Are Home Health Care Services Covered Under California Workers Compensation?
When an employee is injured or becomes ill on the job, the first level of care received may be in an emergency room or hospital. If the injury is serious, however, once released from the hospital, the disabled worker may need continuing care at home.
In this article Cantrell Green, a Long Beach law firm specializing in workers compensation outlines a change to the laws governing home health care services available to workers compensation recipients.
Labor Code Clarifies Workers Compensation Home Health Care
Prior to 2013, the issue of home health care in workers compensation cases was a hotly debated topic. Opponents cited the extraordinary expense if, for instance, a family member provided care for the injured employee 24 hours a day and 7 days a week. Even at a modest hourly rate of $20.00, the annual cost could exceed $170,000. In the event the claim for home health care reimbursement was retroactive, the dollars piled up to an alarming amount.
In 2013, in an attempt to clarify and bring under control the issue of home health care, Senate Bill 863 was introduced, bringing drastic changes to what was available in terms of home care benefits. SB 863 was codified in Labor Code Section 4600(h), which states among other things that in order to be approved, a prescription for home health care services must be issued by a licensed physician.
Retroactive Claims for Home Health Care under Workers Compensation
Another reform outlined in Section 4600(h) pertained to retroactive benefits. Where prior to 2013 time limits for retroactive claims were not specified, the reforms specifically cut off the reach-back period to anything over 14 days prior to the date the prescription was issued.
In a recent case that came before the panel of the Workers’ Compensation Appeals Board entitled Pacas v. The Mailing House, State Comp. Ins. Fund ADJ258484, the question of what constitutes a “prescription” was addressed.
Specifically, the commissioners on a panel of the Workers’ Compensation Appeals Board (WCAB) considered whether a physician’s deposition testimony would qualify as a prescription under the revised laws.
Since timing for retrospective home health care claims is computed based upon the issuance of a prescription, whether or not deposition testimony could constitute a prescription became important.
Prescriptions for Home Health Care can be Oral or in Writing
In the deposition in question in Pacas, the Agreed Medical Evaluator (AME) had testified that home health care was indeed medically necessary for the claimant. After considering the issues at hand, the WCAB panel found that for purposes of time computation, the prescription can either be written or oral, as in the context of a deposition.
Many elements of Labor Code Section 4600(h) have the effect of tightening some loopholes, making it more challenging for an employee to get approvals. However, Pacas at the very least clarifies the issue of home health care rules, and offers a fairly straight-forward method for satisfying requirements for reimbursement for home health care.
Despite Pacas, Home Health Care Reimbursement Approvals are Still Difficult to Obtain
Satisfying the Pacas requirements of Section 4600(h) is only one hurdle to overcome. The physician’s “medical necessity” determination must still rise to the standard outlined in the relevant treatment schedule. In theory, workers compensation benefits are supposed to cover all legitimate medical expenses. In reality, however, even after Pacas, getting coverage for home health care services can still be a bit tricky.
Long Beach Workers Compensation Attorneys
Attorneys at Cantrell & Green understand the very complex laws governing workers compensation. We can advise you as to your rights and what benefits are available to you. And if you need home health care, we can guide you through the process of getting approvals.
Give us a call and schedule a free consultation to discuss your claim, the best way to pursue all avenues of reimbursement, and what benefits are available for you.
Your consultation with our workers’ comp lawyers is 100% confidential, and neither your employer nor your insurance company will be notified that you requested a consultation with us. Our lawyers will help you understand your rights and work tirelessly to ensure that you receive the maximum workers’ comp benefits for which you qualify.