OCCUPATIONAL REHABILITATION FEE SCHEDULE - EFFECTIVE 1 JULY 2018 - WORKSAFE
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CONTENTS 1. OVERVIEW OF THIS FEE SCHEDULE ............................................................................................................................ 3 2. COMMON ABBREVIATIONS & ACRONYMS .................................................................................................................. 4 3. PROVIDER SERVICE REQUIREMENTS ......................................................................................................................... 6 4. ORIGINAL EMPLOYER SERVICES ................................................................................................................................ 10 5. SUPPORT PATHWAY CONTACT.................................................................................................................................... 20 6. FACILITATED DISCUSSION............................................................................................................................................. 22 7. NEW EMPLOYER SERVICES .......................................................................................................................................... 25 8. JOB SEEKING SERVICE (JSS) ........................................................................................................................................ 28 9. CAPACITY SUPPORT SERVICE (CSS) ......................................................................................................................... 35 10. TRANSFERABLE SKILLS ANALYSIS ............................................................................................................................. 38 11. VOCATIONAL ASSESSMENT FOR ENTITLEMENT REVIEW ................................................................................... 39 12. WISE...................................................................................................................................................................................... 41 13. TRAINING ............................................................................................................................................................................. 42 14. GP CONTACT SERVICES................................................................................................................................................. 44 15. FURTHER INFORMATION ................................................................................................................................................ 45 16. APPENDIX – ITEM LIST .................................................................................................................................................... 46 19. APPENDIX – ENDNOTES ................................................................................................................................................. 49
3 1. OVERVIEW OF THIS FEE SCHEDULE This document supplements the Conditions for Approval for Occupational Rehabilitation Providers (Conditions). The Fee Schedule provides WorkSafe approved OR Providers with key information about: 1. Service delivery and fee structures for: Vocational Original Employer New Employer Services applicable Assessments for Services (OES) Services (NES) across OES & NES Entitlement Review Original Employer Capacity Support 130 Week Vocational Retraining Services (OES) Service (CSS) Report Job Seeking Service GP Contact Services (JSS) Transferable Skills Support Pathway Analysis (TSA) Contact (SPC) WorkSafe Incentive Facilitated Discussion Scheme for Employers (FD) (WISE) 2. Incentive payments 3. Service and payment policy; and 4. Invoicing information and requirements. Providers should consider this fee schedule with reference to: WorkSafe Online Claims Manual; Workplace Injury Rehabilitation and Compensation Act 2013 (WIRC Act); Relevant information and publications available at worksafe.vic.gov.au; and Training and guidance available via Discover.
4 2. COMMON ABBREVIATIONS & ACRONYMS Term Description A private sector body with whom WorkSafe has contracted under section Agent 14(4)(d) of the Return to Work Corporation of Victoria Act 1994 (Vic) to provide claims management services from time to time. Certified capacity A Certificate of Capacity issued by the injured worker’s GP or THP, indicating their current capacity for either full, modified or alternative work CSS Capacity Support Service, an OR Service CWC Current work capacity Discover WorkSafe’s online platform for communicating with OR Providers including links to new or updated information, templates, and learning tools. FD Facilitated Discussion, an OR service GP General Practitioner GP CC General Practitioner Case Conference, an OR service JSS Job Seeking Service, an OR service IME Independent Medical Examination MI Primary ‘mental injury’ claim NES New Employer Services, an OR service OES Original Employer Services, an OR service OR Occupational Rehabilitation ORP Occupational Rehabilitation Provider, a WorkSafe authorised provider who delivers OR services to an injured worker
5 Term Description PIE Pre injury employer, the business or organisation where the injured worker was working at the time they sustained their injury or illness PID Pre injury duties, the duties performed by the injured worker at the time they sustained their injury or illness PIH Pre injury hours Productive duties, modified or alternative duties that the pre injury employer PD confirms are available ongoing (effectively as a ‘new permanent role’) for an injured worker who was unable to RTW on pre injury duties RTW Return to Work Self Insurers are employers approved by WorkSafe to manage their own Self Insurer workers’ compensation claims and have full responsibility for meetings its claim liabilities Service referrer The organisation (Agent or a Self Insurer) who has made a referral for OR services SPC Support Pathway Contact, an OR service THP Treating Health Practitioner TSA Transferable Skills Analysis, an OR service WorkSafe WorkSafe Victoria
6 3. PROVIDER SERVICE REQUIREMENTS Service approval & payment Agents and Self Insurers determine and approve what OR services are reasonable and necessary and will provide an OR Approval Form to initiate a service, specifying the approved service type and fee. OR providers should not request an injured worker to sign an additional information consent form in addition to that provided on the Worker’s Injury Claim Form. On occasions where an OR service is requested by a party other than the Agent, OR providers must contact the Agent before commencing the service to confirm approval for the ongoing costs since an employer can only approve up to the cost of its ‘excess’ which does not cover the cost a complete OR service item. OR providers should also note that Agents must provide injured workers with a choice of at least three OR providers as per the WIRC Acti, alternatively the Agent will require evidence from the employer that they have satisfied the requirements of worker choice of OR Provider before approving the cost of an OR Service. OR providers who commence servicing without Agent approval run the risk of the service costs being declined by the Agent or referred to another OR Provider consistent with the requirements of worker choice of OR Provider, section of the WIRC Act. Following receipt of an OR Approval Form signed by the Agent, Agent approval is required prior to