Massachusetts Regulations 452.6.03

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§ 452.6.03 Preferred Provider Arrangements Under Workers' Compensation

(1) If an insurer receives approval of a preferred provider arrangement (PPA), an injured employee shall, if the arrangement is consented to by the employer and includes a provider in the specialty sought by the employee, be required to see a member of the preferred provider arrangement on the initial scheduled visit. Employees subject to any arrangement shall be provided information regarding their rights and obligations under M.G.L. c. 152, Sec. 30 and M.G.L. c. 176I upon initial approval of the preferred provider arrangement and annually thereafter. Such information shall also be posted in a prominent place in all worksites.

(2) The list of names of the providers in the preferred provider arrangement within an employee's geographic region or of all health care providers within the arrangement organized geographically shall be distributed to each covered employee immediately following an alleged workplace injury. The names on such lists shall be arranged in order of medical specialty or provider type. A current list shall also be posted at a convenient and prominent place for covered persons to examine at worksites, and shall be given to any covered person upon request.

(3) Any insurer approved as a preferred provider arrangement for workers' compensation must send to the Department of Industrial Accidents a duplicate copy of all information filed with the Division of Insurance together with a copy of its approval letter.

(4) The Department of Industrial Accidents may require the approved PPA applicant to survey affected employees with a form of the Department's design to assess the employee's understanding of their rights with regard to participation in PPA's.