The purpose and effect of these rule amendments is to (a) mandate the electronic submission of DWC-21 (Reemployment Services Billing Form) and DWC-22 (Reemployment Status Review Form) data from the carriers to the Bureau of Rehabilitation and ...

DEPARTMENT OF EDUCATION
State Board of Education

RULE NO: RULE TITLE
6A-22.001: Definitions
6A-22.002: Rehabilitation Provider Qualifications
6A-22.003: Reemployment Status Review
6A-22.004: Notice Requirements
6A-22.006: Screening Process
6A-22.008: Reemployment Services and Programs
6A-22.009: Employee Responsibilities
6A-22.010: Reporting Services and Costs: Qualified Rehabilitation Provider and Employer or Carrier Responsibilities
6A-22.011: List of Forms
6A-22.012: Expenditures from the Workers' Compensation Administrative Trust Fund
PURPOSE AND EFFECT: The purpose and effect of these rule amendments is to (a) mandate the electronic submission of DWC-21 (Reemployment Services Billing Form) and DWC-22 (Reemployment Status Review Form) data from the carriers to the Bureau of Rehabilitation and Reemployment Services, resulting in increased workers’ compensation system efficiencies; (b) require qualified rehabilitation providers to have a business e-mail address thereby increasing efficiencies in the workers’ compensation system; (c) allow for on-the-job training that is temporary, thereby expanding the opportunities for injured employees to receive training; (d) clarify various Bureau of Rehabilitation and Reemployment Services procedures for screening cases under Section 440.491(6), Florida Statutes; and (e) for cost containment, capping all services provided by qualified rehabilitation providers to the Bureau of Rehabilitation and Reemployment Services at $55.00 per hour.
SUBJECT AREA TO BE ADDRESSED: Rule 6A-22.001, F.A.C., is being amended to eliminate the definitions of “Cooperative working agreement” and “Ergonomic job analysis;” which are terms operationally irrelevant to the Department; to amend the definitions of “Customary residence,” to avert payment of travel costs abuse, “On-the-job training (OJT) contractor,” to replace “cooperative working agreement” with “contract,” and “On-the-job training (OJT) contract;” to limit the employer’s responsibility to assisting in rather than ensuring the injured employee’s return to suitable gainful employment; and to add a definition of “Unemployed” to avert an employer’s retaining an injured employee while withholding the employee’s opportunity to earn wages. Rule 6A-22.002, F.A.C., is being amended to require an applicant for initial listing or renewal as a rehabilitation provider to have and maintain a business e-mail address. Rule 6A-22.003, F.A.C., is being amended to require a carrier to complete and submit a conforming electronic reemployment status form, DWC-22. Rule 6A-22.004, F.A.C., is being amended to require language in the carrier’s notice concerning the employee’s inability to earn at least 80 per cent of his or her compensation rate and to delete and add language clarifying the October 1, 2003, date of accident limitation of eligibility. Rule 6A-22.006, F.A.C., is being amended to require the screening process to consist of a vocational assessment consisting of certain elements to determine the injured employee’s eligibility for reemployment services, to specify which of the reemployment services is to be offered as a result of the vocational assessment, to identify such vocational assessment services as may be provided prior to a determination of eligibility for reemployment services, and to delete the requirement that additional reemployment services following screening shall not be provided to an injured employee who has filed a claim for permanent total disability benefits where the injured employee’s medical condition or vocational capability is in dispute before the Office of the Judges of Compensation Claims as unsupported by law. Rule 6A-22.008, F.A.C., is being amended to eliminate “vocational assessment” as a reemployment service, to remove redundant approval language, to restate affirmatively that an evaluation will determine the necessary reemployment services to return the injured employee to suitable gainful employment, and to clarify “reemployment services.” Rule 6A-22.009, F.A.C., is being amended to clarify that no one of the enumerated participation failures may be deemed a refusal of training and education. Rule 6A-22.010, F.A.C., is being amended to clarify that a qualified rehabilitation provider shall submit a properly completed individualized written rehabilitation program to the employer or carrier for approval; to require that a certified vocational evaluator shall conduct an initial and an exit interview with the injured employee; to clarify that a qualified rehabilitation provider providing any employer or carrier sponsored reemployment services, reemployment assessments or medical care coordination need not submit a written report as therein defined to the Department; and to require a qualified rehabilitation provider providing employer or carrier sponsored reemployment services, reemployment assessments or medical care coordination to report its services using an electronic form DWC-21 and providing filing schedules and instructions. Rule 6A-22.011, F.A.C., is being amended to clarify that the carrier submit the form DWC 21 to the Department and to revise a web address. Rule 6A-22.012, F.A.C., is being amended to clarify that the Department shall authorize reimbursement for reemployment services received from qualified rehabilitation providers from the Workers’ Compensation Trust Fund at a maximum rate and that the total reimbursement for a vocational evaluation may not exceed a certain amount.
SPECIFIC AUTHORITY: 440.491(5), (6), (7), (8) FS.
LAW IMPLEMENTED: 440.491 FS.
IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE NOTICED IN THE NEXT AVAILABLE FLORIDA ADMINISTRATIVE WEEKLY.
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Reginald L. Watkins, Bureau Chief

