What Is 8 CCR §9767.5: MPN Access Standards?

An MPN must have at least three available primary treating physicians and a hospital for emergency health care services, or if separate from such hospital, a provider of all emergency health care services, within 30 minutes or 15 miles of each covered employee's residence or workplace.

What is 8 CCR §9767.5?

Section 9767.5 is the Title 8 rule that sets exact distance and time limits for a Medical Provider Network, not just a loose standard of reasonable access.

An MPN, short for Medical Provider Network, is the roster of doctors an employer or its insurer lines up to treat injured workers. This site's MPN guide covers how an MPN works overall. Section 9767.5 is the part of that framework that forces every MPN to actually be close enough and fast enough to use. It applies to every MPN approved to treat California injured workers, whether the employer chose the network, you predesignated your own doctor, or a third-party administrator is running the claim.

How close must your MPN doctor be?

Your primary doctor and emergency care must be within 30 minutes or 15 miles. A specialist for your injury can be within 60 minutes or 30 miles instead.

The MPN must keep at least three available primary treating physicians, plus a hospital or other emergency provider, inside the shorter distance. For a specialist who treats the kind of injury common in your occupation or industry, the network can use the longer limit. Both limits are measured from your home or your jobsite, whichever gives you the shorter trip.

How fast can you get an appointment?

A first visit is due within 3 business days of your request. A specialist visit is due within 20 business days, with a 10-day checkpoint.

For a routine, non-emergency visit, the MPN must get you a first appointment within 3 business days of telling its medical access assistant you need treatment. For a specialist referral, the network has 20 business days to schedule an appointment in the right referred specialty. If the medical access assistant has not scheduled that specialist visit within 10 business days of your request, the regulation requires your employer to let you obtain the treatment from an appropriate specialist outside the MPN.

Who answers your calls about scheduling?

Every MPN must staff a medical access assistant, based in the United States, who helps you book care in English or Spanish.

Section 9767.5(h) requires at least one medical access assistant to be reachable 7 a.m. to 8 p.m. Pacific time, Monday through Saturday, with someone able to take a voice message and respond by the next business day, excluding Sundays and holidays. The assistant's listed duties include contacting provider offices and scheduling your appointments. This site's MPN doctor list guide explains how to find the roster of providers the assistant books you into.

What if the network cannot meet these limits, or you are away from its area?

The MPN must have a written policy letting you go outside the network when it cannot deliver timely, nearby care, or when you live or work outside its service area.

In a genuine health care shortage area, the Administrative Director can approve alternative access standards for that part of the state, but the MPN has to apply in writing and explain why. Outside that narrow exception, if the network cannot get you reasonable and necessary treatment inside the standards and deadlines above, it must have a written policy letting you see an appropriate specialist outside it. The same is true for ancillary services, such as physical therapy or durable equipment, that are not available nearby. If you are temporarily working, traveling, or recovering outside the MPN's geographic area, it must give you a list of at least three outside physicians who meet the same access standards. And if your treating physician refers you to a specialty the MPN does not include, you may pick a specialist from outside it.

What Labor Code sections does this regulation put into practice?

Section 9767.5 carries out the Labor Code's own access and timely-treatment duty for every MPN.

Labor Code section 4616 is the law that lets an employer or insurer set up an MPN, and it requires medical treatment to stay readily available and accessible to every covered worker; subdivision (h) of that section is what directed the Administrative Director to write this regulation. This card covers that section. Section 4616.3 separately lets you ask for a second opinion, then a third, from other MPN doctors if you disagree with your doctor's diagnosis or treatment plan. This card explains that process, a different question from the access standards here. A related rule, 8 CCR 9767.6, covers how you first get treatment inside the MPN and change doctors after your first visit.

What should you do if your MPN cannot get you timely care?

Write down the date you asked for an appointment and who you asked. If a routine visit has not been offered inside 3 business days, or a specialist visit inside 20 business days (10 if no one has even tried to schedule it), say so in writing and ask for the written policy that lets you go outside the network. Call (661) 273-1780 or use the contact form if your MPN is missing these deadlines or you are not sure the network is really within reach of your home. Yazdchi Law P.C. reviews each workers' compensation matter on its own facts before deciding whether to take it on, from its office in Palmdale. If a workers' comp attorney takes on your MPN problem, the usual fee is 15% to 18% of what the claim recovers, and a workers' compensation judge must approve it under Labor Code section 4906. The attorney cost guide covers that approval process in full.