continuation of services or commencement of a new/different type of service than indicated on the OR Approval Form. Requests for additional funding approval or extensions to service timeframes will be considered on a case-by-case basis and must be Agent approved prior to service delivery. Recommendations for other types of OR services or service suspension/cessation must be discussed with the approving Agent prior to raising expectations with the parties, to ensure the most appropriate claims management approach. When considering whether OES should be suspended or cease, the Agent will need to consider whether pre injury employment options have been exhaustedii. OR providers may proceed with servicing when the Agent has not replied to an Initial or Additional Funding Request within three working days of submitting the request, and the OR Provider has attempted contacting the Agent about the outstanding funding request before proceeding. Exceptions to this rule where servicing must not proceed without signed Funding Approval include: OES beyond three months of aggregate active servicing (i.e. costs billed under item RC715) where work capacity has not been established or there has been no increase in hours since OES commencement; OES servicing beyond 100% pre injury hours requires that a new Funding Request is issued and approved (funding remaining from a previously approved Funding Request expires once a worker commences 100% pre injury hours);
7 Any GP RTW Case Conference on the second or more occasion/s; the first GP RTW Case Conference delivered during an OES service can proceed if there has been no Agent response to the funding request within 3 working days; subsequent conferences require a signed approval before commencing. Invoicing Invoices must be submitted within 10 working days of the completion of the respective service item, unless otherwise specified in this document. Service item fees may be aggregated in the invoicing period, with the exception of invoices containing travel must itemise the costs by service date (no aggregation of billing under the item code for invoicing periods). Worker representative The WIRC Act allows a worker to be represented, assisted and supported in the RTW process. A worker may request their representative be involved in meetings with, or arranged by the Agent or an OR provider with the PIE or the worker’s THP. OR reports or information prepared by an OR provider for a worker should be provided to the worker representative. A worker may verbally advise the Agent or an OR provider that a person is acting as their worker representative. On being made aware of a worker representative, the Agent and an OR provider should liaise with the representative in addition to the worker when scheduling any meetings with the worker so the representative can be present. Note that the WIRC Act states that a worker representative cannot include a legal practitioner. Worker privacy considerations The Agent and an OR provider must only communicate about information that is relevant to the provision of OR services and at all times, a worker’s privacy must be maintained. Similarly, information collected about other parties in the workplace or outside the workplace must be afforded the same considerations and protections. It is recommended that an OR provider advises a worker that information they share may be included in OR reports which are sent to them, their THP, the PIE and the Agent.
8 Reporting WorkSafe templates1 must be used for letters, reports and funding requests; it is the OR provider’s responsibility to access the most current versions from the ‘Discover’ platform. All OR Provider communications for OR service provision must be signed with the standard signature blockiii. OR reports are to be provided to all parties (including the injured worker, their THP and employer) in order to create a common understanding about the types of activities that may be needed to achieve a sustainable RTW), with the following exceptions: OR reports may not be provided to the worker if an exception applies under the Privacy Act 1988 (Cth) or Health Records Act 2001 (Vic) (e.g. It would pose a threat to life or the health of the worker or any other person)iv; NES reports must not be provided to the pre injury employer (even if the worker remains at work with them while receiving NES), unless it has direct relevance to identifying duties with the pre injury employer. Calculating eligibility for RTW incentives across OES and/or NES: RTW Incentives are only payable after an OR service has commenced OES Commencement is identified by an RC700 with a subsequent RC715 item paid o NES Commencement is identified by an RC811 item paid RTW incentives are payable when the Agent / Self Insurer and OR provider agree that the conditions for paying the incentive can be satisfied Which RTW incentive is payable depends on the number of hours being worked excluding overtime and shift allowance RTW incentives specifying a 13 week RTW Sustainability period are calculated from the date 100% PIH (pre injury hours excluding overtime & shift allowance) commenced (associated with RC730 for OES) and PIH have been sustained for 13 weeks with no more than 5 working days off work in that period. In calculating the five working days, any part day time lost from work is counted as one day. A 13 week RTW sustainability period can be attempted twice only and any subsequent completion of a sustainability period will not result in a 13 week sustainability RTW incentive payment. 1 ORPs are encouraged to use WorkSafe templates for Self Insured injured workers however it is not compulsory.
9 What we will not pay for: X RTW incentives more than once on a claim: o Unless OR services had ceased for more than 13 weeks and the Agent or Self Insurer subsequently approved OR recommencement (Agent discretion will be absolute), or o During NES, the worker has commenced employment a second time, with a second new employer (RTW with the first new employer ceased), in which case a maximum of two NES incentives can be paid on the claim. X RTW incentives where RTW has not been achieved or sustained, for example: o Worker ceased work due to a new compensable injury or secondary mental injury o Worker ceased work due to a non-compensable medical condition o Worker resigned o Worker relocated and a RTW is no longer practicable at the pre injury workplace o Employer withdrew duties or terminated employment o Employer ceased trading. X RTW incentives for a worker who commences self-employment during NESv OR Consultant Specifications The ‘Conditions’ specify the minimum qualifications and experience of OR Consultants. OR providers must assign the most appropriate type of consultant to deliver an OR service based on the nature of injury the worker has suffered and the type of OR service required. WorkSafe may further specify and describe the type of OR consultant eligible to deliver specific OR service types. Support Pathway Contact SPC services may only be delivered by Registered Psychologists from OR providers, each consultant must be approved by WorkSafe to deliver the SPC. Facilitated Discussion FD services may only be delivered by OR consultants approved by WorkSafe meeting the following minimum criteria: Experience in a relevant area of conflict resolution, mediation and/or dispute management, and Qualifications in conflict resolution, mediation and/or dispute management and/or National Mediator Accredited Standards (NMAS) accreditation.
