The medical treatment utilization schedule (MTUS) provides medical treatment guidelines for utilization review and an analytical framework for the evaluation and treatment of injured workers. It helps medical providers understand which evidenced-based treatments have been effective in providing improved medical outcomes to those workers, and guides the physicians involved in the UR and IMR process. In 2004 the Legislature charged the DWC administrative director (AD) with adopting an MTUS that would be presumed correct on the issue of extent and scope of medical treatment, and made the American College of Occupational and Environmental Medicine Practice Guidelines, 2nd Edition, (ACOEM) the standard until the adoption of an MTUS by the AD. Thus the ACOEM Guideline was a temporary solution.
After initial adoption, the MTUS is to be updated improving upon the original ACOEM edition. For example, the current version of the MTUS added new guidelines for chronic pain and postsurgical physical medicine treatment., topics not covered in the ACOEM Guideline. The MTUS was also reorganized to restructure the MTUS into a clinical topics format, which will allow for easier updates of the guidelines.
An continuing the effort to improve the Guideline, the Division of Workers’ Compensation has now posted the proposed Mental Illness and Stress Guideline to update the current Stress Related Conditions Guideline of the Medical Treatment Utilization Schedule set forth in section 9792.23.8 to its online forum.
Members of the public may review and comment on the proposals until February 16, 2016. The proposed amendment to the regulations incorporate by reference the March 25, 2015 version of the Official Disability Guideline’s “Mental Illness and Stress Guideline” which the DWC has adopted with permission from the publisher. The new guideline is 582 pages long! Previously the MTUS relied on the language of the Stress Related Conditions Chapter of the ACOEM Practice Guidelines, 2nd Edition (2004), Chapter 15. By contrast, the ACOEM guideline on mental heath issues was extremely vague and terse. The new effort addresses both of those criticisms.
As previously announced, the DWC will be updating all of the clinical topic medical treatment guidelines of the Medical Treatment Utilization Schedule. This online forum follows the October 2015 online forum which posted two new additional guidelines, the proposed Occupational Interstitial Lung Disease Guideline and the Occupational/Work Related Asthma Guideline. Once the online forums have been completed for each specific clinical topic, the DWC will combine all of the proposed regulatory updates and additions to section 9792.23 et seq. into one rulemaking package.