No. 29948 (Amendment): R612-2-27. Commission Approval of Health Care Treatment Protocol

DAR File No.: 29948
Filed: 05/15/2007, 04:47
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rule establishes the standards the Commission will apply in determining whether to approve contracts between health care providers and insurance carriers or self-insured employers regarding protocols for health care treatment of injured workers under Utah's workers' compensation system.

Summary of the rule or change:

This rule defines the terms "scientifically based" and "peer reviewed" as those terms are used in Subsections 34A-2-111(2)(c)(i)(B)(VII)(Aa) and (Bb). The rule also establishes requirements for periodic updating, pricing, accessibility, and disclosure of sources for such health care treatment protocols. Finally, the rule establishes the procedure for obtaining Commission approval or disapproval of a treatment protocol.

State statutory or constitutional authorization for this rule:

Subsection 34A-2-111(2)(c)(i)(B)(VII)

Anticipated cost or savings to:

the state budget:

The administrative and adjudicative costs of implementing this rule can be absorbed within the Labor Commission's existing budget. With respect to costs or savings to the state in its capacity as an employer, the use of health care treatment protocols by the state's workers' compensation insurance carrier should reduce the carrier's medical expenses on behalf of the State. These medical savings will, in turn, reduce the state's insurance costs. The Commission cannot quantify the amount of such savings at this time.

local governments:

Local governments do not have any administrative or adjudicative responsibilities relative to this rule and will not experience any savings or costs in those areas. With respect to costs or savings to local governments in their capacities as employers, the use of health care treatment protocols by local governments should reduce their workers' compensation medical expenses. The Commission cannot quantify the amount of such savings at this time.

other persons:

The use of health care treatment protocols by other persons should reduce their workers' compensation medical expenses. The Commission cannot quantify the amount of such savings at this time. Medical providers who currently receive fees for services that will no longer be authorized under approved health care treatment protocols will experience a corresponding reduction in income.

Compliance costs for affected persons:

The Commission estimates that the purchase price for a set of health care treatment protocols will cost approximately $250.

Comments by the department head on the fiscal impact the rule may have on businesses:

Increasing medical costs are the single most significant cost driver in Utah's workers' compensation system. The health care treatment protocols that are the subject of this rule will have the effect of removing unnecessary medical treatment from the system. This will have a positive fiscal impact for employers and businesses in Utah. Sherrie Hayashi, Commissioner

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Labor Commission
Industrial Accidents
HEBER M WELLS BLDG
160 E 300 S
SALT LAKE CITY UT 84111-2316

Direct questions regarding this rule to:

Joyce Sewell at the above address, by phone at 801-530-6988, by FAX at 801-530-6804, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

07/02/2007

This rule may become effective on:

07/10/2007

Authorized by:

Sherrie Hayashi, Commissioner

RULE TEXT

R612. Labor Commission, Industrial Accidents.

R612-2. Workers' Compensation Rules-Health Care Providers.

R612-2-27. Commission Approval of Health Care Treatment Protocol.

A. Authority. Pursuant to authority granted by Section 34A-2-111(2)( c)(i)(B)(VII) of the Utah Workers' Compensation Act, the Utah Labor Commission establishes the following standards and procedures for Commission approval of medical treatment and quality care guidelines.

B. Standards:

1. Scientifically based: Section 34A-2-11(2)(c)(i)(B)(VII)(Aa) of the Act requires that guidelines be scientifically based. The Commission will consider a guideline to be "scientifically based" when it is supported by medical studies and/or research.

2. Peer reviewed: Section 34A-2-111(2)(c)(i)(B)(VII)(Bb) of the Act requires that guidelines be peer reviewed. The Commission will consider a guideline to be "peer reviewed" when the medical study's content, methodology, and results have been reviewed and approved prior to publication by an editorial board of qualified experts".

3. Other standards: Pursuant to its rule-making authority under Section 34A-2-111(2)(c)(i)(B)(VII), the Utah Labor Commission establishes the following additional standards for medical treatment and quality care guidelines.

a. The guidelines must be periodically updated and, subject to Commission discretion, may not be approved for use unless updated in whole or in part at least biannually;

b. Guideline sources must be identified;

c. The guidelines must be reasonably priced;

d. The guidelines must be easily accessible in print and electronic versions.

C. Procedure: Pursuant to Section 34A-2-111(2)(c)(i)(B)(VII) of the Utah Workers' Compensation Act, a party seeking Commission action to approve or disapprove a guideline shall file a petition for such action with the Labor Commission.

 

KEY: workers' compensation, fees, medical practitioner

Date of Enactment or Last Substantive Amendment: [July 11, 2006]2007

Notice of Continuation: May 28, 2003

Authorizing, and Implemented or Interpreted Law: 34A-2-101 et seq.; 34A-3-101 et seq.; 34A-1-104