MPN Notice to Employee (Current Status)
By
David H. Parker
Permanent MPN Regulations are pending and the Requested effective date for permanent regulations is September 15, 2005. Thus, the emergency legislation relating to notice is still in effect. The following is applicable as of the date of this writing (August 24, 2005) relating to the MPN employee notification process.
Section 9767.12 Employee Notification
(a) An employer or insurer that offers a Medical Provider Network Plan under this article shall notify each covered employee in writing about the use of the Medical Provider Network as required by Labor Code section 4616.3 30 days prior to the implementation of an approved MPN, at the time of hire, or when an existing employee transfers into the MPN, whichever is appropriate to ensure that the employee has received the initial notification. The notification shall also be sent to a covered employee at the time of injury. The notification(s) shall be written in English and Spanish. The initial written notification shall include the following information:
(1) The name of and how to contact the person designated by the employer or insurer to be the MPN contact for covered employees. The employer or insurer shall provide a toll free telephone number if the MPN geographical service area includes more than one area code;
(2) A description of MPN services;
(3) How to review, receive or access the MPN provider directory. Nothing precludes an employer or insurer from initially providing covered employees with a regional area listing list of MPN providers in addition to maintaining and making available its complete provider listing in writing. If the provider directory is also accessible on a website, the URL address shall be listed;
(4) How to access initial care and subsequent care, and what the access standards are under section 9767.5;
(5) How to access treatment if (A) the employee is authorized by the employer to temporarily work or travel for work outside the MPN’s geographical service area; (B) a former or if the injured employee is no longer employed by the whose employer has ongoing workers’ compensation obligations and permanently resides outside the MPN geographical service area; and (C) an injured employee decides to temporarily reside outside the MPN geographic service area during recovery;
(6) How to choose a physician within the MPN;
(7) What to do if a covered employee has trouble getting an appointment with a provider within the MPN;
(8) How to change a physician within the MPN;
(9) How to obtain a referral to a specialist within the MPN or outside the MPN, if needed;
(10) How to use the second and third opinion process;
(11) How to request and receive an independent medical review;
(12) A description of the standards for transfer of ongoing care into the MPN and a notification that a copy of the policy shall be provided to an employee upon request; and
(13) A copy description of the continuity of care policy and a notification that a copy of the policy shall be provided to an employee upon request. as required by Labor Code section 4616.2.
(b) At the time of the selection of the physician for a third opinion, the covered employee shall be notified about the Independent Medical Review process. The notification shall be written in English and Spanish.
(c) Covered employees shall be notified 30 days prior to a change of the medical provider network. If the MPN applicant is an insurer, then a copy of the notification shall be served on the insured employer. The notification shall be written in English and Spanish.
Authority: Sections 133 and 4616, Labor Code.
Reference: Sections 4616, 4616.2 and 4616.3, Labor Code.
Questions Raised
Some specific questions raised by the temporary status of the MPN regulations are answered below:
1) If an employer sends out the letter now or has previously sent one without the pre-designation language, is there a chance that a separate letter must be sent in the future regarding the option to predesignate? Should an employer just wait until the matter is decided so as to avoid the risk of having to send out 2 letters?
Answer: Yes, there is a chance you will have to send-out a separate letter regarding pre-designation later depending on final Regulations. This depends wholly on what the legislature passes as the "final regulations." No, an employer should not wait to send the letters as the MPN may not be utilized without proper notice having been sent.
2) Which employees the letter should receive the letters? Many employer databases contain employees who are:
--Active & assigned (working)
--Active but not currently assigned
--Inactive but eligible for rehire if they were to contact us
Answer: An employer must notify each "covered employee" in writing about the use of the Medical Provider Network as required by Labor Code section 4616.3 (30) days prior to the implementation of an approved MPN, at the time of hire, or when an "existing employee" transfers into the MPN, whichever is appropriate to ensure that the employee has received the initial notification. The notification shall also be sent to a covered employee at the time of injury. The notification(s) shall be written in English and Spanish. The initial written notification shall include the information currently required as outlined above.
I recommend that employers are overly broad in provision of this information. If an employer fails to properly notify anyone they later wish to transfer in to the MPN, the transfer and Network will be rendered ineffective. Thus, it is recommend that all of the above-labeled employees be notified. The short-term cost should be outweighed by the long-term benefit(s), such as they will be, from utilization of an employer-created MPN.
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