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Chapter 4.5. Division of Workers' Compensation Subchapter 1. Administrative Director--Administrative Rules Article 3.5. Medical Provider Networks

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§9767.11. Economic Profiling Policy

(a) An insurer's or employer's filing of its economic profiling policies and procedures shall include:

(1) An overall description of the profiling methodology, data used to create the profile and risk adjustment;

(2) A description of how economic profiling is used in utilization review;

(3) A description of how economic profiling is used in peer review; and

(4) A description of any incentives and penalties used in the program and in provider retention and termination decisions.

Note: Authority cited: Sections 133 and 4616(g), Labor Code. Reference: Section 4616.1, Labor Code.

HISTORY 1. New section filed 11-1-2004 as an emergency; operative 11-1-2004 (Register 2004, No. 45). A Certificate of Compliance must be transmitted to OAL by 3- 1-2005 or emergency language will be repealed by operation of law on the following day.

2. New section refiled 2-28-2005 as an emergency; operative 3-1-2005 (Register 2005, No. 9). A Certificate of Compliance must be transmitted to OAL by 6- 29-2005 or emergency language will be repealed by operation of law on the following day.

3. New section refiled 6-20-2005 as an emergency; operative 6-29-2005 (Register 2005, No. 25). A Certificate of Compliance must be transmitted to OAL by 10- 27-2005 or emergency language will be repealed by operation of law on the following day.

4. Certificate of Compliance as to 6-20-2005 order transmitted to OAL 7-29-2005 and filed 9-9-2005 (Register 2005, No. 36).

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