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| Montana Administrative Register Notice 24-29-256 | No. 9 05/12/2011 | |
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BEFORE THE DEPARTMENT OF LABOR AND INDUSTRY STATE OF
TO: All Concerned Persons 1. On June 6, 2011, at 10:00 a.m., the Department of Labor and Industry (department) will hold a public hearing to be held in the auditorium of the 2. The department will make reasonable accommodations for persons with disabilities who wish to participate in this public hearing or need an alternative accessible format of this notice. If you require an accommodation, contact the department no later than 5:00 p.m. on May 31, 2011, to advise us of the nature of the accommodation that you need. Please contact the Employment Relations Division, Department of Labor and Industry, Attn: Bruce Chamberlain, 3. GENERAL STATEMENT OF REASONABLE NECESSITY: There is reasonable necessity to adopt rules to implement the utilization and treatment (U&T) guideline provisions of Chapter 167, Section 10, Laws of 2011 (House Bill 334). Chapter 167 amended the original U&T guideline statutory language that was put in place by Chapter 330, Section 1, Laws of 2007 (House Bill 738) and Chapter 117, Section 6, Laws of 2007 (Senate Bill 108). The Montana Department of Labor and Industry had begun the process of implementing the previous two bills in proposed administrative MAR Notice number 24-29-249, published on September 23, 2010. A hearing was held on October 15, 2010. Based in part on comments received, the department decided to issue a new notice proposing the utilization and treatment guidelines. Before a new notice was issued, the 2011 Legislature, through Chapter 167, amended 39-71-704, MCA. The department delayed issuing a new notice until the legislative changes became final. As a result, this proposed rule notice addresses both the changes to 39-71-704, MCA, and the comments received from the previous notice. The following statement describes the process the department followed in developing this proposal. After the U&T guideline legislation was first put into place in 2007, a group was formed in the Employment Relations Division under the project name "Utilization and Treatment Guidelines." The U&T project team implemented a project charter, with the purpose to engage the various stakeholders in the process in order to identify and evaluate different U&T guidelines and choose and implement the most appropriate U&T guideline. Under the U&T project charter, the department established a stakeholder committee of treatment providers from around The Medical Provider Group met seven times in open meetings from August 2009 through February 2010 and reviewed four U&T guidelines: Washington State Treatment Guidelines, Colorado State Treatment Guidelines, Work-loss Data Institute Occupational Disability Guidelines (ODG) and In its review of the four U&T guidelines, the Medical Provider Group rated each guideline on both ease of use and content. After extensive review, discussion, and presentations concerning the four U&T guidelines, the Medical Provider Group voted and recommended that the State of Montana have guidelines which incorporate the State of Colorado's Medical Treatment Guidelines (Colorado Guidelines) as the primary source of guidelines for treating injured workers in Montana. The Medical Provider Group then voted and recommended that the department adopt either ODG or ACOEM for those areas not covered by the Colorado Guidelines. Based on the recommendation the Medical Provider Group made to the department, the U&T project team prepared and conducted a Request for Proposal (RFP) process through the Department of Administration's Procurement Office. The purpose of the RFP was to find vendors that would develop a content delivery system for implementing U&T guidelines in Montana, with Colorado Treatment Guidelines as the primary source and either ODG or ACOEM as the secondary source. Through the RFP process, the successful vendor was ACOEM. The department is contracting with ACOEM to build and host a content delivery system for implementation of the U&T guidelines and for the license to use portions of ACOEM for those areas not covered in the Colorado Guidelines. The department intends for the online product to be the "Montana Guidelines" and be a user friendly online system of seamless integration between Colorado Treatment Guidelines and ACOEM guidelines. The Montana Guidelines are available to all users at http://www.mtguidelines.com. The Department will make a hardcopy of the Montana Guidelines available upon request, which may be obtained for the cost of reproduction. This notice proposes to both adopt new rules and amend existing rules to implement the U&T guidelines. Proposed New Rule I, "Utilization and Treatment Guidelines," adopts the specific U&T guidelines as the Montana Guidelines. As now provided by 39-71-704, MCA, there is a rebuttable presumption that the U&T guidelines adopted by the department establish compensable medical treatment for primary and secondary medical services for an injured worker. Since the U&T guidelines are presumed compensable, proposed New