10 New Employer Services OR consultants with an employment or job brokerage background may provide NES services subject to complying with clause 1.9 of the Conditions of Approval for OR providers and in particular clause 1.9 (a). 4. ORIGINAL EMPLOYER SERVICES The purpose of Original Employer Services (OES) is to assist an injured worker to achieve an early, safe and sustainable RTW with their pre injury employer. A secondary purpose is to provide the employer with information and coaching that will equip them to independently continue managing an injured worker upon achieving pre injury hours and pre injury/productive duties. OES is intended as a service delivered in person by the OR Consultant (i.e. face to face) and at the workplace. OES as a RTW intervention aims to achieve outcomes as early as possible and therefore contain service durations to what is reasonable and necessary. What we will pay for: OES active servicing, defined as the aggregate RC715 billing from OES commencement to the last RC715 service date, excluding: o Any suspension periods, or o RTW sustainability periods, or o The cost of the first GP Case Conference on a claim RTW incentives are based on the number of pre injury hours being worked excluding overtime and shift allowance, as calculated by the Agent A brief period of concurrent OES and NES may be appropriate while a worker is participating in an unsustainable RTW with the pre injury employer that requires external job seeking. What we will not pay for: X OES servicing under RC715 for report preparation, writing and distribution (with the exception of the 15 minute allocation for ‘Notifications’). OES must be suspended: As soon as the injured worker is expected to be unfit for a period of four weeks or more; or While an injured worker is participating in approved retraining that precludes them from concurrently participating in a RTW program or OR Service. Suspension must be Agent / Self Insurer approved prior to informing the other parties.
11 OES must cease: As soon as the worker is expected to be unfit for a period of three months or more; or When at the conclusion of the first three months of active servicing there has been no RTW progress defined as: o No work capacity has been established since OES commencement; or o There has been no increase in work hours since OES commencement. Cessation must be Agent / Self Insurer approved prior to informing the other parties. OES may recommence: Where it left off, where RTW was not sustained for 13 weeks; When a worker has regained a capacity to actively participate in OR services following an OES suspension; Repeat Initial Reports are only conducted on Agent request. Continuation of OES services beyond the first three months with no RTW progress is subject to: An OR provider/Agent Case Conference to determine the likelihood of a RTW or progress in hours and/or duties within an additional one month of servicing. If there is no progress after this subsequent month of servicing, OES is to cease; OES continuation must be evidence based, via new medical information supporting an increase in duties/hours; and OES continuation will be for one month at a time requiring an OR provider /Agent Case Conference on each occasion, if there is no progress after this subsequent month of servicing, OES is to cease. An OR provider / Agent Case Conference can be conducted in person or by telephone and is arranged by the Agent. If OES is continuing, the OR Provider submits a funding request for the next month of servicing and the Agent develops an action plan (copy to the OR provider) including required action/s, assigning persons responsible, and timeframes for completion.
12 OES PROCESS OR Approval Form Funding approval 1 (Weekly payments Initial report OES servicing 3 months active servicing RTW progress? Yes month being made) RC700 RC715 No Agent – ORP Conference: Yes Evidence for RTW progress next month? No Cessation Timeframes exclude periods of OES suspension Quick reference guide Service items – OES Item number Max fee (ex GST) Initial Report RC700 $825.80 fixed amount OES Initial Report extension (MI claims only) RC717 $249.32 fixed fee RTW Status Report RC701 $81.74 fixed amount OES Servicing RC715 $166.49 hourly rate Up to 15 minutes at the Notification RC715 hourly rate (currently capped at $41.63) OES Suspension RC764 $40.87 fixed amount OR Provider Travel RC799 $166.49 hourly rate
13 Service item descriptors INITIAL REPORT (RC700) An assessment for the purpose of developing a RTW proposal and identifying what worker and employer support is required for a graduating, durable RTW outcome. Upon receipt of an OR Approval Form, service requirements include: Contact to all parties within three working days (Agent first) to explain the OR service, arrange initial meetings and a workplace assessmentvi Identification of employment history and transferable skills Assessing and managing the expectations of the partiesvii Submit report within 15 working days from receipt of the OR Approval Form. OR providers in consultation with the parties determine whether separate or joint worker and employer meetings are required, depending on the circumstances of the claim. The service includes a workplace assessment, which requires the OR Consultant to attend the workplace. Funding approval for repeat Initial Reports will be at a lesser fee, specified by the Agent following OR provider discussion. Recommendations for retraining may be included in an Initial Report, with prior Agent approval for RC770. OES Initial Reports approved contiguously from an SPC and/or FD service will be more advanced than a completely new referral with the following requirements: Initial contacts are completed within two working days of service approval Workplace visit within five working days of service approval, and submit report within 10 working days from receipt of the OR Approval Form RTW planning commences immediately. INITIAL REPORT EXTENSION – PRIMARY MI CLAIMS ONLY (RC717) Delivered at the same time as an Initial Report (RC700) Additional 90 minutes to allow for complexity of primary mental injury claims, excluding claims that have previously had an SPC and/or FD service. OES SERVICING & NOTIFICATION (RC715) OES servicing Services delivered in accordance with recommendations in the Initial Report for the purpose of commencing or graduating RTW with the pre injury employer.
14 Invoicing under RC715 becomes inactive once an injured worker resumes 100% pre injury hours, indicated by an RC730 incentive (active servicing continues for workers still graduating to pre injury duties) Continuation of servicing requires Agent approval in writing at certain points when previously approved funding expires as follows: o At the end of the first three months of OES o At the end of every additional month of OES beyond the initial three months o Commencement of RTW 100% pre injury hours. RC715 may be utilised (with Agent approval in writing) for assistance with internal job seeking (for a new role with the pre injury employer) and may include preparation of job applications, resumes, interview skills and coaching. Notification The purpose of a notification is to inform all parties of a change in status, on the date it occurs. The notification must include or be: An email communication (unless otherwise requested by stakeholders) Restricted to matters with a WorkSafe notification template Distributed on the same day information received/status changed, where possible (or the next business day) Brief, discrete information at a point in time. Only one notification fee will be applicable on a given date and more than one type of notification can be combined in a single email, if required on the same date. Notifications are not for communicating RTW strategy or action planning. Notifications may signal the need for a subsequent RTW conversation or activity across one or more of the parties. OES Placement and Sustainability Notifications are excluded from RC715 and invoiced under the respective fixed fee incentives. RTW STATUS REPORT (RC701) The RTW Status Report is submitted within 5 working days of every new Certificate of Capacity issued. Certificates of Capacity are typically issued every 28 calendar days. On occasions where a Certificate of Capacity is issued in a shorter period of time (less than 14 days from the last Certificate), then a RTW Status Report is not provided unless there has been or is expected to be a consequential change in the worker’s RTW status.
