In November 2015, the California Division of Workers’ Compensation (DWC) held a San Francisco Bay area meeting to examine the possibility of implementing a schedule of fees for home healthcare services provided to injured workers. Currently, California has no established schedule of fees to reimburse injured workers requiring home healthcare services.
If adopted, the proposed rulemaking would have important impacts on the in-home treatment injured workers will be able to receive. Because there is currently no agreed fee schedule, disagreements between insurers and healthcare providers may negatively impact the timeliness of treatment workplace injury victims need to recover. The scope of the legislation is to eliminate negotiations pertaining to home health care fees between the healthcare provider and insurer.
Who is eligible for home health care treatment in California?
Under the proposed rulemaking, only injured workers are only eligible for home healthcare services if the treatment is medically necessary to treat the effects of a workplace injury. Treatment must be prescribed by qualified doctor, in accordance with state and federal regulations.
Before home healthcare services are provided, a qualified registered nurse will perform an in-home assessment to ascertain the level of care needed by the injured worker, a proposed by the potential legislation. The assessments would be performed in accordance with federal regulations pertaining to the Center for Medicare and Medicaid (CMS) standards.
What home health care services are covered under the new rules?
Home health care services eligible for reimbursement under the proposed new rules include visits by qualified physical therapists, occupational therapists, and speech-language pathologists. Attendant care services, clinical social workers, and registered nurses are also eligible for reimbursement under the proposed new rules.
What is not covered by new home health care workers’ compensation rules?
The proposed regulations would not cover in-home healthcare services provided by family members to treat injuries unrelated to the workplace injury. Family members may only be reimbursed for home healthcare services if the person providing treatment is an employee of a home health care agency, however insurers and employers may agree with injured workers to cover services provided to non-registered home health care providers if he or she is qualified.
What are the proposed home health care reimbursement rates in California?
In conjunction with the suggested rule changes, the California Division of Workers’ Compensation created a table schedule of fees for home health care services. The rates in the table are the maximum allowable amounts (MAA) of reimbursement employers and their insurers will be liable to cover. Billing will need to be submitted in 15 minute increments using the CMS 1500 or the CMS 1450/UB-04 form.
San Francisco workers’ compensation lawyers
Following a workplace accident, there is no guarantee you will always get the workers’ compensation you and your family may need to recover from a workplace accident. Retaining an experienced and qualified San Francisco workers’ compensation attorney should be a top priority to try and maximize your compensation.
Employers and insurance companies are notorious for downplaying victims’ injuries to avoid paying for necessary medical treatment. Injured workers are eligible to receive compensation for medical treatment and lost wages. If you or a family member was injured on the job, speak to a San Francisco workers’ compensation lawyer about your case.