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

6A-22.001 Definitions.

(1) “Cooperative working agreement” means a written contractual agreement between the Department and a qualified rehabilitation provider or a public or private agency to provide comprehensive reemployment services such as on-the-job training development, job placement and follow up.

(1)(2) “Customary residence” is the injured employee’s place of permanent residence. Whenever the injured employee changes his or her permanent residence, the customary residence changes also.

(2)(3) “Customary vicinity” is the distance traveled by the injured employee from his customary residence to his place of employment at the time of injury.

(3)(4) “Education program” means a formal course of study or a certificate program in a training and education facility, agency or institution operating under Chapters 1004, Parts II, III, and IV, 1005, or a career and technical education program defined in Section 1003.01(4)(c), Florida Statutes, which states: “At the post secondary education level, courses of study that provide competencies needed for entry into specific occupations or for advancement within an occupation.” Outside of the State of Florida, an education program shall be approved as governed by comparable statutes of that state.

(5) “Ergonomic job analysis” is the objective study of the relationship among job demands, environmental conditions and human functional characteristics.

(4)(6) “Good cause” is termination resulting from employee conduct:

(a) Evincing such willful or wanton disregard of an employer’s interests as is found in deliberate violation or disregard of standards of behavior which the employer has the right to expect of his employee; or

(b) Carelessness or negligence of such a degree or recurrence as to manifest culpability, wrongful intent, or evil design, or to show an intentional and substantial disregard of an employer’s interests or of the employee’s duties and obligations to his employer.

(5)(7) “Individualized written rehabilitation program” (IWRP) is an individualized written rehabilitation program as defined in the Rehabilitation Act of 1973, 29 U.S.C. 701, et seq.

(6)(8) “Labor market” means an area not to exceed a 50 mile radius of the injured employee’s customary vicinity.

(7)(9) “On-the-job training (OJT) contractor” is a qualified rehabilitation provider or employee of a public or private agency which has entered into a contract cooperative working agreement with the Department for the provision of on-the-job development and follow-up services.

(8)(10) “On-the-job training (OJT) contract” is a contract between an employer, injured employee and the Department in which an employer agrees to hire an injured employee subject to the same working conditions and benefits as all other similarly situated employees. Pursuant to the contract, the employer shall provide training and adequate supervision to enable the injured employee to achieve predetermined competencies to assist the injured employee to ensure a return to suitable gainful employment with the contract employer at the end of the contract period.

(9)(11) “Rehabilitation Company” means a business entity such as a corporation or partnership which employs or contracts to provide services pursuant to Section 440.491, Florida Statutes. All services provided by a carrier or a rehabilitation company under Section 440.491, Florida Statutes, shall be provided only by an individual who is a qualified rehabilitation provider or a facility that is a qualified rehabilitation provider. Neither the employment status of the person providing the services, nor the main method of communication in providing the services negates the statutory requirement that a person providing such services must be a qualified rehabilitation provider.