Rule II for "Prior Authorization" outlines a process for those requested treatment(s) or procedure(s) not addressed, not recommended, or procedures requiring prior authorization by the Montana Guidelines, for treatments or procedures sought after maximum medical healing and for those treatments exceeding duration or frequency limits in the Guidelines. Section 39-71-704, MCA, also allows the department to adopt an independent medical review process for when treatment is denied. Proposed New Rule III sets out an "Independent Medical Review Process" by a designated Medical Director. If a treatment or procedure is denied, injured workers, providers, or insurers may utilize this process for dispute resolution in an effort to provide prompt and appropriate care. Proposed New Rule IV explains that the U&T guidelines are applicable to managed care organizations and preferred provider organizations that contract with workers' compensation insurers and self-insured employers to provide medical care to injured workers. Because the presumption of compensable treatment provided for in 39-71-704, MCA, only applies to injuries that occur on or after July 1, 2007, proposed New Rule V notes that the U&T guidelines establish reasonable care for injuries before that date. In other words, the U&T guidelines proposed for adoption by the department are applicable for all treatment services, both primary and secondary, including chiropractic services and occupational and physical therapy services, provided to the injured worker under the Montana Workers' Compensation Act, regardless of the date of injury. There is reasonable necessity to amend a number of existing administrative rules under ARM Title 24, chapter 29, subchapter 14, "General Medical Rules and Facility Service Rules", and ARM Title 24, chapter 29, subchapter 15, "Nonfacility Service Rules and Utilization Rules" to coordinate with the proposed new rules and ensure that otherwise inconsistent provisions are removed. Any updates to these rules must be undertaken by the department according to the requirements of the Montana Administrative Procedure Act. As part of the responsibilities of the position, the medical director will monitor new procedures and technologies that should be addressed in any updates. The person in this position will, in consultation with health care providers with relevant experience and education, provide for an annual review of the evidence-based utilization and treatment guidelines to consider amendments or changes to the guidelines. The department proposes to make the proposed adoptions and amendments effective as of July 1, 2011. The department reserves the right to make the adoptions and amendments effective at a later date, or not at all. The department reserves the right to adopt or amend only some of the rules identified in this notice. This general statement of reasonable necessity applies to all of the rules proposed for adoption and amendment and will be supplemented as necessary for any given rule. 4. The proposed new rules provide as follows: NEW RULE I Utilization and Treatment Guidelines (1) The department adopts the utilization and treatment guidelines provided by this rule to set forth the level and type of care for primary and secondary medical services. As provided by 39-71-704, MCA, there is a rebuttable presumption that the Montana Guidelines establish compensable medical treatment for primary and secondary medical services for the injured worker. The utilization and treatment guidelines are titled the "Montana Utilization and Treatment Guidelines, 1st edition, 2011" (the Montana Guidelines or guidelines), are found on-line via the internet at http://www.mtguidelines.com, and are incorporated herein by reference. The Montana Guidelines adopted by reference in (1) may be obtained from the Montana Department of Labor and Industry as follows: (a) an electronic copy is available at the web site: http://www.mtguidelines.com; or (b) a printed copy may be obtained for the cost of reproduction from the Employment Relations Division, Department of Labor and Industry, (2) The guidelines include the following nine chapters and General Guideline Principles which are included at the beginning of each chapter: (a) Low Back Pain; (b) Shoulder Injury; (c) Upper Extremity; (d) Lower Extremity; (e) Chronic Regional Pain Syndrome; (f) Cervical Spine Injury; (g) Chronic Pain Disorder; (h) Traumatic Brain Injury; and (i) Eye Injury. (3) When providing treatment for primary and secondary medical services to an injured worker, all health care providers shall use the Montana Guidelines adopted by reference in (1). (a) In cases where treatment(s) or procedure(s) are recommended by the Montana Guidelines, prior authorization is unnecessary unless the Montana Guidelines specify otherwise. (b) The department recognizes that medical treatment may include deviations from the Montana Guidelines as individual cases dictate. The provider or interested party shall follow the procedure for prior authorization under [New Rule II] for cases in which treatments or procedures are requested that is: (i) not specifically addressed or recommended by the Montana Guidelines