15 The report must include: A high level summary of RTW progression since the last issued Certificate of Capacity Expectations for RTW progression for the duration of the latest Certificate of Capacity Stakeholder comments about the impact of the latest Certificate of Capacity and RTW Arrangements o Worker and employer comments must be obtained from actual conversations in the five working days preceding the Status Report Scheduled actions and milestones. OES SUSPENSION (RC764) Notification of OES service suspension (click here for description of when OES suspension is required). A suspension notification must include or be: An email communication (unless otherwise requested by stakeholders) Restricted to matters with the WorkSafe notification template Distributed on the same day information received / status changed Brief, discrete information at a point in time. OES PROVIDER TRAVEL (RC799) Travel for the purposes of delivering OES at the injury workplace or for attending a GP RTW Case Conference. The cost of OES Provider Travel is calculated from the provider’s nearest location to the injury workplace. The cost of OES Provider Travel to a GP RTW Case Conference if from the provider’s nearest location to the GP rooms (location where the GP RTW CC was conducted) Exceptions must be pre-approved by the Agentviii in writing Invoicing for travel must reference the respective OR Provider location number. Quick reference guide RTW incentive payments Item number Max fee (ex GST) Return to work – Commencement RC720 $88.48 fixed amount Return to work – Back@Work RC250 $321.46 fixed amount
16 RTW incentive payments Item number Max fee (ex GST) Return to work – 100% pre injury hours RC730 $283.28 fixed amount Return to work – 13 wk. sustainability (Where OES commenced less than 50 calendar days after RC740 $609.13 fixed amount the Agent Received Date) Return to work –13 wk. sustainability (Where OES commenced on or after 50 calendar days after RC741 $812.15 fixed amount the Agent Received Date) Return to work –13 wk. sustainability RC742 $1,074.92 fixed amount (Where claim is for primary mental injury) Return to work – Pre injury duties / productive duties RC750 $177.01 fixed amount Incentive item descriptors RTW INCENTIVE: COMMENCEMENT (RC720) For workers completely off work at OES commencement Invoiced once a worker commences any return to work less than or equal to 100% pre injury hours.
17 RTW INCENTIVE: BACK@WORK (RC250) The Back@Work incentive aligns OR Provider and Agent efforts at facilitating early return to work, specifically within the first 26 weeks of time loss This incentive is applicable for RTW with the pre injury or a new employer This incentive is not applicable to Self Insurers. Invoiced when OR Providers can demonstrate that for a worker who was off work at OES commencement (or ceased work subsequent to OES commencement): o The worker has returned to work, either partial or full-time, by the first Friday of the week containing day 182 from Agent Received Date (ARD), and o No weekly compensation type 1 or 3 has been paid for 21 calendar days from the Saturday following Friday of the week containing day 182, and o For the purposes of this measure it is expected that a genuine RTW, as it relates to partial RTW will have at a minimum worked at least 10% of pre-injury hours, and o For RTW subsequent to an OES commencement, an invoice for an RC720 incentive reflecting partial RTW has been achieved, or o For RTW subsequent to an NES commencement, an RC889 for an NES Placement Report reflecting RTW with a new employer has been achieved. Explanatory notes: nd ARD is the Agent Received Date for the claim and is counted as day 0 for calculating the 182 day A type 1 weekly compensation payment is made by the Agent for workers with no work capacity A type 3 weekly compensation payment is made by the Agent for workers with a work capacity but the worker is not working The assessment of whether the worker has returned to work will occur in the week containing the 182 nd day nd and will run from the Monday of the week containing the 182 day to the Friday; and The assessment of whether the worker has continued to remain at work for the three weeks following the nd assessment of return to work will start on the Saturday following the Friday of the week containing the 182 day and will run for 21 calendar days. If day 182 falls on either a Saturday or Sunday, day 182 will be taken to be the next Business Day (example Monday) Agents will provide the ‘ARD: Agent Received Date’ on OR Approval Forms, which enables OR Providers to nd calculate the 182 day. RTW INCENTIVE: 100% PRE INJURY HO URS (RC730) A Placement Notification is submitted once the worker has achieved and sustained 100% pre injury hours (subsequent to an OES commencement) 100% pre injury hours must be sustained for at least five working days A Notification fee under RC715 is not applicable for a Placement Notification.
18 RTW INCENTIVE: 13 WEEKS SUSTAINABILITY (RC740) A Sustainability Notification is submitted on the day of the 13 week sustainability date being achieved, and The date of the OR Approval Form is less than 50 calendar days after the ‘Agent Received Date’ for the claim, and The worker was receiving weekly payments at OES commencement and has remained at work performing 100% PIH with no more than five working days off work in the 13 week sustainable RTW period (click here for definition of 13 week sustainable RTW period). A Notification fee under RC715 is not applicable for a Sustainability Notification. RTW INCENTIVE: 13 WEEKS SUSTAINABILITY (RC741) A Sustainability Notification is submitted on the day of the 13 week sustainability date being achieved, and The date of the OR Approval Form is equal to or more than 50 calendar days after the Agent Received Date for the claim, and The worker was receiving weekly payments at OES commencement and has remained at work performing 100% PIH with no more than five working days off in the 13 week sustainable RTW period (click here for definition of 13 week sustainable RTW period). A Notification fee under RC715 is not applicable for a Sustainability Notification. RTW INCENTIVE: 13 WEEKS SUSTAINABILITY FOR MENTAL INJURY (RC742) A Sustainability Notification is submitted on the day of the 13 week sustainability date being achieved, and The OR Approval Form confirms this is a primary mental injury claim (secondary mental injury not recognised for this incentive) The worker was receiving weekly payments at OES commencement and has remained at work performing 100% PIH with no more than 5 working days off in the 13 week sustainable RTW period (click here for definition of 13 week sustainable RTW period). A Notification fee under RC715 is not applicable for a Sustainability Notification.