(10)(12) “Rehabilitation Facility” means an institution or agency accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) for a specific vocational rehabilitation program.

(11)(13) “Test-site” is a Department approved location that may be inspected by the Department, to be used by a qualified rehabilitation provider for vocational evaluation and assessment services.

(12) “Unemployed” means that the injured employee is not receiving wages for services or labor performed for an employer.

(13)(14) “Vocational evaluator” is a qualified individual employed by the Department or who holds the designation of a certified vocational evaluator and is approved by the Department to perform vocational evaluations.

(14)(15) “Vocational specialist” means an individual who possesses:

(a) A master’s degree in vocational rehabilitation (counseling, evaluation, adjustment); or

(b) Is certified by the Commission on Rehabilitation Counselor Certification, or by the Commission on Certification of Work Adjustment and Vocational Evaluation Specialists; and

(c) Is employed by a CARF-accredited facility.

Specific Authority 440.491(5),(6),(7) FS. Law Implemented 440.491 FS. History–New 7-1-96, Amended 2-9-00, 6-26-01, Formerly 38F-55.001, Amended 5-5-04,________.

 

6A-22.002 Rehabilitation Provider Qualifications.

(1) through (3) No change.

(4) Each applicant shall have a business e-mail address, and must maintain that address during the period that the applicant is listed in the Directory.

(5)(4) Department approval of a qualified rehabilitation provider, facility or company shall be revoked for a period of six (6) months for one or more of the following:

(a) Revocation of credentials or certification by the applicable certification or credentialing board.

(b) Misrepresentation of credentials or certification.

(c) Allowing a non-qualified rehabilitation provider to report and bill for services using an individual's, company's and or facility's qualified rehabilitation provider number.

(6)(5) Employees of the Department are exempt from the requirements of subsections 6A-22.002(2) and (3), F.A.C.

Specific Authority 440.491(7) FS. Law Implemented 440.491(7) FS. History–New 7-1-96, Amended 6-26-01, Formerly 38F-55.002, Amended 5-5-04, 2-22-05,_______.

 

6A-22.003 Reemployment Status Review.

(1) The carrier shall conduct a reemployment status review by completing a reemployment status review form, on the DWC-22, which is incorporated by reference in Rule 6A-22.011, F.A.C.

(2) The carrier shall complete an electronic form DWC-22 within 15 days of the reporting requirement deadlines set forth in Section 440.491(3)(a), F.S., and

(a) Shall retain a copy in the carrier’s file, and

(b) Shall submit the electronic form DWC-22 to the Department at its designated Internet web site or at its office in Tallahassee within 15 business days of completion.

(c) Electronic form DWC-22 shall comply with the DWC-22 data dictionary incorporated into this rule by reference.

Specific Authority 440.491(7) FS. Law Implemented 440.491 FS. History–New 7-1-96, Amended 6-26-01, Formerly 38F-55.005, Amended________.

 

6A-22.004 Notice Requirements.

(1) No change.

