New Hampshire Code of Administrative Rules
Lab - Commissioner, Department of Labor
Chapter Lab 700 - MANAGED CARE PROGRAMS IN WORKERS' COMPENSATION
Part Lab 704 - RIGHTS AND RESPONSIBILITIES OF THE PARTIES UNDER MANAGED CARE
Section Lab 704.02 - Managed Care Organization

Universal Citation: NH Admin Rules Lab 704.02

Current through Register No. 40, October 3, 2024

(a) Any person or organization providing managed care services for workers' compensation injuries shall:

(1) Provide the employer with information for distribution to its employees on how to access the network;

(2) Promptly respond to all employee inquiries on how and where to obtain treatment within the network; and

(3) Assign an injury management facilitator to the injured employee's case and advise the injured employee or the employee's representative of the name of the facilitator and the method to be used to contact the facilitator for assistance.

(b) The injury management facilitator shall:

(1) Act as the case manager for the injured employee;

(2) Upon request furnish a complete list of the healthcare providers in the network from which the employee may choose a health care professional;

(3) Upon request of the injured employee, furnish a copy of the protocols established by the managed care organization;

(4) Coordinate among the injured employee, health care professionals and insurer to provide the employee with timely, effective and appropriate health care services in order to achieve maximum medical improvement and an expeditious return to work; and

(5) Advise the injured employee of the conditions under which the injured employee may treat outside the network.

(c) Neither a managed care organization nor an injury management facilitator shall perform the duties or functions of an insurance adjuster including, but not limited to determining the causal relation between the injury and employment, and determining entitlement to indemnity or impairment benefits.

(d) Nothing contained in (c) above shall be used to prohibit the managed care organization or injury management facilitator from obtaining any information necessary to the management of the injured employee's treatment and progress to return to work, nor shall any provision in (c) above be construed to relieve any party of the requirements of Lab 503.01 relating to disclosure.

(e) A managed care organization shall file with the commissioner:

(1) A report every 6 months indicating whether there were any additions or deletions of employers for whom the organization is rendering managed care services, and if so, what those changes were;

(2) A report every 6 months indicating whether there were any additions or deletions to its health care provider network, and if so, what those changes were; and

(3) A report whenever there is a substantial change in the managed care organization or health care provider network originally approved by the commissioner, or if there is a loss of a necessary component identified in Lab 703.01.

(f) A managed care organization shall be subject to monitoring by the commissioner under RSA 281-A:23-a,VI(a), for purposes of determining the program's continued compliance with the standards for approval and delivery of service.

(g) A managed care organization whose approval is terminated for any reason shall notify all its client employers by mail within one week of such termination and shall send a copy to the department of labor.

(h) The notice shall include the following words in a conspicuous location:

"The required New Hampshire approval for this managed care organization has been terminated. Therefore, you should inform your employees that an injured worker is no longer required to get treatment only within the network for workers' compensation injuries. Instead, the injured worker shall have the right to select his or her own healthcare provider."

#5788, eff 2-17-94, EXPIRED: 2-17-00

New. #7212, INTERIM, eff 3-2-00, EXPIRED: 6-30-00

New. #7338, eff 8-2-00; ss by #9217, eff 8-1-08; amd by #10038, eff 12-1-11

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