AB 2294 Summary

• Requires medical provider network (MPN) participating providers to actively participate at each location where they treat patients 8+ hours per week on a monthly average, and prohibits MPNs from restricting address updates for providers meeting this threshold.

• Prohibits authorizations or certifications from directing treatment to specific providers or locations within an MPN, and imposes $10,000 fines per document that preferentially directs care; requires all authorization documents include MPN identification number, name, and network information with $5,000 fines per non-compliant document.

• Establishes minimum (rather than maximum) medical fee schedules for non-physician services and prohibits insurance carriers from contracting with providers at rates below the official medical fee schedule.

• Requires providers reimbursed additional amounts through independent medical review to receive all filing fees within 5 business days, with $1,000 monthly penalties if not paid; presumes authorization granted if utilization review decisions not communicated within 5 days.

• Imposes $50,000 fines on MPNs and carriers when MPNs simultaneously fail access standards for a specialty and deny injured workers care outside the network; requires administrative director to maintain written compliance records and written approval for all MPN plans.