Section 4616.1 Of Article 2.3. Medical Provider Networks From California Labor Code >> Division 4. >> Part 2. >> Chapter 2. >> Article 2.3.
4616.1
. (a) An insurer, employer, or entity that provides physician
network services that offers a medical provider network under this
division and that uses economic profiling shall file with the
administrative director a description of any policies and procedures
related to economic profiling utilized. The filing shall describe how
these policies and procedures are used in utilization review, peer
review, incentive and penalty programs, and in provider retention and
termination decisions. The insurer, employer, or entity that
provides physician network services shall provide a copy of the
filing to an individual physician, provider, medical group, or
individual practice association.
(b) The administrative director shall make each approved medical
provider network economic profiling policy filing available to the
public upon request. The administrative director may not publicly
disclose any information submitted pursuant to this section that is
determined by the administrative director to be confidential pursuant
to state or federal law.
(c) For the purposes of this article, "economic profiling" shall
mean any evaluation of a particular physician, provider, medical
group, or individual practice association based in whole or in part
on the economic costs or utilization of services associated with
medical care provided or authorized by the physician, provider,
medical group, or individual practice association.