West Virginia
TITLE 85
LEGISLATIVE RULE
WORKERS’ COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER
SERIES 27
QUALIFIED REHABILITATION PROVIDER
§85-27-1. General.
1.1. Scope. --
This rule establishes the minimum credentials to be met for an
individual to be recognized as qualified to provide vocational rehabilitation
services for the Workers’ Compensation
Commission, the Insurance Commissioner, private carriers and
self-insured employers, whichever is applicable, and to be reimbursed for such
services.
1.2. Authority. -- W. Va.
Code §§23-1-1 and 23-1-1a(j)(3).
Pursuant to W. Va. Code §23-1-1a(j)(3), rules adopted by the board of
managers and the commission are not subject to legislative approval as would
otherwise be required under W. Va. Code, §29A-3-1 et seq. Public notice requirements of that chapter
and article, however, must be followed.
1.3. Filing Date. -- August 31, 2005.
1.4. Effective
Date. --
October 1,
2005.
§85-27-2. Purpose of Rule.
2.1. The purpose of this
rule is to implement the provisions of W. Va. Code, §§23-4-3, 23-4-3b, and
23-4-9 which relate to the development of standards for vocational
rehabilitation services. W. Va. Code
§23-4-9(a) provides that “it is a goal of the workers’ compensation program to
assist workers to return to suitable gainful employment after an injury . . .
it is the shared responsibility of the employer, the employee, the physician
and the commission to cooperate in the development of a rehabilitation process
designed to promote reemployment for the injured employee.” This rule is intended to ensure vocational
rehabilitation services provided to injured workers are provided in a
professional manner by individuals qualified by education and experience to
provide such services so the highest quality of rehabilitation services may be
afforded to injured workers. This rule
is applicable to any provider of vocational rehabilitation services that
extends such services to injured workers under the West Virginia system of workers’
compensation insurance.
2.2. Upon termination of
the Commission, no registration is required of qualified rehabilitation
professionals. Qualified rehabilitation
professionals are required to verify and provide proof of their certification
or qualifications to the Insurance Commissioner, self-insured employer or
private carrier, or to their third party administrator or managed care
provider, whomever services are provided under this rule. In turn the Insurance Commissioner,
self-insured employer or private carrier, or their third party administrator or
managed care provider, is required to maintain this proof of certification or
proof of qualifications of the qualified rehabilitation professional.
a. The Commission,
Insurance Commissioner, self-insured employer or private carrier, whichever is
applicable, must use only qualified rehabilitation service professionals in
making rehabilitation referrals.
§85-27-3. Definitions.
As used in this legislative rule the following terms have the
stated meanings unless the context of a specific use clearly indicates another
meaning is intended.
3.1.
"Commission" means the West Virginia Workers' Compensation
Commission as provided for by W. Va. Code §23-1-1.
3.2. “Insurance
Commissioner” means the insurance commissioner of West Virginia as provided in section one,
article two, chapter thirty-three of the West Virginia Code, or any third party
administrator of the Insurance Commissioner.
3.3. “Code of Professional Ethics” refers to the code or codes to which a qualified rehabilitation professional subscribes and must include at least one of the following:
a. For certified rehabilitation counselors, the “Code of Professional Ethics for Rehabilitation Counselors” administered by the Commission on Rehabilitation Counselor Certification;
b. For certified disability management specialists, the “Code of Professional Conduct” administered by the Certification of Disability Management Specialists Commission;
c. For certified case managers, the “Code of Professional Conduct for Case Managers” administered by the Commission for Case Manager Certification;
d. For certified vocational evaluators, the “Code of Professional Ethics” administered by the Commission on Certification of Work Adjustment and Vocational Evaluation Specialists;
e. For certified rehabilitation registered nurses, the “Code of Ethics for Nurses with Interpretive Statements” administered by the American Nurses Association and endorsed by the Association of Rehabilitation Nurses;
f. For West Virginia licensed professional counselors, the “Code of Ethics and Standards of Practice” promulgated by the American Counseling Association and administered by the West Virginia Examiners in Counseling;
g. For members of the International Association of Rehabilitation Professionals, the “Code of Ethics, Standards of Practice and Competencies” administered by the International Association of Rehabilitation Professionals”; or
h. For qualified
rehabilitation professionals, a code of ethics or standards of practice
published by a relevant professional organization to which the qualified
rehabilitation professional is a member.
