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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) "American College of Occupational and Environmental Medicine (ACOEM)" is a medical society of physicians and other health care professionals specializing in the field of occupational and environmental medicine, dedicated to promoting the health of workers through preventive medicine, clinical care, research, and education.
(b) "ACOEM Practice Guidelines" means the American College of Occupational and Environmental Medicine's Occupational Medicine Practice Guidelines, 2nd Edition (2004). A copy may be obtained from the American College of Occupational and Environmental Medicine, 25 Northwest Point Blvd., Suite 700, Elk Grove Village, Illinois, 60007-1030 (www.acoem.org).
(c) "Chronic pain" means any pain that persists beyond the anticipated time of healing.
(d) "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.
(e) "Evidence-based " means based, at a minimum, on a systematic review of literature published in medical journals included in MEDLINE.
(f) "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 evaluation and management visit billed under the Official Medical Fee Schedule (OMFS) pursuant to Sections 9789.10-9789.111; and a reduction in the dependency on continued medical treatment.
(g) "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.
(h) "Medical treatment guidelines" means the most current version of written recommendations revised within the last five years 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.
(i) "MEDLINE" is the largest component of PubMed, the U.S. National Library of Medicine's database of biomedical citations and abstracts that is searchable on the Web. Its website address is www.pubmed.gov.
(j) "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; or currently adopted for use by one or more U.S. state governments or by the U.S. federal government; and is the most current version.
(k) "Peer reviewed" means that a medical study's content, methodology and results have been evaluated and approved prior to publication by an editorial board of qualified experts.
(l) "Scientifically based" means based on scientific literature, wherein the body of literature is identified through performance of a literature search in MEDLINE, the identified literature is evaluated, and then used as the basis for the guideline.
(m) "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).