West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-15 - Vocational And Physical Rehabilitation › Section 85-15-10 - Payment for Physical and Vocational Rehabilitation Services

Current through Register Vol. XLI, No. 28, July 12, 2024
10.1. The
				Commission or Insurance Commissioner, private carrier or self-insured employer
				whichever is applicable, will pay for physical and vocational rehabilitation
				services in accordance with the fee schedule in effect at the time the service
				is rendered, adopted by the Commission or Insurance Commissioner, whichever is
				applicable, pursuant to W. Va. Code §
									23-4-3
				and otherwise as set forth in this rule. To the extent there are
				inconsistencies between the fee schedule and this rule, this rule shall govern.
				Only those physical rehabilitation services that are reasonable and necessary,
				in the sole discretion of the Commission, within the scope of the applicable
				rehabilitation plan, and otherwise meet the standards as outlined in Sections
				3.7 and 2.2.b of this Rule and 85 C.S.R. 27, can be reimbursed pursuant to
				these rules.
10.2. Unless otherwise
				specified in a contractual agreement with a provider, the following services
				are considered overhead and the Commission or Insurance Commissioner,
				self-insured employer or private carrier, whichever is applicable, will not pay
				for these services:
a. Administrative and
				supervisory salaries and related personnel expenses;
b. Office rent;
c. Depreciation;
d. Office equipment purchase and
				rental;
e. Telephone expense
				including long distance phone call charges;
f. Postage
g. Shipping;
h. Expendable supplies;
i. Printing costs;
j. Copier costs;
k. Printing of fiche and department
				electronic files;
l. Maintenance
				and repair;
m. Taxes;
n. Automobile costs, maintenance, and
				mileage;
o. Insurance;
p. Dues and subscriptions;
q. Vacation, sick leave, and other expenses
				of a similar nature;
r. Internal
				staffing time;
s. Filing of
				material in case files;
t. Setting
				up files;
u. Activities associated
				with reports other than composing or dictating complete draft of the report
				(e.g., editing, filing, distribution, revising, typing, mailing, and any other
				related time spent by the vocational rehabilitation service provider reviewing
				the work of a qualified rehabilitation provider shall not be paid)
v. Generating and keeping internal record
				keeping forms;
w. Time spent on any
				administrative and clerical activity, including typing, copying, mailing,
				distributing, filing, payroll, record keeping, delivering mail, and picking up
				mail. This does not prohibit reimbursement for actual time spent writing/typing
				reports to the Commission, Insurance Commissioner, self-insured employer or
				private carrier, whichever is applicable.
x. Activities associated with counselors
				training, general discussions regarding office procedures, internal case file
				reviews by supervisors, meetings, and seminars;
y. Unanswered phone calls;
z. Any other item or service not specifically
				identified and separately billed;
aa. No payment will be made for reports
				prepared by physicians and submitted through the counselor; and
bb. No payment will be made for any activity
				after notification by the Commission, Insurance Commissioner, self-insured
				employer or private carrier, whichever is applicable, of case closure or plan
				termination, unless a closure report is requested at which time only those
				charges directly related to the preparation of the closure report will be
				approved.
cc. Upon termination of
				the Commission, self-insured employers and private carriers may contract for
				physical and vocational rehabilitation services with providers for fees greater
				or less than those contained in the fee schedule.