for a body part that is covered by a guideline; (ii) after maximum medical improvement; or (iii) beyond the duration and frequency limits set out in the guidelines. (c) An insurer is not responsible or liable for treatment(s) or procedure(s) as set out in (3)(b) unless: (i) prior authorization is obtained from the insurer pursuant to 39-71-704, MCA, and in accordance with [New Rule II]; or (ii) the treatment(s) or procedure(s) were provided in a medical emergency. (d) For those body parts not included in one of the guideline chapters, providers must apply and follow the general guideline principles that are found at the beginning of each chapter, and an insurer is liable for reasonable medical treatment. (4) All insurers shall routinely and regularly review claims to ensure that care is consistent with the Montana Guidelines adopted by reference in (1). (5) The provisions of this rule and the Montana Guidelines incorporated by reference in (1) apply to medical services provided on or after July 1, 2011. AUTH: 39-71-203, 39-71-704, MCA IMP: 39-71-704, MCA REASON: There is reasonable necessity to adopt New Rule I to implement the Legislature's direction to the department to implement U&T guidelines for workers' compensation patients. Under the proposed rule, if a treatment is recommended in the guidelines, that treatment is considered preauthorized, regardless of the level of the evidence used to describe it, such as "generally well accepted," "generally accepted," or other description. Those procedures considered inappropriate, unreasonable, or unnecessary are designated in the guideline as "not recommended." If the guidelines explicitly require prior authorization for a treatment, prior authorization must be obtained by following the procedures in New Rule II. U&T guidelines are reasonable and necessary because medical costs comprise a greater percentage of the benefits paid in NEW RULE II Prior Authorization (1) Prior authorization must be obtained in cases where treatment(s) or procedure(s) are requested that: (a) are not specifically addressed or recommended by the Montana Guidelines for a body part that is covered by a guideline; (b) are after maximum medical improvement; (c) are beyond the duration and frequency limits set out in the guidelines; or (d) the guidelines require prior authorization before proceeding with the treatment. (2) For those body parts not covered by a guideline, the rule for prior authorization set out at ARM 24.29.1517 applies. (3) When the guidelines explicitly require prior authorization for a treatment or modality, documentation need only include the clinical indications outlined in the guidelines to support that the treatment or modality is appropriate for the injured worker. (4) When prior authorization is required because an interested party wishes to rebut the presumption of the guidelines, the interested party must submit to the insurer documentation to support the request and justification that the medical treatment(s) or procedure(s) are reasonable and necessary care for the injured worker. Documentation must consist of a preponderance of credible medical evidenced-based material and medical reasons to rebut the Montana Guidelines. Documentation submitted to rebut the guidelines may include any information from the following list. However, nothing in this list is intended to imply that any given information is sufficient to rebut the guidelines. Rather, whether the presumption of the guidelines is rebutted can only be determined on a case-by-case basis. Submitted information may include: (a) an explanation or documentation of how the patient's medical condition is different from the medical indications used in the (b) an explanation or documentation of objective findings and functional improvements that would be the expected result of the treatment(s) or procedure(s), either from past experience or from an explanation about the mechanism of injury and the effect of the treatment(s) or procedure(s), and where improvement can be measured; (c) an explanation or documentation of objective signs of functional restoration for treatment conducted thus far; (d) an explanation or documentation of measurable goals and progress points expected from additional treatment; (e) a statement of how the request will benefit both a short-term and long-term treatment plan; or (f) any additional evidence-based utilization and treatment guidelines or studies that support the interested party's case. (5) All prior authorization requests, whether in written, telephone, e-mail, or facsimile (fax) form, must be made at least 14 days prior to the date the service is scheduled to be performed. If the prior authorization request was made by telephone, the burden of proof for showing that the request was made rests with the interested party who made the request. (a) Authorization is presumed to be given by the insurer if there is no written denial sent by the insurer to the interested party within 14 days of either the date the verbal prior authorization request was made or the date the written prior authorization request was mailed. (b) An insurer may notify the interested party of authorization by written