Effective date: August 1, 2015
Application: All injured workers requiring exercise therapy services.
Policy subject: Health care services – general
To provide administrative guidelines for approving and evaluating exercise therapy services.
- 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).
- Exercise therapists who hold a Certified Exercise Physiologist (CEP) designation and are providing services to WCB customers can access the following at www.wcbsask.com:
- The Accreditation Standards and Service Provider Guidelines for Exercise Therapists Providing Primary Level Services to WCB customers (“practice standards”).
- Accreditation requirements.
- Reporting forms, and
- Primary Authorization to Treat forms.
The Saskatchewan Kinesiology and Exercise Science Association (SKESA) and the WCB will negotiate changes to these documents as needed.
- The Claims Entitlement Specialist (CES) or Case Manager (CM) will review completed Primary Authorization to Treat forms with attached referrals to make sure:
- The service is related to the work injury.
- The CEP is WCB accredited.
- The referral is made by a:
- Physical Therapist, or
- The referral notes the goals of exercise therapy.
- Exercise therapy is considered a component of Physical Therapy and/or Chiropractic services offered by a clinic that has obtained WCB authorization to treat and invoice.
- An initial assessment report will be sent to the WCB within three working days of the first appointment. This report should include the objectives of the treatment, as well as an anticipated discharge date. Progress reports (TXP) only need to be filed if there are changes to the treatment plan or anticipated discharge date. The discharge summary (TXD) should be sent within three days of discharge.
- Payment will only be authorized for services performed by an accredited CEP who appears on the WCB Approved Provider List.
- The WCB may refuse payment if conditioning is provided prior to the specified timelines acknowledged in the practice standards (i.e., aerobic conditioning, regional conditioning, functional conditioning, and functional testing).
- WCB will cease funding for treatment when no functional gains are being made or when there are indications that the customer has recovered from the work injury.
- If a claim is subsequently denied following approval, WCB will be responsible for payment up to the date of disallowance notification.
- Compliance with the practices standards may be evaluated through a survey process performed jointly by the WCB and SKESA.
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