Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) Every application submitted under Section
9771(e) shall be
kept current to reflect accurately the actual operation of the HCO. An
applicant or a certified HCO shall file an amendment to its application to show
any change in any information contained in the application. Amendments include
changes, deletions, additions and variations to the original application and
its exhibits, including sample contracts. Amendments shall be filed as set
forth in this section. However, the administrative director may approve an
alternative form of submitting an amendment if it substantially accomplishes
the purposes of this section.
(b)
An original and one copy of an amendment shall be submitted to the
administrative director as follows:
(1)
Submit an Execution Page of the application, indicating it is an "Amendment to
Pending Application" or "Amendment to Application of a Certified
Organization";
(2) Furnish only
those pages of the application and/or those exhibits which are changed by the
amendment.
(3) If a page of the
application is amended, complete all items on that page and "redline" or
otherwise clearly designated the changed item. At the lower left-hand corner of
each page, type "Rev. [date]", giving the effective date of the
amendment.
(4) If an exhibit is
being amended:
(A) Furnish the complete
exhibit as amended, bearing the same number as the original exhibit, with the
changed portions of the exhibit "redlined" or otherwise clearly designated,
or
(B) Furnish the pages of the
exhibit which are amended, each page to be marked with the exhibit number and
the page number of the exhibit, and with the changed portions "redlined" or
otherwise clearly designated. At the lower left-hand corner of each page, type
"Rev. [date]", giving the effective date of the amendment. If this method of
amendment is employed, the applicant shall refile the entire exhibit as amended
whenever more than 10 percent if its pages have been
amended.
(c)
(1) Except as provided in subsection (c)(2),
amendments making material changes in the HCO's application shall be submitted
30 days before the HCO proposes to implement the change. Material changes
include, but are not limited to, a change in the geographical service area, an
increase in projected enrollment, a reduction in the services provided to
employers or injured workers, a change in the structure of reimbursements to
providers, a change in the structural relationships between the medical
director, fiscal or financial administrator, and executive officers and
administrators, or a change in the method of medical decision-making, dispute
resolution or quality assurance. If, in the opinion of the administrative
director, a proposed change raises a question as to the ability of a certified
HCO to meet the requirements of this article, the administrative director may,
within 30 days of receiving the proposed amendment inform the HCO of the
question. When the administrative director informs the HCO that a question
exists, the HCO may not implement the proposed change. The HCO may submit
whatever materials it deems appropriate to justify the amendment and may meet
with the administrative director or staff to discuss the question. Within 30
days after informing the HCO of the question, the administrative director shall
inform the HCO whether the amendment is approved or disapproved.
(2) In the event that it is impossible to
submit a proposed material change in the application 30 days before the change
is implemented, the applicant shall submit the change as soon as the applicant
becomes aware that a change is required. If, in the opinion of the
administrative director, the change or proposed changed raises a question as to
the ability of a certified HCO to meet the requirements of this article, the
administrative director may, within 30 days of receiving notice of the change
inform the HCO of the question. When the administrative director informs the
HCO that a question exists, the HCO may not implement the proposed change, or
shall cease implementing the change. The HCO may submit whatever materials it
deems appropriate to justify the amendment and may meet with the administrative
director or staff to discuss the question. Within 30 days after informing the
HCO of the question, the administrative director shall inform the HCO whether
the amendment is approved or disapproved.
(d) Amendments making non-material changes
shall be filed quarterly on dates specified by the administrative director.
However, a list of providers need be amended only when 10 percent or more of
the names contained in the list for a service area have been changed or when
the sole or principal provider for a particular health care service in a
service area is added or deleted. When amended, the complete list (or the list
for the service area) shall be furnished following the instructions for the
particular item, with each added "redlined" or otherwise clearly designated and
the names of persons deleted from the list shown at the end under the heading
"deletions."
(e) Review of
amendments submitted under section
9771.1, except quarterly updates
under section
9771.1(e)(2), will
be charged based on the actual cost for performing the review. The amount shall
include the actual salaries or compensation paid to the persons reviewing
amendment; the expenses incurred in the course thereof, and overhead costs in
connection therewith as fixed by the Administrative Director. Overhead costs
shall be based on the total expenditure for operating expenses and equipment,
except travel, of the managed care unit of the Division of Workers'
Compensation for the previous fiscal year. The invoice will be sent upon the
completion of the review and shall be paid within 30 calendar days.
1. New
section filed 2-14-96; operative 2-14-96. Submitted to OAL for printing only
pursuant to Government Code section 11351 (Register 96, No. 7).
2.
Editorial correction restoring inadvertently omitted subsection (c)(1)
(Register 2022, No. 40).
Note: Authority: Sections
133, 4600.5, 4600.7, 5307.3, Labor
Code. Reference: Sections 4600.3, 4600.5, Labor
Code.