confirmation, telephone, e-mail, or facsimile (fax). If an insurer provides authorization by telephone, the burden of proof for showing that authorization was granted rests with the interested party. The interested party shall promptly send the insurer written confirmation of any verbal authorization made by the insurer. Such written confirmation shall refer to the name of the claimant, the claim number, the treatment(s) or procedure(s) authorized, and the name of the person giving the authorization and the date the authorization was given. (6) If the insurer denies the prior authorization request, the denial must be in writing and must contain an explanation of the reason(s) for the denial. (a) The denial must not be based solely on the fact that the medical treatment(s) or procedure(s) are not specifically addressed or recommended by the Montana Guidelines. (b) If the written denial is five or fewer days before the expiration of the 14- day response period, the insurer must also notify the interested party of the denial by e-mail or facsimile (fax). (7) When an insurer denies liability for an injury or occupational disease, and the insurer then later assumes liability for a particular condition, the insurer may not deny payment for the medical services provided for that condition during the period of denial based solely on failure to obtain prior authorization. (8) The provisions of this rule apply to medical services provided, or proposed to be provided, on or after July 1, 2011. AUTH: 39-71-203, 39-71-704, MCA IMP: 39-71-704, MCA REASON: Because 39-71-704, MCA, provides that the Montana Guidelines establish a rebuttable presumption, there is reasonable necessity to define the level and type of evidence needed to rebut the guidelines. The proposed rule establishes that in order to rebut the guidelines, documentation must amount to a preponderance of credible medical evidence. The rule also provides that the evidence must include, at a minimum, a written explanation of the medical basis for varying from the guidelines. The rule also proposes additional types of evidence that may be provided. Because 39-71-704, MCA, provides for treatment variations from the guidelines through the mechanism of prior authorization from an insurer, the rule also provides that denials must explain the reason for the denial. To deny requests for prior authorization based solely on the argument that the treatment is not in the guidelines, is a contradiction to the purpose of allowing prior authorization in the first place. NEW RULE III Independent Medical Review Process (1) An interested party who has requested and been denied authorization by the insurer for treatment, or an insurer, may request an independent medical review by the medical director designated by the department prior to mediation under 39-71-2401, MCA. A request for medical review is not mandatory in order to proceed to mediation. (2) The interested party or insurer must submit its request for review to the department and must notify the other party of its request for review. Upon notice of a request for review, the insurer must submit a copy of the request for prior authorization, the denial, and any other relevant medical information to the department. The interested party and the insurer may also submit additional information to the department, if the information falls within the categories outlined in [New Rule II]. Any new information submitted to the department must also be submitted to the other party. (3) The medical director will review the medical records of the injured worker and other information relevant to the denial and issue a recommendation. For purposes of this rule, the medical director is the specific individual designated by the department to serve as the medical director with respect to a given set of disputed treatments or procedures. The medical director may seek consultation from other providers with specialties as would typically manage the medical condition at issue. If a consultation is sought and received, that provider's recommendation is also subject to the provisions of this rule. (4) The medical director shall, within five days of receipt of the request for review, issue a written recommendation to the interested party and the insurer by mail, facsimile, or e-mail, or issue a notice that additional information or time is required to tender a recommendation along with an approximate date the recommendation will be issued, not to exceed 14 days from the date of receipt of the review request. If the medical director does not issue a recommendation within 14 days, the request for review is deemed denied and the parties may proceed to mediation. (5) The medical director's review and recommendation is an informal alternative dispute resolution process without administrative or judicial authority and is not binding on the parties. (a) The medical director's files and records are closed to all persons but the parties. (b) The medical director may not be called to testify in any proceeding concerning the issues discussed in the independent medical review process. (c) The medical director's recommendation and any information contained in the