Chapter 4.5. Division of Workers' Compensation
Subchapter 1. Administrative Director--Administrative Rules
Article 5.5.2. Medical treatment utilization schedule

§ 9792.26. Medical Evidence Evaluation Advisory Committee.

(a) The Medical Director shall create a Medical Evidence Evaluation Advisory Committee (MEEAC) to provide recommendations to the Medical Director on matters concerning the MTUS. The recommendations are advisory only and shall not constitute scientifically based evidence.

(1) If the Medical Director position becomes vacant, the Administrative Director shall appoint a competent person to temporarily assume the authority and duties of the Medical Director as set forth in this section, until such time that the Medical Director position is filled.

(2) The members of the MEEAC shall be appointed by the Medical Director, or his or her designee, and shall consist of 19 members of the medical community holding the following licenses: Medical Doctor (M.D.) board certified by an American Board of Medical Specialties (ABMS) approved specialty board; Doctor of Osteopathy (D.O.) board certified by an ABMS or American Osteopathic Association (AOA) approved specialty board; M.D. board certified by a Medical Board of California (MBC) approved specialty board; Doctor of Chiropractic (D.C.); Physical Therapy (P.T.); Occupational Therapy (O.T.); Acupuncture (L.Ac.); Psychology (PhD.); Doctor of Podiatric Medicine (DPM); Pharmacologist (PharmD); Nurse Practitioner (NP) or Registered Nurse (RN), and representing the following specialty fields:

(A) One member shall be from the orthopedic field;

(B) One member shall be from the chiropractic field;

(C) One member shall be from the occupational medicine field;

(D) One member shall be from the acupuncture medicine field;

(E) One member shall be from the physical therapy field;

(F) One member shall be from the psychology field;

(G) One member shall be from the pain specialty field;

(H) One member shall be from the occupational therapy field;

(I) One member shall be from the psychiatry field;

(J) One member shall be from the neurosurgery field;

(K) One member shall be from the family physician field;

(L) One member shall be from the neurology field;

(M) One member shall be from the internal medicine field;

(N) One member shall be from the physical medicine and rehabilitation field;

(O) One member shall be from the podiatrist field;

(P) One member shall be from the pharmacology field;

(Q) One member shall be from the nursing field;

(R) Two additional members shall be appointed at the discretion of the Medical Director or his or her designee.

(3) In addition to the nineteen members of MEEAC appointed under subdivision (a)(2) above, the Medical Director, or his or her designee, may appoint an additional three members to MEEAC as subject matter experts for any given topic.

(b) The Medical Director, or his or her designee, shall serve as the chairperson of MEEAC.

(c) Members of MEEAC shall make advisory recommendations to the Medical Director or his or her designee to revise, update or supplement the MTUS.

(d) The advisory MEEAC recommendations shall be supported by the best available medical evidence found in scientifically and evidenced-based medical treatment guidelines or peer-reviewed published studies that are nationally recognized by the medical community.

(e) To assess the quality and methodological rigors used to develop a medical treatment guideline, members of MEEAC shall use a modified version of the Appraisal of Guidelines for Research & Evaluation II (AGREE II) Instrument, May 2009. The AGREE II Instrument, May 2009, consisting of 23 key items organized within six domains followed by two global rating items was found in the following website: www.agreetrust.org. A copy of the AGREE II Instrument, May 2009 version may be obtained from the Medical Unit, Division of Workers' Compensation, P.O. Box 71010, Oakland, CA 94612-1486, or from the DWC web site at http://www.dwc.ca.gov.

(1) Members of MEEAC shall use a modified AGREE II that uses the same six domains and two global rating items as the AGREE II Instrument , May 2009 version but includes two additional domains and additional key items:

(A) Additional domain in the modified AGREE II Instrument - Conflict of Interest

1. Key Item in this domain - All conflicts of interest of each guideline development group member were reported and discussed by the prospective group prior to the onset of his or her work.

2. Key Item in this domain - Each panel member explained how his or her conflict of interest could influence the clinical practice guideline development process or specific recommendation.

3. Key Item in this domain - The chairperson of the guideline development group had no conflicts of interest.

(B) Additional domain in the modified AGREE II Instrument - Currency of Guideline

1. Key Item in this domain - The guideline is being updated in a timely fashion (typically at least every three years and, if the guideline is more than five years old, it should be considered to be out of date).

(f) Recommendations in guidelines that have a low AGREE II overall score may still be considered, provided that the evidence supporting the recommendations is the best available medical evidence.

(g) To determine the best available medical evidence, members of MEEAC shall rank the medical evidence used to support recommendations found in either guidelines or peer-reviewed published studies by applying the MTUS Methodology for Evaluating Medical Evidence set forth in section 9792.25.1 and shall choose the recommendations supported by the best available medical evidence.

(h) The members of MEEAC, except for the three subject matter experts, shall serve a two-year term, but shall remain in that position until a successor is selected. The subject matter experts shall serve as members of the medical evidence evaluation advisory committee until the evaluation of the subject matter guideline is completed. The members of the committee shall meet as necessary, but no less than three (3) times a year.

(i) The Administrative Director, in consultation with the Medical Director, may revise, update, and supplement the MTUS as necessary.

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.

HISTORY

1. Renumbering and amendment of former section 9792.23 to new section 9792.26 filed 6-18-2009; operative 7-18-2009 (Register 2009, No. 25).

2. Editorial correction of operative date in History 1 (Register 2009, No. 30).

3. Amendment filed 4-20-2015; operative 4-20-2015 pursuant to Government Code section 11343.4(b)(3) (Register 2015, No. 17).