Califonia Seeks Comments on Workers’ Comp Medical Treatment Utilization Schedule Regs

March 26, 2010

California’s Division of Workers’ Compensation has posted an online forum for members of the public to review and comment on a draft of proposed regulations to update the medical treatment utilization schedule (MTUS). The proposed regulations would update the methods to review scientific evidence and apply this to new evidence accompanying requests for treatment and diagnostic services by treating physicians.

The MTUS’s grading methodology, currently based on the American College of Occupational and Environmental Medicine’s (ACOEM) strength of evidence rating methodology, is being replaced by DWC’s updated methods to evaluate scientific evidence.

The proposed updated regulations include:

  • · New definitions of terms applicable to the specific revised sections within the MTUS.
  • · A new grading methodology offering a comprehensive and uniform approach to evaluating the various types of evidence to support effective treatment to injured workers. It sets forth a method to insure that treatment received by injured workers is current and consistent with advances in scientific medical evidence. The new methodology to grade the overall quality of the scientific evidence base is adapted from various sources including the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group’s rating methodology, the Neck Pain Task Force criteria for evaluating dire clinical scenarios, the Oxman Criteria for evaluating systematic reviews, the Cochrane Back Review Group criteria for evaluating randomized controlled trials, and the U.S. Preventive Services Task Force criteria for evaluating observational studies.
  • · A streamlined utilization review (UR) process to assist UR physicians to evaluate whether the treating physicians’ requests for treatment and diagnostic services are supported by scientific evidence.
  • · A dispute resolution process consistent with the UR regulations.
  • · A requirement that DWC post to the Web site evidence reviews as they become available. The posting of the evidence reviews will further assist UR physicians and qualified medical evaluators (QME) to determine the quality of the scientific evidence supporting the requests for authorization of treatment. Additionally, the treating physician will have access to the posted evidence reviews to consider when requesting medical treatment.

The forum can be found at: http://www.dir.ca.gov/dwc/DWCWCABForum/mtus.htm and members of the public may comment until Thursday, April 8, 2010.

The proposed regulations are authorized by Labor Code sections 5307.27 and 4604.5 which require the DWC administrative director (AD) adopt a medical treatment utilization schedule that provides an analytical framework for evaluation and treatment of injured workers consistent with scientific, nationally recognized, evidence-based guidelines.

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