recommendation that is solely from the medical director are not admissible as evidence in any action subsequently brought in any court of law. (d) The medical director's recommendation, including information contained in the recommendation, may be considered in mediation conducted under 39‑71‑2401, MCA. (6) The insurer shall, within five days of receipt of the recommendation, notify the interested party if the previously denied treatment(s) or procedure(s) is authorized based on the medical director's recommendation. (7) If the insurer does not authorize treatment after issuance of the medical director's recommendation, the interested party may file for mediation with the department pursuant to 39-71-2401, MCA. (8) The provisions of this rule apply to medical services provided, or proposed to be provided, on or after July 1, 2011. AUTH: 39-71-203, 39-71-704, MCA IMP: 39-71-224, 39-71-704, 39-71-2401, MCA REASON: There is reasonable necessity to propose New Rule III to set out a process for an independent medical review because Chapter 167, L. of 2011, provides for such review. The department believes this procedure will streamline disputes over medical treatment, by providing for independent medical input on disputed care. Because this medical review process is similar to mediation and because the medical director's recommendation is advisory, the records of the mediation are closed. Further, to allow the medical director to testify would essentially create a situation where the medical director is in court all the time, acting as an expert for one side or the other. This process is instead intended to allow for medical discussions to find reasonable expedited resolution where possible. NEW RULE IV Applicability of Utilization and Treatment Guidelines for Managed Care ORGANIZATIONS or preferred provider organizations (1) Managed care organizations or preferred provider organizations providing any treatment for primary and secondary medical services to an injured worker shall use the Montana Guidelines. This rule does not alter or change how managed care organizations or preferred provider organizations are paid pursuant to 39-71-704, MCA. (2) The provisions of this rule apply to medical services provided, or proposed to be provided, on or after July 1, 2011.
AUTH: 39-71-203, 39-71-704, MCA IMP: 39-71-704, MCA REASON: There is reasonable necessity to propose New Rule IV to specify that the utilization and treatment guidelines adopted by the department must be used by managed care organizations (MCOs) and preferred provider organizations (PPOs) but do not affect payment and reimbursement agreements made between MCOs and PPOs and insurers. NEW RULE V APPLICABILITY OF UTILIZATION AND TREATMENT RULES (1) The following rules are subject to the applicability provisions of this rule: (a) [NEW RULE I]; (b) [NEW RULE II]; (c) [NEW RULE III]; and (d) [NEW RULE IV]. (2) The rules identified in (1) apply to: (a) injuries that occurred on or before June 30, 2007, for any treatment rendered on or after July 1, 2011, except that the provisions of (3) apply; and (b) injuries that occurred on or after July 1, 2007, for any treatment rendered on or after July 1, 2011. (3) The presumption of compensability in the (4) As used in this rule, the term "injuries" includes occupational diseases which were diagnosed as an occupational disease, or should have been diagnosed as an occupational disease, during the time period specified. AUTH: 39-71-203, 29-71-704, MCA IMP: 39-71-704, MCA REASON: There is reasonable necessity to adopt NEW RULE V in conjunction with the 5. The rules proposed to be amended provide as follows, new matter underlined, deleted matter interlined: 24.29.1401A DEFINITIONS As used in subchapters 14 and 15, the following definitions apply: (1) through (8) remain the same. (9) "Department" means the Montana Department of Labor and Industry. (9) and (10) remain the same but are renumbered (10) and (11). (12) "Evidence-based" means use of the best evidence available in making decisions about the care of the individual patient, gained from the scientific method of medical decision-making and includes use of techniques from science, engineering, and statistics, such as randomized controlled trials (RCTs), meta-analysis of medical literature, integration of individual clinical expertise with the best available external clinical evidence from systematic research, and a risk-benefit analysis of treatment (including lack of treatment). (11) through (16) remain the same but are renumbered (13) through (18). (19) "Insurer" has the same meaning as provided by 39-71-116, MCA. (20) "Interested party" means: (a) the "physician" or "provider" as defined by this rule; (b) the "claimant" or "injured worker"; or (c) the representative of the injured worker. (21) "Maintenance care" has the same meaning as provided by 39-71-116.htm" target="MCA">39 -71-116, MCA. (22) "Medical director" means a person who is an employee of, or contractor to, the department, and who is responsible for the independent medical review of requests for treatment(s) or procedure(s) that are not specifically addressed or recommended by the Montana Guidelines, when those