Voc Improvement Questions and Answers

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Vocational Improvement Project (VIP)

Please submit your questions and feedback using the Voc Improvement Feedback Form so that L&I can continue to update information online.

Voc improvement changes

• How are workers in a plan approved prior to January 1, 2008 affected by the changes?

  Workers currently in an approved plan are not eligible for the new benefits. The processes associated with the pre 1-1-08 benefit system will continue to be used for these workers. This includes requests for plan interruptions and plan modifications and requests for second 52 week approval. The pre 1-1-08 forms will continue to be used for these workers.

• How will these changes affect Vocational Rehabilitation Counselors (VRCs) and interns who are not assigned to a referral, but who provide vocational services to workers?

  The legislation calls for the assigned VRC to meet with the worker and explain Rights and Responsibilities when a plan development referral is made.

  Exception: For out of state referrals, the counselor providing direct services to the worker may be considered the assigned vocational rehabilitation provider for purposes of this meeting.

  It is permissible for another vocational provider or intern, who work for the same firm as the assigned VRC, to provide subsequent services to that worker.

• L&I has stated that there is an expectation for "better assessments". What is meant by that? Can occupational exploration and vocational evaluation be done during an assessment referral?

  L&I is placing more scrutiny on the assessment process. Beginning January 1, 2008, the Vocational Services Specialists (VSS) will review all assessment reports that recommend "eligible". The goal is to ensure that there is sound vocational analysis that demonstrates vocational services are necessary and the worker is likely to benefit from vocational services. If occupational exploration and/or vocational evaluation can help to support the analysis, then these services may be appropriate during assessment.

• Can VRCs continue to request that a doctor provide information on a worker's physical capabilities?

  No. The Insurer Activity Prescription Form (F242‑385‑000) is designed to collect this information and to reduce administrative burden on health care providers. Provider Bulletin 07-08 (165 KB PDF) provides information about this new form and policy. Vocational providers may continue to submit job analysis to health care providers and they may continue to communicate with health care providers on other issues involving return to work.

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• What should a VRC do if he or she receives a voc referral but recognizes that the referral is inappropriate because medical and capacities information is not available on the claim file?

  The referral should be closed ADMA — "VRC declines referral". This should occur as soon as the VRC has determined that the referral is not appropriate.

• What should a VRC do if he or she receives a voc referral but there is conflicting medical and capacities information is not available on the claim file?

  The referral should be closed ADM1 — "Medically unstable". This should occur as soon as the VRC has determined that the conflicting medical must be resolved.

• What is the difference between "Rights and Responsibilities" and "Accountability Agreement"?

  These are separate documents. Both are required by the legislation. L&I has developed a Rights and Responsibilities document to be used to inform an eligible worker of his or her rights and responsibilities in the plan development process. The document will be sent to the worker and the VRC when a plan development referral is made. The assigned VRC is required to review the document with the worker at their initial plan development meeting. L&I has also developed Rights and Responsibilities for use in Assessment and Plan Implementation.

  The Accountability Agreement is not a new requirement. It is attached to the plan that is submitted to L&I and it details expectations regarding the worker's participation in the plan. It carries signature lines for the worker, the VRC and other parties if appropriate. The Accountability Agreement (F280‑016‑000) is referenced in current WAC 296‑19A‑100(2)(h) (www.leg.wa.gov). L&I plans to add further clarification to the Accountability Agreement in the near future. We will notify vocational providers and other interested parties through L&I's Vocational Rehabilitation E-mail List when these changes are made.

• Does L&I intend to adjust referral fee caps because of the changes?

  L&I is studying the fee caps in light of the changes. The fee caps for one or more referral types may be adjusted if it is determined to be necessary.

Plan development

• A worker participated in a plan under the old system, pre-January 2008. If the worker is subsequently eligible for plan development services after January 1, 2008, what benefits are available to him or her?

  As of January 1, 2008 injured workers get a clean slate so if a worker is found eligible for plan development after January 1, 2008, they are entitled to the full benefit amount of the new system regardless of voc services received prior to January 1, 2008. This would include the ability to choose Option 1 or Option 2 after having a plan approved by L&I.

• What happens if a plan cannot be submitted in 90 days?

  L&I has issued Interim Policy 6.46 that defines how an exception to the 90 day plan development requirement can be requested by a VRC. L&I has also filed proposed rules that define how an exception to the 90 day plan development requirement can be requested by a VRC. For more information on the Interim Policy contact the claim manager. See VIP Rule Updates for information about rules under development.

• Are vocational providers who work on self-insured claims required to submit a plan in 90 days also?

  Yes. The 90 day requirement applies to all vocational plan development services, including claims covered by both L&I and by self-insured employers.

• Does a bona fide and valid job offer require a job analysis?

  A bona fide and valid job offer may be made by an employer to a worker who has been determined to be eligible for vocational services. These job offers must be for work that is within the worker's capacities as established by medical information in the claim file. A job analysis is not required. L&I will determine if the job offer is valid.

• Can a plan be submitted that is not expected to start for several months?

  Not in most cases. L&I has developed interim policy on this topic. The interim policy requires that a plan must begin within 90 days of the date the plan is approved. The worker and VRC should be encouraged to look at plans with an immediate start date.

  Exception: The Return to Work Services Program Manager or Self-Insurance Program Manager in consultation with the Return-to-Work Services Program Manager may approve a training plan that begins more than 90 days after the plan approval date when there are no other classes or viable job goals for that worker.

Plan implementation and option 2

• What happens to the vocational referral if a worker chooses option 2?

  The vocational referral will be closed by L&I.

• If a worker chooses option 2, do they have to follow the approved plan?

  No. The worker does not have to follow the approved plan. The worker has up to five years to utilize vocational benefits in conjunction with training provided by a school or institution that is licensed, accredited, or a program approved by L&I.

• What is meant by the requirement that a program providing formal education be licensed, accredited or L&I approved?

  This is required by legislation. L&I intends to draft rules around the requirements for a program to be approved by L&I. In the meantime, a program that already has an L&I provider number may continue to provide services. A program that does not have an L&I provider number must apply for a number. L&I will determine whether to approve the program based on the criteria in the interim guidelines.

• Are there still plan interruptions and plan modifications?

  Plan interruptions and plan modifications may still be used for plans approved before January 1, 2008. There are no plan interruptions for plans approved after January 1, 2008. Those plans must end within two years of the date they begin. Plans approved after January 1, 2008 may still be modified (for cost and or time) provided that the modification falls within the benefit limit and 2-year time limit.