CCSF Medical Provider Network For
Occupationally Injured Employees
|By Mike Hebet, Welfare Officer
POA Journal - July 7007
|Effective July 1, 2007 all San Francisco city employees who sustain job related injuries will be required to seek medical care follow-up from one of the physicians in the CCSF Medical Provider Network (MPN) unless the employee has properly pre-designated a qualified personal physician.
Acute and emergency medical care will continue to be provided at the California Pacific Medical Center - Davies Campus, the St. Francis Memorial Hospital, Kaiser Occupational Medicine (601 Van Ness) and the San Francisco General Hospital Occupational Medicine Clinic. Followup medical care for those without a pre-designated personal physician will be provided only by those physicians who are in the CCSF MPN. The Citys MPN now has 290 physicians with practices throughout the greater Buy Area (including Sacramento, Sonora / Angels Camp / San Andreas) in a wide variety of medical specialties.
The MPN is only for job related injuries/illnesses. For non-job injuries/illnesses, city employees will continue to seek medical care from their selected medical HMO/PPO (Kaiser, City Plan, Health Net, and Blue Shield).
Medical Provider Network
As of January 1, 2005 California law (Labor Code section 4616) allowed employers, or their insurers, to establish medical provider networks for the provision of medical treatment to injured employees. The network must include physicians primarily engaged in the treatment of occupational injuries as well as those primarily engaged in the treatment of non-occupational injuries. The number of physicians in the MPN must be sufficient to enable treatment for job related injuries or conditions to be provided in a timely manner. Furthermore, the medical specialties of the MPN doctors must be varied so that all injured employees will be able to secure adequate and competent treatment in the geographic area where the employees are employed.
A MPN is a group of health care providers (doctors) set up by an insurer or self-insured employer (such us CCSF) and approved by the State of California to treat workers injured on the job. Each MPN must include a mix of doctors specializing in work-related injuries and doctors with expertise in general areas of medicine such as orthopedics, pulmonary, neurology, dentistry, surgery, chiropractic, podiatry, pain management, cardiology, internal medicine dermatology, psychiatry, rheumatology, gastroenterologist, allergy/immunology, ear/nose/throat, radiology etc. MPNs must allow employees a choice of provider(s) in the network after the employees first visit to the acute/ emergency medical facility. Furthermore, employees must be allowed to change their MPN doctor for any reason. MPN providers must be listed by geographical region of their practice as well as their medical specialty. Medical treatment for job injuries must be readily available at reasonable times to all employees. It must also be readily accessible.
The CCSF recently sought approval of its MPN plan from the administrative director of the California Department of Industrial Relations. That plan was approved for implementation on and after July 1, 2007. California regulations (section 9767.12) require that the CCSF notify each of its employees in writing about the use of its MPN prior to its implementation. Additional notification is required for newly hired employees and covered employees at the time they report a job injury. These written notifications must include MPN information such as: contact persons and phone numbers, description of MPN services, an MPN provider directory, instructions as to how to access MPN medical care, how to choose an MPN physician, how to change a physician in the MPN, how to get a specialist referral, standards of transfer of care from a non-MPN physician to an MPN physician, and how to get 2nd and 3rd opinions about any proposed MPN medical care.
The CCSF MPN must give an occupationally injured city worker a regional list of all providers that includes at least three physicians in each specialty commonly used to treat work injuries/illnesses. The MPN must also provide access to primary care physicians within 15 miles and specialists within 30 miles of your employment/residence. If you live outside the MPN service area, you will be allowed to choose your own doctor. The MPN must provide initial treatment within 3 days and must furnish specialist treatment within 20 days of your request.
The Citys Department of Human Resources has mailed out required notifications (40,000 packets) to all city employees and did conduct 20 information sessions at various locations (Main Library, City Hall, SF Port, and the SF International Airport). It further provided all employees with a CCSF Medical Provider Network Handbook.
Pre-designation of Personal Physician
City employees were provided with a pre-designation of personal physician form (DWC form 9783) which states: In the event you sustain an injury or illness related to your employment, you may be treated for such injury or illness by your personal medical doctor (MD) or doctor of osteopathic medicine (DO). To pre-designate several requirements must be met: (1) CCSF must offer group health coverage (it does); (2) your doctor is your regular physician who has previously directed your medical treatment and who retains your medical records; (3) your physician is a licensed general practitioner, internist, obstetrician, gynecologist, or family practitioner; (4) prior to your job injuries, your doctor agrees to treat you (note: your pre-designated personal physician is not required to sign this form); and (5) prior to your job injury, you have completed and submitted the pre-designation form to your employer. Your personal physician may be a medical group (Kaiser) as long as that group is predominantly involved in the treatment of non-occupational injuries /illnesses.
Chiropractors and acupuncturists can no longer be pre-designated. However, there are chiropractors that can be selected on the CCSF MPN and your pre-designated or MPN doctor can refer you to a chiropractor or acupuncturist. All pre-designations (1st day, 30 day) previously submitted are no longer valid and will not be recognized by the Citys compensation division.
You must go to the CCSF acute and emergency care facility for initial care. Thereafter follow-up care is provided by either your pre-designated doctor or your selected MPN doctor.
Treated for a Work-Related Injury Before the CCSF MPN Begins?
If you are currently under medical care for an occupational injury, there will be no immediate transfer to a doctor within the CCSF MPN. The workers compensation division will evaluate all open medical care claims. You qualify for continuing treatment with your non-MPN doctor for up to a year if your injury or illness meets any of the following conditions: (a) acute - treatment will be completed in 90 days; (b) serious or chronic - no full cure within 90 days, will stay with your current treater for up to 1 year; (c) terminal- death likely within one year, stay with your current doctor; and (d) pending surgery which has been authorized - no transfer if the surgery completed in 180 days. You can disagree with any decision of the compensation division to transfer your medical care and make use of the procedures to express this disagreement.
If you have properly pre-designated a primary treating doctor, you will not be transferred into the MPN.
What To Do Now
If you wish to pre-designate your personal physician to treat you fur occupational injuries or illnesses, complete the Pre-designation Form (DWD form 9783) and forward it as instructed on the form. The POA Union maintains a record of pre-designations; please send a copy to Welfare Officer Mike Hebel Local 798 if you wish to be included in this record-keeping.
If you need further information or clarification, contact Anthony LaCombe who is the CCSF MPN designated contact person. Anthony can be reached at (800) 394-9304. To access the MPN directory of doctors, go to: http://pponetwork.com/CCSF.