requests are denied, and whose responsibility will also include other areas to be determined by the department. A person serving as a medical director must be a physician licensed by the state of (23) "Medical stability", "maximum medical improvement", "maximum healing", or "maximum medical healing" has the same meaning as provided by 39-71-116.htm" target="MCA">39 -71-116, MCA. (17) through (20) remain the same but are renumbered (24) through (27). (28) "Palliative care" has the same meaning as provided by 39-71-116.htm" target="MCA">39 -71-116, MCA. (21) remains the same but is renumbered (29). (30) "Primary medical services" has the same meaning as provided by 39-71-116.htm" target="MCA">39 -71-116, MCA. (a) with respect to services provided on or before June 30, 2011, that for those matters identified by ARM 24.29.1517 the provider receives (either verbally or in writing) authorization from the insurer to perform a specific procedure or series of related procedures, prior to performing that procedure; and (b) with respect to services provided on or after July 1, 2011, the interested party receives prior authorization (either verbally or in writing) from the insurer to perform treatment for those cases identified by [New Rule II]. (23) and (24) remain the same but are renumbered (32) and (33). (34) "Rebuttable presumption" means that the (25) and (26) remain the same but are renumbered (35) and (36). (37) "Secondary medical services" has the same meaning as provided by 39-71-116, MCA. (27) through (29) remain the same but are renumbered (38) through (40). (a) With respect to services provided on or before June 30, 2011, the (b) With respect to services provided on or after July 1, 2011, a treatment plan must be made in accordance with the
AUTH: 39-71-203, MCA IMP: 39-71-116, 39-71-704, MCA
REASON: There is reasonable necessity to amend the definitions rule applicable to ARM Title 24, chapter 29, subchapter 14 for General Medical Rules and Facility Service Rules and subchapter 15 for Nonfacility Service Rules and Utilization Rules to define common medical terms used in utilization and treatment guidelines for primary and secondary medical services for the injured worker, such as: "evidence-based"; "maintenance care"; "medical stability", "maximum healing", or "maximum medical healing"; "palliative care"; "primary medical services"; and "secondary medical services". There is reasonable necessity to define the term "medical director" to clarify that this individual is a physician licensed by the state of
24.29.1402 Payment of Medical Claims (1) As required by 39‑71‑704, MCA, charges submitted by providers must be the usual and customary charge billed for nonworkers' compensation patients. Payment of medical claims must be made in accordance with the schedule of facility and nonfacility medical fees adopted by the department. (a) For services provided on or after July 1, 2011, payment of medical claims must also be made in accordance with the utilization and treatment guidelines adopted by the department in [New Rule I]. (2) through (7) remain the same.
AUTH: 39-71-203, MCA IMP: 39-71-203, 39-71-510, 39-71-704, MCA REASON: There is reasonable necessity to amend this rule to eliminate confusion by clarifying that medical providers need to bill their usual and customary charges, even though medical claims are paid according to the fee schedule. In other words, (1)(a) means that providers must bill workers' compensation patients the same charges as any other patients for the same service. There is reasonable necessity to also clarify that payment of medical claims must be made in accordance with the implementation of New Rule I. 24.29.1406 FACILITY BILLS (1) remains the same. (2) (3) through (5) remain the same. AUTH: 39-71-203, MCA IMP: 39-71-105, 39-71-107, 39-71-203, 39-71-704, MCA REASON: There is reasonable necessity to amend ARM 24.29.1406 at the same time as other medical service rules are being amended in order to clarify and emphasize the need to use electronic billing systems. 24.29.1407 Prosthetic Appliances (1) remains the same. (2) For services provided on or after July 1, 2011, claims must be paid in accordance with the utilization and treatment guidelines adopted by the department in [New Rule I].
AUTH: 39-71-203, MCA IMP: REASON: There is reasonable necessity to amend ARM 24.29.1407 to clarify that New Rule I applies to services for prosthetics provided on or after July 1, 2011. 24.29.1501 PURPOSE (1) remains the same. (2) The purpose of evidence-based utilization and treatment guidelines is to assist injured workers in receiving prompt and appropriate care, assist injured workers in stay-at-work/return-to-work options, assist clinicians in making decisions for specific conditions, and help insurers make reimbursement determinations. Although the primary purpose of the guidelines is advisory and educational, the guidelines are enforceable for payment purposes. The department recognizes that acceptable medical practice may include deviations from these guidelines, as individual cases dictate. Therefore, these guidelines are not relevant as evidence of a provider's legal standard of professional care.
