Effective date: April 1, 2016
Application: All injured worker requiring occupational therapy services.
Policy subject: Health care services – Providers
To provide administrative guidelines for approving and evaluating occupational therapy services.
- Upon Workers’ Compensation Board (WCB) approval, a worker entitled to benefits under The Workers’ Compensation Act, 2013 (the “Act”) is also entitled to (Section 103):
- Any medical aid that may be necessary because of the work-related injury.
- Any other treatment by a health care provider.
- Any orthotic appliance or apparatus that may be necessary as a result of the injury, and
- Any travel and sustenance costs associated with receiving medical treatment as a result of the injury.
- The WCB is authorized to determine health care services fees (Section 104(1)).
- The WCB can spend money for any specialized treatment or medical aid that it considers necessary (Section 115).
- All occupational therapists (OTs) accredited to provide services to WCB customers and who are fully licenced members in good standing of the Saskatchewan Society of Occupational Therapists (SSOT), can find the following information on www.wcbsask.com:
- Accreditation Standards and Service Provider Guidelines for Saskatchewan Workers’ Compensation Board Primary Occupational Therapy Service Providers.
- Service Fees and Fee Codes for Saskatchewan Workers’ Compensation Board Primary Occupational Therapy Service Providers.
- Billing and reporting forms.
- If a worker needs occupational therapy, the Vocational Rehabilitation Specialist or attending care giver will notify Medical and Health Care Services (MHCS) to arrange care.
- Typically, the WCB will not pay for treatment that begins before receiving a Primary Level Authorization to Treat from an OT. Upon approval, OTs can see workers for up to 10 visits (after they send the OTI form) unless the WCB says otherwise.
- If a customer needs more treatment after the initial 10 visits, the OT will send a progress report (OTP) to the WCB.
- If the WCB approves, the OT can see the worker for up to 10 more visits.
- If the worker needs more treatment after the first extension, the OT will send another progress report (OTP) to the WCB. If the WCB approves, the OT can see the worker for up to 10 more visits. At this time, and for every progress report (OTP) sent thereafter, the Case Manager will request the WCB Physical Therapy Consultant to review the worker’s progress.
- If the worker wants more treatment, but has not had treatment for more than 30 days, the OT must send another Primary Level Authorization to Treat – Occupational Therapy form. OTs can only resume treatment once they hear from the WCB.
- If treatment is not approved by the WCB before treatment commences, the WCB will fund up to five treatments or up to the date of the disallowance letter, whichever comes first. This includes treatment for urgent referrals where a worker has sustained a hand injury or had surgery to a hand within the past three weeks.
- If the WCB denies an occupational therapy claim for coverage after approving treatment, the WCB will pay for services up to the date of notification.
- MHCS will contact OTs (by phone and in writing) that continually send initial reports (OTI), progress reports (OTP) or discharge reports (OTP) late to the WCB. MHCS will issue a final warning if the late reporting continues. Thereafter, the WCB will not pay for services that OT’s provide after reports are due.
- If the worker needs more comprehensive care, the OT will tell the WCB that an assessment team review is required (e.g., the worker’s recovery is not progressing, psychological or pain management services are required). The assessment team will determine if secondary or tertiary treatment is more appropriate. If the worker will benefit from further treatment, the OT can continue treatment while waiting for the assessment team review.
- The WCB Physical Therapy Consultant will review files that have two or more progress reports (TXP) if the worker is not discharged or sent for an assessment team review. However, CESs and CMs can request the assistance of the WCB Physical Therapy Consultant at any time during the review of claims.
- If the CES, CM or WCB Physical Therapy Consultant finds that the WCB should deny coverage, the file manager will tell the OT.
- MHCS will note all complaints and resolutions on the service provider’s accreditation file.
- Compliance with the practice standards may be evaluated through a clinical survey process.
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