Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a)
The Early Intervention Program (EIP) is a voluntary employee benefit available
to all departmental employees, who have sustained an industrial injury/illness.
The EIP is designed to provide employees with information regarding the
assessment and processing of qualified industrial injury/illness claims, as
referenced in subdivision (b), and the available choices regarding benefit
options and compensability. The Office of Environmental Health and Safety
(OEHS), within the Department, shall administer the EIP.
(b) All employees who have sustained the
following qualified injury/illness shall be eligible for an Early Intervention
Counselor (EIC) visit, as referenced in (d)(4):
(1) Psychological stress;
(2) Stress-related injuries, including but
not limited to, hypertension, cardiac, gastrointestinal; or
(3) Trauma-induced stress, including but not
limited to, assault, blood borne pathogen exposure or infectious disease
exposure.
(c) All
employees with a claimed injury/illness who have an actual or anticipated
long-term disability of thirty (30) days or more, or who have an undeterminable
or disputed injury shall be eligible for EIC.
(d) Definitions.
(1) Adjusting Agency, means the entity, under
a State of California Interagency Agreement with the California Department of
Human Resources that administers workers' compensations claims on behalf of the
Department.
(2) Early Intervention
Selection Committee (EISC) means a local committee at the institution(s)
comprised of the Director's representatives in a number equal to the number of
Employee Representative Associations who bargain with the Department on behalf
of employee bargaining units, one representative from each of those
Associations, and a non-voting chairperson.
(3) Agreed Medical Panel Doctor (AMPD), means
a Physician as defined in Labor Code 3209.3, or a Physician holding a valid
license to practice medicine in an adjoining state when services will be
rendered in that state, who is authorized by the EISC to provide evaluations
and treatment within the scope of the EIP.
(4) Early Intervention Counselor (EIC), means
an independent, non-departmental employee, authorized by the EISC, who provides
information to qualified injured/ill employees regarding workers' compensation
and other employee entitlement benefit options.
(5) Return-to-Work Coordinator (RTWC) means a
State employee who is the Department's local representative, entrusted with the
responsibility of coordinating the EIP at the local level. The RTWC shall be
the chairperson of the EISC.
(e) The EIP shall:
(1) Provide for a qualified injured/ill
employee to receive an initial EIC visit, regarding workers' compensation
benefit options and other entitlement benefits when referred by the
RTWC.
(2) Provide for a qualified
injured/ill employee to be referred to an AMPD by the RTWC regarding disputed
compensability claims.
(3) Ensure
all employee medical and personnel records are kept confidential at all
times.
(f) The EISC
shall:
(1) Review resumes of qualifications,
as referenced in (g)(1), and authorize individuals to provide EIC services
within the scope of the EIP for a term of three (3) years;
(2) Review and investigate any verbal or
written complaint filed against an EIC, within 120 days of receipt;
(3) Issue a written statement within 30 days
of completion of the review to the reporting party if complaint is found to be
invalid;
(4) Issue a written Notice
of Decision via Certified U.S. Mail within 30 days of completion of the review
if the complaint is found to have merit. The Notice shall include:
(A) A written statement of charges addressing
complaint; and
(B) A written
statement informing the EIC of his or her right to appeal within 30 days of
mailing of the Notice of Decision; and
(C) A written corrective action order. For
purposes of this section, a corrective action order may include, but is not
limited to, a written notice to the EIC to provide an explanation of inaccurate
EIP information provided to the employee; or a written notice to correct any
inaccurate billing statement; or a written notice to cease any unprofessional
conduct during the course of an EIC visit. The written corrective action order
shall include a time frame during which the matter must be corrected, and a
means by which the EIC must notify the EISC of the required corrections;
or
(D) A written statement of
Intent to Revoke Authorization to provide EIC services.
(5) Conduct a meeting to hear an appeal
within 60 days of a request by the EIC, giving the EIC an opportunity to
present a defense to any complaint prior to revoking the EIC's authority to
provide EIP services.
(6) Make a
final determination within 14 days of the appeal, either sustaining, modifying
or revoking the Decision after an appeal is heard. The authorization of an EIC
to provide services shall be revoked if it is determined that the following has
occurred:
(A) Upon investigation of a serious
complaint filed against the EIC, the complaint is found to have merit by the
EISC. For the purposes of this section, a serious complaint means an alleged
crime or act performed by an EIC, which includes but not limited to those
involving theft, fraud, fiscal dishonesty, or sexual misconduct.
