(a) A network must file a modification request with
and receive approval from the department before the network makes
a material modification to its network configuration. The modification
request must be filed not later than 30 days prior to implementation
of the material modification.
(b) A modification request for a modification to network
configuration must include:
(1) a description and a map of the network's service
area or areas, with key and scale, that identifies each county, ZIP
code, partial ZIP code, or part of a county to be served as required
by §10.22 of this title (relating to Contents of Application);
(2) network configuration information, as required
by §10.22(11) of this title; and
(3) if the modification involves adding or modifying
telehealth service, telemedicine medical service, or teledentistry
dental service, an explanation of how the network would update its
provider directory, and any statements or restrictions on services
that can be provided via telehealth service, telemedicine medical
service, or teledentistry dental service.
(c) The applicant must file a copy of the form of any
new contracts or amendment of any existing contracts as described
by and required under §10.22(3), (4), and (5) of this title if
the modification of network configuration causes changes.
(d) A modification request is not considered complete
and reviewable until the department has received all information required
under this section, including any additional information the department
requests as needed to make the determination.
(e) Before the department considers a modification
request to modify a network's configuration, the applicant must be
in good standing with the department and in compliance with all applicable
requirements under this chapter; Insurance Code Chapter 1305, concerning
Workers' Compensation Health Care Networks; and Labor Code Title 5,
concerning Workers' Compensation.
(f) Prescribed modification request forms may be obtained
from:
(1) the department's website;
(2) the department's workers' compensation network
email address; or
(3) the MCQA mailing address.
(g) For purposes of this section, a material modification
includes a change to the network configuration that alters the ability
of the network to comply with the availability and accessibility requirements
described in §10.80 of this title (relating to Accessibility
and Availability Requirements).
|