Document name
Secondary and Tertiary Treatment
Document number
PRO 51/2016

Effective date: May 1, 2016

Application: All secondary and tertiary treatment program health care providers.

Policy subject: Health care services – Providers

Purpose:

To provide administrative guidelines for approving and evaluating secondary and tertiary treatment.

BACKGROUND

Policy section content
Section detail
  1. 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):
    1. Any medical aid that may be necessary as a result of the injury.
    2. Any other treatment by a health care professional.
    3. Any prosthetic or apparatus that may be necessary as a result of the injury, and
    4. Any transportation or sustenance occasioned by the medical aid.
  2. The WCB is authorized to determine health care services fees (Section 104).
  3. The WCB strives to ensure the injured worker’s best recovery from a work injury. This includes a safe and suitable return to work as soon as medically possible. This goal can be achieved by ensuring:
    1. Active treatment at the primary level, and
    2. Timely access to secondary and tertiary services where required.
  4. The WCB has established the Health Care Advisory Committee (HCAC) to evaluate the medical care provided to injured workers. This includes recommendations regarding secondary and tertiary treatment.

PROCEDURE

Policy section content
Section detail
  1. All secondary and tertiary treatment centres who are accredited by the WCB to provide services to injured workers can access the following at www.wcbsask.com:
    1. The Secondary and Tertiary Treatment Centre Manual.
    2. Accreditation standards.
    3. Fees.
    4. Reporting forms.

The Coalition of Physical Rehabilitation Centres of Saskatchewan (CPRCS) and the WCB will negotiate changes to these documents as needed.

General

  1. An assessment team review may be requested by a health care provider or the Case Manager (CM) where:
    1. The worker is not working and has no confirmed return-to-work (RTW) date and:
      1. The expected recovery date has been exceeded; or
      2. A passive treatment plan is in place where active treatment is appropriate; or
      3. A definitive diagnosis has not been achieved and is hindering recovery and RTW planning; or
      4. Significant risk factors for chronic disability have been identified (as per Appendix II of the Secondary and Tertiary Treatment Centre Manual).
    2. The worker continues in employment but has not returned to full duties and/or full hours after the work injury.
  2. Assessment teams:
    1. Recommend specialist or diagnostic services.
    2. Identify the appropriate level of treatment for the worker (i.e., primary, secondary or tertiary).
    3. Provide a timeline for RTW planning and indicate if there is anything that would preclude the worker from a return to their pre-injury employment.
  3. The secondary or tertiary treatment of a WCB customer will require:
    1. Prior approval by the Primary Care Provider (PCP).
    2. Recommendation by an assessment team, and
    3. Intake arranged by a WCB Health Care Services (HCS) Coordinator, or
    4. Direct referral from the PCP who received the assessment team recommendations.
  4. Where the PCP does not choose a treatment centre, the WCB will try to retain a customer in the same clinic that provided primary care. The WCB will make efforts to:
    1. Maintain a one week intake standard, and
    2. Ensure fair distribution of these customers.
  5. The HCS Facilitator acts as a liaison between the treatment center and other WCB staff to:
    1. Ensure adequate supports are in place to achieve a successful recovery and return-to-work (RTW).
    2. Assist the treatment team with health-related issues.
    3. Inform WCB’s case management team of the customer’s progress and the direction health and disability management is taking.
    4. Advise the WCB case management team of any interventions required and to advise the treatment team of any actions the WCB will take to resolve any non-health related issues.
  6. The HCS Facilitator, with the assistance of the Case Manager (CM), will intervene if a RTW plan cannot be established and to determine if vocational services are required.
  7. The HCS Facilitator will monitor and intervene where barriers are identified in the customer successfully completing a return-to-work plan. This may include arranging expedited diagnostics or referring the file to a WCB orthopedic consultant.
  8. The HCS Facilitator must notify the PCP, CM and HCS Manager where a customer sustains an injury during rehabilitation.
  9. The HCS Facilitator will communicate monthly with the treatment centre. Additional communication may occur if the HCS Facilitator requires more information on the customer’s progress.
  10. The WCB will determine a Composite Index Score and an employer-attached RTW Score for each treatment program. The WCB will use this data to evaluate the performance of the treatment centre
  11. HCS will note all customer complaints and resolutions on the service provider’s accreditation file.

Policy references

Policy reference content

Section heading

Act Sec #

Section detail

55, 103, 104, 111, 115

Section heading

Supersedes

Section detail

PRO 57/2013 Medical Fees – Secondary and Tertiary Treatment Centres

Section heading

Complements

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