(2) A carrier shall use the following written notice: “Your continuing disability indicates you may be unable to perform the duties of the job held at the time of your work-related injury. If this is correct and you are unable to return to work in any capacity with your current employer or find other employment which would allow you to earn your preinjury wages, you may be eligible for a screening for reemployment services from the State of Florida, Department of Education. Upon receipt of your request, the Department will assess your case to determine what services are necessary to return you to suitable gainful employment. Reemployment services that you may be eligible for include job seeking skills training, counseling, referrals to other agencies, job market information, transferable skills analysis, job development, job placement, job analysis, job modification, vocational testing, vocational evaluation, on-the-job training, securing a general education diploma (GED), or formal training and education. Additionally, if you have reached maximum medical improvement and are unable to earn at least 80 per cent of your compensation rate, and subject to the overall limitation of one hundred four (104) weeks of temporary total disability benefits payable in a workers’ compensation case with a date of accident which falls on or after October 1, 2003, the carrier shall pay training and education temporary total disability benefits for a period up to 26 weeks upon beginning a Department approved retraining program or the carrier may elect to pay temporary partial disability/wage loss benefits if you earn wages as the result of on-the-job training or work while enrolled in a program. An additional 26 weeks may be approved if deemed necessary by the Judge of Compensation Claims. If your date of accident occurred on or after October 1, 2003, the above benefits shall not be in addition to the 104 weeks’ maximum number of weeks payable for temporary total disability benefits prior to reaching maximum medical improvement. To request a screening, contact your local state Division of Vocational Rehabilitation District Office or the Central Office in Tallahassee at [phone] and ask to speak with a staff person in the Reemployment Services Section of the Bureau of Rehabilitation and Reemployment Services.” The carrier shall send a copy of this notification to the Bureau of Rehabilitation and Reemployment Services, Department of Education, 101A Forrest Building, 2728 Centerview Drive, Tallahassee, Florida 32399-0664 within ten days of mailing the notification to the injured employee.

Specific Authority 440.491(5), (6), (8) FS. Law Implemented 440.491 FS. History–New 7-1-96, Amended 6-26-01, Formerly 38F-55.006, Amended 3-1-05,________.

 

6A-22.006 Screening Process.

(1) No change.

(2) The screening process shall consist of:

(a) A review of all available medical and vocational documentation relevant to the compensable injury to determine whether the injured employee is able to perform the duties of the pre-injury occupation; and

(b) A review of the documentation which supports the payment of temporary partial disability and wage loss benefits to determine the injured employee’s inability to obtain suitable gainful employment because of his injury; and

(c) An interview with the injured employee.

(d) A vocational assessment. The vocational assessment shall determine the relevance and weight of the following factors in the case: the permanent physical restrictions, if any, present in the case; the availability of employment with the employer at the time of the injury; the injured employee’s transferable skills and the labor market; whether the injured employee conducted an unsuccessful job search, and the reasons the job search was unsuccessful; the injured employee’s education and academic skills and vocational education; the injured employee’s motivation; the injured employee’s financial ability to complete training; and the availability of transportation to allow the injured employee to complete training. The vocational assessment shall determine whether the injured employee is ineligible to receive reemployment services, or is eligible to receive reemployment services. If the injured employee is eligible to receive services, the vocational assessment shall determine which of the following shall be offered to the injured employee: placement, and/or on-the-job training, and/or an evaluation, and/or a re-training program costing less that $2,500 and lasting six months or less.

(3) through (4) No change.

(5) The Department may provide the following vocational assessment services as part of the screening process to determine eligibility: Orientation, employability skills training, counseling, vocational testing, transferable skills analysis, labor market surveys, vocational assessment services, job analysis and evaluation.

(6)(5) The Department shall not provide any reemployment services, including a vocational evaluation unless the injured employee provides documentation to establish identity and employment eligibility. Such documentation shall be consistent with the acceptable documents for verifying identity and employment eligibility as required by the US Department of Justice, Immigration and Naturalization Service’s Employment Eligibility Verification Form I-9 (Rev. 11-21-91).

(7)(6) The Department shall not provide a vocational evaluation or any reemployment services when form DWC-23, which is signed by the injured employee, is received by the Department more than one (1) year from the date of last payment of indemnity benefits or the furnishing of remedial treatment, care, or attendance from the employer or carrier.

(8)(7) Following a Department screening the Department shall not provide any additional reemployment services or refer the injured employee for a vocational evaluation:

(a) If the injured employee has filed a claim for permanent total disability benefits under Section 440.15(1), F.S., which the carrier has denied, wherein either the injured employee’s medical condition or vocational capabilities are in dispute, until such time as an Office of the Judge of Compensation Claims adjudicates the injured employee’s claim; or

(a)(b) If the injured employee’s medical condition is unresolved or unstable, until such time as the medical condition becomes stable; or

(b)(c) If the injured employee has reached maximum medical improvement and returned to and maintained suitable gainful employment for at least 90 calendar days; or

(c)(d) If the injured employee refuses to accept reemployment services from the Department.

