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Homecare Workers Procedures Manual

Last Updated: 03/04/2010

S. Workers' Compensation

  1. Benefit Fund Assessment
  2. Client Consent Form (SDSD 0354) - which clients need to sign?
  3. Client Consent Form (SDSD 0354) - Purpose
  4. Client Consent Form - refusal to allow workers' compensation
  5. Client Consent Form (SDSD 0354) - Required signatures
  6. Costs (Workers’ Compensation) to the client-employer
  7. Coverage - Claim Acceptance or Denial
  8. Independent Choices providers and Workers Compensation
  9. Insurance premium, Workers Compensation
  10. Requests for Information (from SAIF or Oregon Home Care Commission)
  11. Spousal Pay Homecare Workers and Workers’ Compensation
  12. State Plan Personal Care and Workers’ Compensation
  13. Task List
  14. Where to send or direct Workers’ Compensation claims
  15. Transmittals

1. Benefit Fund Assessment

The benefit fund assessment is a fee that pays for return-to-work services if a Homecare Worker is injured on the job.

Return-to-work services assist workers with returning to work as soon as possible. If a worker cannot immediately perform their current job due to physical limitations or constraints the worker may be returned to a transitional or light-duty job. Workers’ compensation premiums finance most of the benefits received by workers if they are injured or suffer an occupational disease on the job. See Policy Transmittal 04-020 and OAR 411-031-0040 (10) c) (B) for more information.

2. Client Consent Form (SDSD 0354) - which clients need to sign?

All clients who employ Homecare Workers must sign the form. These forms must be signed for recipients of the waivered In-Home Services Program, Oregon Project Independence, State Plan Personal Care and Spousal Pay Program cases when a Homecare Worker is providing services. The forms will not be used for Independent Choices Program clients or for clients who receive services exclusively from Contracted In-Home Care Agencies.

3. Client Consent Form (SDSD 0354)– Purpose

Clients must sign the consent form to allow insurance premiums to be paid to cover the HCWs he or she employs. By signing the client is consenting to release any information necessary to process claims and agrees to cooperate with providing information necessary for the claim processing in case their employees become injured. Clients that do not consent to providing their HCW with this insurance coverage will not be eligible to receive services from a Homecare Worker. All Homecare Workers are entitled to the benefit because of the collective bargaining agreement.

4. Client Consent Form – refusal to allow workers' compensation

If a client-employer refuses to allow workers’ compensation for his or her HCW(s) the client would have to find another type of provider to provide his or her services. An in-home agency could provide in-home services or other community-based care options could be explored.

5. Client Consent Form (SDSD 0354) – Required signatures

The client-employer must sign once when initially employing Homecare Workers. Only one form needs to be signed for all Homecare Worker the client may employ. If the client-employer moves into alternate care for a period of time (such as two months residing in a nursing facility or adult foster home) the client-employer will need to sign a new form once they begin receiving Homecare Worker services again.
 
6. Costs (Workers’ Compensation) to the client-employer

The Home Care Commission will pay for the workers compensation premium on behalf of the client who is the employer. The client may be charged for the Benefit Fund Assessment in their client pay-in depending upon the client's income and how their pay-in is calculated.
• Clients on SSI do not have a pay-in and will not be charged for the benefit fund assessment.
• Clients who pay a liability based on the difference between their income and the OSIPM standard will not pay any additional monthly amount for the benefit fund assessment.
• Clients who are charged a client pay-in based on the exact cost of their services will pay an incremental amount. For most clients this cost is less than $1.00 per month.
o The amount of the Benefit Fund Assessment charge can vary annually but is approximately is 1.4 cents (.014) per hour of service the client receives per month.  When the rate of the benefit fund assessment increases or decreases, changes are made in Oregon ACCESS so that the pay-in worksheet accurately includes the correct calculation.

