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 9767.15 - Compliance with Current MPN Regulations; Reapproval

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) MPNs approved prior to January 1, 2014
					 that are not in compliance with the current MPN regulations must file a
					 modification and update to comply with the current regulations no later than
					 January 1, 2018. If the MPN is required to apply for reapproval before January
					 1, 2018 based on the four-year approval period, then the MPN shall update to
					 the current regulations with its reapproval filing, whichever is
					 sooner.
(b) The MPN applicant shall
					 file a new complete application for reapproval no later than six months prior
					 to the expiration of the MPN's four-year date of approval.
(1) For MPNs approved prior to January 1,
					 2014, the four-year date of approval begins from the most recent approved
					 filing prior to January 1, 2014.
(2) For MPNs approved after January 1, 2014,
					 the first four-year date of approval begins from the date the original
					 application is approved.
(3) After
					 an MPN has been reapproved, the expiration of reapproval will be four years
					 from the date of the last complete plan reapproval.
(4) Each application for reapproval shall
					 meet all requirements for a new MPN original application.
(5) Each filing for reapproval shall meet the
					 requirements for geocoding as follows: Provide an electronic copy in Microsoft
					 Excel format of the geocoding results of the MPN provider directory to show
					 estimated compliance with the access standards set forth in section
					 9767.5. The access standards set
					 forth in section
					 9767.5 are determined by the
					 injured employee's residence or workplace address and not the center of a zip
					 code. 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. The geocoding results shall
					 include the following separate files summarizing data reasonably available at
					 the time of compilation:
1) a complete list
					 of all zip codes within the MPN geographic service area;
2) a narrative or graphic report that
					 establishes where there are at least three available primary treating
					 physicians within the fifteen-mile access standard from the center of each zip
					 code within the MPN geographic service area;
3) a narrative or graphic report that
					 establishes where there is a hospital or an emergency health care service
					 provider within the fifteen-mile access standard from the center of each zip
					 code within the MPN geographic service area;
4) a narrative or graphic report that
					 establishes-where there are at least three available physicians in each of the
					 specialties commonly required to treat injured workers covered by the MPN
					 within the thirty-mile access standard from the center of each zip code within
					 the MPN geographic service area;
5)
					 a list of all zip codes where access standards are not met in the geographic
					 service area or areas to be served by the MPN for primary treating physicians,
					 for acute care hospitals or emergency facilities, and for each specialty listed
					 to treat common injuries experienced by injured workers covered by the MPN, and
					 a narrative report explaining if medical treatment will be provided according
					 to an approved alternative access standard or according to a written policy
					 permitting out of MPN treatment in those areas; and
6) each physician listed in the MPN provider
					 directory shall be assigned at least one provider code as set forth in section
					 9767.3(c)(2) of
					 this section to be used in the geocoding reports.
(6) The time frames for the review process
					 for a plan for reapproval are as stated in section
					 9767.2(b).
(7) If the filing for reapproval is not filed
					 within the requisite six months prior to the expiration of approval, then the
					 MPN may be subject to penalties or other administrative actions. If an
					 application for reapproval is filed less than 60 days prior to the approval
					 expiration date, then the MPN may be subject to penalties and MPN approval will
					 be suspended after the date of expiration if the review is not completed prior
					 to the expiration of the MPN plan's approval.