(9)(8) The Department shall not refer the injured employee for a vocational evaluation if the injured employee:

(a) Has returned to suitable gainful employment as a result of placement services provided by the Department; or

(b) Has no documented permanent physical restrictions related to the injury; or

(c) Has transferable skills which would allow return to work in suitable gainful employment; or

(d) Was terminated by the employer for good cause unrelated to the injury or any restrictions or limitations resulting therefrom; or

(e) Terminated suitable gainful employment for reasons unrelated to the injury.

Specific Authority 440.491(5), (6) FS. Law Implemented 440.491 FS. History–New 7-1-96, Amended 6-26-01, Formerly 38F-55.009, Amended 5-5-04,_______.

 

6A-22.008 Reemployment Services and Programs.

(1) The Department shall approve sponsorship of reemployment services provided through an on-the-job training program, vocational assessment, job placement or a training and education program when recommended in and approved as part of a Department reemployment plan.

(2) When the Department provides an evaluation to the injured employee, the evaluation shall determine the reemployment services necessary to return the injured employee to suitable gainful employment. The Department will approve and sponsor reemployment retraining services if:

(a) The vocational evaluation is completed by a Department approved vocational evaluator, and

(b) The vocational evaluation contains the information identified in paragraph 6A-2.010(2)(e), F.A.C.; and

(c) The vocational evaluation demonstrates that the injured employee:

1. Has no transferable skills which would allow for return to suitable gainful employment with the same employer, same job; same employer, different or modified job; new employer, same job; new employer, modified or different job; or

2. Requires additional Department sponsored reemployment services to enable the injured employee to return to suitable gainful employment.

(3) through (5) No change.

(6) The Department shall not sponsor reemployment services if the vocational evaluation does not recommend reemployment services.

Specific Authority 440.491(5), (6) FS. Law Implemented 440.491 FS. History–New 7-1-96, Amended 2-9-00, 6-26-01, Formerly 38F-55.011, Amended 3-1-05,________.

 

6A-22.009 Employee Responsibilities.

(1) No change.

(2) An employee who refuses retraining and education after the recommendation of a vocational evaluator and approval by the Department, will forfeit his or her entitlement to further training and education benefits, as well as additional payment for lost wages under Chapter 440, Florida Statutes. The following shall not be deemed a refusal of training and education:

(a) Failure to participate in a recommended retraining program due to medical instability; or

(b) Failure to participate in a recommended retraining program due to an adverse change in the employee’s medical status; or

(c) Failure to participate in a recommended retraining program due to the school’s failure to offer the approved program, or and

(d) Failure to participate in a recommended retraining program due to a family medical emergency.

Specific Authority 440.491(5), (6) FS. Law Implemented 440.491 FS. History–New 7-1-96, Amended 6-26-01, Formerly 38F-55.012, Amended 3-1-05,________.

 

6A-22.010 Reporting Services and Costs: Qualified Rehabilitation Provider and Employer or Carrier Responsibilities.

(1) A qualified rehabilitation provider providing employer or carrier sponsored reemployment services shall:

(a) Submit a properly completed individualized written rehabilitation program to the employer or carrier for approval within 30 days of referral which specifies the recommended services and associated costs necessary to return the injured employee to suitable gainful employment, using terminology consistent with Department service code descriptions to the employer or carrier for approval when recommending:

1. Reemployment services as a result of a reemployment assessment, or

2. Three or more counseling sessions, or

3. A vocational evaluation, or

4. A work evaluation, or

5. Training and education, including on-the-job training, or

6. Placement services, or

7. Changes to the initial individualized written rehabilitation program.

(b) Maintain a copy of the properly completed individualized written rehabilitation program in the injured employee’s file.

