803

KAR 25:101. Provision of workers' compensation rehabilitation services.

 

      RELATES

TO: KRS 342.710

      STATUTORY

AUTHORITY: KRS 342.260(1), 342.710

      NECESSITY,

FUNCTION, AND CONFORMITY: KRS 342.260(1) requires the Office of Workers' Claims

to promulgate administrative regulations to carry out its work and the work of

the administrative law judges. KRS 342.710(3) requires rehabilitation services

for an employee who has suffered an injury covered by KRS Chapter 342. This

administrative regulation establishes requirements for the provision of

rehabilitation services pursuant to KRS 342.260 and 342.710.

 

      Section

1. Definitions. (1) "Administrative law judge" means an individual

appointed pursuant to KRS 342.230(3).

      (2)

"Commission on Accreditation of Rehabilitation Facilities" or

"CARF" means the national organization which accredits rehabilitation

facilities.

      (3)

"Directory of Qualified Rehabilitation Facilities" means the directory

of facilities in Kentucky:

      (a)

Which are licensed pursuant to KRS Chapter 216B; and

      (b)1.

Which are accredited by CARF in either comprehensive inpatient rehabilitation

or outpatient medical rehabilitation; or

      2.

Whose application for accreditation is pending.

      (4)

"Directory of Vocational Evaluation Facilities" means the directory

of facilities in Kentucky which are:

      (a)

Accredited by CARF in the area of comprehensive vocational evaluation services;

or

      (b)

Assessment centers operated by the Department for Technical Education.

      (5)

"Medical rehabilitation services" means those medically oriented

services beyond basic medical surgical and hospital treatment which are

necessary for the accomplishment of feasible, practical, and justifiable

physical rehabilitation goals.

      (6)

"Rehabilitation services" means both medical rehabilitation services

and vocational rehabilitation services provided pursuant to KRS 342.710.

      (7)

"Vocational evaluation" means a comprehensive process which utilizes

a combination of structured interviews and testing.

      (8)

"Vocational rehabilitation services" means those vocationally related

services which are necessary to restore an injured employee to suitable

employment.

 

      Section

2. Application for Listing in Directory of Qualified Rehabilitation Facilities.

(1) An application for listing in the Directory of Qualified Rehabilitation

Facilities shall not be required for a facility fully accredited by CARF in

either comprehensive inpatient rehabilitation or outpatient medical

rehabilitation as the names of those facilities are obtained from CARF.

      (2)

Provisional listing in the Directory of Qualified Rehabilitation Facilities may

be granted by the Office of Workers' Claims to a facility:

      (a)

Which is licensed through the Cabinet for Health and Family Services pursuant

to KRS Chapter 216B;

      (b)

Whose application to CARF for accreditation is pending; and

      (c)

That complies with the requirements established in subsection (3) of this

section.

      (3)

A facility shall file the following with the Office of Workers' Claims to

request provisional listing:

      (a)

Letter requesting provisional listing in the directory; and

      (b)

Copy of the application which has been submitted to CARF for accreditation in

comprehensive inpatient rehabilitation or outpatient medical rehabilitation.

      (4)

The provisional listing shall be valid for one (1) year unless CARF

accreditation is granted or denied prior to that time.

 

      Section

3. Referral of an Injured Employee by the Self-Insured Employer or Insurance

Carrier. (1) A self-insured employer or insurance carrier may voluntarily refer

an injured employee at any time for rehabilitation case management services

involving the coordination of medical rehabilitation services and vocational

rehabilitation services.

      (2)

A self-insured employer or insurance carrier shall refer an injured employee to

a case manager who is qualified as either a certified case manager, certified

rehabilitation counselor, certified insurance rehabilitation specialist, or

certified rehabilitation registered nurse.

 

      Section

4. Referral of an Injured Employee by an Administrative Law Judge. (1) An

administrative law judge may refer an injured employee to a Office of Workers'

Claims employee for implementation of rehabilitation services pursuant to KRS

342.710(3).

      (2)

A Office of Workers' Claims employee shall refer the employee for a vocational

evaluation at a facility listed in the Directory of Vocational Evaluation

Facilities.

      (3)

Absent medical incapacitation or another compelling circumstance, the employee

shall attend the vocational evaluation when scheduled.

      (4)

The cost of the vocational evaluation including travel expenses shall be paid

by the employer or other party designated by the administrative law judge.

      (5)

The employee's travel expenses shall be reimbursed in accordance with 200 KAR

2:006.

      (6)

Upon receipt of the vocational evaluation report, the employee and the employer

or insurance carrier shall cooperate in the implementation of services designed

to restore the employee to suitable employment. (21 Ky.R. 792; eff. 11-7-94;

Am. 24 Ky.R. 2169; 2684; eff. 6-15-98; 27 Ky.R. 1095; 1488; eff. 12-21-2000;

TAm eff. 8-9-2007.)