19 RTW INCENTIVE: RTW PRE INJURY / PRODUCTIVE DUTIES (RC750) Applicable for workers receiving weekly payments at OES commencement: The OES invoice for RC740 or RC741 or RC742 may also include RC750 when a worker has remained at work on 100% PIH with no more than 5 working days off work in the 13 week sustainable RTW period and at the 13 week sustainable RTW date the worker is working in productive duties. A Sustainability Notification is submitted once the conditions for this incentive have been met. A Notification fee under RC715 is not applicable for a Sustainability Notification. Applicable for workers at work on pre injury hours at OES commencement: A Sustainability Notification is submitted on the day when the worker resumes pre injury duties or productive duties, sustained for 4 weeks with no more than 5 days or part days’ time off work or performing less than PID/PD. No other incentive is payable in this circumstance. A Notification fee under RC715 is not applicable for a Sustainability Notification.
20 5. SUPPORT PATHWAY CONTACT – PRIMARY MENTAL INJURY CLAIMS The Support Pathway Contact (SPC) is a one-off contact to an injured worker, conducted early in a primary mental injury claim to assist case management and RTW planning. Only Registered Psychologists can deliver this service. OR providers must have consultants (Registered Psychologists) who have been approved by WorkSafe to deliver SPC. SPC PROCESS Facilitated Discussion Treatment Other OR service OR Approval Form Support Pathway Agent Telephone Contact Contact Retraining Mobile Case Worker Employer Mgt Contact Contact Other Quick reference guide Service items – Support Pathway Contact Item number Max fee (ex GST) Support Pathway Contact RC706 $408.72 fixed amount
21 What we will not pay for: X RTW incentives X Travel should the consultant opt for a face to face meeting X If OES is approved after a SPC RC717 cannot be billed Service item descriptors SPC REPORT (RC706) Initial contact to the Agent for service context. A single phone-based contact to the injured worker (may be conducted via secure video conferencing with worker agreement) utilising the Support Pathway tool available via Discover. A face-to-face contact with the worker can be undertaken, no additional funding will be provided for this. A single phone-based contact to the employer to inform the employer of the worker’s participation in SPC and to discuss pathway options that may be considered. The SPC report is submitted one day prior to the Agent Telephone Contact*. The Agent Telephone Contact is conducted within five working days of the OR Approval Form receipt. The OR provider informs the worker if another type of OR service is approved as a result of the Agent Telephone Contact. Pathway options considered are expected to be outlined within the SPC Report. The OR provider may also determine that there is a workplace relationship issue and/or a conflict at the workplace which may require a Facilitated Discussion service. The SPC Report is only to be circulated to the worker, the worker’s THP, the Agent (cc WorkSafe) The SPC Report is not to be sent to the employer. *Agent Telephone Contact The Agent Telephone Contact is conducted on the telephone between the OR provider and Agent (this may include Case Manager, Injury Management Advisor/Return to Work Specialist). The purpose of the Agent Telephone Contact is to determine what further services or supports are required and to ensure an appropriate claims management plan is in place. The Agent develops an action plan following the telephone contact (copy to the OR provider) including required action/s, assigning persons responsible, and timeframes for completion.
22 6. FACILITATED DISCUSSION – PRIMARY MENTAL INJURY CLAIMS The Facilitated Discussion (FD) service is a brief intervention for primary mental injury claims where a workplace relationship issue is a barrier to the injured worker’s RTW. Referral to this service occurs via the Agent (direct referral) or following a Supported Pathway Contact. Where RTW is identified as a possibility as a result of information obtained during an FD, then with Agent pre-approval it can be followed by an OES Initial Assessment and OES commencement under RC715. OR providers must seek approval from WorkSafe to deliver the FD service and only use WorkSafe approved consults for delivering the FD service. FACILITATED DISCUSSION PROCESS OR Approval Form Pre-meetings Facilitated Agreed Action Plan OES/NES/ THP Contact Opt in Worker & employer Discussion Claims Management Support Pathway Contact Opt out GP CC (optional) Facilitated Discussion Claims management postponed Quick reference guide Service items – Facilitated Discussion Item number Max fee (ex GST) Facilitated Discussion – Preparation RC707 $1,277.25 fixed amount Facilitated Discussion – Meeting RC708 $766.35 fixed amount GP RTW Case Conference RC277 $166.49 hourly rate (up to 2 (Maximum of 2 conferences per claim) hours maximum) Travel RC799 $166.49 hourly rate
23 What we will not pay for: X RTW incentives X Additional pre-meetings held with the worker and/or employer X If OES is approved after FD service, RC 717 cannot be billed Service item descriptors FACILITATED DISCUSSION - PREPARATION (RC707) This part of the service consists of: Initial contact to the agent for service context. Initial contact to the THP to: o Advise the THP that their patient/the injured worker has been referred to the FD service; o Discuss the process of the FD service; o Advise the THP that contact will be made with the injured worker to determine if they are agreeable to participating in the FD service. Separate ‘pre-meetings’ with the worker and relevant party/parties from the employer involved in the workplace relationship issue. FD allows for a maximum of two separate pre-meetings, no additional funding will be provided if an additional pre-meeting is held. Preparation of the parties for a potential FD. Joint FD meeting between the worker and relevant party/parties from the employer. The joint FD meeting is to be held at a safe mutual location, the FD meeting must not be held at the pre-injury workplace. WorkSafe recommends that the meeting is held at an OR provider office that is geographically close to the parties involved. Submission of Part A of the FD Report is required irrespective of whether a FD meeting proceeds. Part A of the FD Report is to be circulated to the worker, the worker’s THP, the Agent, the employer/party involved (cc WorkSafe). Preparation and Meeting components of the FD service (RC707 and RC708) must be completed within four weeks of the OR Approval Form receipt. FACILITATED DISCUSSION - MEETING (RC708) This part of the service consists of: An OR provider facilitated meeting between the worker and parties from the workplace involved in a workplace relationship issue. Assisting parties to reach a workable agreement that will enable a safe RTW. Recording outcomes in a written action plan distributed upon conclusion of the FD.
