Workers' compensation: medical provider networks.

(1) Existing law establishes a workers' compensation system, administered by the Administrative Director of the Division of Workers' Compensation, to compensate an employee for injuries sustained in the course of their employment. Existing law requires the employer to provide medical, surgical, chiropractic, acupuncture, and hospital treatment that is reasonably required to cure or relieve the injured worker from the effects of the injury and authorizes an insurer, employer, or entity that provides physician network services to establish or modify a medical provider network (MPN) for the provision of medical treatment to injured employees. Existing law requires every MPN to post on its internet website information about how to obtain a copy of any notification regarding the MPN that is required to be given to an employee by regulations adopted by the administrative director. This bill would allow an injured employee to authorize their primary treating physician to request an electronic copy of any notification that an injury is subject to an MPN or that an employee is required to transfer treatment to an MPN. (2) Existing law requires an MPN to post and update a roster of all participating providers, including physicians and ancillary service providers, as defined, within the MPN. This bill would instead require the roster to include all physicians and would allow the roster to include persons or entities that provide or contract with persons or entities that provide ancillary services, treatment, management services, or coordinate patient care, as specified. (3) Existing law requires an insurer, employer, or entity that provides physician network services to submit a plan for the MPN to the administrative director. Existing law requires the director to approve a plan for an MPN if they determine it meets certain requirements and deems any plan the director does not act on in 60 days approved. Existing law requires that a plan for an MPN be periodically reapproved and prohibits the director from withholding approval or disapproving a medical provider network based solely on the selection of providers. This bill would, if the director disapproves a plan or determines that it contains deficiencies, require the director to allow the applicant 45 days to submit additional information and materials, as requested. The bill would require the director to respond within 30 days of receiving additional information and either approve the plan or request additional information or clarification. (4) Under existing law, an employer or insurer has the exclusive right to determine the members of their network, and prohibits the director from withholding approval or disapproving an MPN based on the selection of providers. This bill would specify that an employer or insurer has the right to determine the members of their network in regard to physicians if the physician is duly licensed and with the scope of their practice, and in regard to a person or entity that provides ancillary services regardless of whether the person or entity is doing business as a sole proprietorship, partnership, corporation, or other business entity.