Occupational Rehabilitation Facilities with current accreditation by the Commission on Accreditation of Rehabilitation Facilities (CARF) are eligible for exemptions from preauthorization and concurrent review requirements for Work Conditioning and Work Hardening if the following two conditions are met:

1. The service is within the recommendations of the ODG guidelines for the specific diagnosis.

2. The CARF accredited facility is on the DWC current exemption list.

It also states that an exempted CARF facility does need to obtain preauthorization prior to providing Work Conditioning or Work Hardening services if the service is not specified as recommended by the ODG for a specific diagnosis, or when the service exceeds the number or duration of visits listed in the ODG.

For all parties trying to control the cost of the file, this information would be pertinent to have. According to TDI-DWC, the carrier does have the right to request a retrospective medical necessity review.

We have found situations where neither the TPA nor the CCM were aware that expensive Work Hardening was taking place. It had been ordered by the Chiropractor without notification. In these cases, contact with the injured worker was how it was discovered. Otherwise, their first knowledge would have been when the bill arrived!

The link listed below will lead you to a current list of facilities that have been granted an exemption. http://www.tdi.state.tx.us/WC/dm/documents/carfexmptcurr.pdf

April 2010
Author: Maxine Russell, BSN, RN, CCM
Editor: D. Perry