24 Submission of the completed FD report and agreed action plan is required within four weeks from receipt of the OR Approval Form. OES commencement may be approved following a successful FD, providing it is appropriate to do so. GP RTW CASE CONFERENCE (RC277) Click here for link to RC277 description OES PROVIDER TRAVEL (RC799) Click here for link to RC799 description
7. NEW EMPLOYER SERVICES There are three types of New Employer Services (NES) depending on the worker’s current work capacity as follows: 1. Job Seeking service (JSS): For injured workers with a certified CWC or For injured workers who have completed a Capacity Support Service (CSS) and may not have a certified capacity, but have an IME capacity 2. Capacity Support Service (CSS): For injured workers with an IME capacity only 3. Transferable Skills Analysis service (TSA): For injured workers without an IME or certified CWC (who satisfy relevant criteria). NES PROCESS These flowcharts show at a high level the different requirements for work capacity across the three NES service types: Job Seeking Service Certified capacity (JSS) Agent determines Capacity Support IME capacity OR Approval Form worker’s CWC & Service (CSS) decides on NES referral type Transferable Skills Analysis Service No capacity (TSA)
26 Pathways to NES & Reporting TSA RTW Job Completed and Seeking Plan submitted Every 8 wks JSS Certified JS Report & capacity > or Active job seeking, ORP brokerage, review of RTW Job IME capacity worker meetings/contacts 8 wks Seeking Plan only after CCS 4 Wks 12 wks completed TSA Completed and Agent submitted determines CSS OR Approval worker’s CWC IME capacity Form 6 Week Service Period & decides on only NES referral type Retraining may be TSA TSA Agent/OR Considered in Focus on No capacity Case any NES transferable skills (certified and Conference Service and vocational IME) options What we will pay for: RTW incentive payments where the Agent is satisfied the conditions for payment has been met. An RC891 incentive is payable to the OR Provider who negotiates RTW with the pre injury employer after NES commencement, where no prior OES has been delivered by the same provider An RC750 incentive is payable to the OR Provider who negotiates RTW with the pre injury employer after NES commencement, where the provider previously delivered an OES service Note: Agents may request workers provide evidence of new employment such as payslips to help determine which RTW incentive is payable, however a worker is not required to comply unless they are also seeking weekly payments while employed. For privacy reasons, an OR Provider must not request this employment evidence from a worker. NES must be suspended: As soon as the injured worker is expected to be unfit for a period of four weeks or more; or While a worker is participating in approved retraining unless the worker can concurrently market themselves to prospective employers while completing the course. NES must cease: As soon as the worker is expected to be unfit for a period of 13 weeks or more
27 Recommencing NES: NES may recommence where RTW with a new employer was not sustained for 13 weeks or ceased thereafter with resumption of entitlement to weekly payments Previously completed NES services should not be repeated on recommencement of NES o In most cases JSS 8 weekly reviews will be most appropriate (RC813) for recommencing NES Agents may exercise discretion for approval of NES recommencement at the point it had concluded when employment commenced Agents may exercise discretion to consider whether JSS or CSS should be recommenced based on CWC.
28 8. JOB SEEKING SERVICE (JSS) The purpose of this service is to provide job seeking assistance, job brokerage, and job seeking skills training to workers who have: A certified current work capacity, or Who have completed a CSS and remain certified as unfit for all work however have a CWC based on IME opinion. JSS PROCESS TSA Completed and RTW Job submitted Seeking Plan Certified Every 8 wks capacity JS Report & or Active job seeking, ORP brokerage, review of RTW worker meetings/contacts 8 wks Job Seeking IME capacity Agent 12 wks Plan only after CCS completed Approval Quick reference guide Service items – NES Item number Max fee (ex GST) Job Seeking Service - Commencement RC811 $1,285.82 fixed amount Job Seeking Service - Active RC812 $1,178.68 fixed amount Job Seeking Service - Support RC813 $664.33 fixed amount NES Workplace Report RC810 $166.49 hourly rate NES Placement Report RC889 $651.17 fixed amount NES Provider Travel RC899 $166.49 hourly rate
29 Service item descriptors JOB SEEKING SERVICE - COMMENCEMENT (RC811) This is the first part of the three part JSS service. This part of JSS is completed over a three week period that consists of the following: Meaningful engagement with the injured worker Cognitive and emotional preparation for job seeking Identify transferable skills and prioritised vocational options Job seeking preparation and skills training. A JSS report is submitted upon completing this part of the JSS service (report not required where the worker has completed a CSS immediately prior to the JSS commencement). Invoiced within 10 working days of: Submitting the JSS report, or The worker commencing RTW with a new employer, or At the completion of CSS when JSS is expected to automatically commence. JOB SEEKING SERVICE - ACTIVE (RC812) This is the second part of the three part JSS service. This part of JSS is completed over a nine week period immediately following submission of a JSS report under RC811. During this service: Both the OR Provider and worker intensively job seek OR Provider job brokerage activities Build on existing Job Seeking skills The worker will be equipped to independently job seek at the conclusion of this service Updates to the job seeking program based on continuous review of the job seeking goals and experience.
