§ 3426. Employee Early Intervention Program.

(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 complainant 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.

HISTORY

1. New section filed 8-19-2002; operative 9-18-2002 (Register 2002, No. 34).

2. Amendment of subsections (d)(2), (d)(5) and (j)(2) and amendment of Note filed 1-27-2004 as an emergency; operative 1-27-2004 (Register 2004, No. 5). Pursuant to Penal Code section 5058.3, a Certificate of Compliance must be transmitted to OAL by 7-6-2004 or emergency language will be repealed by operation of law on the following day.

3. Certificate of Compliance as to 1-27-2004 order transmitted to OAL 4-7-2004 and filed 5-18-2004 (Register 2004, No. 21).

4. Change without regulatory effect amending subsection (d)(1) filed 1-8-2014 pursuant to section 100, title 1, California Code of Regulations (Register 2014, No. 2).

Note

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.