Chapter
1305
Workers' Compensation Health Care Networks
Sections
1305.001
Short Title
1305.002
Purpose
1305.003
Limitations on Applicability
1305.004
Definitions
1305.005
Participation in Network; Notice of Network Requirements
1305.006
Insurance Carrier Liability for Out-of-network Health Care
1305.007
Rules
1305.008
Administrator Certificate of Authority Required
1305.051
Certification Required
1305.052
Certificate Application
1305.053
Contents of Application
1305.054
Action on Application; Renewal of Certification
1305.055
Use of Certain Insurance Terms by Network Prohibited
1305.056
Restraint of Trade; Application of Certain Laws
1305.101
Providing or Arranging for Health Care
1305.102
Management Contracts
1305.103
Treating Doctor; Referrals
1305.104
Selection of Treating Doctor
1305.106
Payment of Health Care Provider
1305.107
Telephone Access
1305.151
Transfer of Risk
1305.152
Network Contracts with Providers
1305.153
Provider Reimbursement
1305.154
Network-carrier Contracts
1305.155
Compliance Requirements
1305.201
Network Financial Requirements
1305.251
Examination of Network
1305.252
Examination of Provider or Third Party
1305.301
Network Organization; Service Areas
1305.302
Accessibility and Availability Requirements
1305.303
Quality of Care Requirements
1305.304
Guidelines and Protocols
1305.351
Utilization Review in Network
1305.353
Notice of Certain Utilization Review Determinations; Preauthorization Requirements
1305.354
Reconsideration of Adverse Determination
1305.355
Independent Review of Adverse Determination
1305.356
Contested Case Hearing on and Judicial Review of Independent Review
1305.401
Complaint System Required
1305.402
Complaint Initiation and Initial Response; Deadlines for Response and Resolution
1305.403
Record of Complaints
1305.404
Retaliatory Action Prohibited
1305.405
Posting of Information on Complaint Process Required
1305.451
Employee Information; Responsibilities of Employee
1305.502
Consumer Report Cards
1305.503
Confidentiality Requirements
1305.551
Determination of Violation; Notice
1305.552
Disciplinary Actions
1305.1545
Restrictions on Payment and Reimbursement
