San Francisco, CA – The Office of Administrative Law (OAL) has approved the Division of Workers’ Compensation’s (DWC) final version of the Medical Treatment Utilization Schedule (MTUS) regulations. The MTUS regulations went into effect April 20, 2015.
“These regulations will clarify the process to be used to evaluate medical evidence and are required to be applied when there are competing recommendations and a dispute about which recommendation shall guide the injured worker’s medical care,” said Dr. Rupali Das, DWC Executive Medical Director. “The clarity will allow treating physicians, reviewing physicians and claims administrators to make better informed decisions and should reduce disputes over medical treatment.”
The MTUS regulations include:
- Clarification of the role of the MTUS as the primary source of guidance for treating physicians and physician reviewers for the evaluation and treatment of work-related illness or injury, and that the MTUS constitutes the standard of care for the provision of medical care in accordance with Labor Code section 4600.
- A description of the two limited situations that may warrant treatment based on recommendations found outside of the MTUS: (1) if the medical condition or injury is not addressed by the MTUS, or (2) if the MTUS’ presumption of correctness is successfully rebutted.
- Guidance in how to conduct a search for medical evidence in order for treating physicians and reviewing physicians to consistently and efficiently navigate the vast array of medical literature.
- Requirements for treating physicians and reviewing physicians to properly complete and document Requests for Authorizations, Utilization Review Decisions and Independent Medical Review Decisions as it relates to the medical evidence that the physician believes guides the reasonableness and necessity of the requested treatment.
- The methodology that shall be applied by reviewing physicians to evaluate the quality and strength of evidence used to support competing recommendations.
- An amendment to the composition of the Medical Evidence Evaluation and Advisory Committee to include two additional members, one from the pharmacology field and one from the nursing field.
The final regulations are posted on the DWC website.
Source: CA DIR