(B) The EIC fails to notify the EISC by
written statement certifying charges set forth in the corrective action order
have been corrected;
(C) The EISC
determines inadequate EIC performance due to neglect of duty, misconduct, or
illegal or unprofessional conduct.
(D) The EIC fails to appeal the complaint
within the 30-day appeal process.
(7) Issue a written Final Decision to the EIC
via Certified U.S. Mail.
(8) Base
decisions on a simple majority of the members in attendance. The decision of
the EISC is final and is not appealable beyond the 30-day appeal
process.
(g) The EIC
shall:
(1) Submit a resume of qualifications
to the RTWC, including, but not limited to, a demonstration of knowledge and
experience regarding worker's compensation laws and other employee entitlement
benefits;
(2) Respond within seven
(7) working days of receipt of a referral by the local RTWC and shall:
(A) Contact the injured/ill employee by
telephone at the number provided by the RTWC, or contact the injured/ill
employee by Certified U.S. Mail;
(B) Inform the employee about the EIP;
and
(C) Schedule an EIC visit, if
requested by the employee.
(3) Notify the local RTWC of the scheduled
visit with the injured/ill employee within three (3) working days of contact
with the employee, if the employee requests an EIC visit;
(4) Explain all benefit options to
injured/ill employee during the EIC visit;
(5) Obtain prior approval from the local RTWC
for additional telephone calls or visits to the injured/ill employee;
(6) Attend training, if requested, by the
OEHS;
(7) Submit billings for early
intervention services to the RTWC in accordance with the following:
(A) All billings for casework provided are to
be itemized in tenths of an hour.
(B) All EIC visits and casework provided are
to be billed at the Professional Hourly Rate of $65.
1. Billable costs include, but are not
limited to, initial file review; scheduling contact with employee; contact with
employee; meeting with employee; assessment of employee needs; counseling; and
guidance. Any file review or consultation with the employee that exceeds two
(2) hours shall include a report providing documentation in support of the need
for the extended time.
2.
Non-billable costs include, but are not limited to, postage, clerical services,
photocopies, in-house waiting time, attempted telephone contacts, and in-house
staffing.
(C) All
reimbursement for mileage are to be billed at the travel rate of $32.50 per
hour and $0.31 per mile.
(h) The EIC shall not have access to an
employee's confidential medical and personnel records.
(i) The AMPD shall provide medical,
psychological, and psychiatric treatment under Labor Code 4600, and provide
written opinions or evaluations to assist in decisions regarding compensability
pursuant to CCR, Title 8, Section 9785, at the request of the RTWC.
(j) The RTWC shall:
(1) Serve as local EIP coordinator;
(2) Coordinate local EISC meetings at the
institution(s) and participate as a non-voting chairperson;
(3) Refer the qualified injured/ill employee
to an EIC within three (3) working days of knowledge of the employee's EIP
eligibility;
(4) Review, authorize,
and forward itemized billings submitted by the EIC for payment to the Adjusting
Agency; and
(5) Maintain a log of
injured/ill worker EIC referrals and submit to the OEHS by the 10th of every
month.
(k) The Adjusting
Agency shall:
(1) Compile reports and
statistical data as requested by the Department;
(2) Refer departmental injured/ill employees
to a Physician for any additional medical, psychological, and psychiatric
evaluations as needed to determine compensability for disputed claims;
and
(3) Pay itemized bills for EIP
services submitted by the RTWC.
Note: Authority cited: Sections
5058 and
5058.3, Penal
Code; and Section
3214, Labor
Code. Reference: Section
5054, Penal
Code; Sections
139.2,
3209.3,
3214,
4600 and
5307.1, Labor
Code; CCR, Title 2, Section 714; CCR, Title 8, Sections 9785, 10132 and
10132.1; CCR, Title 15, Div. 3, Section 3434; Section
8547.2(b),
Government Code; and State of California, Interagency Agreement, A9450207,
AM-IV.
Note: Authority cited: Sections
5058 and
5058.3, Penal
Code; and Section
3214, Labor
Code. Reference: Section
5054, Penal
Code; Sections
139.2,
3209.3,
3214,
4600 and
5307.1, Labor
Code; CCR, Title 2, Section 714; CCR, Title 8, Sections 9785, 10132 and
10132.1; CCR, Title 15, Div. 3, Section
3434; Section
8547.2(b),
Government Code; and State of California, Interagency Agreement, A9450207,
AM-IV.