30 The OR Provider submits a ‘Joint RTW Job Seeking Plan’ at completion of this service which will: Form the basis for continuing job seeking activities Reflect changes to the prioritised vocational options based on the job seeking experience to date Detail the strategy for the next reporting period Detail of activities completed by both the OR Provider and worker Job brokerage activities completed by the OR Provider List worker meetings and contacts Reasons the RTW goal is yet to be achieved Detail ORP support that will be provided. Invoiced within 10 working days of: Submitting the Joint RTW Job Seeking Plan, or The worker commencing RTW with a new employer, or At the same time as a RTW incentive (if payable) if RC811 had already been paid. JOB SEEKING SERVICE - SUPPORT (RC813) This is the third part of the three part JSS service. This part of JSS is an 8 week service that commences immediately following submission of a ‘Joint RTW Job Seeking Plan’ (RC812). The service repeats until the worker successfully secures employment or entitlement to weekly compensation is assessed at 130 weeks of compensation. Note, the Agent arranges a worker interview at approximately 52 weeks of NES (combined CSS and JSS), including the OR Provider and certifying practitioner (if possible) to review progress and strategies for RTW. A Job Seeking Report is submitted at completion of every 8 week period (requirements of the report content are the same as for the Joint RTW Job Seeking Plan). Invoiced at the commencement of each 8 week service. NES WORKPLACE REPORT (RC810) A workplace assessment completed prior to the commencement of a worker’s new employment. Workplace modifications, assistive equipment, and WISE requirements should form part of the assessment. The assessment is not conducted if the worker does not wish to disclose their workers compensation status to the new/prospective employer.
31 NES PLACEMENT REPORT (RC889) A report and invoice submitted upon a worker commencing new employment during a JSS or CSS service. Submitted simultaneously with an NES Workplace Report, if conducted. NES PROVIDER TRAVEL (RC899) Travel for the purposes of delivering NES in the following circumstances: When the worker is unable to travel to the OR Provider’s nearest location Attending a GP RTW Case Conference Attending an Agent case conference, or Conducting an NES Workplace Report. Requirements: The cost of NES Provider Travel is calculated from and to the provider’s location nearest to where the worker resides or where the new workplace is located The cost of NES Provider Travel to a GP RTW Case Conference if from the provider’s nearest location to the GP rooms (location where the GP RTW CC was conducted) NES Provider Travel must be pre-approved by the Agent OR Providers must seek Agent approval to deliver services that is not from the nearest office location vii Invoicing for travel must reference the appropriate OR Provider location number. For workers at risk of harm to self or others, the costs of a second OR Consultant attendance at worker meetings can be Agent approved (see item code RC899). RC899 billing for ‘workers at risk’ of self harm or harm to others where circumstances necessitate the attendance of a second OR Consultant at a worker meeting (for safety and security purposes): Cost of the second OR Consultant’s travel and time in attendance at the worker meeting may be billed May be used in connection with any type of OR Service (OES or NES) Costs must be Agent approved prior to the meeting.
32 RTW incentive payments Descriptor Item number Max fee (ex GST) Incentive Type 1 RC890 $4,714.70 fixed amount Incentive Type 2 RC891 $2,571.67 fixed amount Incentive Type 3 RC892 $8,357.88 fixed amount Incentive Type 4 RC893 $4,286.10 fixed amount Back@Work RTW Incentive RC250 $321.46 fixed amount NES RTW incentives: NES RTW incentives specifying 13 week RTW Sustainability periods are calculated from when the dates the worker commences in new employment A worker may only have five days or part days off work in a 13 week RTW Sustainability period A 13 week RTW Sustainability period can only be attempted twice for the same new employer; no RTW incentives will be paid when the Sustainability period has been attempted and could not be fully completed twice NES RTW incentives are payable for workers who gain new employment during a ‘non entitlement period’ which is a designated period of time during which weekly payments stop with a planned resumption date. To determine which RTW incentive should be paid, the Agent calculates the number of weeks that would have been paid to the worker at the date the JSS or CSS commenced assuming that the non-entitlement period had not been applied. Worker Assistance Scheme (WAS) Upon a worker accepting new employment, OR providers should assist then to submit a ‘Worker Assistance Scheme Payment Form’ to the Agent (available on the WorkSafe website). The Worker Assistance Scheme supports workers with the costs involved in transitioning back to employment. This is a payment of $200 to a worker who secures new employment for a minimum of 15 hours per week, while participating in an NES service. The payment is not to be used for items of clothing or equipment that the employer is required to provide.
33 Incentive item descriptors NES INCENTIVE TYPE 1 (RC890) An incentive payable once a worker has commenced new employment and an NES Placement Report has been submitted (RC889). Invoiced when all the following conditions have been met: An NES Placement Report has been submitted (RC889) At the NES commencement date, the worker was receiving weekly payments At the NES commencement date, less than 78 weeks of weekly payments had been paid RTW has been sustained for 13 weeks No weekly payments payable at the 13 week sustainable RTW date NES INCENTIVE TYPE 2 (RC891) An incentive payable once a worker has commenced new employment and the following conditions have been met: An NES Placement Report has been submitted At the NES commencement date, less than 78 weeks of weekly payments had been paid RTW has been sustained for 13 weeks AND The worker was receiving weekly payments at NES commencement with a 50% reduction in weekly payments at the 13 week sustainable RTW date OR There were no weekly payments at the NES commencement date and the 13 week sustainable RTW date This incentive is also payable when RTW with the pre injury employer is achieved, however only when the OR Provider has not previously delivered an OES service to the worker.