AUTH: 39-71-203, MCA IMP: 39-71-704, MCA REASON: There is reasonable necessity to amend ARM 24.29.1501 to provide a more detailed statement regarding evidence-based utilization and treatment guidelines and to clarify that the guidelines are not absolute because every injured worker is unique. This section is proposed to clarify that the guidelines are not intended to create a legal standard of care. This proposed rule does not contradict New Rule II and does not create an independent avenue from New Rule II for the introduction of evidence for treatment outside the guidelines. Rather, it is only a general purpose statement as indicated in the title. 24.29.1517 PRIOR AUTHORIZATION FOR CERTAIN SERVICES (1) This rule applies to: (a) services provided on or before June 30, 2011; and (b) body parts not covered by the (1) through (8) remain the same, but are renumbered (2) through (9). AUTH: 39-71-203, MCA IMP: 39-71-704, 39-71-743, MCA REASON: There is reasonable necessity to amend ARM 24.29.1517 to clarify that the rule only applies to services provided on or before June 30, 2011, to avoid any inconsistencies that may arise from the application of the Montana Guidelines provided in New Rule I and the prior authorization provisions of New Rule II. 24.29.1519 SECOND OPINIONS FOR SERVICES PROVIDED ON OR BEFORE JUNE 30, 2011 (1) With respect to services provided on or before June 30, 2011, the (a) through (c) remain the same. (2) and (3) remain the same. AUTH: 39-71-203, MCA IMP: 39-71-704, MCA REASON: There is reasonable necessity to amend ARM 24.29.1519 to clarify that the rule only applies to services provided on or before June 30, 2011, to avoid any inconsistencies that may arise from the application of the Montana Guidelines provided in New Rule I. 24.29.1526 DISALLOWED PROCEDURES (1) and (2) remain the same. (3) Medical services which are not payable include, but are not limited to, the following: (a) (b) (c) (d) frequency specific microcurrent; (e) HEALOS/leopard cage; (f) inter X therapy; (g) kinesis myofascial integration; (h) lidoderm patch; (i) percutaneous disc nucleoplasty; and (j) medical marijuana. AUTH: 39-71-203, MCA IMP: 39-71-704, MCA REASON: There is reasonable necessity to amend ARM 24.29.1526 to add disallowed procedures that the Montana Board of Medical Examiners has recommended are not compensable. The amended rule contains updates from 2006 forward. This list supplements any procedure listed in the Montana Guidelines as "not recommended". 24.29.1574 CHIROPRACTIC FEE SCHEDULE FOR SERVICES PROVIDED (2) through (7) remain the same. AUTH: 39-71-203, MCA IMP: 39-71-704, MCA REASON: There is reasonable necessity to amend ARM 24.29.1574 to clarify that the rule only applies to services provided on or before June 30, 2011, to avoid any inconsistencies that may arise from the application of the Montana Guidelines provided in New Rule I and the prior authorization provisions of New Rule II. 24.29.1575 CHIROPRACTIC -- PRIOR AUTHORIZATION AND BILLING LIMITATIONS FOR SERVICES PROVIDED (2) through (12) remain the same. AUTH: 39-71-203, MCA IMP: 39-71-704, MCA REASON: There is reasonable necessity to amend ARM 24.29.1575 to clarify that the rule only applies to services provided on or before June 30, 2011, to avoid any inconsistencies that may arise from the application of the Montana Guidelines provided in New Rule I and the prior authorization provisions of New Rule II. 24.29.1585 OCCUPATIONAL AND PHYSICAL THERAPY FEE SCHEDULE FOR SERVICES PROVIDED (2) through (7) remain the same. AUTH: 39-71-203, MCA REASON: There is reasonable necessity to amend ARM 24.29.1585 to clarify that the rule only applies to services provided on or before June 30, 2011, to avoid any inconsistencies that may arise from the application of the Montana Guidelines provided in New Rule I and the prior authorization provisions of New Rule II. 24.29.1586 OCCUPATIONAL AND PHYSICAL THERAPISTS -- PRIOR AUTHORIZATION AND BILLING LIMITATIONS FOR SERVICES PROVIDED (2) through (11) remain the same. AUTH: 39-71-203, MCA IMP: 39-71-704, MCA REASON: There is reasonable necessity to amend ARM 24.29.1586 to clarify that the rule only applies to services provided on or before June 30, 2011, to avoid any inconsistencies that may arise from the application of the Montana Guidelines provided in New Rule I and the prior authorization provisions of New Rule II. 24.29.2002 STANDARDS FOR DIAGNOSIS FOR SERVICES PROVIDED ON OR BEFORE JUNE 30, 2011 (1) through (4) remain the same. (5) This rule applies to services provided on or before June 30, 2011.
