Effective date: February 1, 2016
Application: All injured workers requiring physical therapy services.
Policy subject: Health care services – Providers
To provide administrative guidelines for approving and evaluating physical therapy services.
- Upon Workers’ Compensation Board (WCB) approval, a worker is entitled to benefits under The Workers’ Compensation Act, 2013 (the “Act”) states that upon approval by the Workers’ Compensation Board (WCB), a worker entitled to benefits is also entitled to (Section 103):
- Any medical aid that may be necessary because of the work-related injury.
- Any other treatment by a health care provider.
- Any orthotic appliance or apparatus that may be necessary as a result of the injury, and
- Any travel and sustenance costs associated with receiving medical treatment as a result of the injury.
- The WCB is authorized to determine health care services fees (Section 104).
- Physical therapists who are members in good standing of the Saskatchewan College of Physical Therapists (SCPT) and accredited by the WCB to provide services to injured customers can access the following at www.wcbsask.com:
- The Accreditation Standards and Service Provider Guidelines for Physical Therapists Providing Out-Patient and Private Clinic Services to WCB customers (“practice standards”).
- Accreditation requirements.
- The Primary Chiropractic and Physical Therapy Soft Tissue Treatment Guidelines.
- Reporting forms, and
- Primary Authorization to Treat forms.
The Saskatchewan Physiotherapy Association (SPA) and the WCB will negotiate changes to these documents as needed.
- The WCB Physical Therapy Consultant will review files that have two or more progress reports (PTP). A Claims Entitlement Specialist (CES) or a Case Manager (CM) may request the assistance of the WCB Physical Therapy Consultant at any time during the review of claims.
- HCS will contact, by phone and in writing, physiotherapists (PT’s) that continually send initial reports (PTI’s) or progress/discharge reports (PTP) late to the WCB. If late reporting continues, HCS will issue a final warning and the WCB will not pay for services that the PTs provide after the reports are due.
- The WCB will only reimburse functional conditioning treatment for customers after they have been unable to return to regular or modified work duties for at least four consecutive weeks. If the worker needs functional conditioning before then, the PT will contact the WCB. The WCB Physical Therapy Consultant will review the worker’s progress before making a decision.
- The WCB will accept PTI’s or a Physical Therapy Initial Recurrent (PTIR) submitted for recurrent treatment (i.e., if primary care resumes after the customer was discharged more than 30 days prior or where the customer accesses primary care after a secondary or tertiary program). The CES or CM and the WCB Physical Therapy Consultant will review the report and advise the clinic if further treatment will be approved.
- For all soft tissue injuries, the Case Manager (CM) will review the customer’s file at seven weeks post-injury to:
- Evaluate the risk of prolonged recovery.
- Determine if the worker needs an assessment team review.
- Ensure vocational (return-to-work) interventions are occurring, and
- Ensure that the PT is using the WCB’s standards of care and treatment protocols.
- If the WCB denies a physical therapy claim for coverage (following the initial assessment or request for further treatments), the WCB will pay for services up to the date of notification. The WCB will charge the costs of these claims to the administrative fund.
- Compliance with the practice standards may be evaluated through a clinical survey process
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