3.4. "Vocational rehabilitation services" means professional counseling, consulting or rehabilitation case management services reasonably necessary to enable an injured worker to return to suitable gainful employment as soon as practical. This may include, but is not limited to, coordination of medical services, vocational assessment, vocational evaluation, vocational counseling, vocational rehabilitation plan development, vocational rehabilitation plan monitoring, job development, and job placement. Furthermore, “vocational rehabilitation services” means services covered by W. Va. Code § 23-4-9, which provide new skills or modified or alternative work to enable an injured worker to return to suitable gainful employment as soon as practical. Services may include, but are not limited to, adult basic education, vocational-technical training, college training, on-the-job training, travel expenses related to training, job modifications and placement tools.
3.5. “Qualified
Rehabilitation Professional” means a person who has the education, experience
and skills necessary to provide vocational rehabilitation services as defined
in 85 C.S.R. 15 and pursuant to the rehabilitation priorities set forth in 85
C.S.R. 15, to make recommendations consistent with medical documentation,
concerning an injured worker's ability to accept and perform suitable gainful
employment, and to design, implement and supervise programs to enhance an
injured worker's capacity to accept and perform suitable gainful employment. A
qualified rehabilitation professional need not personally have the ability to
administer and interpret all medical, psychological or vocational testing, but
must be able to evaluate the test results provided by other professionals. A qualified rehabilitation professional is
required to consider all appropriate rehabilitation priorities in each case.
3.6. “Supervised
experience” means work in the field of vocational rehabilitation services in
which the individual receives at least one (1) hour of formal instruction, case
review, and case direction with a supervising professional for every twenty
(20) hours worked. The Commission,
Insurance Commissioner, private carrier or self-insured employer, whomever
services are provided, may request documentation of such supervision. The supervised experience required by this
rule must conform to the criteria for acceptable employment experience set
forth in this rule.
3.7. “Certified
rehabilitation counselor” means that earned designation as awarded by the
Commissioner on Rehabilitation Counselor Certification.
3.8. “Certified
disability management specialist” means that earned designation as awarded by
the Certification of Disability Management Specialists Commission.
3.9. “Certified case
manager” means that earned designation as awarded by the Commission for Case
Manager Certification.
3.10. “Certified
rehabilitation registered nurse” means that earned designation as awarded by
the Association of Rehabilitation Nurses.
3.11. “Licensed
professional counselor” means that earned designation as awarded by the West
Virginia Board of Examiners in Counseling.
3.12. “Certified
vocational evaluation specialist” means that earned designation as awarded by
the Commission on Certification of Work Adjustment and Vocational Evaluations
Specialists.
3.13. “Catastrophic
injury” means an injury with one of the following diagnoses: quadriplegia, paraplegia, hemiplegia,
traumatic brain injury (excluding mild brain injury or mild traumatic brain
injury), major extremity amputation, or
burns requiring admission to a specialized burn center.
3.14. “Private Carrier”
means any insurer, including the successor to the Commission, authorized by the
insurance commissioner to provide workers’ compensation insurance pursuant to
chapters twenty-three and thirty-three of the West Virginia Code, but shall not
include self-insured employers.
3.15. “Self-insurer” and
“self-insured employer” mean employers who are eligible and have been granted
self-insured status under the provisions of W. Va. Code §23-2-9.
3.16. “Board” means the
workers’’ compensation board of managers created pursuant to the provisions of
W. Va. Code §23-1-1a.
§85-27-4. Minimum Education and Experience Requirements.
