Document name
Secondary and Tertiary Treatment
Document number
PRO 51/2016
Effective date: May 1, 2016
Application: All secondary and tertiary treatment program health care providers.
Policy subject: Health care services – Providers
Purpose:
To provide administrative guidelines for approving and evaluating secondary and tertiary treatment.
BACKGROUND
- Upon Workers’ Compensation Board (WCB) approval, a worker entitled to benefits under The Worker’s Compensation Act, 2013 (the “Act”) is also entitled to (Section 103):
- Any medical aid that may be necessary as a result of the injury.
- Any other treatment by a health care professional.
- Any prosthetic or apparatus that may be necessary as a result of the injury, and
- Any transportation or sustenance occasioned by the medical aid.
- The WCB is authorized to determine health care services fees (Section 104).
- The WCB strives to ensure the injured worker’s best recovery from a work injury. This includes a safe and suitable return to work as soon as medically possible. This goal can be achieved by ensuring:
- Active treatment at the primary level, and
- Timely access to secondary and tertiary services where required.
- The WCB has established the Health Care Advisory Committee (HCAC) to evaluate the medical care provided to injured workers. This includes recommendations regarding secondary and tertiary treatment.
PROCEDURE
- All secondary and tertiary treatment centres who are accredited by the WCB to provide services to injured workers can access the following at www.wcbsask.com:
- The Secondary and Tertiary Treatment Centre Manual.
- Accreditation standards.
- Fees.
- Reporting forms.
The Coalition of Physical Rehabilitation Centres of Saskatchewan (CPRCS) and the WCB will negotiate changes to these documents as needed.
General
- An assessment team review may be requested by a health care provider or the Case Manager (CM) where:
- The worker is not working and has no confirmed return-to-work (RTW) date and:
- The expected recovery date has been exceeded; or
- A passive treatment plan is in place where active treatment is appropriate; or
- A definitive diagnosis has not been achieved and is hindering recovery and RTW planning; or
- Significant risk factors for chronic disability have been identified (as per Appendix II of the Secondary and Tertiary Treatment Centre Manual).
- The worker continues in employment but has not returned to full duties and/or full hours after the work injury.
- The worker is not working and has no confirmed return-to-work (RTW) date and:
- Assessment teams:
- Recommend specialist or diagnostic services.
- Identify the appropriate level of treatment for the worker (i.e., primary, secondary or tertiary).
- Provide a timeline for RTW planning and indicate if there is anything that would preclude the worker from a return to their pre-injury employment.
- The secondary or tertiary treatment of a WCB customer will require:
- Prior approval by the Primary Care Provider (PCP).
- Recommendation by an assessment team, and
- Intake arranged by a WCB Health Care Services (HCS) Coordinator, or
- Direct referral from the PCP who received the assessment team recommendations.
- Where the PCP does not choose a treatment centre, the WCB will try to retain a customer in the same clinic that provided primary care. The WCB will make efforts to:
- Maintain a one week intake standard, and
- Ensure fair distribution of these customers.
- The HCS Facilitator acts as a liaison between the treatment center and other WCB staff to:
- Ensure adequate supports are in place to achieve a successful recovery and return-to-work (RTW).
- Assist the treatment team with health-related issues.
- Inform WCB’s case management team of the customer’s progress and the direction health and disability management is taking.
- Advise the WCB case management team of any interventions required and to advise the treatment team of any actions the WCB will take to resolve any non-health related issues.
- The HCS Facilitator, with the assistance of the Case Manager (CM), will intervene if a RTW plan cannot be established and to determine if vocational services are required.
- The HCS Facilitator will monitor and intervene where barriers are identified in the customer successfully completing a return-to-work plan. This may include arranging expedited diagnostics or referring the file to a WCB orthopedic consultant.
- The HCS Facilitator must notify the PCP, CM and HCS Manager where a customer sustains an injury during rehabilitation.
- The HCS Facilitator will communicate monthly with the treatment centre. Additional communication may occur if the HCS Facilitator requires more information on the customer’s progress.
- The WCB will determine a Composite Index Score and an employer-attached RTW Score for each treatment program. The WCB will use this data to evaluate the performance of the treatment centre
- HCS will note all customer complaints and resolutions on the service provider’s accreditation file.
Policy references
Section heading
Act Sec #
Act Sec #
55, 103, 104, 111, 115
Section heading
Supersedes
Supersedes
PRO 57/2013 Medical Fees – Secondary and Tertiary Treatment Centres
Section heading
Complements
Complements