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

§9767.2. Review of Medical Provider Network Application.

(a) Within 60 days of the Administrative Director's receipt of a complete new application, the Administrative Director shall approve for a four-year period or disapprove a new application based on the requirements of Labor Code section 4616 et seq. and this article. An application shall be considered complete if it includes correct information responsive to each applicable subdivision of section 9767.3. Pursuant to Labor Code section 4616(b), if the Administrative Director has not acted on a new application plan within 60 days of submittal of a complete plan, it shall be deemed approved on the 61st day for a period of four years.

(b) Within 180 days of the Administrative Director's receipt of a complete plan for reapproval, the Administrative Director shall approve for a four-year period or disapprove the complete plan for reapproval based on the requirement of Labor Code section 4616 et seq. and this article. A plan for reapproval shall be considered complete if it includes correct information responsive to each applicable subdivision of section 9767.3. If the Administrative Director has not acted within 180 days of receipt of a complete plan for reapproval, it shall be deemed approved on the 181st day for a period of four years.

(c) The Administrative Director shall provide notification(s) to the MPN applicant: (1) setting forth the date the MPN application or reapproval plan was received by the Division; (2) informing the MPN applicant if the MPN application or reapproval plan is not complete and the item(s) necessary to complete the application or reapproval plan; and (3) if the Administrative Director is aware that the MPN applicant is not eligible to have an MPN.

(d) No additional materials shall be submitted by the MPN applicant or considered by the Administrative Director until the MPN applicant receives the notification described in (c).

(e) The Administrative Director's decision to approve or disapprove an application shall be limited to his/her review of the information provided in the application or reapproval plan.

(f) Upon approval of a new Medical Provider Network Plan, the MPN shall be assigned a unique MPN Identification number. This unique MPN Identification number shall be used in all correspondence with DWC regarding the MPN, including but not limited to future filings and complaints, and shall be included in the complete employee notification, transfer of care notice, continuity of care notice, MPN IMR notice and end of MPN coverage notice.

(g) An MPN applicant may choose to withdraw an approved MPN that has never been implemented by sending a letter signed by the MPN's authorized individual to the Administrative Director with the name and approval number of the MPN to be withdrawn, and a statement verifying that the MPN has never been used and that the MPN applicant will not use the MPN in the future.

Note: Authority cited: Sections 133 and 4616(h), Labor Code. Reference: Section 4616, 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, including new subsection (c) and subsection relettering, transmitted to OAL 7-29-2005 and filed 9-9-2005 (Register 2005, No. 36).

5. Amendment of section heading, section and Note filed 8-27-2014; operative 8-27-2014 pursuant to Government Code section 11343.4(b)(3) (Register 2014, No. 35).