California Regulations 10132

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§ 10132 Fee Schedule

[Repealed]

(a) The Fee Schedule promulgated by the Administrative Director shall be deemed reasonable for providers of vocational rehabilitation services pursuant to Labor Code section 139.5. For services provided to employees injured on or after 1/1/94, the maximum aggregate permissible fees paid for evaluation, plan development and job placement may not exceed $4500, nor may the maximum aggregate permissible fees in each phase of the fee schedule be exceeded.

(b) For injuries occurring prior to 1/1/94, the fee schedule promulgated by the Administrative Director effective 1/1/94 shall be presumed reasonable for services to employees who are determined medically eligible on or after 1/1/94.

(c) For employees who were determined medically eligible prior to 1/1/94, the fee schedule promulgated by the Administrative Director effective 1/23/91 shall apply.

(d) For employees injured on or after 1/1/94 who initiate rehabilitation benefits or services pursuant to Section 10125 on or after 1/1/98, the fee schedule promulgated by the Administrative Director effective 1/1/98 shall apply.

(e) Rehabilitation providers and claims administrators may enter into agreements with any party to provide services at rates less than those provided by the Fee Schedule. Any agreements, however, shall be made in writing prior to the provision of such rehabilitation services. Fees that are charged back to a file by an in-house QRR who is providing rehabilitation services shall not exceed this fee schedule and are subject to the maximum permissible fees for counseling for injuries occurring on or after 1/1/94.

(f) Charges by a claims administrator for the activities of an employee supervising outside rehabilitation providers shall not exceed this fee schedule and shall not be attributed to the maximum permissible fees for counseling. These charges shall be attributed as expenses and not losses for the purposes of insurance rating pursuant to Labor Code Section 139.5(i) for injuries occurring on or after 1/1/94.

(g) Disputes pertaining to the application of the Fee Schedule shall be initially determined by the Rehabilitation Unit.

(h) Service provided by persons other than the firm in which the Qualified Rehabilitation Representative is employed must be clearly identified and billed separately.

(i) Qualified Rehabilitation Representatives appointed by the Rehabilitation Unit to act in the capacity of an independent Vocational Evaluator shall strictly adhere to the fee schedule.

(j) All billings from vocational rehabilitation service providers are due and payable within sixty (60) days of receipt by the claims administrator unless within the sixty (60) day period an objections filed contesting the billing or any portion thereof. Any portion of the billing not contested shall be paid within the sixty day period. Absent objection as described, billings not paid within sixty days from the date of receipt are subject to penalty under Labor Code sections 129 and 129.5. A copy of each billing shall be sent to the employee, and his or her representative, if any, at the time the bill is sent to the claims administrator.


Note: Authority cited: Sections 129, 129.5, 133, 139.5 and 5307.3, Labor Code. Reference: Sections 4635, 4636, 4638 and 4639, Labor Code.