Workers’ Compensation Networks

1. Workers’ Compensation Networks Contingency Plans for Delegated WC Network Contracts Charles Reyna IV HWCNC & QA Division Texas Department of Insurance

2. Delegated WC Network Contract A contract under which a WC Network delegates one or more Required WC Network Functions to a third party.

3. Required WC Network Function A function which a WC Network is required to perform, e.g.: • Contracting with providers for care • Complaint resolution • Credentialing providers • Quality Improvement program

4. Third Party/Delegated Third Party Any entity/person other than: • the WC Network • the insurance carrier

5. Contingency Plan When a WC Network Delegates one or more required functions to a Third Party, the WC Network must have a plan for reassuming the delegated function(s) in the event of contract termination or failure to perform.

6. Required Contingency Plan Elements As applicable, include, but are not limited to, a description of: • the affected parties who must be notified; • who is responsible to perform the notification; • the request/provision of reports and related documentation; • the assignment of staff to reassume the delegated function; • training of any new staff to perform the reassumed function; • follow-up reporting of reassumed function; • any procedures for re-delegation to another third party; • any re-delegation procedures; and • any pre-delegation audits.

7. **NOTE** The Contingency Plan is not required to be included in, attached to or a part of the Delegated Contract.

8. Sample Contingency Plan Available at: tdi.texas.gov/wc/wcnet/documents/contingency.doc

9. TEXAS DEPARTMENT OF INSURANCE Health and WC Network Certification & QA 333 Guadalupe • P.O. Box 149104 Austin, Texas 78714-9104 866-554-4926 toll free • 512-322-4266 www.tdi.state.tx.us HWCN - Mail Code 103-6A • 512-490-1013 fax IRO - Mail Code 103-5A • 512-490-1011 fax WC Networks - MC 103-5B • 512-490-1028 fax