20 Miss. Code R. § 2-III

Current through June 25, 2024

Section 20-2-III - WORK HARDENING RULES

A. Work Hardening Program Guidelines

1. Work hardening is an interdisciplinary, individualized, job or goal-specific program of activity with the goal of returning an injured patient to work. Work hardening programs use real or simulated work tasks and progressively graded conditioning exercises that are based on the individual's measured tolerances. Work hardening provides a transition between acute care and successful return to work and is designed to improve the bio-mechanical, neuromuscular, and cardiovascular functioning of the worker. Approval or certification must be based on whether the proposed work hardening program appears reasonably tailored to accomplish the stated goals.

a. A work hardening program must, at a minimum, have the following components:

* Development of strength and endurance of the individual in relation to the return to work goal;

* Equipment and methods that quantify and measure strength and conditioning levels, i.e., ergometers, dynamometers, treadmills, measured walking tolerances;

* Commercial strength and exercise devices, free weights, and circuit training. Goals for each worker are dependent on the demands of their respective jobs;

* Simulation of the critical work demands, the tasks, and the environment of the job to which the worker will return. Job simulation tasks that provide for progression in frequency, load, and duration are essential. They must be related to the work goal and include a variety of work stations that offer opportunities to practice work related positions and motions, i.e., clerical, plumbing, electrical;

* Education that stresses body mechanics, work pacing, safety and injury prevention, and that promotes worker responsibility and self-management. The education component requires direct therapist and worker interaction;

* Assessment of the need for job modifications. Focus on whether the worker can return to the stated job goal but only with changes, i.e., added equipment, changes in work position or ergonomics, changes at the work site;

* An individualized written plan that identifies observable and measurable goals, the methodology being used to reach these goals, the projected time necessary to accomplish the goal, and the expected outcomes. This plan must be signed by both the provider and the patient;

* This plan needs to be based on a functional capacity (baseline) evaluation and must be completed within the first two (2) days of the program and compared to the critical demands as stated on the job analysis. A comparative analysis (re-evaluation) is done prior to discharge to determine job readiness;

* A reporting system that includes:

- Documentation of the initial plan;

- Documentation of progress or lack of progress and future goals;

- A discharge summary that includes an assessment of the functional capacity level and the achievement of the individual's program goals; and

- A record of the worker's daily attendance including number of days and number of hours per day in the program.

2. Criteria for admission:

a. The worker must have reached a point in his or her recovery where no further active or invasive treatment intervention is being anticipated;

b. Physical recovery sufficient to allow participation for a minimum of four (4) hours a day for three to five days a week;

c. Worker's current levels of functioning interfere with his/her ability to carry out specific tasks required in the work place; and

d. A defined return to work goal which includes:

* A documented specific job to which the patient can return, along with a specific job analysis;

* A return to work goal agreed to by the employer and the patient/employee;

* The facts must show how the worker must be able to benefit from the program; and

* The facts must show the worker is motivated to return to work. A worker whose primary limitation is psychological or clouded by significant illness behavior (i.e., significant self-imitation on F.C.E.) is typically not going to be motivated and will not likely benefit.

3. Criteria for discharge from a work hardening program:

* The worker has reached the goal stated in the plan;

* The worker has not progressed according to the program plan;

* The worker has not reached interim goals and is not benefitting from the program; or,

* Number of absences exceeds those allowed by the program (a maximum of two (2) absences is recommended);

* Worker does not adhere to the schedule;

* Completion of the program (the program should take two (2) to four (4) weeks to complete);

* The previously identified job is no longer available.

B. Massage therapy requires prior authorization of the payer before treatment can be rendered. Medical necessity must be established prior to approval. Reimbursement must be arranged between the payer and provider.

C. Fees:

1. In all cases, for both voluntary and non-voluntary discharge, payment is for the actual duration of treatment provided.

2. CPT code 97545 (initial two (2) hours) and code 97546 (each additional hour) are to be used to bill work hardening. CPT code 97545 is to be billed for the initial two (2) hours of the work hardening program and is a one-time charge. CPT code 97546 is to be used for billing each additional hour of the work hardening program after the initial two (2) hours (indicated by code 97545).

20 Miss. Code. R. § 2-III

Amended 6/14/2017

Amended 6/15/2019.