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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
(a) Once an applicant has completed an application and submitted a fee in accordance with Section 9771 and has demonstrated to the administrative director that its organization has met all of the criteria for certification, the administrative director will certify the organization as an HCO for a period of three years, unless earlier revoked or suspended.
(b) Once the Administrative Director has determined that an entity licensed as a full service health care service plan under Section 1353 of the Health and Safety Code (a Knox-Keene Health Care Service Plan Act) and deemed to be an HCO pursuant to Labor Code Section 4600.5(c) has complied with the requirements of Section 9771 subsections (g)(1) and (2) the administrative director shall certify the organization as an HCO, pursuant to Section 4600.5(c), for a period of three years unless earlier revoked or suspended.
(c) A certification shall state that a particular entity is certified as a health care organization to provide health care to injured employees for injuries and diseases and other services in accordance with the terms of the entity's application. The certification shall also state: (1) the geographic service area in which the health care organization is permitted to provide health care, (2) the maximum number of enrollees, (3) the name or names under which the health care organization is permitted to provide health care, (4) the date of expiration of the certification, and (5) any other conditions or limitations.
(d) The HCO will be recertified at the expiration of each subsequent three year period, provided it continues to meet the requirements of this article and timely pays a recertification fee of $1,000.
Note: Authority cited: Sections 133, 4600.5, 4600.7, 4603.5 and 5307.3, Labor Code. Reference: Sections 4600, 4600.5 and 4600.7, Labor Code.
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).
2. Amendment of subsection (a), repealer and new subsection (b), amendment of subsection (c), repealer and new subsection (d), repealer of subsection (e), and amendment of Notefiled 2-14-96; operative 2-14-96. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 96, No.
3. New subsection (b), repealer of subsection (d) and subsection relettering filed 1-9-2003; operative 1-9-2003 pursuant to Government Code section11343.4 (Register 2003, No. 2).
4. Amendment of subsection (d) filed 11-4-2009; operative 1-1-2010 (Register 2009, No. 45).
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