The Office of Administrative Law (OAL) has approved the Division of Workers’ Compensation’s final version of Medical Provider Networks (MPN) regulations, one of the sections that implemented major reform provisions of Senate Bill 863. The MPN regulations went into effect August 27, 2014.
“We’re pleased to announce that the MPN regulations have been approved and are immediately effective,” said Christine Baker, Director of the Department of Industrial Relations (DIR). DWC is a division of DIR. “These regulations will help improve patient access to physicians within MPNs.”
The MPN regulations include:
1) A streamlined application process that allows electronic submission of MPN applications, modifications and reapprovals
2) Unique MPN Identification numbers to be assigned to each MPN in order to identify a specific MPN
3)The requirements for an MPN applicant to qualify as an entity that provides physician network services. Allowing these entities to qualify as an MPN applicant better aligns legal responsibility with operational responsibility
4) Improved access to medical care with the introduction of MPN Medical Access Assistants and the regulatory standards that they must meet to properly assist injured workers to find and schedule medical appointment with MPN physicians
5) Clarified access standards that require an MPN to have at least 3 available physicians from which an injured worker can choose from, and if the time and location access standards are not met, MPNs shall have a written policy permitting out-of-network treatment
6) Sets forth the physician acknowledgment requirements to ensure that physicians in the MPN have affirmatively elected to be a member of the network and a streamlined process for obtaining acknowledgments from medical groups
7) Greater accountability with the requirement that MPNs are approved for a period of four years and the procedural timelines for MPN re-approval
8) Oversight of MPNs is strengthened with the formal complaint process
9) DWC’s ability to enforce MPN statutory and regulatory compliance is improved with the regulations that set forth the petition for suspension or revocation of MPN process. In addition, the regulations establish additional grounds for the probation, suspension, or revocation of an MPN and the procedures by which MPNs are reviewed by DWC and assessed administrative penalties.
The final regulations are posted on the DWC website.The fillable MPN forms will be posted next week.