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Chapter 4.5. Division of Workers' Compensation
Subchapter 1. Administrative Director--Administrative Rules
Article 4. Certification Standards for Health Care Organizations

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§9777. Patient Assistance and Notification.

(a) The HCO shall inform HCO enrollees upon enrollment in the plan and annually thereafter of the details of their coverage, and their rights and options under the HCO including: (1) how HCO enrollees are informed of the procedure for processing and resolving grievances, including the location(s) and telephone number where grievances may be submitted; and (2) how HCO enrollees are informed of their right to file a complaint with the administrative director in accordance with subdivision (d) of Section 9775.

(b) The HCO shall provide patient education specifically designed for injured workers with work-related injuries or illnesses.

(c) HCO enrollees must be able to receive information on a 24-hour basis regarding the availability of necessary medical services available within the HCO. The information may be provided through recorded telephone message after normal working hours. It must include information on how the enrollee can obtain emergency services or other urgently needed care and how the employee can access an evaluation within 24 hours of the injury as required under paragraph 4 of subdivision (b) of section 9773.

(d) Informational materials must be in a form understandable to all enrollees and available in Spanish. HCOs must provide in their application a description of how the information specified in subdivisions (a) through (c) will be provided to HCO enrollees. A copy of the informational material provided to HCO enrollees, including the text of phone messages, shall be made available to the administrative director upon request.

(e) The HCO shall provide for periodic evaluation of the HCO by enrollees. The HCO must provide a survey to HCO enrollees and patients, which shall be in the form and manner prescribed by the administrative director. The HCO must describe its method for incorporating the results of the survey in its quality assurance program. The completed forms and any data extracted from such forms shall be made available to the administrative director upon request.

NOTE: Authority cited: Sections 133, 4600.5, 4603.5 and 5307.3, Labor Code. Reference: Sections 4600 and 4600.5, Labor Code.

HISTORY

1. New section filed 12-31-93; operative 1-1-94. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 93, No. 53).

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