The following are considered
the minimum education and experience requirements to provide vocational
rehabilitation services under the West
Virginia workers’ compensation insurance system:
4.1. A doctorate or
masters degree from an accredited college or university in rehabilitation
counseling, counseling, psychology, physical and/or occupational therapy,
social work, nursing, or in a field that promotes the physical, psychosocial or
vocational well-being of persons being served as well as at least twelve (12)
months of full-time or equivalent part-time employment providing vocational
rehabilitation services, as defined in this rule, to individuals receiving
benefits or services from a disability compensation system or a public
rehabilitation system of which six (6) months must have been under the
supervision of a qualified rehabilitation professional; or
4.2. Current licensed
professional counselor or certified vocational evaluation specialist
certification as well as at least twelve (12) months of full-time or equivalent
part-time employment providing vocational rehabilitation services, as defined
in this rule, to individuals receiving benefits or services from a disability
compensation system or a public rehabilitation system, of which six (6) months
must have been under the supervision of a qualified rehabilitation
professional; or
4.3. A baccalaureate
degree from an accredited college or university in rehabilitation counseling,
counseling, psychology, occupational therapy, social work, nursing, or in a
field that promotes the physical, psychosocial or vocational well-being of
persons being served as well as at least thirty-six (36) months of full-time or
equivalent part-time employment providing vocational rehabilitation services,
as defined this rule, to individuals receiving benefits or services from a
disability compensation system or a public rehabilitation system, of which
twelve (12) months must have been under the supervision of a qualified
rehabilitation professional; or
4.4. A baccalaureate
degree from an accredited college or university in any client serving field with transcripts
documenting successful completion of at least five (5) of the following
courses: medical aspects of disability, psychosocial aspects of disability,
vocational-occupational information, job placement, theories of counseling,
delivery of rehabilitation services, personal and vocational adjustment, vocational
and career development, assessment and standardized testing, human resource
management, health care administration or case management. In addition, the applicant must have at least
forty-eight (48) months of full-time or equivalent part-time employment
providing vocational rehabilitation services, as defined in this rule, to
individuals receiving benefits or services from a disability compensation
system or a public rehabilitation system, of which twenty-four (24) months must
have been under the supervision of a qualified rehabilitation professional; or
4.5. Certified case
managers, certified rehabilitation counselors, certified disability management
specialists, or certified rehabilitation registered nurses. These limited types of qualified rehabilitation
professionals are required to verify and provide proof of their certification
to the Insurance Commissioner, self-insured employer or private carrier, or to
their third party administrator or managed care provider, whomever services are
provided under this rule. In turn the
Insurance Commissioner, self-insured employer or private carrier, or their
third party administrator or managed care provider, is required to maintain
this proof of certification of the qualified rehabilitation professional.
§85-27-5. Acceptable Employment
Experience.
5.1. Full-time employment is considered as 35 hours per week.
5.2. Part-time
experience is determined by calculating the total number of hours of acceptable
experience divided by 35 hours, to result in the number of weeks of credit for
acceptable experience.
5.3. Employment
verification must provide evidence that 100% of the time counted as acceptable
employment experience was spent providing vocational rehabilitation services to
persons with impairments and disabilities.
At least 50% of the activities must be directly related to serving
persons with disabilities. Time spent in
travel and waiting are not considered vocational rehabilitation services.
5.4. Employment
experience must reflect activity in at least four (4) of the areas described in
5.4.a through 5.4.l to be considered acceptable.
5.4.a. Vocational rehabilitation consulting, career counseling or mental health counseling;
5.4.b. Developing and monitoring vocational rehabilitation services/care;
5.4.c. Job placement and/or job development;
5.4.d. Job analyses;
5.4.e. Individual appraisal;
5.4.f. Supervision of counselors or qualified rehabilitation professionals;
5.4.g. Vocational training;
5.4.h. Consultation in disability management;
5.4.i. Forensic rehabilitation services;
5.4.j. Return-to-work plan development and implementation;
5.4.k. Vocational evaluation; and
5.4.l. Medical rehabilitation case coordination.
§85-27-6. Continuing Education.
