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TREATMENT GUIDELINES (MTUS)

"The medical treatment utilization schedule (MTUS) provides medical treatment guidelines for utilization review and an analytical framework for the evaluation and treatment of injured workers. It helps medical providers understand which evidenced-based treatments have been effective in providing improved medical outcomes to those workers. The MTUS is promulgated by the DWC administrative director under Labor Code sections 5307.27 and 4604.5, and can be found in sections 9792.20 et seq. of Title 8, California Code of Regulations.

The MTUS lays out treatments scientifically proven to cure or relieve work-related injuries and illnesses. It also deals with how often the treatment is given (frequency), extent of treatment (intensity), and for how long (duration), among other things." DWC MTUS

SB 863 created "a new state function" with independent medical review (Section 1(f) of SB 863). The IMR process, invoked if an employee disputes a utilization review decision, determines whether the proposed treatment is medically necessary. It is based on standards "which shall be applied in the order listed, allowing reliance on a lower ranked standard only if every higher ranked
standard is inapplicable to the employee’s medical condition," the first of which is "guidelines adopted by the administrative director pursuant to Section 5307.27."

In sum, treatment for a work injury is determined by a state agency, the DWC. The injured worker can get other, unapproved treatment, but at his or her own expense or through a private plan.

Label Item Links Comments
Labor Code Labor Code §4604.5 provides, in relevant part, that the MTUS "shall be presumptively correct on the issue of extent and scope of medical treatment. The presumption is rebuttable and may be controverted by a preponderance of the scientific medical evidence establishing that a variance from the guidelines reasonably is required to cure or relieve the injured worker from the effects of his or her injury. The presumption created is one affecting the burden of proof.
(b) The recommended guidelines set forth in the schedule adopted pursuant to subdivision (a) shall reflect practices that are evidence and scientifically based, nationally recognized, and peer reviewed. The guidelines shall be designed to assist providers by offering an analytical framework for the evaluation and treatment of injured workers, and shall constitute care in accordance with Section 4600 for all injured workers diagnosed with industrial conditions."
LC §4604.5   
  Labor Code §5307.27: Administrative Director to adopt a medical treatment utilization schedule, that shall incorporate the evidence-based, peer-reviewed, nationally recognized standards of care...."
LC §5307.27  
Regulations/Rules New MTUS regulations effective 4/20/15 (read in conjunction with All MTUS Regs) MTUS regs 4/20/15  
  All MTUS regs
All MTUS Regs
 
Chronic Pain Medical Treatment Guidelines 8 CCR §9792.24.2
Websites

DWC home page for Medical Treatment Utilization Schedule

Official Disability Guidelines

MTUS - DWC page

ODG; see too Work Loss Data

 
Practice Tips Know what is and what is not recommended treatment before going to war on treatment denials. Advise clients early on about the limitations on treatment.    
Articles

Evidence-Based Medicine Can Be Hazardous to Your Health by Robert G. Rassp, Esq.

MTUS: handout from DWC 21st annual educational conference 2/14

Providing Optimal Treatment through the use of EBM/MTUS by Steven Feinberg, M.D.: handout from DWC 21st annual educational conference 2/14

Rassp on EBM

 

MTUS

Feinberg handout

 
Magazine Articles Evidence-Based Medicine by Steven D. Feinberg, M.D.

SB 863 and the Chronic Pain Dilemma by Steven D. Feinberg, M.D.

Feinberg on EBM


Feinberg on Chronic Pain Guidelines

An inside view of EBM and treatment guidelines
Roundtable    
Miscellaneous      

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