Current through Register 2024 Notice Reg. No. 38, September 20, 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.
1. New
section filed 9-9-2005; operative 9-9-2005 (Register 2005, No.
36).
2. Amendment of section heading, section and NOTE filed
8-27-2014; operative 8-27-2014 pursuant to Government Code section
11343.4(b)(3) (Register 2014, No. 35).
Note: Authority cited: Sections
133, 4616(h) and
5300(f), Labor
Code. Reference: Sections
4609, 4616, 4616.2 and 4616.3,
Labor Code.