6.1. Every two (2)
years, commencing from the effective date of this rule, each qualified
rehabilitation professional is required to maintain and present documentation
to the Insurance Commissioner, self-insured employer or private carrier, or to
their third party administrator or managed care provider, whomever services are
provided under this rule, of completion of forty (40) contact hours of
continuing education. Provided, at least
three (3) hours of continuing education credits in ethics must be completed
every two (2) years.
a. Certified case
managers, certified rehabilitation counselors, certified disability management
specialists, and certified rehabilitation registered nurses are exempt from the
provisions of this section, but are required to verify and provide proof of
their certification to the Insurance Commissioner, self-insured employer or
private carrier, or to their third party administrator or managed care
provider, whomever services are provided under this rule.
6.2. Qualified rehabilitation
professionals are required as outlined in section 6.1 of this rule to maintain
documentation of continuing education at their place to employment, to be
reviewed by the Commission or Insurance Commissioner, whichever is applicable,
when determined necessary by the applicable, Commission or Insurance
commissioner personnel.
6.3. Programs of
continuing education are formally organized educational programs offered in the
form of a class, course, workshop, seminar, distance learning, staff development
or training activity. Programs should enhance professional skills, values,
knowledge, and/or ethical considerations in the qualified rehabilitation
professional’s practice. The following is a representative list of applicable
subjects:
a. Professional ethics;
b. Rehabilitation counseling or counseling;
c. Career Development or Vocational Counseling;
d. Medical, vocational and psychosocial aspects of disability;
e. Disability case management;
f. Managed care and disability management concepts;
g. Workers’ compensation and/or disability compensation systems;
h. Community agencies and resources;
i. Plan development in rehabilitation;
j. Job development and placement;
k. Foundations of rehabilitation;
l. Research and statistics;
m. Organizational psychology; social psychology; educational psychology;
n. Employer consultation services;
o. Family, gender and multicultural issues;
p. Tests and measures or vocational assessment; individual intelligence testing;
q. Problems in substance abuse;
r. Theories/techniques of work adjustment;
s. Environmental and attitudinal barriers for individuals with disabilities; and
t. Theories of personality; individual differences; personality measures.
6.4. Continuing
education programs approved by the Commission on Rehabilitation Counselor
Certification, the Certification of Disability Management Specialists
Commission, the Commission for Case Manager Certification, the Commission on
Certification of Work Adjustment and Vocational Evaluation Specialists, the
American Board of Vocational Experts, the National Board of Certified
Counselors, or the West Virginia Board of Examiners in Counseling will be
accepted. Fifteen (15) contact hours for
each academic graduate semester hour or ten (10) contact hours for each
academic graduate quarter hour will be granted for classes in rehabilitation
counseling, counseling, psychology, occupational therapy or nursing
successfully completed at accredited educational institutions.
6.5. A qualified
rehabilitation professional whose eligibility was established based on
certification as a certified rehabilitation counselor, certified disability
management specialist, certified vocational evaluation specialist, certified
rehabilitation registered nurse or certified case manager must maintain that
certification to continue to be a qualified rehabilitation professional.
Documentation of current certification must be maintained at their place of
employment to be reviewed by the Commission, Insurance commissioner, private
carrier or self-insured employer, or to their third party administrator or
managed care provider, whomever services are provided under this rule, when
determined necessary by the applicable Commission, Insurance Commissioner,
private carrier or self-insurance, or their third party administrator or
managed care provider, personnel.
§85-27-7. Other Requirements.
7.1. An injured worker
petitioning for permanent total disability benefits referred for a rehabilitation
evaluation must be evaluated by a qualified rehabilitation professional with
either a masters or doctorate degree in rehabilitation counseling, counseling
and guidance, or psychology, or by a qualified rehabilitation professional with
either the certified rehabilitation counselor, licensed professional counselor,
vocational evaluation specialist, or certified disability management specialist
certification or by a qualified rehabilitation professional who is certified by
the American Board of Vocational Experts. Provided, an injured worker
determined to have suffered a catastrophic injury must be assigned to a nurse
qualified rehabilitation professional with at least one of the following
certifications: (1) certified rehabilitation registered nurse; (2) certified
case manager; or (3) certified disability management specialist.
§85-27-8. Severability.
If any provision of this rule or the application thereof to any entity or circumstances shall be held invalid, such invalidity shall not affect the provisions or the applications of this rule which can be given affect without the invalid provisions or application and to this end the provisions of this rule are declared to be severable.