initial filing or reopening of a claim.      The format for this form will be supplied by the department.

(3) A vocational rehabilitation plan shall be submitted to the self-insurance section by the self-insurer no later than ten calendar days after being signed by the injured worker, vocational rehabilitation provider and the employer. The plan will follow the criteria below:

(a) A vocational rehabilitation plan shall be approved by the referral source prior to its implementation. After the plan has been approved by the referral source, injured worker and vocational rehabilitation counselor, a copy of it shall be sent to all individuals with responsibilities under it. The plan shall contain the following:

(i) Assessment of the skills and abilities, based on the physical capacities and mental status, aptitudes, and transferable skills of the injured worker;

(ii) The services necessary to enable the injured worker to become employable at gainful employment;

(iii) Labor market information indicating the employability of the injured worker at plan completion;

(iv) An estimate of the cost and the time necessary for the completion of the plan;

(v) A direct comparison of the injured worker's skills with potential types of employment to demonstrate a likelihood of success;

(vi) If necessary, a job analysis of the injured worker's previous occupation, including earnings, may be included; and

(vii) Any other information that will significantly affect the plan.

(b) The following priorities shall be addressed and justification given to why each preceding priority was not used:

(i) Return to the previous job with the same employer;

(ii) Modification of the previous job with the same employer including transitional return to work;

(iii) A new job with the same employer in keeping with any limitations or restrictions;

Modification of a new job with the same employer including transitional return to work;

(iv) Modification of the previous job with a new employer;

(v) A new job with a new employer or self-employment based upon transferable skills;

(vi) Modification of a new job with a new employer;

A new job with a new employer or self-employment involving on-the-job training; and

(vii) Short-term retraining and job placement.

(c) Each plan shall be signed by the vocational rehabilitation counselor and the injured worker. The following statement shall be printed above the signatures:

I have read the above plan and understand its contents. By signing this plan I agree to faithfully execute my responsibilities described in it.

(4) Closing report.      Upon completion of a formal program, the self-insurer will submit the closing report to the department. The closing report shall contain at least the following:

(a) Assessment of the injured worker's employability status at the time of completion of vocational services;

(b) Whether or not the injured worker has returned to work;

(c) Any remaining barriers to the injured worker becoming employable at gainful employment; and

(d) An ability to work summary may be substituted for a closing report.

(5) Rehabilitation outcome report.      This form is to be submitted with the final self-insurer's report on occupational injury or disease (SIF-5) or, in the case of medical only claims, with the self-insurers accident report (SIF-2), which is submitted at the time of claim closure.      The format for this form will be supplied by the department and applies to all claims where vocational rehabilitation services have been provided.

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(1) No later than paying ninety continuous days of time loss following the initial filing or reopening of a claim, the self-insurer shall notify the self-insurance section as to whether or not vocational rehabilitation services are necessary and likely to enable the injured worker to become employable at gainful employment.      Each of these cases will be reviewed by the self-insurance section.      The criteria outlined in RCW 51.32.095, WAC 296-19A-010 and department guidelines must be followed to determine employability.      If the injured worker is determined employable, the self-insurer will submit an employability assessment form which contains objective reasons why the injured worker is employable.      Within twenty calendar days of receipt of an employability assessment form, the supervisor's designee within the self-insurance section will inform the self-insurer and the injured worker as to whether or not self-insurers determination of employability is approved.      If an employability determination cannot be made due to medical instability, the self-insured shall request an extension by notifying the self-insurance section of the injured worker's condition and when a determination can be made.      If the request for extension is not approved, notice will be sent within fifteen calendar days of receipt.

(2) The supervisor's designee within the self-insurance section of the department will receive from the self-insurer the vocational rehabilitation plan signed by the injured worker and employer.      Within ten calendar days of receipt of the vocational plan, the supervisor's designee will inform the self-insurer, the vocational rehabilitation counselor and the injured worker that the plan has been received.      A review of the vocational rehabilitation plan by the supervisor's designee will be initiated upon request by the employer or the injured worker.      Reasons for the review must be stated in writing.      A request for a plan review must be made prior to completion or termination of the plan.      If necessary, conflict resolution techniques, such as conferences and fact-finding, will be used in order to resolve problems with the plan in as fair and expedient manner as possible.      The supervisor's designee shall notify the parties of the plan review results no later than sixty days from the date the request was received.

Disputes of the supervisor's designee's determination must be submitted to the director in accordance with WAC 296-19A-410 to 296-19A-470.

(3) Upon completion of the formal program, the self-insurer will submit to the self-insurance section a closing report.      Within ten calendar days of receipt of the closing report, the supervisor's designee shall inform the injured worker and employer that vocational services have concluded.

(4) The self-insurer shall provide the self-insurance section with a rehabilitation outcome report on a form prescribed by the department.      The rehabilitation outcome report shall be attached to the final self-insurer's report on occupational injury or disease (SIF-5) or, in the case of medical only claims, with the self-insurers accident report (SIF-2), which is submitted at the time of claim closure.      A rehabilitation outcome report will be submitted on all claims where vocational rehabilitation services have been provided.

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OTS-3975.1

REPEALER

     The following sections of the Washington Administrative Code are repealed:

WAC 296-18A-445	Self-insured reports.
WAC 296-18A-500	Self-insurers.
WAC 296-18A-510	Vocational rehabilitation counselor qualifications.

OTS-3888.2

REPEALER

     The following sections of the Washington Administrative Code are repealed:

WAC 296-18A-420	Definitions.
WAC 296-18A-440	Reports.
WAC 296-18A-450	Vocational rehabilitation plan.
WAC 296-18A-460	Audits.
WAC 296-18A-470	Disputes.
WAC 296-18A-480	Responsibilities.
WAC 296-18A-490	Billing for vocational services.
WAC 296-18A-515	Period of registration.
WAC 296-18A-520	Job modification assistance.

© Washington State Code Reviser's Office