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Division of Workers' Compensation - Managed Care Program -- HCOs

The Managed Care Program reviews applications from health care organizations and certifies them for the delivery of managed care services under California workers' compensation law. Three types of organizations may apply for HCO certification: HMOs licensed by the Department of Managed Care Regulation; disability insurers licensed by the Department of Insurance; and other workers' compensation health care provider organizations, otherwise known as WCHCPOs.

For general information regarding group health coverage and HMOs, you should contact the California Department of Managed Health Care at 1-800-HMO-HELP, http://www.dmhc.ca.gov.

Certification standards for HCOs are contained in Sections 9770 through 9779 of Title 8, California Code of Regulations.

Interested parties may download the application package for HMOs and disability insurers acrobat image or for WCHCPOs acrobat image . To have a copy of either application package mailed to you or for further information, contact the DWC Managed Care Program, P.O. Box 420603, 9th floor, San Francisco, CA, 94142, phone 415-703-4600. Technical specifications for data reporting, a requirement of HCO certification, are contained in Data Reporting in the HCO Program acrobat image .

Once certified, HCOs should download and use the Cover Sheet for HCO Material Modification Request acrobat image when any modification or amendment, as required by Section 9771.1 of Title 8, CA Code of Regulations, is prepared. The cover sheet should be filled out and attached with the submission of material to DWC's Managed Care Program for review.

Self-insured employers and insurers may contract with an HCO to provide medical and disability management services to injured workers. Employees must be provided a choice of at least one HCO, and an open enrollment process is required (Title 8, California Code of Regulations, Sections 9779.3 and 9779.4). HCOs must include a comprehensive health care delivery system, including assignment of primary treating physician, consultation and referral, inpatient hospital care, emergency services, diagnostic facilities, home health services, a quality assurance and medical case management system, return to work coordination, consultation on health and safety, and data reporting.

Employees offered a choice of HCOs must also be given the option to pre-designate their own personal physician. Once enrolled in an HCO, the HCO's services and providers must be used for between 90 and 180 days after an injury or illness occurs.

What Do Injured Workers Think of Their Medical Care? is a survey of patient satisfaction with medical care in the states' workers' compensation system. It contains questions on medical care, return to work, and functional outcomes following a work injury or illness. Those interested in using this survey should contact the DWC Managed Care Unit. You may download the technical report (1997) acrobat image on the development of the survey, the actual questionnaire used acrobat image and a May 2001 DWC research brief, What Do Injured Workers Think About Their Medical Care and Outcomes After Work Injury?

List of certified Health Care Organizations (HCO) Word icon version acrobat image version

June 2007