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MEDICAL PROVIDER NETWORK (MPN)

"A medical provider network (MPN) is an entity or group of health care providers set up by an insurer or self-insured employer and approved by DWC's administrative director to treat workers injured on the job. Under state regulations, each MPN must include a mix of doctors specializing in work-related injuries and doctors with expertise in general areas of medicine. MPNs are required to meet access to care standards for common occupational injuries and work-related illnesses. The regulations also require MPNs to follow all medical treatment guidelines established by the DWC and allow employees a choice of provider(s) in the network after their first visit. Additionally, MPNs must offer an opportunity for second and third opinions if the injured worker disagrees with the diagnosis or treatment offered by the treating physician. If a disagreement still exists after the second and third opinion, an injured worker in the MPN may request an independent medical review (IMR)."  DWC MPN page

Effective 1/1/14 for all date of injuries:

LC §4616(a)(3): A treating physician shall be included in the network only if...provides a separate written acknowledgment in which the physician affirmatively elects to be a member.

LC §4616(a)(4): Every MPN shall post on its Internet Web site a roster of all treating physicians in the medical provider network and shall update the roster at least quarterly.

LC §4616(a)(5): Every MPN shall provide one or more persons within the United States to serve as medical access assistants to help an injured employee find an available physician of the employee's choice.

SB 863 amended Labor Code §5502 to provide an expedited hearing for disputes over whether the injured employee is required to obtain treatment within a medical provider network, and no other issue may be heard until the medical provider network dispute is resolved. [Note that this is misnumbered and “paragraph (2)” should be “(B)”]

SB 863 amended Labor Code §4605, a statute which allows an employee to pay for a consulting or attending physician, to provide: “Any report prepared by consulting or attending physicians pursuant to this section shall not be the sole basis of an award of compensation. A qualified medical evaluator or authorized treating physician shall address any report procured pursuant to this section and shall indicate whether he or she agrees or disagrees with the findings or opinions stated in the report, and shall identify the bases for this opinion.”

Clearly SB 863 was designed to allow the employer to control medical treatment and medical evidence by tightening the purse strings, making it unlikely that anyone treating an injured worker outside the MPN-dominated system will get paid, or any evidence the employee pays for will be the basis for an award of compensation.

Note, however, that under Labor Code §4603.2(a)(2), “If the employer objects to the employee's selection of the physician on the grounds that the physician is not within the medical provider network used by the employer, and there is a final determination that the employee was entitled to select the physician pursuant to Section 4600, the employee shall be entitled to continue treatment with that physician at the employer's expense in accordance with this division, notwithstanding Section 4616.2.”

There is an independent medical review process for MPNs under Labor Code §4616.4. It is doubtful that this procedure is in use. A form is available for this purpose.

See, too, Liens, Medical Treatment

Label Item Links Comments
Labor Code Labor Code §4616: “...an insurer, employer, or entity that provides physician network services may establish or modify a medical provider network for the provision of medical treatment to injured employees.”

Labor Code §4603.2 governs non-network physician or services, billing, etc.

LC §4616



LC §4603.2

 
Continuity of care, termination of provider

Second and third opinions on diagnosis or treatment

Independent medical review process

LC §4616.2

LC §4616.3

LC §4616.4

This is not the second opinion under Labor Code §4601(a)

This is not the same "IMR" created by SB 863 to contest utilization review: See Independent Medical Review

Regulations/Rules

Medical Provider Network: latest regs eff. 8/27/14

New regulations: pdf copy

MPN Regs

Regs (pdf)

 
Cases  
Forms MPN forms
MPN forms   
Websites Division of Workers' Compensation MPN page DWC MPN  
  PDRater.com has an MPN list PDRater MPNs also try Google
Practice Tips The latest statistics show the vast majority of treatment is under the MPN system. SB 863 nailed most if not all exit doors shut, so “treatment on a lien” will soon be gone from the scene, if SB 863 survives legislative and appellate challenges. We need to work effectively within the system, encouraging good treaters to apply to MPNs, etc. Download the 3-13-13 CWCI study  
Articles CAAA 2013 Winter Convention Begins With a Focus on Medical Treatment Control, Expedited Hearings, and MPNs byDavid Bryan Leonard

Medical Provider Networks & Expedited Hearings: handout from DWC Educational Conference 2013

SB 863 Tweaks the Medical Provider Network Paradigm

Effect of SB 863 on MPNs, etc.


MPNs & EH

 

MPN Tweaks

 

 

Magazine Articles Medical Provider Networks: Journey through the Labyrinth by Marjory Harris, Esq. MPNs
 
Roundtable    
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