34 NES INCENTIVE TYPE 3 (RC892) An incentive payable once a worker has commenced new employment and an NES Placement Report has been submitted (RC889). Invoiced when all the following conditions have been met: An NES Placement Report has been submitted At the NES commencement date, the worker was receiving weekly payments At the NES commencement date, more than 78 weeks of weekly payments had been paid RTW has been sustained for 13 weeks No weekly payments payable at the 13 week sustainable RTW date NES INCENTIVE TYPE 4 (RC893) An incentive payable once a worker has commenced new employment and the following conditions have been met: An NES Placement Report has been submitted (RC889) At the NES commencement date, more than 78 weeks of weekly payments had been paid RTW has been sustained for 13 weeks AND There has been a 50% reduction in weekly payments made at the 13 week sustainable RTW date compared to the NES commencement date. OR There were no weekly payments at the NES commencement date and the 13 week sustainable RTW date. RTW INCENTIVE: BACK@WORK (RC250) Click here for link to RC250 description
9. CAPACITY SUPPORT SERVICE (CSS) The purpose of this service is to establish whether an injured worker has a current work capacity for potential job seeking. The injured workers must: Have a capacity for employment based on current IME opinion, and Be certified with no capacity for employment. CSS PROCESS The OR Provider must plan and implement a six week strategy, utilising their expertise and judgment to structure the CSS to ensure it is customised to the individual needs of the worker. The following flow chart depicts a possible structure for CSS: TSA Completed and submitted Commence JSS/ 6 Week Service Period Discuss with Agent IME capacity CSS Approval Form Worker only GP RTW CC & meetings GP RTW CC & Action Plan (frequency as Action Plan necessary) Workers who have been certified with a CWC at CSS conclusion may move directly into the JSS service. The suitability of JSS for workers whose remain certified unfit by the 5th week of CSS must be discussed with the Agent, which may exercise discretion for timing of the next optimal service or case management plan. Quick reference guide Service items – CSS Item number Max fee (ex GST) Capacity Support Service (CSS) RC814 $750.07 fixed amount Capacity Support Service (CSS) Report RC815 $535.76 fixed amount
36 Service item descriptors CAPACITY SUPPORT SERVICE - CSS (RC814) A six week service developed by the OR Provider that: Liaises with the GP, utilising 1-2 GP Case Conferences as necessary, to establish a certified capacity in preparation for potential job seeking Engages, supports and prepares a worker for potential job seeking Transitions into JSS automatically if a certified capacity is obtained Invoiced at the beginning of this six week service. CAPACITY SUPPORT SERVICE - REPORT (RC815) A report submitted within 5 working days of completing the CSS six week service. Invoiced within 10 working days of: Submitting the CSS report, or The worker commencing RTW with a new employer; CSS resumes where it concluded if RTW is unsustained. Outcome incentive CSS Incentive item Item number Max fee (ex GST) Capacity Change Incentive RC888 $1,071.52 fixed amount
37 Service item descriptor CSS INCENTIVE (RC888) For workers who at the date of the OR Approval for CSS, had a capacity based on current IME opinion but were certified with no capacity for employment This incentive is payable for a change in worker medical certification (unfit to fit) and the worker has remained certified fit throughout the first 12 weeks of the subsequent JSS service o Not payable when a worker has more than 10 working days or part days unfit in this 12 week period This incentive is also payable when RTW with a new employer commences during CSS and the respective NES incentive sustainability period has been successfully completed.
10. TRANSFERABLE SKILLS ANALYSIS The purpose of a Transferable Skills Analysis (TSA) is to conduct an assessment of transferable skills to support case management planning for injured workers who: Have no certified capacity, and Have no capacity based on IME opinion. The TSA identifies potential employment options and the associated preparatory steps, which may be considered as part of the treatment plan and functional goals. TSA is more likely to provide benefit to the worker and case management plan when: There is medical evidence to suggest the worker’s injury is improving and there is potential CWC in the short term The worker has expressed an interest in vocational options, or The TSA Report will be support reviews with the certifying practitioner or an IME for determining whether there is a CWC For workers with weekly compensation post 130 weeks to support discussion regarding opportunities. Quick reference guide Service items – TSA Item number Max fee (ex GST) Transferable Skills Analysis RC816 $664.33 fixed amount Service item descriptor TRANSFERABLE SKILLS ANALYSIS (RC816) Completion of the assessment report is followed by an OR Provider and Agent case conference to discuss the recommendations and suitability of other vocational services such as retraining or CSS.
39 11. VOCATIONAL ASSESSMENTS FOR ENTITLEMENT REVIEW The purpose of these services is to enable Agents to request the collection or update to information about an injured worker’s vocational options and transferable skills in connection with their review of a worker’s ongoing entitlement. Where an injured worker does not have an ongoing entitlement to weekly benefits and no prior JSS has been completed, a minimum of 28 weeks of JSS should be provided. A referral straight into JSS can be considered, ensuring that adequate services are provided to the worker. Quick reference guide Service items – Vocational Assessments Item number Max fee (ex GST) 130 Week Vocational Report RC500 $166.49 hourly rate Supplementary 130 Week Vocational Report RC505 $166.49 hourly rate (up to 4 hours maximum negotiated) Service item descriptors 130 WEEK VOCATIONAL REPORT (RC500) A Vocational Assessment conducted to assist the Agent in determining a worker’s ongoing entitlement to weekly payments at 130 weeks of paid/payable compensation. This should not be conducted prior to the worker’s 90th week of paid/payable weekly compensation. Report submission is within 15 working days from receipt of the OR Approval Form. Minimum report content: o The worker’s age, education, skills, interests and work experience o The nature of the worker’s capacity and the details provided in the medical information o The nature of the worker’s pre-injury employment o A list of any actual or perceived barriers to RTW o OR Services, including retraining, that are being, or have been, provided to the worker o Prioritised suitable employment for which the worker is currently most suited, including details of the duties, expected wage and requirements o Identified suitable employment that exists within the workers labour market, including the worker’s accessibility to employment
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