BEFORE THE DEPARTMENT OF LABOR AND INDUSTRY

  OF THE STATE OF MONTANA

 

In the matter of the adoption of NEW RULES I through IX, related to the reopening of medical benefits automatically closed in certain workers' compensation claims

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CORRECTED NOTICE OF ADOPTION

TO: All Concerned Persons

 

          1. On November 25, 2015, the Department of Labor and Industry published MAR Notice No. 24-29-312 regarding a public hearing on the proposed adoption of the above-stated rules on page 2073 of the 2015 Montana Administrative Register, Issue No. 22. On February 5, 2016, the department published the notice of adoption at page 204 of the 2016 Montana Administrative Register, Issue Number 3.

 

          2. The department inadvertently failed to delete certain language from ARM 24.29.3124 (NEW RULE VIII) in the notice of adoption. In response to public comments, the department removed references to the nature and type of medical benefits being reopened, and to references to any specific number or duration of treatments allowed pursuant to the reopening. The corrections make the rule consistent with the changes to ARM 24.29.3117 and 24.29.3124 that were made in the notice of adoption.

 

3. The rule as adopted in the corrected form, reads as follows, new matter underlined, deleted matter interlined:

 

          NEW RULE VIII (24.29.3124) REVIEW BY MEDICAL REVIEW PANEL - REPORT AND RECOMMENDATIONS (1) Unless both the worker and the insurer agree to have a petition for reopening reviewed solely by the department's medical director, the petition will be reviewed by a three-member panel of physicians. 

(2) The medical review panel may recommend that medical benefits be reopened only if:

          (a) the worker's medical condition is a direct result of the compensable injury or occupational disease; and

          (b) the worker needs additional medical benefits in order to:

          (i) continue to work; or

          (ii) return to work.

          (3)   Each member of the medical review panel shall prepare a report as to the panel member's evaluation of the medical records submitted for review and any additional information that has been submitted. The panel member must determine whether the evidence submitted demonstrates that further medical benefits meet the criteria of (2). The panel member's report must state the reason(s) and rationale for the recommendation.

          (4) If a panel member concludes that additional medical benefits are necessary, the panel member shall identify the nature and extent of the medical benefits that should be provided. The analysis must include the reasons and rationale that explain:

          (a) the nature or type of medical benefits recommended to be furnished, whether identified by specific procedure or by general description;

          (b) the extent of the duration (whether by time or number of treatments) of the benefits expected to be needed; and

          (c) (b) whether and how the recommendations are consistent with the department's current utilization and treatment guidelines.

          (5) Following the medical review panel members' individual reviews, the medical director shall issue a report and make recommendations on behalf of the panel with respect to the reopening of medical benefits that reflect the views of the majority of the panel members.

          (6) A party disagreeing with the medical director's report and recommendations may bring the dispute to the Workers' Compensation Court after following the mediation requirements provided by law.

 

          AUTH: 39-71-203, MCA

          IMP:    39-71-717, MCA 

    

/s/ MARK CADWALLADER          /s/ PAM BUCY                          

Mark Cadwallader                       Pam Bucy, Commissioner

Alternate Rule Reviewer              DEPARTMENT OF LABOR AND INDUSTRY

 

 

 

Certified to the Secretary of State March 28, 2016.