Washington Administrative Code

(1) The vocational rehabilitation provider must submit a written progress report to the department every thirty calendar days from the date of the electronic referral or upon request of the department.(2) All progress reports must summarize progress during the most recent reporti…

When plan implementation and monitoring services are completed, the vocational rehabilitation provider must submit a closing report with one of the following recommendations:(1) Plan successfully completed. If the worker successfully completes the vocational rehabilitation plan, …

The department may make a referral for forensic services to obtain an independent and objective evaluation of the vocational rehabilitation components of a complex claim. The department will only authorize a forensic evaluation when previous vocational referrals have not resolved…

(1) A forensic evaluation constitutes an analysis of prior vocational services and the medical conditions of an injured worker, including pre and post injury, to determine whether any further vocational services are necessary and likely to enable the injured worker to become empl…

A forensic evaluation requires thirty-day progress report(s) and a final report.(1) Progress reports. Each progress report must include:(a) A detailed explanation why the forensic referral was not completed as of the date of the report;(b) A summary of all activities taken in the…

The department can request a stand alone job analysis to analyze the requirements and characteristics of a job(s), an injured worker's ability to perform job functions and duties, and whether the injured worker requires further vocational rehabilitation services in order to becom…

(1) The following information must be included in a labor market survey that is submitted to the department as documentation in support of a vocational recommendation. This information must be presented in the form of a summary report and accompanied by the results of the individ…

When completing a job analysis, the vocational rehabilitation provider must:(1) Include identifying information on each page. This information includes the worker's name and claim number, and the specific job title surveyed and its DOT code. If the DOT code is not an accurate ref…

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 authorize job modifications when the following criteria are met:(1) The claim is open or in statutory pension status; and(2) Due to the …

An amount not to exceed $10,000 from the department is available per worker per job or job site. If combined with prejob accommodations for the same return to work goal, the maximum combined benefit available for job modification and prejob accommodation is $10,000. The employer …

As provided for in RCW 51.32.095(7), the supervisor or the supervisor's designee, in his or her discretion, may authorize prejob accommodations when the following criteria are met:(1) The claim is open or in statutory pension status; and(2) The injured worker's attending doctor c…

An amount not to exceed $10,000 from the department is available per worker per claim. If combined with job modifications for the same return to work goal, the maximum combined benefit available for job modification and prejob accommodation is $10,000.[Statutory Authority: RCW 51…

(1) A vocational provider assisting the injured worker in applying for prejob accommodation assistance must submit to the department a prejob accommodation assistance application. Prejob accommodations assistance applications shall be submitted on a form prescribed by the departm…

(1) An employer requesting job modification assistance must submit to the department a job modification assistance application. A vocational provider may assist the employer with the application.(2) The job modification assistance application shall include, but not be limited to:…

Provider community commentary, expert opinion and best practices suggest that there is a correlation between a higher quality level of vocational rehabilitation services and higher qualifications of vocational rehabilitation providers. To ensure the provision of the highest possi…

No. The department may only issue provider numbers to persons, firms, partnerships, corporations and other legal entities that satisfy the qualification requirements in WAC 296-19A-210.[Statutory Authority: RCW 51.04.020, 51.04.030, 51.32.095, 51.36.100, 51.36.110. WSR 00-18-078,…

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 rehabilita…

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 using copies and originals of all files and records maintained by the provider;(3) Conduct audits away from a provider's place …

For information regarding the formal appeals process refer to chapter 51.52 RCW.[Statutory Authority: RCW 51.04.020, 51.04.030, 51.32.095, 51.36.100, 51.36.110. WSR 03-11-009, § 296-19A-245, filed 5/12/03, effective 2/1/04.]

The department will give ten working days' written notification to a provider before starting an audit.[Statutory Authority: RCW 51.04.020, 51.04.030, 51.32.095, 51.36.100, 51.36.110. WSR 00-18-078, § 296-19A-250, filed 9/1/00, effective 6/1/01.]

