Provider Connection
Utilization and Treatment Guidelines
May 27, 2011
Legislative Updates
Utilization and Treatment Guidelines
The Montana Department of Labor & Industry (DLI) held a hearing June 6, 2011, to adopt the Utilization & Treatment Guidelines (Montana Utilization and Treatment Guideline, 1st Edition, 2011) and medical services rules. U&T Guidelines were passed as part of House Bill 738 in the 2007 legislative session and the draft form may be found at http://www.mtguidelines.com.
The U&T Guidelines will take effect July 1, 2011, and will change the way treatment is provided within workers’ compensation. Some of the highlights are:
- The Montana U&T Guidelines are based on Colorado’s U&T Guidelines and the Official Disability Guidelines of the American College of Occupational and Environmental Medicine (ACOEM).
- Prior authorization process changes based on U&T Guidelines. Prior authorization will only be required when:
- The treatment(s) or procedure(s) is not specifically addressed or recommended by the U&T Guidelines for a body part that is covered by a guideline,
- After maximum medical improvement, or
- Beyond the duration and frequency limits set out in the guidelines.
- A medical advisor will be employed by DLI to:
- Monitor new procedures and technologies.
- Consult with health care providers with relevant experience and education.
- Provide an annual review of the evidence-based Utilization and Treatment Guidelines.
- Review requests for any treatment(s) or procedure(s) that is not specifically addressed or recommended by the U&T Guidelines, when those requests have been initially denied.
- There are two types of medical services within the U&T Guidelines: primary and secondary.
- Per MCA 39-71-116 – primary medical services means treatment prescribed by a treating physician, for conditions resulting from the injury, necessary to achieving medical stability.
- Per MCA 39-71-116 – secondary medical services are those medical services or appliances that are considered not medically necessary for medical stability.
- The U&T Guidelines will include nine chapters:
- Low Back Pain
- Lower Extremity
- Shoulder Injury
- Upper Extremity
- Chronic Region Pain Syndrome
- Cervical Spine Injury
- Chronic Pain Disorder
- Traumatic Brain Injury
- Eye Injury
Please see the DLI website for complete information regarding the U&T Guidelines at http://dli.mt.gov.
