| (a) A network must file a modification request with
and receive approval from the department before the network may expand,
eliminate, or reduce an existing service area, or add a new service
area. An officer or other authorized representative of the network
must verify the modification request by attesting to the truth and
accuracy of the information in the modification request.
(b) A modification request for a service area modification
must include:
(1) a description and a map with key and scale, showing
both the currently approved service area and the proposed new service
area, as required under §10.22(9) of this title (relating to
Contents of Application);
(2) network configuration information, as required
under §10.22(11) of this title; and
(3) separate and consolidated projections as described
in §10.22(13) of this title for the existing network, the proposed
new service area, and the proposed network.
(c) If a modification request for a service area changes
any of the following items, the applicant must file the new item or
any amendments to an existing item with the modification request filed
under this section:
(1) 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;
(2) a brief narrative description of the administrative
arrangements, organizational charts as required under §10.22(1)
of this title, and other pertinent information;
(3) biographical data, on a form prescribed by the
department, regarding each individual who governs or manages the affairs
of the network as required under §10.22(2) of this title; and
(4) a copy of each management contract as described
under §10.22(6) of this title.
(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 that determination.
(e) Before the department considers a service area
modification request, 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, in the existing service areas and in each proposed
service area.
(f) A corrected notice of network requirements and
employee information form and acknowledgment form that comply with
Insurance Code §1305.005, concerning Participation in Network;
Notice of Network Requirements; and §1305.451, concerning Employee
Information; Responsibilities of Employee; and §10.60 of this
title (relating to Notice of Network Requirements; Employee Information)
must be provided to affected employees.
(g) 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.
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