7. Coverage – Claim Acceptance or Denial

SAIF is the insurance carrier and will decide whether a claim is accepted or denied. Typically, workers compensation would only accept a claim for an injury that occurred while the Homecare Worker is on the job, performing authorized services. If a Homecare Worker was injured while on his or her own time or while providing a service that was not authorized in the Service Plan or Task List, that injury might be denied.

8. Independent Choices providers and Workers Compensation

Independent Choices Providers are not in the bargaining unit and therefore will not be covered by workers' compensation premiums paid by the Home Care Commission. An Independent Choices consumer may choose to purchase workers compensation coverage for his or her employee.

9. Insurance premium, Workers Compensation

The Oregon Home Care Commission pays the cost of the Workers' Compensation insurance premium for Homecare Workers in the bargaining unit. The cost of the premium is included in the client pay-in nor otherwise charged to the client.

10. Requests for Information (from SAIF or Oregon Home Care Commission)

Local SPD/AAA offices might receive requests for information about Homecare Worker injuries for Homecare Workers’ who have filed workers’ compensation claims. Local offices can release the information to the workers’ compensation insurance carrier, SAIF or to the Oregon Home Care Commission, the claims processor. Each client receiving Homecare Worker services signed a Workers Compensation Agreement and Consent form (SDS 0354) agreeing to provide or release information necessary to process a workers’ compensation claim for their Homecare Worker. You do not need any additional release of information. The insurance carrier may want to know if you have any narration about the Homecare Worker or the client-employer reporting the Homecare Worker’s injury or accident and any details.

11. Spousal Pay Homecare Workers and Workers’ Compensation

Spousal Pay providers are covered by the bargaining agreement and will be covered by workers' compensation insurance. Client-employers of Spousal Pay Provider must sign the workers’ compensation consent form. Spouses who are working as employee providers for participants in the Independent Choices Program are not covered by the bargaining agreement and are not covered by workers' compensation insurance unless the participant chooses to privately pay for that coverage.

12. State Plan Personal Care and Workers’ Compensation

Homecare Workers who provide State Plan Personal Care Services are covered by workers’ compensation and are in the bargaining unit. Client-employers under State Plan Personal Care must sign the workers’ compensation consent form. Personal Care Attendants (provider type PA) who provide personal care services to Developmental Disability Services and Mental Health Services clients are not in the bargaining unit and are not covered by workers’ compensation.

13. Task List

It is important for the Case Manager to indicate what services are authorized on the Task List. If a Homecare Worker gets injured while providing a service that was not authorized on the Task List, the claim might be denied. For example, pet care or yard work is a service that is not covered under Medicaid. If a Homecare Worker volunteered to feed the client’s animal or lift a bag of fertilizer and was injured while performing that activity, the injury claim would most likely be denied for coverage by workers’ compensation because that was not a task authorized on the Task List.

14. Where to send or direct Workers’ Compensation claims

If a HCW calls and wants to report a Workers’ Compensation claim, you need to have the Homecare Worker call the Oregon Home Care Commission at 1-888-365-0001 (toll free) or in Salem at (503) 378-3099. They will process the claim and send it to SAIF. You should go ahead and document anything reported to you about the injury. This information could be helpful later if questions arise.


If a Homecare Worker comes in to the office asking about filing a claim, you can give the HCW the brochure: “What to do if you are injured on the job.” It is form number SDS 415D in English and can be accessed on the forms web page. The brochure is also available in Spanish and Russian under form number 0355a.

15. Transmittals

SPD-AR-08-052
08/11/08
Action Requests: HCW Workers' Compensation Information and Form/Brochure Revisions
SPD-IM-04-028
03/25/04
Info: Worker's Compensation Brochure Mailing to Homecare Workers
SPD-PT-04-007
03/08/03
Policy: Client Consent Letter for Workers' Compensation Coverage for HCW
SPD-PT-04-021
05/10/04
Policy: HCW Workers' Compensation client consent form dropdown selection on Oregon ACCESS
SPD-PT-04-020
05/07/04
Policy: Homecare Benefit Fund Assessment (BFA), FICA and Oregon ACCESS Pay-in Calculation/Worksheet Changes
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