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HOME HEALTH CARE

SB 863 amended Labor Code §4600, the treatment statute, to specify : "(h) Home health care services shall be provided as medical treatment only if reasonably required to cure or relieve the injured employee from the effects of his or her injury and prescribed by a physician and surgeon licensed pursuant to Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code, and subject to Section 5307.1 or 5703.8. The employer shall not be liable for home health care services
that are provided more than 14 days prior to the date of the employer’s receipt of the physician’s prescription."

The doctor will also need to do a Request for Authorization and a report justifying the need for in home or attendant care. The request is subject to utilization review and, if applicable, independent medical review (IMR).

Labor Code §5307.8 requires the administrative director to adopt a new schedule on or before 7/1/13 for “payment of home health care services provided in accordance with Section 4600 that are not covered by a Medicare fee schedule and are not otherwise covered by the official medical fee schedule adopted pursuant to Section 5307.1.”

The new statute does not allow fees “for any services, including any services provided by a member of the employee's household, to the extent the services had been regularly performed in the same manner and to the same degree prior to the date of injury.”

“If appropriate, an attorney's fee for recovery of home health care fees under this section may be awarded in accordance with Section 4906 and any applicable rules or regulations.”

See, too, Medical Treatment

Label Item Links Comments
Labor Code Limits on home health care Labor Code §5307.8  
Regulations/Rules 8 CCR §9789.90 [Reserved] 8 CCR §9789.90 Comments are available here
Cases 

State Farm v. WCAB (Pearson) (2011) 192 Cal. App. 4th 51: the law as it was pre-SB 863

Roque Neri Hernandez v. Geneva Staffing, Inc. dba Workforce Outsourcing, Inc., et al.: WCAB in en banc decision: a "how-to" guide for the practitioner who wants to get home health care paid by the employer

State Farm v. WCAB (Pearson)

 

Hernandez v. Geneva Staffing en banc

 
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Practice Tips     
Articles

Home Health Care Service – Now & Then 

Home Health Care in the Context of a Psychiatric Injury

Application of SB 863 Changes to Home Health Care Services

Clearing the Hurdles of Home Health Care Under SB 863: Neri Hernandez En Banc

Home health care now and then

HHC for Psych Injury

Application of SB 863 Changes to HHC Services

Clearing the Hurdles

 
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