AUTH: 39-71-203, MCA IMP: 39-71-203, 39-71-704, MCA REASON: There is reasonable necessity to amend ARM 24.29.2002 to clarify that the rule only applies to services provided on or before June 30, 2011, to avoid any inconsistencies that may arise from the application of the Montana Guidelines provided in New Rule I.
24.29.2003 WORKERS' COMPENSATION DOES PAY FOR CERTAIN SERVICES PROVIDED ON OR BEFORE JUNE 30, 2011 (1) and (2) remain the same. (3) This rule applies to services provided on or before June 30, 2011.
AUTH: 39-71-203, MCA IMP: 39-71-203, 39-71-704, MCA REASON: There is reasonable necessity to amend ARM 24.29.2003 to clarify that the rule only applies to services provided on or before June 30, 2011, to avoid any inconsistencies that may arise from the application of the Montana Guidelines provided in New Rule I.
6. Concerned persons may present their data, views, or arguments, either orally or in writing, at the hearing. Written data, views, or arguments may also be submitted to: Diana Ferriter, Employment Relations Division, Department of Labor and Industry, P.O. Box 8011, Helena, Montana 59604-8011; by facsimile to (406) 444-1574; or by e-mail to [email protected], and must be received no later than 5:00 p.m., June 10, 2011. 7. An electronic copy of this Notice of Public Hearing is available through the department's web site at http://dli.mt.gov/events/calendar.asp, under the Calendar of Events, Administrative Rules Hearings Section. The department strives to make the electronic copy of this Notice of Public Hearing conform to the official version of the notice, as printed in the Montana Administrative Register, but advises all concerned persons that in the event of a discrepancy between the official printed text of the notice and the electronic version of the notice, only the official printed text will be considered. In addition, although the department strives to keep its web site accessible at all times, concerned persons should be aware that the web site may be unavailable during some periods, due to system maintenance or technical problems, and that a person's difficulties in sending an e-mail do not excuse late submission of comments. 8. The department maintains a list of interested persons who wish to receive notices of rulemaking actions proposed by this agency. Persons who wish to have their name added to the list shall make a written request, which includes the name and e-mail or mailing address of the person to receive notices, and specifies the particular subject matter or matters regarding which the person wishes to receive notices. Such written request may be mailed or delivered to the Department of Labor and Industry, attention: Mark Cadwallader, 9. The bill sponsor contact requirements of 2-4-302, MCA, apply and have been fulfilled. The department contacted the primary sponsor of House Bill 334 (2011) by e-mail and by regular mail on April 15, 2011. The department also provided additional notification to the sponsor of Senate Bill 108 (2007) by phone on April 29, 2011, and the sponsor of House Bill 738 (2007) via e-mail on April 29, 2011, supplementing the original contacts to both of those bill sponsors that occurred in November, 2009. The details of that original contact were described with specificity in MAR Notice No. 24-29-249, published on September 23, 2010. 10. The department's Hearings Bureau has been designated to preside over and conduct this hearing. /s/ MARK CADWALLADER /s/ KEITH KELLY Mark Cadwallader Keith Kelly, Commissioner Alternate Rule Reviewer DEPARTMENT OF LABOR AND INDUSTRY Certified to the Secretary of State May 2, 2011
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A directory of state agencies is available online at http://www.mt.gov/govt/agencylisting.asp.
For questions about the organization of the ARM or this web site, contact [email protected].
