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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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§9767.12. Employee Notification

(a) When an injury is reported or an employer has knowledge of an injury that is subject to an MPN or when an employee with an existing injury is required to transfer treatment to an MPN, a complete written MPN employee notification with the information specified in paragraph (2) of this subdivision, shall be provided to the covered employee by the employer or the insurer for the employer. This MPN notification shall be provided to employees in English and also in Spanish if the employee primarily speaks Spanish.

(1) A complete MPN notification with the information specified in paragraph (2) of this subdivision may be sent electronically in lieu of by mail, if the covered employee has regular electronic access to email at work to receive this notice at the time of injury or when the employee is being transferred into the MPN. If the employee cannot receive this notice electronically at work, then the employer shall ensure this information is provided to the employee in writing at the time of injury or when the employee is being transferred into the MPN.

(2) The complete written MPN employee notification shall include the following information:

(A) The unique MPN Identification number. How to contact the person designated by MPN applicant to be the MPN Contact for covered employees to answer questions about the use of MPNs and to address MPN complaints. The employer or insurer shall provide a toll-free telephone number with access to the MPN Contact if the MPN geographic service area includes more than one area code. A toll-free number must also be listed for MPN Medical Access Assistants, with a description of the access assistance they provide, including finding available MPN physicians of the injured workers' choice and scheduling and confirming physician appointments, and the times they are available to assist workers with obtaining access to medical treatment under the MPN;

(B) A description of MPN services as well as the MPN's web address for more information about the MPN and the web address that includes a roster of all treating physicians in the MPN;

(C) How to review, receive or access the MPN provider directory. An employer, insurer, or entity that provides physician network services shall ensure covered employees have access to, at minimum, a regional area listing of MPN providers in addition to maintaining and making available its complete provider directory listing in writing and/or on the MPN's website. The MPN's website address shall be clearly listed. If an employee requests an electronic provider directory listing, it shall be provided electronically on a CD, flash drive, via email or on a website. The URL address for the provider directory shall be listed with any additional information needed to access the directory online including any necessary instructions and passcodes. MPN applicants are responsible for updating an MPN's provider listings, at minimum, on a quarterly basis with the date of the last update provided on the listing given to the employee. Each provider directory listing shall include a phone number and an email address for reporting of provider listing inaccuracies. If a listed provider becomes deceased or is no longer treating workers' compensation patients at the listed address, the provider shall be taken off the provider directory within 45 days of notice to the MPN through the contact method stated on the provider directory listing to report inaccuracies.

(D) How to access initial care and subsequent medical care and how to contact the medical access assistants if an employee needs help in finding a physician or scheduling an appointment;

(E) The mileage, time requirements and alternative access standards required under section 9767.5;

(F) How to access treatment if (A) the employee is authorized by the employer to temporarily work or travel for work outside the MPN's geographic service area; (B) a former employee whose employer has ongoing workers' compensation obligations permanently resides outside the MPN geographic service area; and (C) an injured employee decides to temporarily reside outside the MPN geographic service area during recovery;

(G) How to choose a physician within the MPN;

(H) What to do if a covered employee has trouble getting an appointment with a provider within the MPN and how to use the medical access assistants for help;

(I) How to change a physician within the MPN;

(J) How to obtain a referral to a specialist within the MPN or outside the MPN, if needed;

(K) How to use the second and third opinion process;

(L) How to request and receive an MPN independent medical review;

(M) A description of the standards for the transfer of care policy and a notification that a copy of the policy in English or in Spanish if the employee speaks Spanish shall be provided to an employee upon request; and

(N) A description of the standards for the continuity of care policy and a notification that a copy of the policy in English or in Spanish if the employee speaks Spanish shall be provided to an employee upon request.

(b) When MPN coverage will end, the employer or the insurer for the employer shall ensure each injured covered employee who is treating under its MPN is given written notice of the date the employee will no longer be able to use its MPN. The notice required by this section shall be provided in English and also in Spanish if the employee speaks Spanish. (1) The employer or the insurer for the employer shall ensure that every affected injured covered employee using its MPN is provided the following information prior to the date its MPN coverage ends:

(A) The effective date the employee can no longer use the MPN. The unique MPN Identification number shall be stated in the notice.

(B) Whether the MPN will still be used for injuries arising before the date MPN coverage ends.

(C) The address(es), telephone number(s), and email address(es) of the MPN Contact and MPN Medical Access Assistants who can address MPN questions, and an MPN website.

(D) For periods when an employee is not covered by a MPN, an employee may choose a physician 30 days after the date the employee notified the employer of his or her injury.

(2) The following language may be provided in writing to injured covered employees to give the required notice of the end of coverage under an MPN: “The <Insert MPN Name> Medical Provider Network (MPN), under the unique MPN Identification number <Insert MPN Identification number> will no longer be used for injuries arising after <Insert Date MPN Coverage Ends>. You will/will not <Select Whichever is Appropriate> continue to use this MPN to obtain care for work injuries occurring before this date. For new injuries that occur when you are not covered by a MPN, you have the right to choose your physician 30 days after you notify your employer of your injury. For more information contact <Insert MPN Contact and Medical Access Assistants toll free number(s), MPN Address(es), MPN Email Address(es), and MPN Website.”

(3) This required notice may be provided by mail or included on or with an employee's paystub, paycheck or sent electronically in lieu of mail, if the employee has regular electronic access to email at work to receive this notice prior to the end of MPN coverage. If the employee cannot receive this notice electronically at work within the required time frame, then the employer shall ensure this information is provided to the employee in writing prior to the end of MPN coverage.

(4) Any pending MPN Independent Medical Review will end with the employee's coverage under the MPN.

(c) At the time of the selection of the physician for a third opinion, the covered employee shall be notified about the MPN Independent Medical Review process, as set forth in section 9768.9(a).

Note: Authority cited: Sections 133 and 4616, Labor Code. Reference: Sections 4616, 4616.2 and 4616.3, Labor Code.

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, including amendment of section, transmitted to OAL 7-29-2005 and filed 9-9-2005 (Register 2005, No. 36).

5. Amendment filed 8-9-2010; operative 10-8-2010 (Register 2010, No. 33).

6. Amendment filed 8-27-2014; operative 8-27-2014 pursuant to Government Code section 11343.4(b)(3) (Register 2014, No. 35).

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