Definitions - General

As used in this chapter, the following terms are used as follows: (1) “Administrator” means the administrator of the Tennessee Bureau of Workers’ Compensation. (2) “Bureau” means the Tennessee Bureau of Workers’ Compensation. (3) “Case Management” means medical case management or the ongoing coordination of medical care services provided to an injured or disabled employee and for the purpose of this chapter shall only be provided by a case manager or case manager assistant, who is actively registered with the Bureau and in good standing with their credentialing and/or licensing organization(s). (4) “Case Manager (CM)” means an individual who provides or supervises the provision of case management services under this chapter and who is either (a) or (b): (a) A licensed registered nurse (RN), licensed to practice nursing in Tennessee under T.C.A., Title 63, who possesses one (1) or more of the following: 1. A Master’s Degree in Vocational Rehabilitation Counseling (VRC); or 2. Certification as a Certified Disability Management Specialist (CDMS); or 3. Certification as a Certified Rehabilitation Registered Nurse (CRRN); or 4. Certification as a Certified Occupational Health Nurse (COHN); (b) Certified as a Certified Case Manager (CCM). (5) “Case Manager Assistant (CMA)” means an individual who provides case management services under the direct supervision of a case manager and who meets one (1) of the following: (a) The individual is a registered nurse (RN), licensed to practice nursing in Tennessee under T.C.A., Title 63, or (b) The individual possesses one (1) of the following: GENERAL RULES OF THE WORKERS’ COMPENSATION PROGRAM CHAPTER 0800-02-07 CASE MANAGEMENT 1. A Master’s Degree in Vocational Rehabilitation Counseling (VRC); or 2. Certified Disability Management Specialist (CDMS); or 3. Certification as a Certified Rehabilitation Counselor (CRC). (c) Case manager assistants providing services on Tennessee claims shall work under the direct supervision of a registered case manager for no more than twenty-four (24) months from the date their registration was approved by the Bureau as a case manager assistant or less than twenty-four (24) months from the registration date if the case manager assistant obtained certification in one (1) of the categories under the definition of a case manager, provided proof to, and was accepted by the Bureau. A case manager assistant, at the end of a 24-month period shall be certified by one (1) of the categories under the definition of a case manager or their registration with the Bureau will terminate. Persons who are not current case manager assistants shall have a 24-month period from the date they become case manager assistants under the supervision of a case manager, who is actively registered with the Bureau and in good standing with their credentialing and/or licensing organization(s), to obtain certification. Once certification is obtained or is initially provided upon registration pursuant to Rule 0800-02-04, a case manager shall provide such certification to maintain their registration and shall not serve as a case management assistant again unless approved by the Bureau. Failure to provide copies of renewal certifications will inactivate the case manager or case manager assistant’s status. (6) “Case Manager Assistant Supervisor (CMAS)” is a case manager, actively registered with the Bureau and in good standing with their credentialing and/or licensing organization(s), who oversees a case manager assistant. The supervising case manager is responsible for ensuring that the case manager assistant is following Tennessee law as well as the Tennessee case management rules. The case manager supervisor is identified upon registration of a case manager assistant and does not have to be the same person as the direct supervisor. If the case manager assistant becomes inactive, or is no longer employed by the parent company, then the case manager assistant shall immediately be assigned a new case manager assistant supervisor. Unless a case manager assistant supervisor is properly assigned, the case manager assistant status shall be inactive. (7) “Catastrophic Injury” means any injury which is one (1) of the following: (a) Spinal cord injury involving severe paralysis of an arm, a leg, or the trunk; (b) Amputation of an arm, a hand, a foot, or a leg involving the effective loss of use of that appendage; (c) Severe brain or closed head injury as evidenced by: 1. Severe sensory or motor disturbances; 2. Severe communication disturbances; 3. Severe complex integrated disturbances of cerebral function; 4. Severe disturbances of consciousness; 5. Severe episodic neurological disorders; or GENERAL RULES OF THE WORKERS’ COMPENSATION PROGRAM CHAPTER 0800-02-07 CASE MANAGEMENT 6. Other conditions at least as severe in nature as any condition provided in subparagraphs (1) through (5) of this paragraph; (d) Second or third degree burns over 25 percent of the body as a whole or third degree burns to 5 percent or more of the face or hands; or (e) Total or industrial blindness. (8) “Commissioner” means the Commissioner of the Department of Labor and Workforce Development. (9) “Contractor” means that organization or organizations referred to in T.C.A. § 50-6-124 [Section 8 of Public Chapter 900 of the Acts of 1992]. (10) “Department” means the Tennessee Department of Labor and Workforce Development. (11) “Face-to-Face Meeting” means a meeting occurring in the physical presence of both the injured worker and the case manager. (12) “Medical Director” means the Medical Director appointed by the Administrator of the Bureau of Workers’ Compensation pursuant to T.C.A. § 50-6-126. (13) “Protected or Personal Health Information (PHI)” means any information that is classified as protected under the Federal Health Information Portability and Accountability Act (HIPPA), 1996, or its later amendments. (14) “Virtual Meeting” means a meeting between the injured worker and the case manager or case manager assistant conducted over a secure network with two-way audio/visual communications acceptable to the injured worker and without technical interruptions.