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

§9767.5.1. Physician Acknowledgments.

(a) An MPN applicant shall obtain from each physician participating in the MPN a written acknowledgment in which the physician affirmatively elects to be a member of the MPN as provided in this section. This section does not apply to a physician who is a shareholder, partner, or employee of a medical group that elects to participate in the MPN, however this section applies to the medical group that elects to participate in the MPN.

(b) The following persons may execute the acknowledgment:

(1) If the acknowledgment is for one or more physicians, it shall be executed by:

(A) The physician(s); or

(B) An employee of the physician or an employee of the physician's office; or

(C) If authorized by the physician(s), an agent or representative of a medical group. (2) If a medical group elects to participate in an MPN, an authorized officer or agent of the medical group shall execute the acknowledgment. Unless the acknowledgment is for all physicians who are shareholders, partners, or employees of a medical group, or all physicians in a distinct department or unit of the medical group, the acknowledgement shall include or refer to a list of the participating physicians, and the officer or agent shall update the list within 90 days of any additions to or removals from the list.

(1) A tangible document bearing an original signature, or a facsimile or electronic image of the original document and signature.

(2) An electronically signed document in compliance with Government Code section 16.5 or Civil Code sections 1633.1 et seq. whichever is applicable.

(3) An electronic acknowledgment using generally accepted means of authentication to confirm the identity of the person making the acknowledgment.

(d) The acknowledgement shall identify the MPN in which the physician or group participates. Multiple MPNs may be identified in a single acknowledgment or separate acknowledgments or in any combination. Any form that presents more than one MPN for the physician's acknowledgment shall enable the physician either to opt in or to opt out of each MPN. The MPN or MPNs may be identified by reference to a website listing where a person described in subdivision (b) is enabled to observe which MPN or MPNs are selected for the physician or group. If permitted by the written acknowledgment, the website listing may be amended without further action by the physician or the group, provided that the website enables the physician or the group to de-select any MPN. If the physician or group is removed from an MPN by anyone other than a person described in subdivision (b), the MPN applicant shall give the physician or group notice of that fact in writing or electronically.

(e) The acknowledgment shall be obtained at the time of the following occurrences:

(1) If, on or after August 27, 2014, the physician or medical group enters into a new contract or renews a contract to participate in the MPN, then the acknowledgment shall be obtained at the time of entering into or renewing the contract.

(2) If, on or after August 27, 2014, the physician joins a medical group that already has a contract to participate in an MPN or MPNs, the acknowledgment shall be obtained at the time of the physician's joining the medical group.

(3) If, on or after January 1, 2014 but before August 27, 2014, the physician or medical group enters into a new contract or renews a contract to participate in the MPN, then the acknowledgment shall be obtained no later than January 1, 2015.

(4) If, on or after January 1, 2014 but before August 27, 2014, the physician joins a medical group that already has a contract to participate in an MPN or MPNs, the acknowledgment shall be obtained no later than January 1, 2015.

(5) If a contract entered prior to August 27, 2014 is continuous or automatically renews without a new execution by or on behalf of the physician, then the acknowledgment shall be obtained no later than January 1, 2016, unless the MPN applicant can satisfy either (A) or (B) below:

(A) The contract identifies the MPN in which the physician or group is participating.

(B) A website address is openly published where a person described in subdivision (b) is enabled to observe which MPN or MPNs have been selected for the physician or group and to de-select any MPN. The means to authenticate a person to access the website and to de-select any MPN shall be made available upon reasonable proof of the requesting person's identity as one of the persons authorized in subdivision (b).

(f) The MPN applicant shall retain a copy of the executed acknowledgment so long as it remains in force and for three years thereafter.

(g) The MPN applicant is responsible for obtaining physician acknowledgments and must ensure that all physician acknowledgments are up to date, meet regulatory requirements, and are readily available for review upon request by the Administrative Director.

Note: Authority cited: Sections 133 and 4616, Labor Code. Reference: Section 4616(a), Labor Code; Section 16.5, Government Code; and Sections 1633.1 et seq., Civil Code.

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