90- 351 C.M.R. ch. 6, § 2

Current through 2024-51, December 18, 2024

Section 351-6-2 - Provider Requirements

1.Evaluation and Plan

A. A provider must consider medical evidence and information received with a referral for evaluation.

B. If a provider finds the employee is not suitable for employment rehabilitation services, the provider must clearly articulate the reason(s) in the evaluation.

C. If a provider finds an employee is suitable for employment rehabilitation services, the provider must include in the evaluation, at a minimum, the following:

i. Clearly articulated reasons the provider believes employment rehabilitation services are warranted;

ii. A concise summary of medical records reviewed;

iii. The source, date, and description of the employee's current work capacity, including restrictions;

iv. Clearly defined vocational goals for the employee; and

v. A detailed employment rehabilitation plan, including a clear plan for workforce re-entry, an outline of expected costs, and the estimated length of the plan.

D. A provider must submit the evaluation of the employee to the Executive Director or the Executive Director's designee no later than sixty days after the referral from the Board, unless the provider has received an extension of time from the Executive Director or the Executive Director's designee.

2.Plan Implementation

A. If a plan is implemented, the provider shall submit monthly reports to the Executive Director or the Executive Director's designee and all interested parties.

B. The provider shall communicate in a timely and responsive manner with the Executive Director or the Executive Director's designee after selection and during plan implementation.

C. Except in cases that lump sum settle, no later than thirty days after the conclusion of the plan, the provider must submit a final report that indicates whether the employee has returned to work.

i. If the employee has returned to work, the report must indicate where the employee is working, and how the plan resulted in that particular employment.

ii. If the employee does not return to work, the report must indicate why the plan was unsuccessful.

D. The Employment Rehabilitation Fund is not responsible for costs incurred after a case is lump sum settled. If the provider was not notified of the date of the lump sum settlement, then any costs incurred after the settlement date shall be paid by the employer/insurer.

3.Extension and Modification Requests; Provider

The provider may request an extension or modification of a previously approved plan. A request must include the information required in §2(1)(C). The provider must submit a request for an extension of time or modification to the Executive Director or the Executive Director's designee within 30 days of the date the plan is scheduled to end.

4.Conflict of Interest

The provider must decline any referral to conduct an evaluation on a case for which the provider has a conflict of interest and must notify the Executive Director or the Executive Director's designee immediately of such conflict.

5.Billing

A. A provider must submit a completed Vendor Activation/Change form or other form approved by the State Controller to receive payment for services provided to the Board.

B. A provider must submit monthly invoices for payment of costs and services. Invoices must include, at a minimum, dates of service, invoice number, and provider name and address.

C. Payment for costs and services included in a plan must be made directly to providers, unless the payor and the provider agree otherwise.

90- 351 C.M.R. ch. 6, § 2