(1) Internal staff and parties to a claim can submit concerns or complaints to the department about a vocational provider or firm at any time. The department's program that is responsible for the conduct of vocational providers reviews all concerns and complaints. The program's i…

(1) Corrective actions or sanctions can include, but are not limited to:(a) Reprimand;(b) Remedial education courses and/or other educational or training programs;(c) Temporary supervision when meeting with a client; and/or(d) Probation;(e) Inability to receive payment or recoupm…

(1) Specific to allegations of sexual misconduct or contact, the department will initiate an investigation by department staff or by an external investigative agency following a complaint or an internal request for review. The department shall determine any appropriate sanctions …

Vocational providers have unsupervised access to injured workers and their personal identifiers and medical information. Because of this, they are subject to periodic criminal background checks at least once every two years, in addition to satisfying a background check before rec…

(1) The department shall establish an independent review panel of at least three private sector vocational providers. The panel will act as consultants whenever the department believes misconduct or failure to pass a criminal background check may warrant permanent restrictions or…

(1) Reasons the department can order corrective actions against a vocational rehabilitation provider include, but are not limited to, the following:(a) Charging the department for services that do not contribute to the completion of a vocational referral, including, but not limit…

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.[Statutory Authority: RCW 51.04.020, 51.04.030, 51.32.095, 51.36.100, …

By rendering vocational rehabilitation services to industrially injured or ill workers under Title 51 RCW, the vocational rehabilitation provider agrees to comply with Title 51 RCW, chapters 296-19A and 296-15 WAC, and the department's fee schedule.[Statutory Authority: RCW 51.04…

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 rehabilitation services to industrially injured or ill workers. More detailed billing instructions for vocational rehabilitation se…

The following services are considered overhead and the department 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 di…

Vocational rehabilitation 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 reh…

(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…

(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 …

(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.[Statutory Authority: RCW 51.04.020, 51.04.…

(1) When a vocational rehabilitation 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) In…

(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 rehabilitatio…

The purpose is to avoid delays in vocational rehabilitation services by resolving disputes between industrially injured or ill workers, employers and the referral source.[Statutory Authority: RCW 51.04.020, 51.04.030, 51.32.095, 51.36.100, 51.36.110. WSR 00-18-078, § 296-19A-410,…

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.[Statutory Authority: RCW 51.04.020, 51.…

A vocational rehabilitation provider cannot dispute a vocational determination.[Statutory Authority: RCW 51.04.020, 51.04.030, 51.32.095, 51.36.100, 51.36.110. WSR 00-18-078, § 296-19A-430, filed 9/1/00, effective 6/1/01.]

(1) A finding that an industrially injured or ill worker is eligible for vocational rehabilitation services, or a finding that he or she is ineligible for vocational rehabilitation services, may be disputed.(2) An approved vocational rehabilitation plan may also be disputed.(3) A…

The department must receive the written dispute within fifteen calendar days of receipt of notification to the worker or employer. The dispute must explain the reason(s) for the disagreement with the determination. The department may accept the dispute if it is not received withi…

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.[Statutory Authority: RCW 51.04.020, 51.04…

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 …

(1) "Training provider" means any entity offering education in any form or manner for the purpose of instructing, training, or providing knowledge or skills.(2) "Accredited" means the training provider has been approved by the state agency responsible for regulating degree granti…

The department can approve and issue a provider account number to:(1) An accredited training program or provider.(2) A licensed training program or provider.(3) An apprenticeship program approved through the Washington state apprenticeship training council.(4) A training provider…

(1) A training provider must be approved by the department and receive a provider number to be eligible to provide training services or to receive payment for services.(2) All training providers must:(a) Comply with all federal and state laws, regulations, and other requirements …

Application must include the following information attested by the training provider's chief administrative officer:(1) An identification of owners, shareholders, and directors:(a) The complete legal name, current telephone number, and current mailing address of the owner;(b) The…

A nonaccredited or unlicensed training provider exempt from any other applicable state licensing requirement must provide proof of continuous operation for at least two years prior to the date of application.Exception:A program that is part of a publicly funded entity; e.g., city…

An approved nonaccredited or unlicensed training provider must reapply two years after the date of the most recent application to the department.[Statutory Authority: RCW 51.04.020, 51.04.030, 51.32.095, 51.32.099, and 2007 c 72. WSR 09-24-108, § 296-19A-550, filed 12/2/09, effec…

When a nonaccredited or unlicensed training provider seeks a provider number from the department, the provider must give the department all the following documentation, or its request will be denied:(1) A copy of the training provider's catalog. The training provider must publish…