(2) A certified vocational evaluator providing Department sponsored vocational evaluations shall:

(a) Ensure any test site used for Department sponsored vocational evaluations meets the definition of “test site” set forth in subsection 6A-22.001(13), F.A.C.; and

(b) Be responsible for the administration, scoring and interpretation of all testing instruments and work samples used as part of the vocational evaluation process; and

(c) Remove or cure conditions that invalidate test results; and

(d) Provide adaptive evaluation tools or techniques to accommodate any physical or functional disability or language barrier; and

(e) Conduct an initial interview with the injured employee.

(f)(e) Submit to the Department, within 30 calendar days of Department approval of services, a written report which shall:

1. Include an interpretation of testing instruments and work samples used, specifying the form and level of tests, percentile scores, norm groups, grade levels, standard scores and stanine scores as applicable to the test instrument; and

2. Identify the injured employee’s physical and intellectual capabilities, aptitudes, achievements, work related behaviors; and interests. The interests of the injured employee alone cannot be the only basis for the vocational evaluator’s recommendation; and

3. Identify residual or transferable skills; and

4. Identify the most appropriate vocational objectives; and

5. Identify which reemployment service(s) are necessary for the injured employee to return to suitable gainful employment; and

6. Discuss how the provision of the recommended service(s) will facilitate reemployment; and

7. When a retraining program is recommended, include the rationale for the recommended program, the entrance, enrollment and exit requirements of the program, the anticipated program costs and the proximity of the program to the injured employee’s customary residence; and

8. Include an individualized labor market survey which supports the injured employee’s ability to compete for employment in the identified vocational goal(s) and shall include information documenting:

a. The potential wage earning capacity,

b. The physical demands of the identified vocational goal as identified by potential employers,

c. The minimum educational requirements and work experience required by potential employers, and

d. Each potential employer’s job openings for the six months prior to the survey and projected openings for the upcoming six months.

(g) Conduct an exit interview with the injured employee.

(h)(f) Submit to the Department, within 10 days of submission of the written report, the original receipt statement signed by the injured employee and the vocational evaluator.

(3) Any qualified rehabilitation provider providing any employer or carrier or Department sponsored reemployment services, reemployment assessments or medical care coordination shall submit with each DWC-21, which is incorporated by reference into this rule, a written report which reports services provided and expected outcomes, covering the following points:

(a) Summary by date of contacts with the injured employee and other pertinent parties; and

(b) Problems or issues adversely affecting the reemployment process and the corrective actions taken in that process; and

(c) Continuing feasibility of the reemployment plan; and

(d) Vocational activities planned for the subsequent month; and

(e) Justification for change or modification of current plan.

(4) through (5) No change.

(6) A qualified rehabilitation provider providing either employer or carrier or Department sponsored reemployment services, reemployment assessments, medical care coordination and vocational evaluations, shall:

(a) Report on electronic form DWC-21 only those services provided by or through the authorized qualified rehabilitation provider. Services not rendered by or through the qualified rehabilitation provider may not be billed or reimbursed.

(b) Submit a properly completed electronic form DWC-21 listing the specific service(s) provided, utilizing only valid service codes and descriptors for those direct services rendered to the injured employee. Direct services are those services provided or required by an individualized written rehabilitation program. Other services are to be billed in the manner agreed upon by the employer or carrier and the qualified rehabilitation provider.

1. The initial electronic form DWC-21 shall be submitted to the Department within 30 days of the contract approval date for Department sponsored services or to the employer or carrier within 30 days of the date of the referral for employer or carrier sponsored services.

2. An interim electronic form DWC-21 shall be submitted at 30-day intervals thereafter during which the authorized services are provided. The DWC-21 should not be filed if services are not provided within any 30-day period.

3. A final electronic form DWC-21 shall be submitted within 30 days of the date of the last service provided or according to the terms of a contract with the Department for vocational evaluation services.

(c) Close a file and submit a final electronic form DWC-21 when attorney involvement interferes with the provision of direct services.

(7) through (8) No change.

