What Is California Labor Code §5307.8: Home Health Care Fee Schedule?

Notwithstanding Section 5307.1, the administrative director shall adopt, after public hearings, a schedule for payment of home health care services provided in accordance with Section 4600 that are not covered by a Medicare fee schedule and are not otherwise covered by the official medical fee schedule adopted pursuant to Section 5307.1.

What does Labor Code 5307.8 actually pay for?

This law creates a separate, set price list that covers home health care tied to a work injury, used only when no other fee schedule already prices that specific care.

Some injuries need help at home, not just a visit to a clinic. Bathing, dressing, wound care, or help moving safely around the house can all be part of recovering from a serious work injury. Before this rule existed, it was not always clear what a workers' compensation carrier actually owed for that kind of help. Labor Code 5307.8 settles that question by directing the administrative director, the state official who sets fee rules for the Division of Workers' Compensation, to adopt exact rates for that care. Those rates can follow In-Home Supportive Services rules already used under the Welfare and Institutions Code, or another state or federal home health fee schedule, including one used for the Medi-Cal program or by the federal Office of Workers' Compensation Programs.

This rule reaches any injured worker whose treating doctor orders home health care as part of necessary treatment for a work injury. It matters most for workers recovering from a serious injury such as a severe burn, a spinal cord injury, an amputation, or major surgery, where daily help at home is part of the recovery plan rather than an extra comfort.

How does a home health care fee request actually work in a claim?

Your treating doctor has to ask for the care in writing, and the schedule the state adopts under this law sets what gets paid once it is approved.

Home health care usually starts with a written treatment request from your treating doctor. The request should describe the specific tasks you need help with, such as bathing, wound care, or getting in and out of bed, and roughly how many hours a week that care takes. Like other medical treatment requests, it can still go through utilization review, where a reviewer checks the request against medical guidelines before approving, changing, or denying it. Once a request is approved, this fee schedule, not a private negotiation between you and a caregiver, sets what gets paid for that care.

What will this fee schedule not pay for?

It will not pay for home care a family member was already giving, in the same way and to the same extent, before the work injury happened.

Labor Code 5307.8 draws one clear line. If a member of your household regularly gave you that same kind of help before you were hurt, at the same level, the law does not turn that same ordinary help into a paid benefit just because an injury also happened. The fee schedule is meant for care your injury itself created a need for, not for help your family already gave for free. A doctor's report that spells out exactly what changed after the injury, and how much more care you now need, helps draw that line clearly.

How does Labor Code 5307.8 fit with the rest of your medical care rules?

It works alongside the law that creates your right to treatment and the schedule that prices most other medical care, filling a gap those two rules leave open.

Labor Code 4600 is the broader law that gives an injured worker the right to medical treatment reasonably needed to cure or relieve the effects of a work injury. Home health care has to fit inside that same standard first. Labor Code 5307.1 sets the main official medical fee schedule for most other treatment, such as doctor visits, surgery, and hospital care, but that schedule specifically leaves out home health care, physician services, drugs, and facility fees. Section 5307.8 is the rule that steps in notwithstanding the 5307.1 schedule, pricing that one kind of care instead of leaving the gap unpriced.

What can you do if home health care is cut back or denied?

Ask for the denial or change in writing, and get help if you need to fight for fees this law is supposed to cover.

If a request for this care is denied or reduced, you should receive a written reason, since the same review and appeal rules apply as with any other treatment denial. Keep the doctor's request, the carrier's decision, and your own notes on how your daily needs changed after the injury. Labor Code 5307.8 also lets a judge award attorney's fees for recovering unpaid home health care fees under Labor Code 4906, the same law that requires a workers' compensation judge to approve any attorney's fee in a California case. See our guide on what a workers' comp attorney actually costs for how that approval process works.

Yazdchi Law P.C., based in Palmdale, takes on California workers' compensation claims that involve home health care disputes and denied treatment requests. If a work injury left you needing help at home, ask your treating doctor to spell out exactly what care you need and why, and keep a copy of every request and decision.

Call (661) 273-1780 or use the contact form to talk about what your claim still needs.