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New Medical Provider Network Regulations

Friday, October 1, 2010 | 0

By Peggy Sugarman
Grancell, Lebovitz, Stander, Reubens and Thomas

The California Division of Workers' Compensation has adopted major changes to the Medical Provider Network (MPN) notice requirements effective Oct. 8, along with conforming changes to the general posting and DWC 1 Claim Form/Potential eligibility notices.

As the Knight case so clearly describes, failure to provide MPN notices that comply with the regulatory requirements allows the injured employee to obtain  medical treatment services from non-MPN providers. So, it is important to ensure that all applicable notices are up to date. This includes:

  • DWC 7 - General posting notices for the workplace. These have been revised to include information on MPNs along with a section to add the MPN name, contact and effective dates. The changes also add information on the right to predesignate a treating physician and its effect on obtaining treatment within the MPN network, as well as information on the employer’s liability for medical treatment up to $10,000 prior to the acceptance or denial of the claim.
  •  DWC 1 – Claim Form and Notice of Potential Eligibility. These are similarly revised to include the above information while eliminating the vocational rehabilitation section.
  •  Medical Provider Network notices which dramatically simplify the basic posting and initial/new hire notices and generally leave the detailed notices for the date of injury and transfer of care events.
While the MPN statute requires notices to be in English and Spanish (and both the DWC 7 and DWC 1 have Spanish translations on the forms), the state will now allow the initial implementation, time of hire, date of injury and date of transfer into the MPN notices to be in English and in Spanish to Spanish-speaking employees. This should eliminate some frustration for claims administrators who have been unsuccessful in getting English-speaking workers into the MPN because they failed to also provide the notice in Spanish, a form over substance argument. 
 
Further, the regulations now allow notices to be sent electronically so long as the employee has “regular access” to email at work. This is also true for the complete notices, but for those employees who are off on TTD administrators will need to ensure that the notice can be received within the required timeframes. In these instances, written and mailed notices are appropriate.
 
There are a few additional changes that are important:
  • A MPN Plan Modification will be required for changes to the MPN contact person, provider listing access or website information, a change in the MPN administrator, and a change of “deemed entities” named (Taft-Hartley, etc.).
  • MPN Provider Listings must be updated at least quarterly and must include an email address and phone number so that users can report any inaccuracies.
  • MPN Network administrators must remove providers who are no longer treating WC patients or who are deceased within 60 days of their notice.
For those who will implement a MPN plan on or after the effective date, the “complete” notice must also be posted in close proximity to the posting notice required under CCR section 9881.
 
For more current copies of the new regulations and posting notices, go to:
http://www.dir.ca.gov/dwc/dwcRulemaking.html.

In addition, the California Workers’ Compensation Institute has updated their WC posting notice (DWC equivalent) which has been approved by the DWC along with their new hire pamphlet. Both of these as well as well as the five-part NCR claim form with NOPE and their (optional) facts for injured workers pamphlet can be ordered online at http://www.cwci.org/store.html and shipped immediately. 

Peggy Sugarman is training director for Grancell Lebovitz, Stander, Reubens and Thomas, a workers' compensation defense firm with 10 offices throughout California. This column was reprinted with permission from the firm's quarterly client newsletter.

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