(9) The employer or carrier shall:

(a) Ensure that the information required in this rule is provided on the form DWC-21 prior to payment and filing of the electronic form DWC-21 with the Department, and

(b) Approve or deny the provision of services recommended as part of an individualized written rehabilitation program within 15 calendar days of receipt of the same; and pay or deny form DWC-21 bills within 45 calendar days after receipt of a bill for services provided to an injured employee, and

(c) Complete items 20, 21 and 23 on every electronic form DWC-21 filed with the Department. In item 20 it is necessary to legibly enter the date the form DWC-21 was received. In item 21 it is necessary to legibly enter the date the form DWC-21 was reimbursed. In item 23 it is necessary to enter the amount reimbursed only if it is different from the amount billed by the qualified rehabilitation provider or facility, and

(d) File electronic form DWC-21 with the Department of Education at its designated Internet web site or at its office in Tallahassee, Florida within 30 days after the full or partial payment of form DWC-21 (A DWC-21 filed with the Department shall have a date stamp in the upper right hand corner indicating the date the DWC-21 is sent to the Department), and

(e) Be responsible for the legibility, accuracy and completeness of the social security number, date of accident, the employer or carrier’s and servicing company/TPA’s Department of Insurance, Division of Workers’ Compensation’s assigned four digit carrier code number and Federal Employer Identification Number (FEIN), and those areas that the employer or carrier completes on form DWC-21.

(10) No change.

(11) An electronic form DWC-21 filed with the Department which is not completed according to these rules will be returned by the Department to the employer or carrier. Upon receipt of the returned form, the employer or carrier shall properly complete and refile the form with the Department within 15 days.

(12) Paper fForm DWC-21 is incorporated by reference in Rule 6A-22.011, F.A.C. Electronic form DWC-21 shall comply with the DWC-21 data dictionary incorporated into this rule by reference.

Specific Authority 440.491(5), (6), (7) FS. Law Implemented 440.491 FS. History–New 7-1-96, Amended 6-26-01, Formerly 38F-55.013, Amended 5-5-04,________.

 

6A-22.011 List of Forms.

(1) Forms DWC-21, DWC-22, DWC-23, DWC-24 and DWC-96 and accompanying instructions are incorporated by reference as part of this rule to become effective April 2004. Each form shall be typed or legibly completed in order for the form to be considered properly filed or submitted with the Department.

(a) Department reemployment services billing form shall be submitted to the Department on form DWC-21. The carrier shall submit the form DWC 21 to the Department.

(b) Reemployment status review form shall be submitted to the Department on form DWC-22.

(b)(c) Request for screening form shall be submitted to the Department on form DWC-23.

(c)(d) Department and student agreement for sponsorship of training and education form shall be completed on form DWC-24.

(d)(e) Qualified rehabilitation provider application shall be submitted to the Department on form DWC-96.

(2) A copy of the forms and accompanying instructions incorporated by subsection 6A-22.011(1), F.A.C., may be obtained from the Department of Education, Bureau of Rehabilitation and Reemployment Services, 2728 Centerview Drive, Suite 101A, Forrest Building, Tallahassee, Florida 32399-0400. Copies are also available at the following Department web site: http://www.flrules.org/default.asp http://www.firn.edu/doer/rules/rules.htm.

Specific Authority 440.491(5),(6),(7) FS. Law Implemented 440.491 FS. History–New 7-1-96, Amended 6-26-01, Formerly 38F-55.014, Amended 5-5-04,_______.

 

6A-22.012 Expenditures from the Workers’ Compensation Administration Trust Fund.

(1) Upon receipt of the completed evaluation report, Tthe Department shall authorize reimbursement for reemployment services received from qualified rehabilitation providers the evaluation from the Workers’ Compensation Administration Trust Fund at a maximum rate of $55.00 per hour,. The total reimbursement for an evaluation may not to exceed $1,100.00 per evaluation.

(2) through (8) No change.

Specific Authority 440.491(5), (6), (7), (8) FS. Law Implemented 440.491 FS. History–New 7-1-96, Amended 12-2-98, 6-26-01, Formerly 38F-55.015, Amended________.