California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 4 - Certification Standards for Health Care Organizations › Section 9773 - Treatment Standards

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) HCOs shall provide all HCO enrollees with
					 access to all medical, surgical, chiropractic, and hospital treatment which is
					 reasonably required to cure or relieve the effects of an injury in accordance
					 with Section
					 4600 of the
					 Labor Code. This treatment must be provided without payment of any co-payment,
					 deductible, or premium share by an HCO enrollee. HCOs must provide a
					 description of the method for providing treatment required under the code,
					 including a list of its physical facilities. The description must include the
					 occupational health care delivery capabilities of the HCO, including the number
					 of primary treating physicians and specialists, the number and types of
					 licensed or state-certified health care support staff, the number of hospital
					 beds, and the arrangements and the methods by which occupational health care
					 services will be provided, which shall include the following:
(1) Provider services, including consultation
					 and referral. HCOs must identify the total number of full time equivalent
					 physicians and providers of each different specialty type available to provide
					 treatment for work injuries or illnesses on a regular basis.
(2) Inpatient hospital services, which shall
					 include acute hospital services, general nursing care, use of operating room
					 and related facilities, intensive care unit and services, diagnostic laboratory
					 and x-ray services, special duty nursing as medically necessary, physical
					 therapy, respiratory therapy, administration of blood and blood products, and
					 other diagnostic, therapeutic and rehabilitative services as medically
					 reasonable or medically necessary, and coordinated discharge planning including
					 planning of such continuing care as may be necessary, both medically and as a
					 means of preventing possible rehospitalization.
(3) Ambulatory care services, (including
					 outpatient hospital services) which shall include diagnostic and treatment
					 services, physical therapy, speech therapy, occupational therapy services as
					 appropriate, and those hospital services which can reasonably be provided on an
					 ambulatory basis.
(4) Emergency
					 services, including ambulance services and out-of-area coverage for emergency
					 care.
(5) Diagnostic laboratory
					 services, diagnostic and therapeutic radiological services, and other
					 diagnostic services.
(6) Home
					 health service, which shall include, where medically appropriate, health
					 services provided at the home of an HCO enrollee as provided or prescribed by a
					 physician or osteopath licensed to practice in California. Such home health
					 services shall be provided in the home, including nursing care, performed by a
					 registered nurse, public health nurse, licensed vocational nurse or licensed
					 home health aide.