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 9772 - General Standards

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) HCOs must demonstrate that they meet the
					 following requirements:
(1) All facilities
					 located in this state including, but not limited to, clinics, hospitals,
					 laboratories, and skilled nursing facilities to be utilized by the HCO for the
					 delivery of occupational medical and health care services or other services
					 specifically required by this article shall be licensed by the State Department
					 of Health Services, if such licensure is required by law, and shall meet any
					 other relevant certification requirements. Facilities not located in this state
					 shall conform to all licensing and other requirements of the jurisdiction in
					 which they are located.
(2) All
					 personnel employed by or under contract to the HCO shall be licensed or
					 certified by their respective board or agency, where such licensure or
					 certification is required by law.
(3) All equipment required to be licensed or
					 registered by law shall be so licensed or registered and the operating
					 personnel for such equipment shall be licensed or certified as required by
					 law.
(4) The HCO shall provide
					 continuity of care and timely referral of patients to other providers in a
					 manner consistent with professionally recognized standards of care.
(5) All services shall be available and
					 accessible at reasonable times to all HCO enrollees.
(6) The HCO may employ and utilize allied
					 health personnel for the furnishing of occupational health services to the
					 extent permitted by law and provided such use is consistent with professionally
					 recognized standards of care; however, any course of treatment beyond first
					 aid, as defined in subdivision (c) of Section
					 14311, shall provide for at least
					 one face to face visit with a primary treating physician.
(7) The HCO shall have the organizational,
					 financial, and administrative capacity to provide services to employers, claims
					 administrators, and HCO enrollees. The HCO shall be able to demonstrate to the
					 Division that medical decisions are rendered by qualified providers unhindered
					 by fiscal and administrative management, and that such decisions adhere to
					 professionally recognized standards of care.
Any applicant that is owned in whole or in part or
						controlled by a workers' compensation insurer or self-insured employer shall,
						in addition to the requirements set forth above, further demonstrate that the
						organization's claims function shall have no influence or control over medical
						decision-making. The applicant shall further demonstrate that the clear
						authority of its Medical Director over all medical decisions is reflected both
						in its organizational chart and any internal procedure manual or other internal
						description of HCO operations.
(8) All contracts with claims administrators,
					 employers, providers and other persons or entities furnishing services
					 specifically required by this article shall be consistent with the requirements
					 of this article and Division 4 of the Labor Code.