San Francisco, CA – The Division of Workers’ Compensation (DWC) has posted a second 15-day notice of modification to the proposed medical provider networks (MPN) regulations to the DWC website. Members of the public are invited to present written comments regarding the proposed modifications to firstname.lastname@example.org until 5 p.m. on March 25, 2014.
The proposed modifications include:
- Reorganization of the Physician Acknowledgments section to make it easier to follow. Further description of the requirements for acknowledgments obtained through a website listing. Clarification of the occurrences and dates when physician acknowledgments are required.
- Clarification that the geocoding results will be used by DWC in reviewing MPN plans to give an approximation of MPN compliance with the access standards set forth in section 9767.5. Deletion of the requirement that MPNs provide a list of all ZIP codes in which there is a healthcare shortage. Insertion of the requirement that MPNs provide a list of all ZIP codes where access standards are not met.
- Clarification of the definition of Medical Provider Network Medical Access Assistant. Requirements where the same individual performs both the duties of a Medical Provider Network Medical Access Assistant and a claims adjuster.
- Clarification that the MPN Web site listing of all treating physicians in the MPN must indicate those not currently taking new workers’ compensation patients and designate “by referral only” those secondary treating physicians who may only be seen with an approved referral.
- Deletion of the definition of Medical Provider Network Approval Number. Insertion of the definition of Medical Provider Network Identification Number and clarification of when it is to be used.
- Requirement that interpreters must be certified pursuant to Title 8, CCR section 9795.1.6(a)(2)(A) and (B) in order to be listed as an ancillary service provider.
- Requirement that MPNs approved prior to January 1, 2014 that are not in compliance with current MPN regulations must file a modification and update to comply no later than January 1, 2018.
- Requirement that the Access Standards time frame is triggered by notice to the MPN Medical Access Assistant. Clarification that the MPN Medical Access Assistant will have 10 business days instead of 5 business days of an employee’s request to schedule a timely medical appointment with an appropriate specialist.
- Clarification that penalties for a violation of MPN Access Standards may be assessed if the MPN Applicant fails to permit an injured covered employee to
obtain medical treatment from an out-of-network physician when the MPN Medical Access Assistant fails to meet the required time lines. Clarification of penalties for notice violations.
The notice, text of the regulations, and forms can be found on the proposed regulations page.
Source: CA DWC