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Chapter 4.5. Division of Workers' Compensation
Subchapter 1. Administrative Director - Administrative Rules
Article 5.5.2. Medical treatment utilization schedule
§ 9792.20 Medical Treatment Utilization Schedule - Definitions
As used in this Article:
(a) “ACOEM” means means the American College of Occupational and Environmental Medicine's Occupational Medicine Practice Guidelines published by the Reed Group containing evidenced-based medical treatment guidelines for conditions commonly associated with the workplace. ACOEM guidelines may be obtained from the Reed Group (http://go.reedgroup.com/mtus).
(b) “Chronic pain” means pain lasting three or more months from the initial onset of pain.
(c) “Claims administrator” is a self-administered workers' compensation insurer, a self-administered self-insured employer, a self-administered legally uninsured employer, a self-administered joint powers authority, a third-party claims administrator, or the California Insurance Guarantee Association.
(d) “Evidence-Based Medicine (EBM)” means a systematic approach to making clinical decisions which allows the integration of the best available research evidence with clinical expertise and patient values.
(e) “Functional improvement” means either a clinically significant improvement in activities of daily living or a reduction in work restrictions as measured during the history and physical exam, performed and documented as part of the medical evaluation and treatment; and a reduction in the dependency on continued medical treatment.
(f) “Medical treatment” is care which is reasonably required to cure or relieve the employee from the effects of the industrial injury consistent with the requirements of sections 9792.20-9792.26.
(g) “Medical treatment guidelines” means the most current version of written recommendations which are systematically developed by a multidisciplinary process through a comprehensive literature search to assist in decision-making about the appropriate medical treatment for specific clinical circumstances reviewed and updated within the last five years
(h) “Nationally recognized” means published in a peer-reviewed medical journal; or developed, endorsed and disseminated by a national organization with affiliates based in two or more U.S. states and is the most current version.
(i) “ODG” means the Official Disability Guidelines published by the Work Loss Data Institute containing evidenced-based medical treatment guidelines for conditions commonly associated with the workplace. ODG guidelines may be obtained from the Work Loss Data Institute, 169 Saxony, #101, Encinitas, California 92024 (www.ODG@worklossdata.com).
(j) “Peer reviewed” means that a study's content, methodology and results have been evaluated and approved prior to publication by an editorial board of qualified experts.
(k) “Scientifically based” means based on scientific literature, wherein the body of literature is identified through performance of a literature search, the identified literature is evaluated, and then used as the basis to support a recommendation.
(l) “Strength of Evidence” establishes the relative weight that shall be given to scientifically based evidence.
Note: Authority cited: Sections 133, 4603.5, 5307.3 and 5307.27, Labor Code. Reference: Sections 77.5, 4600, 4604.5 and 5307.27, Labor Code.
1. New article 5.5.2 (sections 9792.20-9792.23) and section filed 6-15-2007; operative 6-15-2007 pursuant to Government Code section 11343.4 (Register 2007, No. 24).
2. Amendment of subsection (b), new subsection (c), subsection relettering and amendment of newly designated subsection (g) filed 6-18-2009; operative 7-18-2009 (Register 2009, No. 25).
3. Editorial correction of operative date in History 2 (Register 2009, No. 30).
4. Amendment filed 4-20-2015; operative 4-20-2015 pursuant to Government Code section 11343.4(b)(3) (Register 2015, No. 17).
5. Amendment of subsection (a) filed 1-11-2018; operative 12-1-2017. Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.27(a) (Register 2018, No. 2).