DWC Issues 15-Day Notice for Modifications to Proposed Medical Provider Networks Regulations
By Press Release - December 10, 2013
The Division of Workers’ Compensation (DWC) has posted a 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 dwcrules@dir.ca.gov until 5 p.m. on December 26, 2013.
The proposed modifications include:
• Clarification of individual physician acknowledgments and streamlining of group acknowledgment requirements
• Penalty changes to align notice violations with the entity responsible for giving actual notice, and penalty changes to limit multiple violations for an MPN applicant and reduction of penalties
• Access standards revised to delete five commonly used specialties, but out-of-network treatment required if time and location requirements for treatment not met within MPN
• Clarifications to alternative access standard requirements, out-of-network policies and required physician appointment time frames
• Reapproval plan changes, including a six-month review period and clarification regarding geocoding requirements
• MPNs approved on or before January 1, 2011 will be deemed approved until December 31, 2014
• Change from 30 to 45 days to correct reported provider listing inaccuracies
• Clarification of definitions for “ancillary services,” “entity that provides physician network services,” “health care shortage,” “MPN Medical Access Assistants,” “MPN Plan,” and “MPN Applicant”
• Clarification of MPN Medical Access Assistant responsibilities
• Clarification of application plan requirements: including for electronic signatures, ancillary services and quality of care
• Change in definition for “systematic failure” of MPN as a basis for a Petition for Suspension or Revocation
• Elimination of modification filing requirements for a 10 percent provider listing change and for a 25 percent change in covered employees
• Clarification of documentary evidence to produce for random reviews
• Changes to mitigation requirements to specify a time frame and to allow for first time violations to be considered as a factor.
The notice, text of the regulations, and forms can be found on the proposed regulations page.
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