California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 3.5 - Medical Provider Network › Section 9767.12 - Employee Notification

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) When an injury is reported or an employer
					 has knowledge of an injury that is subject to an MPN or when an employee with
					 an existing injury is required to transfer treatment to an MPN, a complete
					 written MPN employee notification with the information specified in paragraph
					 (2) of this subdivision, shall be provided to the covered employee by the
					 employer or the insurer for the employer. This MPN notification shall be
					 provided to employees in English and also in Spanish if the employee primarily
					 speaks Spanish.
(1) A complete MPN
					 notification with the information specified in paragraph (2) of this
					 subdivision may be sent electronically in lieu of by mail, if the covered
					 employee has regular electronic access to email at work to receive this notice
					 at the time of injury or when the employee is being transferred into the MPN.
					 If the employee cannot receive this notice electronically at work, then the
					 employer shall ensure this information is provided to the employee in writing
					 at the time of injury or when the employee is being transferred into the
					 MPN.
(2) The complete written MPN
					 employee notification shall include the following information:
(A) The unique MPN Identification number. How
					 to contact the person designated by MPN applicant to be the MPN Contact for
					 covered employees to answer questions about the use of MPNs and to address MPN
					 complaints. The employer or insurer shall provide a toll-free telephone number
					 with access to the MPN Contact if the MPN geographic service area includes more
					 than one area code. A toll-free number must also be listed for MPN Medical
					 Access Assistants, with a description of the access assistance they provide,
					 including finding available MPN physicians of the injured workers' choice and
					 scheduling and confirming physician appointments, and the times they are
					 available to assist workers with obtaining access to medical treatment under
					 the MPN;
(B) A description of MPN
					 services as well as the MPN's web address for more information about the MPN
					 and the web address that includes a roster of all treating physicians in the
					 MPN;
(C) How to review, receive or
					 access the MPN provider directory. An employer, insurer, or entity that
					 provides physician network services shall ensure covered employees have access
					 to, at minimum, a regional area listing of MPN providers in addition to
					 maintaining and making available its complete provider directory listing in
					 writing and/or on the MPN's website. The MPN's website address shall be clearly
					 listed. If an employee requests an electronic provider directory listing, it
					 shall be provided electronically on a CD, flash drive, via email or on a
					 website. The URL address for the provider directory shall be listed with any
					 additional information needed to access the directory online including any
					 necessary instructions and passcodes. MPN applicants are responsible for
					 updating an MPN's provider listings, at minimum, on a quarterly basis with the
					 date of the last update provided on the listing given to the employee. Each
					 provider directory listing shall include a phone number and an email address
					 for reporting of provider listing inaccuracies. If a listed provider becomes
					 deceased or is no longer treating workers' compensation patients at the listed
					 address, the provider shall be taken off the provider directory within 45 days
					 of notice to the MPN through the contact method stated on the provider
					 directory listing to report inaccuracies.
(D) How to access initial care and subsequent
					 medical care and how to contact the medical access assistants if an employee
					 needs help in finding a physician or scheduling an appointment;
(E) The mileage, time requirements and
					 alternative access standards required under section
					 9767.5;
(F) How to access treatment if (A) the
					 employee is authorized by the employer to temporarily work or travel for work
					 outside the MPN's geographic service area; (B) a former employee whose employer
					 has ongoing workers' compensation obligations permanently resides outside the
					 MPN geographic service area; and (C) an injured employee decides to temporarily
					 reside outside the MPN geographic service area during recovery;
(G) How to choose a physician within the
					 MPN;
(H) What to do if a covered
					 employee has trouble getting an appointment with a provider within the MPN and
					 how to use the medical access assistants for help;
(I) How to change a physician within the
					 MPN;
(J) How to obtain a referral
					 to a specialist within the MPN or outside the MPN, if needed;
(K) How to use the second and third opinion
					 process;
(L) How to request and
					 receive an MPN independent medical review;
(M) A description of the standards for the
					 transfer of care policy and a notification that a copy of the policy in English
					 or in Spanish if the employee speaks Spanish shall be provided to an employee
					 upon request; and
(N) A description
					 of the standards for the continuity of care policy and a notification that a
					 copy of the policy in English or in Spanish if the employee speaks Spanish
					 shall be provided to an employee upon request.