As part of its ongoing efforts to implement Senate Bill 863, the Division of Workers’ Compensation (DWC) has posted proposed changes to the existing Medical Provider Network (MPN) regulations to the online forum where members of the public may review and comment on the proposals. The reform provisions of SB 863 substantially modified the MPN requirements. The modifications include:
- Expanding the types of entities who may qualify to have an MPN.
- Establishing an MPN approval period of four years.
- Allowing any person to submit a complaint against an MPN.
- Providing a petition process to either revoke or suspend an MPN.
- Authorizing DWC to conduct reviews of MPN s and assess administrative penalties for violations of statutory and regulatory requirements.
The proposed amendments to the MPN regulations modify regulatory definitions, which include a definition of an entity that provides physician network services. The regulations also detail the changes to MPN operating requirements, which include physician acknowledgments, Internet Web site postings of providers, medical access assistants, quality of care, geocoding and MPN disclosure requirements to medical providers. In addition, the regulations set the requirements for MPN approval for a period of four years and the procedural timelines for MPN re-approval.
Regarding compliance and enforcement, the proposed regulations set forth the process for filing a written complaint against an MPN, and the manner to petition DWC for the suspension or revocation of MPN status. Finally, the regulations detail more enforcement actions, establishing additional grounds for the probation, suspension, or revocation of an MPN, and the procedure by which MPNs are reviewed by the Division and assessed administrative penalties.
The proposed changes to the MPN regulations start with section 9767.1 of title 8 of the California Code of Regulations. The forum can be found online on the D WC website. Comments will be accepted on the forum until 5 p.m. on May 23 . Please feel free to participate in this important process.