Health care organizations (HCO)
The Medical Unit reviews applications from health care organizations (HCOs) and certifies them for the delivery of medical treatment under California workers' compensation law. Three types of organizations may apply for HCO certification: health maintenance organizations, (HMOs) licensed by the California Department of Managed Care Regulation; disability insurers licensed by the Department of Insurance; and workers' compensation health care provider organizations, (WCHCPOs) authorized by the Department of Corporations.
Certification requirements for HCOs are contained in Title 8 of the California Code of Regulations, sections 9770 through 9779.8 and Labor Code sections 4600.3 and through 4600.6. The regulations were revised in 2010 to reduce HCO fees.
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 that allows employees to predesignate their own personal physician, personal chiropractor, or personal acupuncturist (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.
Interested parties may obtain an optional form to apply for HCO certification by contacting:
DWC Medical Unit
P.O. Box 71010
Oakland CA 94612
Once certified, HCOs are required to file updates to the application when any modification or amendment is made to a certified HCO application, as required by Title 8 of the CA Code of Regulations section 9771.1