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State Compensation Insurance Fund filed a modification for the State Fund Medical Provider Network (MPN) Plan with the Division of Workers’ Compensation. The Division of Workers’ Compensation has approved the plan. With this approval there is a requirement that each covered employee must receive a copy of the revised Employee’s Guide to the State Fund Medical Provider Network brochure.
One of the savings provisions of Workers’ Compensation Reform (SB 899) is for employers to use a medical provider network (MPN) for the treatment of on-the-job injuries to employees. An MPN is an entity or group of providers set up by an insurer or self-insurer. Each MPN requires approval by the administrative director of the Division of Workers’ Compensation. Under this legislation, only insurers can set up an MPN, not employers. In the case of self-insurers, those business owners are their own insurer. They are acting in the capacity of insurer when setting up an MPN.
By utilizing the State Fund MPN, policyholders have medical control for the life of the claim, with limited exceptions. As a result, policyholders can begin to realize cost savings.
In addition, all employers must post and keep posted a notice that states the name of the current workers’ compensation insurance carrier of the employer, both in English and Spanish, in a conspicuous location frequented by employees, and where employees may easily read the notice during the workday hours. Please note that failure of the employer to post the notice required by law shall automatically permit the employee to be treated by his or her primary treating physician, who may or may not be a member of the State Fund MPN. If the primary treating physician is not a member of the State Fund MPN, State Fund may lose medical control over the claim. Please verify that the provider named in the posted notice is in the State Fund MPN. Overall, to comply with the law, State Fund offers three publications for you to use as follows:
When distributed as specified in the table, these publications can help policyholders provide employees with the timely and detailed information that the law requires. Please note that policyholders must distribute the most current version of the Employee’s Guide to the State Fund Medical Provider Network (03/06). Please destroy any prior versions. To request a printed supply of the 03/06 version for distribution, call our Customer Service Center. By law, we may implement the revised MPN plan after we have provided 30 days’ notice to all covered employees.
Of the legislative reforms, the MPN has the greatest potential to reduce medical treatment costs, bring further rate relief to California employers, and provide medical care to injured employees. To receive the full benefit of the cost reductions policyholders should channel every one of their injured employees to the State Fund MPN physicians. Taking full advantage of the State Fund MPN and California’s other recent reforms will net policyholders the best results for reducing claims costs. State Fund is committed to implementing all provisions of the reform.
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