Bulletin No. 12-04
March 18, 2004

ACOEM guidelines must be used in employers' utilization review plans beginning March 22

Beginning Monday, March 22, the American College of Occupational and Environmental Medicine (ACOEM) Practice Guidelines, Second Edition, will be presumed correct on the issue of extent and scope of medical treatment in employers' required utilization review plans. Other appropriate medical treatment guidelines may also be used to support utilization review decisions, as set forth in Labor Code section 4604.5(g).

The requirement that all employers have a utilization review plan and submit it to the DWC administrative director is contained in recently enacted Labor Code section 4610(b), which went into effect on Jan. 1. Employers may submit the plan directly or through an insurer or utilization review organization. It should be mailed to:

Richard Gannon, administrative director
Division of Workers' Compensation
455 Golden Gate Avenue, 9th Floor
San Francisco, CA 94102

Draft utilization review regulations were the subject of a recent DWC online forum, and comments received are now under review. A revised draft of the regulations should be available shortly for further comments from the public before formal adoption as emergency regulations. The revised draft, when available, will be posted to the DWC forum web site at http://www.dir.ca.gov/wcjudicial.htm.